Working two emergency room shifts a month helps this professor keep his clinical skills sharp. Carl Heine is the Associate Dean for Clinical Education at Washington State University’s Elson S. Floyd College of Medicine and an emergency room physician at Spokane’s Deaconess Hospital. A sense of moral injury, burnout, overwhelm, and lack of enthusiasm is felt across the community of healthcare professionals. Listen to learn how Dr. Heine achieves work balance by blending the rewards reaped in helping patients when they need it most as an E.R. doctor with the sense of optimism experienced while instructing students of medicine as a university professor. Dr. Heine also emphasizes the need to treat whole communities alongside treating the individual members of those communities.
“Finding Joy: The Health Care Professional’s Journey to Well-being" is a podcast resource developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.
The Interprofessional Education Research team wishes to thank the following individuals for their invaluable contributions to this project:
• Dr. Barb Richardson, nurse, educator, and interprofessional champion;
• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine;
• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and
• Claire Martin-Tellis, Executive Producer, and Solen Aref, student intern, who developed the first five episodes of the “Finding Joy” podcast.
This episode of “Finding Joy” was produced by Doug Nadvornick, Program Director, Spokane Public Radio.
If you would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu We also encourage you to visit our podcast blog as well as our team's website at: https://opioideducation.wsu.edu/about/.
Doug: “Is it enough for you?”
Carl Heine: “That's a great question. I have two goals with continuing to do clinical work. One is I wanna keep my skills up and that's a really important thing to me is to still be competent at what I'm doing when I'm in the emergency department, four or six shifts a month. It is pretty easy to keep your clinical skills up because you're still seeing enough stuff, two shifts a month. I am a little more worried about whether I will have my skillset as sharp as it would be, because that's not a lot of time.”
Doug: “What are the skills that seem to slip away in that case?”
Carl Heine: “Some of the things that slip away most quickly are just procedural skills that, if you don't practice doing things, you aren't as good at them. Fortunately I've been doing this for a while so I've done lots of them. Once you know how to ride a bicycle, you can get back on a bike and keep riding, although the first time you get back on, when you haven't been on for a while, you may be a little bit wobbly and there are skills in emergency medicine that are pretty critical to be able to do quickly with a pretty, unstable patient, things like endo intubation or placing central lines. So those sorts of skills I worry about, you know, are my skills still sharp. Some of the thinking skills, because I teach them and I still think about them working with the students, those skills. I'm not as worried about degradation. But some of the other skills that I may not have practiced for a while, I could spend a while since I put in a chest tube. I’m pretty sure I could still do that confidently, but at some point you have to worry about that.”
Doug: “When you have students with you, what are you good at teaching?”
Carl Heine: “The procedural skills depends on the patients that we're seeing. Things that are common in the emergency
department that are really good skills for the students to learn are suturing wounds. We have people coming in needing stitches regularly and helping students learn how to sew wounds is a great one. Putting on splints when people have a fracture. Reducing dislocations. Those are good skills that we can work on in the emergency department for procedural skills. So I do those pretty regularly.”
Doug: “How has medical education changed from maybe the days that you were a medical student and why are they doing things differently?”
Carl Heine: “I remember textbooks <laugh>. I remember my first personal digital assistant, prior to smartphones. So I remember having pockets stuffed with reference material, and now I have a little electronic box that I carry in my pocket that has access to more data and information than I could have possibly carried before. Access to data and simple facts is so prevalent now that focusing on getting students to remember that stuff isn't as important. When I went to school, we had a textbook for physiology. Now, when I teach physiology, I've got five different textbooks that are all online. And for this topic, I say read this chapter and this book, and for that topic, another book, a different chapter is a little bit clearer. And so you can kind of pick and choose a little bit more because of the online access. The translation from facts and information to knowledge and wisdom is still really hard and figuring out which source of facts, which references are more trustworthy. And so there's a different set of skills that students today need because they don't need to remember as many facts, but they need to know how to organize, categorize, criticize the facts that they are accessing. So it's changed the way you have to get them to think. Another thing that I think, and this is, you know, one of my biases, because I also teach health system science stuff, that’s thinking about the healthcare of a community, rather than just the individual patient in front of you and how you kind of help the community to be
healthier is becoming a bigger part of medical education, rather than just making sure you do the best job for the individual in front of you, but making sure you do the right thing for your community.”
Doug: “Carl, that's all I had. Anything I didn't ask you about that you, think's important to talk about?”
Carl Heine: “Yeah, there are a couple of things I do want to also add. Medicine is hard and with the pandemic it's been even harder and there's different labels for it. You know, burnout is the most common one, but moral injury and providers at all levels feeling a little overwhelmed and less enthusiastic. One of the really nice things about teaching is it kind of helps to reinvigorate and kind of gets you thinking positively about the patient care that you're doing. It kind of gives you fresh eyes to look at the medical care. And I see a lot of the physicians that are kind of tired and grumpy, but they feel more energized when they have a student that works with them. And so there's a benefit to the individual physician, beyond just the relationship with the student.”
Carl Heine is the associate dean for clinical education for Washington State University’s Elson S. Floyd College of Medicine. He’s also an emergency room physician at Spokane’s Deaconess Hospital. We thank him for his perspective.
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The Interprofessional Opioid Curriculum team also wishes to thank these people for their contributions:
• Dr. Barb Richardson, nurse, educator, and interprofessional champion;
• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine
• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and
This episode of “Finding Joy” was produced by Doug Nadvornick.
If you are interested in sharing your perspective about wellness and resiliency as a healthcare professional or would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu We also encourage you to visit our website at: https://opioideducation.wsu.edu/about/.