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Episode 2: Interview with Dr Haida Luke of her book "It's not about the Stethoscope!
14 Plays21 days ago
Dr Haida Luke (PhD) is an experienced educator, program facilitator and health-system practitioner with a strong background in interdisciplinary communication, leadership capability development and applied behavioural science. She holds a PhD from The University of Queensland and postgraduate qualifications in educational psychology and education, supported by more than two decades of work across healthcare, academia, government and large-scale system-improvement programs.
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Transcript
Intro
Introduction to Dr. Luke and His Book
00:00:21
Melanie Barlow
Hi and welcome to another episode. I'm Dr. Mel and this podcast i am super excited to be joined by Dr. Luke, author of It's Not About the Stethoscope, which is a really fascinating explanation of medical education, professional identity and the culture of medicine.
Inspiration Behind Writing the Book
00:00:43
Melanie Barlow
So Dr. Luke, thanks for being here. Thank you for having me. I'm delighted to be part of the conversation. Excellent. So I'm going to start with a pretty obvious question.
00:00:55
Melanie Barlow
What inspired you to write It's Not About the Stethoscope? Well, the inspiration came from when I was working in a hospital and I was observing the transition that I could see from medical students to when they became junior doctors.
00:01:12
Melanie Barlow
And what I noticed was that medical school was doing a really excellent job of teaching scientific knowledge and clinical skills, but there wasn't really much attention given to how I could see the young doctors learning the culture of medicine and I really wanted to understand that process and make it visible and document that for my PhD.
Symbolism of the Book Title
00:01:34
Melanie Barlow
Excellent. So I'm really curious about the title of the book. It's not about the stethoscope. Thank you. Well, I thought that the stethoscope really symbolised medicine, really about becoming a doctor, But through my research, I found that becoming a doctor involves much more than mastering just the tools and the techniques.
00:01:54
Melanie Barlow
I found that the transformation really happens through learning the particular values of medicine, expectations, relationships, and in particular, the unwritten rules of the profession.
00:02:06
Melanie Barlow
So what I used the title and the image meant to capture, for example, on page 86 of my book, I had a doctor tell me is all hidden curriculums, all informal learning.
00:02:19
Melanie Barlow
It's not as if you're going to get a lecture on good characteristics. It's really about becoming and interacting and working with the people that you respect and picking up their qualities. And that's where they develop their characteristics from. So it's not just about medicine. It's not just about the stethoscope, becoming a junior doctor.
00:02:38
Melanie Barlow
Excellent. That's so interesting.
Concept of 'Medical Habitus'
00:02:40
Melanie Barlow
I saw that one of the key ideas in the book was around medical habitus. Could you explain that in simple terms? And did I say it right? You did. Medical habitus is a way that doctors come to sort of think or behave or see themselves as members of the medical profession. So it's come from a French sociologist Pierre Bourdieu and he talks about a sense of place, one's own sense of place and those places of others as well. So It's from sociology, but I've applied it to medical sociology.
00:03:18
Melanie Barlow
And it really starts to describe how over time doctors are absorbing the norms and the particular expectations of medicine, but often without realizing it from an internal point of view. And it unconsciously shapes everything from how they communicate to how they make decisions, what they wear and what their habits are. So you did this for your PhD research.
Impact of Informal Learning and Hidden Curriculum
00:03:40
Melanie Barlow
What surprised you the most?
00:03:42
Melanie Barlow
Yeah, great question. So I was really surprised by how much learning takes place outside the formal education and also how fast. I found that junior doctors within the first six weeks were learning crucial lessons through observation, trial and error, and in particular interactions with their colleagues. I found that the informal curriculum was really just as influential as the official weekly curriculum that I was responsible for.
00:04:10
Melanie Barlow
Wow, so the informal curriculum, I guess that's, I've also heard it called like the hidden curriculum. Can you give me an example of like what that hidden or unwritten rule that junior doctors commonly learn?
00:04:26
Melanie Barlow
Yeah, for sure. so i I observed medical ward rounds and I also interviewed doctors at the beginning and the end of their training year. And what I learned was that one particular example was how hierarchy operates within hospitals.
00:04:41
Melanie Barlow
And it was really around how the new doctors discovered who they can approach, when to ask questions, and how to communicate their concerns. So these lessons weren't actually taught explicitly, but they were really influencing the professional development of the junior doctors.
Reflection on Medical Culture's Impact on Patient Care
00:05:00
Melanie Barlow
And so as you were talking and about that medical habitus, was kind of struck with the connection to it and reflective practice. So i guess in my own work, I've argued that professionals often learn and have really significant like lessons through having those concrete experiences and then reflecting on them, a bit like the Colbs experiential learning cycle.
00:05:25
Melanie Barlow
How important then you think reflection is in helping junior doctors understand the culture that they're about to enter? Yeah, so similar to your work, really reflection is fundamental. And what I noticed that the culture of medicine is often absorbed unconsciously through everyday experiences.
00:05:46
Melanie Barlow
So the reflection creates that opportunity for doctors as well to step back and examine what are they learning, what do they need to learn, what do they want to learn, and also how those assumptions are forming and how their own professional identity is developing as they progress through the early years of medical training.
00:06:07
Melanie Barlow
And so we spoke about how that hidden culture and curriculum influence the junior doctors, but how does that play out and influence patient care? For sure. So it has positive and negative effects.
00:06:21
Melanie Barlow
Having a strong professional culture does actually support teamwork and accountability. But if we have certain behaviors that are discouraging speaking up, as in a lot of your work in reframingconversations.com, or having people admitting uncertainty, we know that patient care and patient-centered care can suffer. So really understanding these dynamics is important for creating those healthier healthcare environments, as well as professional development environments as well.
00:06:54
Melanie Barlow
I guess many medical students imagine that you know graduation means they've become a doctor. Your research suggests that really that's just the beginning, right? Is there a tension between maintaining, I guess, empathy and adapting to the medical culture?
Balancing Empathy with Professional Demands
00:07:15
Melanie Barlow
Exactly, Dr. Mel. So really graduation is just the beginning of that entry into the profession. Professional identity really continues to develop for so many years afterwards in a number of professions in m teaching, all sorts of allied health professions and so on. So really becoming a doctor is a social process as Pierre Bourdieu describes in his research around habitus.
00:07:41
Melanie Barlow
but it's also an educational one. So there can be particular tension with empathy fatigue. Doctors face intense workloads, emotional pressure, and so many complex decisions as we know.
00:07:54
Melanie Barlow
But really sometimes the coping mechanisms they adopt can create sort of a distance from patients. And the challenge really is around finding ways to remain compassionate while also maintaining and responding to the professional demands that is there in the medical culture.
00:08:11
Melanie Barlow
Empathy fatigue is is a real thing. And I guess, you know, when you were talking about how their identity is formed through observation and that, like, I guess this is where we also need to support senior doctors because they're the ones influencing the professional identity, aren't they, of the junior doctors.
00:08:31
Melanie Barlow
What aspects then of medical education do you think is currently working well?
Positive Changes in Medical Education
00:08:37
Melanie Barlow
So I think there's a lot that's working well today. So we have really become increasingly aware of the value and the importance of transformational communication skills and that communication skills are based in professionalism as well as that reflective practice. So there are a lot of really positive developments.
00:08:59
Melanie Barlow
There's now greater recognition that being a good doctor really involves more than just that technical competence but the communication skills are fundamental there. yeah You're speaking my language. I am. Reframing conversations is my language. I guess I've often argued that workplaces themselves are learning environments, right? What responsibility then does healthcare organisations have in shaping these professional identities of junior doctors? Yeah, for sure. So our learning environments from universities to professional colleges to conferences and so on, they have an enormous responsibility because we know through your work and through mine that organizational culture does influence how people learn.
00:09:47
Melanie Barlow
It influences how people communicate and how people behave. So having supportive environments through psychological safety that encourages questions, mentorship, and reflection can really foster positive professional development and that's what we need in our current educational and healthcare environments.
00:10:06
Melanie Barlow
So, off-soul cultures that discourage openness do limit learning and growth, which we don't want. Absolutely.
Junior Doctors' Role in Medical Culture
00:10:16
Melanie Barlow
So I guess that raises an interesting question about agency.
00:10:21
Melanie Barlow
While organisations shape individuals, I guess, In return, individuals can shape organizations. To what extent then do you think can junior doctors influence the medical culture rather than simply adapting to it?
00:10:39
Melanie Barlow
Yeah, great, excellent question. So I think the first thing to sort of think about is that junior doctors may not always feel powerful, but they are actually active participants in the culture through their own actions, through their own interactions, understanding and using their professional values, they really do contribute to a cultural evolution and that the change in communication and speaking up is really around beginning with individuals who do model alternative ways of thinking and behaving in that medical culture.
00:11:13
Melanie Barlow
Great. I heard you before yeah talking about social learning and Something I've also looked at is you know communities of practice and building professional relationships.
Role of Mentors in Professional Development
00:11:25
Melanie Barlow
How significant then is those mentoring relationships in helping doctors navigate that hidden curriculum? So mentorship is well documented to be a really fundamental component to professional growth.
00:11:41
Melanie Barlow
But mentors are invaluable, especially for women. They make the invisible visible by explaining expectations. It offers guidance and it also models a lot of the key professional behavior that's important in our various medical cultures.
00:11:57
Melanie Barlow
So having effective mentors really does help junior doctors interpret the experiences that they're experiencing at work and also how to translate that into their private life.
00:12:08
Melanie Barlow
So being a junior doctor can be confusing or overwhelming, but having that mentorship is fundamental. Amazing. So what changes then would you most like to see and I guess have the challenges facing junior doctors changed since you wrote the book?
Need for Open Discussions on Professional Culture
00:12:31
Melanie Barlow
So yeah, that's a great question. So I really would like universities and healthcare care organizations to really understand and openly discuss the professional culture and especially the role of psychological safety and how important communication is across the hierarchies.
00:12:48
Melanie Barlow
So healthcare systems, you know we know that they're always evolving, but the fundamental challenges remain, and that's around communication and psychological safety. We will always have those workload pressures, but professional identity information and really navigating the complex organizations are still really helpful highly relevant issues for medical training staff.
00:13:12
Melanie Barlow
Yeah. Yeah. And I guess critical reflection. has always been central to my thinking. Do you believe medical education really encourages enough that critical examination of the professional culture?
00:13:28
Melanie Barlow
Yeah, so having that critical examination and that that critical lens of the professional cultures that we work in and that we rely on is really important. And there has been progress. But of course, in all of our workplaces, there's always work to do. So students and junior staff do need those safe spaces where they can question those assumptions. They can start to explore what the tensions might be.
00:13:52
Melanie Barlow
And they do need to discuss the aspects of the medical culture that might affect their own professional well-being and then that of patient care as well.
00:14:05
Melanie Barlow
So I guess if we're looking across both our areas of interest, I see a shared concern with, I guess, understanding how professionals become who they are, right?
00:14:18
Melanie Barlow
Why is that question so important? Well, it is important for us to understand how professionals become who they are and how we have become who we are because our professional identity does actually influence everything else. It shapes how doctors communicate both at work and outside of work, how they make decisions, how they respond to challenges, and also how they relate to patients and families. So if we understand how our professional identities develop, we can also support the practitioners and the healthcare care systems in which we work with healthy conversations and psychological safety.
00:15:00
Melanie Barlow
Great. I see a lot of lessons out of your research apply beyond medicine because it touches on power and hierarchy and professional identity. So how do these things, I guess more broadly, influence learning,
00:15:19
Melanie Barlow
For sure. And so we have a lot of professions that have hidden cultures and unspoken expectations. We have it in nursing, we have it in law, teachers, academic culture, business leaders.
00:15:31
Melanie Barlow
they They all undergo forms of professional socialization and it's been studied for many decades. So I guess the broader lesson is really around professional identity because it's shaped as much by culture as well as formal training.
00:15:46
Melanie Barlow
So we can't really avoid hierarchies in in medicine because responsibility and expertise has to be clearly defined. But it's really around how are those hierarchies going to be used.
00:15:58
Melanie Barlow
And one of those things is around supportive leadership. So that encourages learning and growth. With rigid hierarchies, this can inhibit the communication and the innovation.
00:16:11
Melanie Barlow
Yeah, and certainly from Amy Edmondson's work, you know, psychologically safe organisations and teams are more innovative. So, yeah. OK, so I'm a newly qualified doctor. What advice would you give me?
Advice for New Doctors
00:16:25
Melanie Barlow
Well, I think a lot of your work as well is it really important in thinking about communication skills. So staying curious, being curious about what's going on and why.
00:16:38
Melanie Barlow
just not only in your professional development, also within yourself. Ask questions, as seek mentors, and do reflect on your own experiences.
00:16:49
Melanie Barlow
Well, the technical knowledge is, of course, important and fundamental. Self-care and understanding yourself as a newly qualified doctor is key. Your professional environment also is really valuable and I think also seeking further training and workplace communication, those skills are really going to benefit any of our professional careers.
00:17:12
Melanie Barlow
Great advice. I guess that really resonates strongly with my interest in workplace learning. So I'm just thinking medical schools devote considerable attention to that formal curriculum.
00:17:27
Melanie Barlow
Yet both of our work suggests that some of the most powerful learning occurs during the doing right in the clinical settings. How do you see then things like experiential learning, like simulation, contributing to the development of medical habitus?
00:17:45
Melanie Barlow
Yeah, for sure. And so that learning really does contribute to medical habitus. because medical habit has developed through participation in practice, through our professional experiences.
00:17:58
Melanie Barlow
So junior doctors do learn by observing colleagues. They learn by responding to the challenges of everyday work life. They learn by making the decisions and of course interacting with patients and and families.
00:18:12
Melanie Barlow
So this these experiences shape their understanding. but sometimes unconsciously. So that's where Pierre Bourdieu's concept of medical habitus is really applicable because the unconscious internal absorption of the dispositions is really what it means to be a doctor in so many ways that formal teaching alone doesn't necessarily achieve. Gosh, it's so complex.
00:18:38
Melanie Barlow
I guess one issue I've explored... is the role of self-awareness in professional growth, you know, having reflexivity. i guess that's, you know, why spent time creating some, you know, e-learning modules and and workshops.
00:18:58
Melanie Barlow
I guess though, to what extent does becoming a doctor require individuals to understand not only about medicine, but really fundamentally about themselves, who they are,
00:19:13
Melanie Barlow
That's right. And so, you know, as professionals, we do actually want to understand ourselves and our workplace context. And so so that self-awareness and lifelong learning is really essential. And I've also done those e-learning modules through reframing conversations.
00:19:28
Melanie Barlow
And I think that health professionals are constantly navigating that uncertainty and responsibility and emotional demands. And when we understand our own values, our own reactions and our motivations, it really helps practitioners engage more thoughtfully with both their patients and their colleagues, which is key.
00:19:49
Melanie Barlow
hair Okay, I've got a two part question here. So I guess looking back, is there anything you would add if you were writing the book? It's not about the stethoscope today.
00:20:02
Melanie Barlow
and What keeps you optimistic about the future of medicine? Yeah, so i mean we want to live in the present as much as we can so I would probably keep it it as what it was for that time but I would probably explore more deeply the impact of technology now with AI in changing healthcare systems, you know globalization and there's a growing focus on well-being and resilience amongst healthcare professionals. but Despite those challenges, you know, I really continue to see a remarkable dedication, compassion, and a genuine desire to improve patient care these days with constant feedback surveys and so on.
00:20:46
Melanie Barlow
But we also have different generations, and we've also got interprofessional collaborative practice, learners working together. Nice. So I guess if...
00:20:59
Melanie Barlow
There's a medical student, doctor, educator read your book. What, and they should. what What was one, I guess, takeaway message from your book that you would want them to have?
00:21:15
Melanie Barlow
Yeah, and so becoming a doctor really is so much more than just acquiring those knowledge and skills. It's really about understanding at a deeper level level the culture that you're entering. the particular values that you embody and the values that you might be absorbing as you're working in that professional culture.
00:21:35
Melanie Barlow
Your professional identity really does develop as you are a a young professional. And if we start to make those processes more visible, i think we can really support professional development and better healthcare practitioners and the effect would be a better healthcare system as well.
00:21:54
Melanie Barlow
Yeah, and help bridge that kind of theory to practice. gap. Yeah, super important. So both of us seem, i guess, concerned with learning, of course, and which happens kind of beneath the surface. So I guess the implicit as well as the explicit.
00:22:15
Melanie Barlow
What can then medical educators do to help make those hidden processes that are just so important and big contributors to identity formation more visible to
Encouraging Cultural Discussions for Better Understanding
00:22:27
Melanie Barlow
the students? Yeah, great and great question. So I think one approach really that I have found to be useful is to create those opportunities for discussion about the professional culture. Don't make it a hidden discussion that students should be encouraged to examine those workplace experiences.
00:22:45
Melanie Barlow
They should examine them critically. We should be able to talk about ethical challenges and also reflect on how those professional norms are transmitted. making these conversations really explicit in a psychologically safe way does help our learners better understand the professional environments that they're entering.
00:23:07
Melanie Barlow
Amazing. So Dr. Lake, thank you. It's been a really fascinating discussion. One of the highlights for me is just how much learning occurs beyond the formal curriculum and I think it's just Super important professional identity formation is key in any profession. Right. And I think understanding the culture and helping any health practitioner settle in and understand the culture that is health care.
00:23:39
Melanie Barlow
It's super important, not only for, I guess, professionalism and skills, but just for their own well-being. Yeah, so thank you.
00:23:51
Melanie Barlow
No, thank you, Dr. Mel. I really greatly enjoyed the conversation. And thank you to the listeners for joining us on this episode. So i just want to highlight that Dr. Lute's book, Not About the Stethoscope, is available on Kindle and via Amazon, and it should also be in your local university library.
00:24:11
Melanie Barlow
So until next time, thanks for listening. And remember, if you want to engage in any of the learning on reframingconversations.com, we have a 10% discount for listeners. So just put in the code LAUNCH10.
00:24:28
Melanie Barlow
Until next time, take care.