Kung Fu Panda & Residency: Growth Mindset

Margaret: [00:00:00] There are many moments in up-leveling and training years where you are not ready and you are making mistakes, and it's not imposter syndrome. You are truly kind of bad at it, and that is okay. 

Preston: It's called leaping because you always are gonna have to jump to the next level. You're never gonna be able to step

Margaret: Hello, How to Be Patient nation. I am back. I am the same as I was before- She's back ... not better. Welcome to season four for me, even though you've already been spending it with Preston and our illustrious guests. 

Preston: Mm-hmm. 

Margaret: Two of 'em You have allowed me-- Two, two. All, all two. Both. Both of them Well, there's the voice in your head as well.

But besides, there, there's- Yeah, 

Preston: three's a crowd there, 

Margaret: yeah ... there's a puppet you bring. Mm-hmm. Preston allowed me to take a break because I was burning out in fellowship, and I was on call, four of nine weekends for the last couple months. But now we're back, and I'm rejuvenated, and I've been listening to what Preston's been...

[00:01:00] Oh. 

Preston: So producers, that quick cut was for Margaret peeking. She's in her peak performance phase. I'm peeking. And we had to correct the- I was too excited ... the 

Margaret: audio equipment. Yeah, so they could handle it. I was too excited to be back, you know. I also need to work on keeping my mic in the same place slash I need to get a stand 'cause I broke the one Preston gave me.

But when this episode comes out, it's gonna be end of summer, I think. It'll be end of summer, and for some of you, that means it'll be end of summer intern year. For Preston and I, I'm in my last year of training, and Preston, you are in your last year of residency. 

Preston: Mm-hmm. 

Margaret: And so we're not- 

Preston: Second to last year training.

Margaret: Second to last year, yeah. We're, not starting brand new, but I still think the academic turning, year turning over, it usually comes with new responsibilities or other new parts. And we have our interns or our med students who are listening and are earlier on in the journey of training. And so I texted Preston the other day and I said, "Can we do a, coping with intern year or making sense of, new learning stages in medicine [00:02:00] slash Kung Fu Panda mindset episode?"

And he said yes, maybe 'cause he's burnt out now. But he said yes. Mm-hmm. And so our episode today is going to be about growth mindset as told through Kung Fu Panda and applied to upleveling in medicine. 

Preston: Which, I'm excited to see how that comes together. I don't think I necessarily can picture it, but I absolutely said yes because I love Kung Fu Panda and I love growth mindset.

So I was like, what are the odds that these two things come together and don't make me excited? 

Margaret: Exactly. Well, and we-- I feel like we frequently, one thing throughout the podcast, like every f- every time I put a question in or, a "What do you guys want us to talk about?" Even though we've done burnout episodes and we've had other angles on this, I think how do you hold the kind of heavy gift and burden that is medicine, especially in training, is a kind of a, a theme question that we get of "Can you keep talking about [00:03:00] this?"

Or, "Thank you for helping a little bit with my burnout. I at least laugh sometimes and learn something on the way- Mm-hmm ... on my commute." 

Preston: Those are good. My favorite is, I know we get this all the time- Tell us, give us tips. How do you keep from being so burnt out? And we're like-

Margaret: What impression are you getting? 

Preston: Yeah, tr- we're afloat. don't get me wrong, the, the plane has not crashed. 

Margaret: Oh, Air Force. 

Preston: That's why. But, we are experiencing turbulence. And, so it's like, "Give us tips on how to avoid burnout like you." I'm like, "Girl, we" We got nothing. "Burnout is not avoided.

We're, weathering the storm, but, trust, the burnout is here." 

Margaret: Trust, you, it will be dealt with, but it is also happening. So I mean, I feel like we love to talk about this. I also think this is, I think our, media papa, Dr. Glaucomflecken, and Lady Glaucomflecken both just did, an episode [00:04:00] on this.

I saw a recent, clip from their podcast about dealing with h- having, dealing with having hobbies and trying to not burn, be burnt out and all of these things. So I don't think this is a question that gets answered once and is done, and so it doesn't surprise me that it's a question that comes up for us a lot, right?

It's different, and I think also people are hoping, and we ourselves are probably hoping that if you just listen to the right episode about how to make medicine and training less hard, we're gonna unlock something. And if I was better at getting us advertisers, I would say that this episode is that.

But it's, but it may offer good information. 

Preston: No, it's, what you really need is to do the right module, the right wellness module. 

Margaret: Right. 

Preston: For sure. So, so if you haven't found it yet, keep looking. I'm sure it's out there. 

Margaret: Could be this one. It could be on our Patreon- 

Preston: Mm-hmm ... it's a module. we could make this a module, yeah.

Do you guys want a module after this? We'll be all more trust. Do you guys want, 

[music]: should we do the CME journey of this? 

Margaret: But that being said, it's not a module, but Preston knows [00:05:00] this, and people who follow me outside the podcast know that I love creating stup- silly little, like, acronyms and stuff, mostly just 'cause it helps me remember things I'm trying to work on.

And other times in this podcast, we've joked about how, if you create an acronym and enough, special metaphors for a system, then you can sell it. We're not gonna sell this, but if you catch me using acronyms to help you remember different topics that are just totally made up, this is why. I enjoy them.

I found other people enjoy them, mostly 'cause I think it just helps you have memory for something if you can make it a little catchy. 

Preston: I just think it's fun in general to turn anything into an acronym, unprompted. instead of "Hey, we going to Taco Bell?" be like, "When are we hitting TB?" 

Margaret: When are we getting infected- 

Preston: You know?

TB. I think it makes us fun and quirky. Yeah. So that I'll sell that. I'll sell that all day. 

Margaret: I'll sell that. I'll sell being fun. So before we go into one of... So the broad overview for this episode is gonna be talking about growth mindset, which I recently read the book by [00:06:00] Carol Dweck, which someone mentioned to me actually my intern year, like it was sitting on their desk and unprompted, they sort of were talking about it.

I think it was my chief. But that book combined with the narrative arc that is in Kung Fu Panda, it's also in many kind of hero's journey stories And going to the next part of medical training, which automatically has its challenges and obstacles. And at the core of a hero's journey and the growth mindset is, how do we deal with challenges and obstacles, including ones that are neutral and ones that are unfair or hard, and how do we carry those and grow through them?

And so that is the lens that we'll be taking today. The trials. I remember 

Preston: that from my English class. and then they go through the trials. Yes. 

[music]: You're like, "And then there's this action." 

Preston: Yeah. we're in the, we answered the call to action. And we're like, "Why did we answer the call to action?"

[music]: Exactly. 

Preston: that's where we're at. 

Margaret: And I wanna shout out, the Psychiatry and Psychotherapy podcast by [00:07:00] Dr. David Puder, 'cause he actually has a few episodes talking about medicine and the hero's journey. I have not listened to those episodes in a long time, but I-- they were notable to me. And the hero's journey is something that is, an archetype in many, places.

But shout out him, 'cause I think that he was one of the first ones who put it into medicine for me. We still need to get you on our podcast if we can ever, if we can capture you. Anything you wanna talk about. We, me and Preston talked about, weightlifting and exercise. We could do another episode on it with him.

Mm-hmm. but I wanna start with something which is true, spoilers ahead for Kung Fu Panda, which is a question I, Preston and I texted you earlier today. But I actually wanna start with our, the love for medicine or for the thing that we're doing. And before we do that, because people can be burnt out, I wanna start with something that you admire or has been inspiring you lately that does not need to be related to medicine.

It can be anything that you've seen, that it's like, that felt like something, a little spark. [00:08:00] It, gave me a little glimmer. I say don't start with medicine because I want us to refamiliarize with the feeling of the glimmer and the inspiration. When, and when you're fall of intern year, you may be slightly starting just overwhelmed and you don't wanna think about the hospital and you're burnt out, which we will get to.

But so for now, Cole's mind, and Preston, tell us, for you, something that, has inspired you or that you've admired recently that felt a little sparky. 

Preston: I would have to say the World Cup- Okay, go on ... which I have been watching very closely. So I was, for context for listeners, I don't think I talk about this much.

Everyone knows I ran track in college. I'll talk about that. Everyone knows. But I was actually a big soccer player before that. I like, from the age of nine to 11, I was kinda like just tearing it up on the rec scene. Then I started that whole, you know, like the competitive club soccer boy- Mm-hmm

pipeline where it's just, your entire life becomes your, club soccer team. Everyone's kinda "Why?" it takes a little while for people to be like [00:09:00] Why are we doing two-a-day practices and having to do all these extra leagues and going to training camps and trying to get discovered by coaches?

It was like that whole thing. 

Margaret: Or baby goats. I... 

Preston: yeah, exactly. and then I, played in high school. I had some offers to go to college and was, like, torn, ultimately decided to do track in college. But I really loved soccer for a while, and then I really hated it and got burnt out from it. I felt stressed by it.

Then I started to do, pickup soccer a little bit here and there, and then it kinda fell off. But then watching the World Cup, Erling Haaland, who is the, he's the star for Norway. If you're not familiar with his memes, he's got like 

Margaret: that- Jason can we put a meme up here? 

Preston: He's got the slick back ponytail, and he is really tall, he's really fast, he's really tenacious.

He, acts like a golden retriever running after a tennis ball, except that's how he operates at the world stage, and he's, world-class. He, essentially- Looks like a Targaryen. 

Margaret: Is this the one? 

Preston: Yeah. He scores for fun, is how it feels. And that's the part that gives me, [00:10:00] the hope. 

Margaret: Mm-hmm.

Preston: I'm like, he, makes me feel excited about soccer again. Because I'm like- When was the last time 

Margaret: you 

Preston: felt 

Margaret: that way? I'm 

Preston: like... It's been a while. It's been a long time. Yeah. Yeah. 'Cause, 'cause even when I started doing it for pickup, like pickup soccer, I was like, "This is the..." It was like drinking my medicine.

this is the journey- to, rediscovering myself as a kid and all this stuff. Mm-hmm. You know, I should just do it. But, I was like, man, that ins- that inspired me. 'cause you wanna go out and, have fun with it. And- Yeah ... so that's been the thing I've been, following, l- let me play a sport again, not just- 

Margaret: Yeah

Preston: optimize everything, lift, run, punish my body so that it's healthier. 

Margaret: Let me play. 

Preston: play a game. 

Margaret: Yeah. Yeah. It's interesting that you say that, 'cause so mine wasn't the World Cup, but it is the last couple of months I feel like, many people, I, wasn't, never had followed women's basketball, honestly, before, Caitlin Clark, and then, Paige Bueckers, and these other people.

And I've been watching the WNBA for the first time, and, [00:11:00] I used to like watching basketball. First I was forced to watch basketball 'cause I'm the youngest of four, and you're coming. You're going to these games no matter how good or bad they are. So it's funny that yours is, from directly being, an, the athlete in this and trying to rediscover it and reintegrate it.

And that's the admiration and the joy coming in. And for me, it's kind of like discovering Like parts of myself that obviously I'm still watching, but I think I always thought of myself as like a creative English history person, and I was never particularly athletic. And so watching, first of all, I'm in Boston, so like the World Cup- Mm-hmm

has been going on here and has been like, the city's been very alive with it, which is one part. But then watching, like actually rooting for a team and like looking forward to watching games. I haven't felt that way since I was in college and like watching Notre Dame football, even though we were horrible.

But for me, it's an integration that's combined with teaching workout classes and actually continuing to get stronger is I have never... You come from a background of being athletic. I have never viewed myself as [00:12:00] athletic. It has always felt like something that is like a closed-off world to me. I didn't, I sort of, we'll get into this, had maybe a fixed mindset of "I'm not naturally inclined towards this, so I, this is just not a part of me."

Preston: Mm-hmm. Yeah. It's exactly how 

[music]: I feel about music. Mm-hmm, 

Preston: yeah. It's like the, it's so foreign to me. I've never been told I've been good at it, so I'm not, encouraged to, want to go explore it. So, so it's that kind of thing where you're just like, "You know what? I'll just leave it on the table."

Margaret: Yeah. Yeah. So I just think it's interesting that we're coming from two different places, ending up with, a sport inspiration, but then, what we're getting out of it is different. And we could probably talk about this and we have in other episodes- Yeah ... forever. 

Preston: So did you ever play, basketball or were you, this 

Margaret: was always- I played basketball 

Preston: for like-

just a fan ship? 

Margaret: Well, I was a cheerleader, Mm-hmm ... which that could be examined as psychologically. Yeah. But I think also, part of me, very frankly, was raised to not think that women's sports were a big deal. that, [00:13:00] that was not, that was still something that was ... I mean, people still say that, but, that people didn't watch women's sports professionally.

People barely watch women's sports professionally now, relatively, but, it's growing. And so I think that combined with my own sense, I played for a couple years, I was a cheerleader. I was only a basketball season cheerleader 'cause I liked watching basketball. and then I did, cross country.

I did volleyball for, three or four years. But again, I was never particularly strong or athletic or fast. And so- 

[music]: Mm-hmm ... 

Margaret: that compared to areas like in school or for me actually with music, it was like, oh, well, these ones, I have some natural aptitude for, and so therefore these are the things I grow and build.

And listeners, you may be thinking, this isn't about Kung Fu Panda at all. We are transitioning there. 

Preston: I hope- There are two wolves inside of you. 

Margaret: Exactly. One is a panda and one is about sports. 

Preston: And the, the one that grows is 

Margaret: the one you feed. But so I think that this, you know, illustrates really well this [00:14:00] kind of point that a lot of people experience and that is talked about in the book on growth mindset, which we'll, I'll define in a second.

But the, people can have different mindsets around different areas of their life. And you and I have maybe similar ones about, academics or the working in medicine and training in that way, but we have different ones about these other areas of life. And both of us have had experiences, it sounds like, being pretty fixed in one area, but pretty if I just put time and thought and t- energy into this other thing, I can get better at it.

And I think that's important ta- talking about what we're gonna talk about with the training year. What I mean by that, especially if you're changing phases of your medical training, so you're going from college to med school, to residency, to fellowship, or even, residency to attending hood, I think new ways of being and holding responsibility, even if you stay in the same specialty, emerge and then the question of how do I interpret the feeling of challenge and overwhelm becomes really central.[00:15:00] 

Does that make sense? 

Preston: Yeah. So- some people see challenges as, a game or, like a chance of growth. this is a way, another thing for me to win at, and some people see ch- challenge as another way to be, like, put down or another thing- Right ... that's gonna be a barrier to me being the type of person I want.

And then even just how you frame this upcoming challenge is almost gonna be, like, deterministic into- 

[music]: Mm-hmm ... 

Preston: to how, you change your outcome. 

Margaret: Yeah. Yeah. So I think that one of the reasons I ask, what's something that you admire or has inspired you lately and asked outside of medicine, as I already said, was, like, people might be burnt out, so it- Therefore, they would be forcing it if we asked about medicine right away.

but I think, and this is where we get to Kung Fu Panda, spoilers, but w- the way this movie starts is he is, an assistant for his dad at their noodle shop, and his dad loves noodles. And he's like, "No, you're gonna be a noodle guy, too" And he t- lies about [00:16:00] having this, noodle- Yeah. "My 

Preston: secret ingredient soup."

Margaret: Exactly. He lies about having, a, the noodle dream when he really had a dream about, practicing kung fu. And he finds out that, coming to town, they're going to name the special kung fu warrior, and he's "This is my dream, to go." So he kind of abandons the, the noodle cart and does everything to get into the, like

It's not a stadium, but I don't wanna use the wrong word. But this pla- the place where they're holding the event to choose this, dragon warrior. 

Preston: Mm-hmm. Arena. I feel like arena could fit. 

Margaret: I think arena, yeah. Maybe, 

Preston: yeah. 

Margaret: I don't know. I think 

Preston: that's- it's more like the quad of the temple. 

Margaret: Yes. Is how it- Yeah.

Preston: Yeah. 

Margaret: And so he ... But it starts with, the movie starts with him dreaming about this thing. So it starts with liking. I don't think you have to ... There are parts of intern year or anything that's challenging in medicine that are not intrinsically liking. you don't have to every part of it.

But I think being grounded in what has drawn you and being a little grounded when you can be in the spark in medicine, [00:17:00] helps us start in the right place. Because what we're about, what we're gonna continue to talk about as we build on this, is that if he had stayed with, the noodle soup, not to cause anyone to have an existential crisis.

but, if he'd stayed with the noodle soup and tried to just, keep forcing it, it ... There's a lot of shoulds that can go into what type of medicine you practice if you go into medicine. And I think what, the rest of what we're gonna talk about goes on the assumption that there is some natural glimmer in going into healthcare that has existed for you at some point in your life.

Preston: Mm-hmm. There's something about being a doctor that felt like going to that kung fu championship. 

Margaret: Yes. Somewhere. It felt aligned in some way. So starting with the liking, one part about liking is familiarity. and so I don't know if you had this experience, but if there were any specialties that you went into, third year or clinical year of med school, and you're like, "I'm never gonna like this.

I have no natural liking toward the subject," you [00:18:00] had it. You actually really enjoyed that month. And then in hindsight you're like, "Yeah, I still would never pick that specialty" And some of it was just enjoying becoming more skillful in something. 

Preston: Oh, yeah, pathology, 100%. Mm-hmm. 

[music]: Mm-hmm. 

Preston: So I think I took some, vindication from, learning how to identify, some oma bodies and differentiating between the, different types of tissue, whether I'm looking at, bone or lung or- kidney biopsy by like whatever microscopic H&E stain it was, and then I'll never look at it again.

Right. But I did it. Right. Yeah, that's definitely it for me. 

Margaret: There's-- Right. So there's an element of liking or familiarity that makes us ... we don't feel overwhelmed. We don't feel anxious. We feel like we're competent. These are all things that humans like in general. And with things that are truly, not very up your alley or that you don't have any social [00:19:00] pressure to like or to try to keep up with, it is an indicative, I'm trying to think of 

Preston: a way to say this. It can be more fun because there is n- 

Margaret: Yeah ... 

Preston: there's, no expectation. That's true. 

Margaret: But the, the mastery itself is something that we enjoy. if you think about- Mm-hmm ... kids learning to do anything, there's something human about curiosity that we, naturally seek- Mm-hmm

the next thing. we n- Yeah ... we have an ability and a, you know, an aim towards learning probably- 

Preston: Yeah. We love 

Margaret: getting better ... as part of this. Yeah. And so that, though, combined-- So you have the liking for medicine, and then you have some familiarity, hopefully, coming from med school into residency or any other phase, but then there's the parts that are new that you don't have familiarity with.

So growth mindset is sort of the psychological set of ways that you respond to challenge or obstacle. And what she talks about in the book is the different studies they did on, like, how do people in all these different settings, so like kids who are o- [00:20:00] given the opportunity to, would you like to do the same easier puzzle that you did last time, or would you like to do the harder puzzle that's new to you?

How do they respond to those kinds of challenges in academics? How do, athletes think about getting injured or, going to the next level of play? And some of the core components of it is that, growth mindset does not ... views our, personal strengths and abilities and kind of almost all aspects of self as mutable or changeable, and that it changes by practice And so the fixed mindset is much more kind of either you have this or you don't, and it's 

Preston: a threat If you believe that you are capable of change- Right, 

Margaret: right

Preston: in the first place. Okay. 

Margaret: And that failure, th- risk of failure, so trying outside the comfort zone, is a threat even in areas where you're pretty sure you're good. So many people talk about, going from high school to college, and it's like you were the [00:21:00] smart kid in college, and then you go to a school where there's tons of smart kids, and it's very threatening to kind of your sense of self and your identity because you have been told you're a smart kid your whole life, and you've never gotten anything below a B+.

And then suddenly, what is... Are you no longer smart anymore? If smart is something you are- Mm-hmm ... or are not, and it cannot be changed or adapted, which would be the fixed mindset, then even testing things that you are strong at becomes threatening because, s- if you're not the best anymore, what are you?

Preston: Mm-hmm. What, follow-up question for that. So could you have this fixed mindset that you're smart, but the problem is the rigid ways in which you measure your intelligence? So I'm smart, that's fixed, but I measure it with my grades. 

[music]: Mm-hmm. 

Preston: Or I measure it by, like, how I perform on the bell curve of the class.

Because if you measure it in a, what if you measured your intelligence by, you know, how well you can overcome challenges or how well you respond to challenges? I don't [00:22:00] know. you, c- compare it with resilience, like that wouldn't necessarily, that, threaten your identity. So- Yeah. 

Margaret: No, I think 

Preston: that's a great point

could that be a healthy fixed mindset, or is that really just being mutable and give me a different name? 

Margaret: No, I think this is the exact right point. I think that this, like many concepts we've talked about, can go by other names. And when I was reading the book, resilience was something that was coming up a lot because, what if my fixed mindset is that there is, that I am good no matter what I do, and the point of life is trying?

L- and that's not what fixed mindset means. I will give this credit to it. Mm-hmm. I think fixed mindset is sort of that there cannot be... It is, it's less about that it's literally fixed and it's one way of thinking. It's more about the deeper part of this that you're s- are saying is The way that you interpret challenge and failure is like more what it means- Mm-hmm

to have growth or fixed mindset, not just like I have one way of relating to this. 

Preston: I see. I'm, smart or I'm not. That's- 

Margaret: Yeah ... 

Preston: that's what's fixed. 

Margaret: And or I'm smart- Yeah ... based on if other people tell me I'm smart. [00:23:00] 

Preston: And that's what's fixed. 

Margaret: Yeah. 

Preston: Yeah. I'm pretty- And 

Margaret: like that there's 

Preston: a certain amount

only if other people tell me I'm pretty. 

Margaret: Yeah. 

Preston: Or if I'm the prettiest. Yeah. Okay. 

Margaret: Right. And so, so this is kind of this frame that we're in. So when it comes to medicine, and I th- I think that this is where this comes up especially and is important for when you enter new levels of, training and there's new challenges, is how do we make sense and what is our go-to kind of thinking and behavior pattern when we are bad at something, which most of us, myself included, will have periods through the training process where you are not very good at holding the weight of medicine.

The one caveat I will give this episode is there are many parts of medicine historically and at present where we are dealing with horribly heavy morbid things and systems that are-- can be very treat us like cogs in the machine. That is true. You guys have heard us talk about that a lot in other episodes, and we will continue to, but that is not what this [00:24:00] episode ab- is about.

This episode I'm talking about the burden that is of healthcare that we do have the ability to carry, but that we have to learn how to carry. 

Preston: I would say the, I'm not sure if you a-asked this as a rhetorical or not, but the most common way we handle the feeling that we're not good at something i-in medicine is we externalize.

it's more socially acceptable to say "I just get down on myself and I'm like I'm gonna do better next time and, you know, I'll overcome it." But I think at, at-- the, common one I see all the time is they just blame other people. And so like the classic scenario you'd see is like in the OR like, you know, the patient's bleeding a lot and then the surgeon's like, "You idiot, you're not holding the clamp right.

Like you're not retracting right. where's the, nurse getting the gauze?" Like they're externalizing all those things if they have a competence issue. And then same thing happens in psychiatry. Like I would say the continuously hardest part for me in training and going forward is gonna be my psychiatric interview and psychotherapy in general.

Like that's a [00:25:00] place where I say there's the highest skill ceiling and the most room for growth for anyone. And the common one is like you don't get along with the patient, you don't get through to them, you don't advance in therapy and you're like, "They just don't wanna get better." 

Margaret: Mm-hmm. Yeah.

Preston: "They don't wanna improve." Yeah. "They're not listening to me." But like I'm just externalizing for, me being incompetent. 

Margaret: Yeah. 

Preston: So I, think that's, just like every-- like the baseline gut reaction to medicine. 

Margaret: I think that's true. I also think there is a level to which like you don't see internalizing Like, you don't, people don't say out loud, so you don't hear it Disorder.

The other thing I will say, and this is, true, women are more likely to have internalizing disorders, and men are more likely to have externalizing disorders to some extent. There's some overlap. the overlap between men and women's mental health is more significant than the places where we're that different.

it's not that huge of a difference, but in general, there is a trend, and it's part of how, boys and men are socialized and part of how women are socialized is what is a good [00:26:00] woman? Be quiet and kind and soft and receptive and mater- like, nurturing. What is a good boy? A hero, someone who produces, someone who leads, someone who is, looked at and powerful.

And so that is just the two things I would say. I think I see a lot of internalizing, but I also am friends with many women in medicine more so, and I work with a lot of women. And so I think you can't hear internalizing. And I also don't disagree with you that exter-- I think there's just a lot of, like, how we hold it, and it's like, do you wanna hold it in this way that pushes it over here, but it's still really heavy and hard to sustainably hold?

Or do you wanna push it over here? Which, like- Mm-hmm ... the internalizing side, which is also heavy and not sustainable and leads to a different kind of resentment or frustration with people. And- 

Preston: Yeah ... yeah. Are you gonna litter it on the front lawn, or are you gonna shove it in your closet? 

Margaret: Period. 

Preston: And- Exactly

and I'm driving through the neighborhoods, and I'm seeing everyone's front lawns, and I'm like, "Everyone be littering in their front lawn," and you're like, "You haven't seen their closets." 

Margaret: I'm like, "I'm [00:27:00] organizing their closets right now." so we started with, okay, liking, right? So finding the thing, the glimmer in medicine that has drawn you, that, you know, aligns with some of our prior episodes on ACT, like values work.

We start with the liking. We understand that liking is part familiarity and part competence and part, And then for the part that we don't yet or that we find challenging and want to like, whatever, it's a mixture. The growth-- like, the start of, the growth mindset of how do we view what this obstacle means.

The next part, so I'm using all Ls for this, today, is leaping, which is, I have entitled Catching the Opportunity. And we will catch that opportunity right after this break

Welcome back. We're gonna talk about leaping. And so again, I made up this, these different words to make this just catchy, which I really enjoyed doing today I won't lie to you. this one is, I think a little bit [00:28:00] more abstract and it's kind of a constant thing over, especially I'm thinking about intern year, like the first year of med school, where there's so much newness and so much challenge.

but I think the liking is a start. And then in Kung Fu Panda, what I'm just gonna cry. In Kung Fu Panda, he ends up after really pushing to just ... He really likes kung fu and wants to see them crown it. He eventually, sets off a firework that, blows him up and he lands in the arena, and then the guy decides that it's him who's this, special warrior.

Preston: Mm-hmm. 

Margaret: And he, he was supposed to choose one of the five who this other mi- ma- master had already trained and, are very, svelte and cool and skilled- Yeah ... and the right person. Master Shifu 

Preston: had his lineup. 

Margaret: Period. 

Preston: And the Well, well, what's the, The 

Margaret: turtle ... the tortoise again? I don't know the turtle's name.

Preston: Yeah. 

Margaret: Not true fans here. 

Preston: And he, [00:29:00] closes his eyes, and he's got the finger out. Yeah. And then he's pointing at him, and he's "There are no mistakes." 

Margaret: Yes. Yes. And so, right, if we had fixed mindset, which I think you could say Sh- the Shifu, the master guy, the younger one, the coach person is, he's like, this person, this being, this panda could never be what we need this to be.

Mm-hmm. It could never be in this elevated position. It's supposed to be one of these people who has the abilities and is, and, you know, has, have worked on them for a long time. we'll put that aside for now in this metaphor. But this person will never be like these people, and that is a fixed mindset.

Whereas- Oogway ... 

Preston: you 

Margaret: got- That's his name. Oogway. Oogway saying, like- Oogway ... "There are no mistakes. You must learn to make this person the Dragon Warrior" That's growth mindset. there's a belief that people, by actions, can become something different and something remarkable. 

Preston: People can [00:30:00] grow and change.

Margaret: The leaping I think of as catching the opportunity, which once you matched, you caught the opportunity. I think of things outside of that, that we won't talk about today, but are, like, things where you're not really sure, but then something like our podcast happens, where you were like, "Hey, do you wanna do a podcast?"

And I was like, "What? I, what?" And then it was like, well, this is an opportunity. I was not yet ready to do it. And, we were both really nervous when we started. 

Preston: Mm-hmm. 

Margaret: And now we're more comfortable doing it, and we're talking about Kung Fu Panda, but there are these opportunities that come before you're ready.

And I don't mean, being total, go into a hospital and practice without going to med school. But there are many moments in up-leveling and training years where you are not ready, and you are making mistakes, and it's not imposter syndrome. You are truly kind of bad at it, and that is okay. 

Preston: Yeah.

There's, no-- It's called leaping because there's, you always are gonna have to jump to the next level. you're never gonna [00:31:00] be able to, step. Yeah. my-- So I have a lot of friends in the Air Force who are pilots, and it's a similar thing for them. They go through the simulators, and they fly with an instructor pilot, but the first time you fly by yourself, it's always a leap.

And there's even some aircraft, like the, the F-22, only has one seat. So that means that the first time you ever fly in the plane, you'll be by yourself. Mm-hmm. it's alway- It-- There's no, any amount of stepping stones, you're always gonna have to take that big jump, and you're gonna have to make mistakes then to survive that, that friction point.

Margaret: Right. There will be some leaps, and, I think modern medical training, we do a good job of trying to make 'em not impossible leaps, but there w- I think for everyone, there will be points where You're not sure. you're, you don't have that guarantee. It's not just a little, a small step away.

It feels very much different than the place that you're in. And that act of trust and having a growth [00:32:00] mindset here is the trust that, this thing that looks hard but that other people have done and that I, think I can, and I have reasonable evidence to think I can, I am willing to experience feelings and sensations and situations that are not super comfortable with trust that I can become something that feels different than who I am now.

Preston: Mm-hmm. And you know what's, fascinating about leaping too is I, feel like- 

Margaret: I like how you're running with my fit- made up acronym. I really appreciate 

Preston: that you are. Oh, I mean, it's, all gospel to me. Yeah. The- 

Margaret: If I started a cult, Preston would be the only one in the cult. You're like, "This is a 

Preston: bop."

Exactly, yeah. and I'll design the cloaks. Period. So it's almost easier to engage in the leap, I think, when you're not thinking so much about it coming. And there's some times when it's inevitable, but I, was thinking this last weekend. I was talking with some, some surgeons, where I was doing, a figs thing, and so they brought in all these different, surgical residents.

And we were, talking about, or they were talking about, [00:33:00] their first time operating. their first time running a case by themselves, not just assisting, like finishing it. And they're like, "It doesn't get announced to you. No one's like, 'In two weeks, you have your first operation.' It'll just be, like, a routine, drawn on day, and you'll s- get a little bit into the surgery, and then the attendee goes, 'Oh, I got a page.

I'm gonna scrub out. You're good to finish, right?'" And they're like Yeah, For sure. 

[music]: For sure, right? 

Preston: I'm like, yeah, I got, it. The, so the, that's a huge leap for them, but almost the fact that it's, sprung on in, the moment, they don't have time to ruminate over it.

They don't have time to, stress. They just have to kind of trust their training and then go through from there. and I guess I was thinking, if I was a surgeon, if I was in surgical training, I think I would prefer it that way rather than stressing over, every aspect of, the procedure I'm gonna have by myself.

Margaret: Yeah. Yeah. No, I agree. I think they're like those [00:34:00] moments, like the first time you're on call by yourself, or like even when you're not sure who's checking, your orders. Or sometimes, I even have felt this, it's a different thing, but, like, when you start doing therapy for the first time and it's just you and the patient- Mm-hmm

in the room, you're like, "What? should this be here? Am I able to do this?" I remember being like- 

Preston: Yeah ... I did- You're 

Margaret: looking around 

Preston: for the camera. You're like, "Hello?" 

Margaret: You're just like, "I did not... Okay, I guess here we go."

Preston: Oh my gosh. I had one of my-- I- I've been finishing with my therapy patients because I, finished the last two years and we were discharging, and one of them told me, 'cause on my first session I said, "I don't really know how we're gonna work through your problems. We'll figure it out together."

It was like my first day as a therapist. And she, the, the patient told that to me and said, "Yeah, I went home and thought I broke my therapist." And I was like, "Very, fair." He was like, "I didn't 

Margaret: know what I was doing, girl." 

Preston: I'm like, well, broken, like I [00:35:00] needed to push start, same thing. 

Margaret: Whatever. 

Preston: But still we rise, yeah.

Margaret: So you've been wa- like, getting Love Island TikTok'd. 

Preston: I have, yeah. 

Margaret: Still we rise, I guess. yeah, so I, think also just, hearing other people who are further along in the path talk about that there is a leap and there is this fear. And again, normalizing it helps facilitate more of, a growth mindset approach.

Instead of viewing it as like-- 'Cause what is-- You've heard this rant from me before, and so I'll keep it short. But, what is medicine besides, learning how to perform an identity that you are not to get into the next step? it, there's so much of it that is showing, an entire year of surveillance, which I'm not saying doesn't make sense, 'cause it does.

It's an important job we're doing. But, entire year where you're being graded on how you think and how you show up and kind of your personality and how you are with patients. We get very used to, being very dependent on other people's opinion/grading of us because we have [00:36:00] to be. Like, you spend college even, thinking of how competitive medicine is.

we spend so much time trying to perform to that external opinion. And if we go back to this growth mindset versus fixed, that's very more aligned with, a fixed mindset. And I think that the work of medicine and, the traditional view of medicine also can be something that facilitates a, there is a white-- a right, Freudian slip.

There is- ... a racist, sexist, whatever way to wear a white coat. And if you don't, you may end up with $200,000 of debt and no degree. And also you're bad and unethical, right? there's so many-- I even think about, like, when we started the podcast, being like, "Is this ethical? Am I allowed to do this?" And there's just so many places where we look outside of ourselves in medicine to figure out if what we're doing is the correct thing and if we're good.

And then- We experience things like intern year, or for me, like I failed a couple tests my first year of med school, and are like, we look around, everyone else is performing, [00:37:00] and we think, no, we don't see anyone else with the, mess in the closet or in the backyard. there's no front yard yet because we're all working really hard to perform.

And then we experience this internal thing of, sadness or being so challenged, being overwhelmed. And we think, "Wow, not only did I not, do I not do this well, but also, I'm feeling all these feelings that other people don't and don't struggle with, and so I'm also alone." I think that is a really, hard thing to hold that I think a lot of people actually hold at different points in their training in medicine.

Preston: Mm-hmm. Loners. TL. 

Margaret: Yeah, the feeling that other people aren't struggling. 

Preston: Mm-hmm. 

Margaret: That you, you are particularly not fit for this. And I think by being-- by performing and showing, perfection is a big route of how we spend our time to get into medicine, it makes a lot of sense that we're all trying to, keep up a certain facade.

But then all of us- Mm-hmm ... I don't know, I just think so many people internally-- And, being in psychiatry, we talk about this [00:38:00] differently. I think also other people in other specialties, like maybe the surgeons you were hanging out with, they talk to us more openly than they talk to maybe each other sometimes.

Preston: Each other, yeah. Yeah. It's a, what is it called? Duck syndrome. It's, just another metaphor for- Oh, it's like- ... for everything we're saying. But like- 

Margaret: Yeah, the- 

Preston: Yeah, ducks are gliding on the lake, but underneath, their f- the, the feet are paddling as fast as they can. 

Margaret: Yeah. So I guess I, I include that in, the leaping part, just to say that the leap will be uncomfortable and will feel like-- I don't know that it'll feel like you can't do this, but it'll kind of be It's asking you to be a different person than you are.

Not in a like- Mm-hmm ... abandon the old version of yourself, but it is asking you to become something that is different, but you need to take, you need to take the leap. the next one, our next phase in this hero's journey and in Kung Fu Panda, so he accepts this opportunity. There, and then he's in the valley, and the valley is this learning.

This is our L word for it, which is the practice. [00:39:00] I forget who it was, but there was a thing they, one of my theology professors used to use when we were talking about, like, why do Catholics go to mass all the time at the same time? And there's this clip of this NBA player who had been fined 'cause he, hadn't been at practice, and he's "What?

You're talking about practice. You're not even talking about the game. what do you mean practice? Why are we..." But this part, the learning is the practice, right? And if we can sink into the learning, this is usually when there's a montage, and this was true in Kung Fu Panda as well, where the first part is still more of this like you're so different from everyone else and you're never gonna get it, and it's like you should just give up.

And then there's that flip point and the song turns on, and something clicks and the practice starts to pay off. I think one of the things that I like and that, one of the things I wanted to bring up from Kung Fu Panda is a couple things. There's a part you find out later in the movie where he thinks his dad's noodle special recipe has a secret ingredient, and there is no secret ingredient.

And it's just about the thing itself, like there's no secret special power he does or doesn't have. [00:40:00] there's no special ingredient in the soup that is there or not there that he has to figure out- Mm-hmm ... and then everything is fixed. But the other part of this is that in Kung Fu Panda, he, the master cannot train him like he trained all the other people.

He learns that he has a strong drive for food and that he can do all sorts of like acrobatic athletic things if food's on the table. But the, the... And that's a silly example, but the point of this is where in medicine can you give yourself permission to do something that's a little bit different in terms of giving yourself some permission to do things in a way that fits you more than just fits what you think these are the 100 things a doctor should do in this exact way?

Like I think- Yeah ... of something as small as does your pen have to just be like black and you print out the list in one way, or can you bring a pink highlighter? That like for me it was literally small things like that. And can you make this learning slightly more pleasant and slightly more attuned to your [00:41:00] strengths?

Preston: I'm picturing that scene where they're like doing the chopstick- Mm-hmm ... karate fight over the dumpling in the bowl. 

Margaret: Yeah. 

Preston: And it's c- it's cute because it's like Shifu's learning about Po as Po's learning about kung fu. Like it, it's a two-way street. I think for me it was- Like, the unique Preston Food Motivated style, a lot of it was like my chronic onlineness and how I could use that to relate to patients.

So I, I recall, a patient making a joke and me, like, being able to reference that TikTok back with them. That was very much like the, the Preston Panda style. You know, where like a, maybe the, a normal or traditional doctor would be like stone-faced, neutral, like blank wall. And I'm like, "Oh yeah, I'm, I know that Instagram reel."

Or "Do you follow this person? that's so fun." And using that as kind of like my in or my- 

Margaret: Yeah ... 

Preston: my dumpling. 

Margaret: Well, it reminds me of the videos, [00:42:00] of the person that we had on Amino. So that's not his actual name. The, the videos are t- like, like me if I match for residency in Atlanta. 

Preston: Like- Yeah, me training for residency in Atlanta.

Margaret: But yeah, that connecting. I think-- Well, and I think there's the obvious one too for you, which is like the skits. Like your account is, I think a joyful translation of humor into the life of medicine and that clearly, I mean, that's why we're here. Like clearly something too. Okay, so the valley we're not gonna stick too long on.

I have one more here and that is luxuriating, 'cause that was the best word I could come up for this. Luxuriating. And that is in small and large ways, noticing when you are somewhere new that you've been trying to get to. And so in Kung Fu Panda, how many times will I say Kung Fu Panda before this episode ends?

Unknown. There's the moment that you're talking about where they have this like training montage and they're like fighting over him being able to get the food [00:43:00] from the master, and eventually he beats him and does. And they have this moment of just like locking eyes and it's like we've done something here.

And I think the temptation can be to not notice you're done until there's some external thing yelling at you that you have made it. So you graduate med school, you grad, you become an attending. Mm-hmm. You finish the year. 

Preston: The diploma, the- Yeah ... yeah, the ceremony. Yeah. 

Margaret: But I think if we can get curious and find those moments when they kind of, when it feels like something special or something joyful has happened or if you-- There's moments where it comes to mind and maybe it's listening to an episode like this in the beginning of your year and then at the end and it draws up different things that once you have a year, like six months of experience under your belt That if we can catch those moments that are small, that represent, like at the beginning of this rotation, I felt not sure how to...

I always had to ask my senior how to manage the, like, sliding scale insulin or something. Now I don't ask them at all. Like, when those float [00:44:00] into kind of our consciousness, can we stay there for a second? Can we tell someone we care about who we think is not so burnt out that they don't have the capacity to be nice back and say "Notice that win."

Can you talk to your friends not in healthcare about this kind of stuff? Like, where are there places where when that sm- even the small wins or accomplishments come up, we can expand them by not just having them pass, but by talking h- about it to someone who cares about us and who has the capacity to let us be kind of proud of something and excited.

Preston: Those moments for me are always when you are orienting a new person. 

Margaret: Yeah. 

Preston: And I think that's true for everyone in medicine. When you're, onboarding the new interns, you're po- poke-- So I think that's probably true for a lot of PGY2s right now that are showing other people how to operate the EMR and their processes and they're going, "Wow, I've learned so much."

Margaret: Yes. Yeah. I think you're totally right I, we 

Preston: like- That's, the luxurious 

Margaret: We, ran [00:45:00] this group, in 2020 I ran it at WashU. Went f- that was like fourth years and first year med students during like COVID. We were all isolated and it was like a resilience in medicine group. And we did different like skills, sort of like what we're talking about today.

But at the end of it we did like a survey and what was most helpful to the intern- or to the first year med students and to the fourth year med students was the connection between them and the normalizing for the first years. And then for the fourth years, the sense that you're saying of "Wow, I am actually so different than I was three and a half..."

I've, grown so much, I've done so much. There's been hard parts. But being in medicine is truly, I think, a like an incredible opportunity to grow in the human condition. And I think that's also part of this is I've grown all these skills, I'm becoming the doctor I wanted to be. But it takes, I think the experience of talking to someone who is actually brand new.

I think it's hard to force it. You can't just be like, "Think-" Mm-hmm. "I don't think." You can be like, "Think nice thoughts," and then [00:46:00] you're gonna be like, "Wow, I feel different." But the experiential part that actually fully engages you to see the difference- Mm-hmm ... is what I mean by the like celebrating those little moments or savoring them.

Preston: Yeah. remember, so to the interns, you're gonna be learning a lot from your uppers, but remember you're teaching them too. You're teaching them how far- Yeah ... they've come, and they're grateful for that. It's teaching them how 

Margaret: much smarter... No, 

[music]: just 

Margaret: kidding. 

Preston: You're helping them luxuriate in their progress 'cause they were like you just a year ago, and then that, and you're gonna be like them- 

Margaret: Yeah

in 

Preston: just a 

Margaret: year. And you see proof as well of like people who, if they're being honest with you, like also felt as unprepared or not ready as you feel, and now they didn't die and they feel- They are that next person. So they took the leap and they ended up learning through the valley, and there will be valleys.

and I, think-- I guess my last point with this one is there is so much difficulty inherent in medicine because of the nature [00:47:00] of the work that we do and the amount of illness and death and struggle that we see. And that has to be-- I'm not against complaining, obviously, Mm-hmm ... or processing. But I think unless we do it on purpose, it's hard in medicine for there to be places that you are authentically noticing the good work and the good growth and, the purpose of what we do.

And so I think that this is just an important part that you don't need to force all the time, but if you find the thread to see if you can pick it up or if there are places for people where they like-- I felt this with, Laurel Braitman's writing group out at Stanford, who's one of my mentors, that was, like, writing medicine.

It was always a beautiful experience to go to that and do something sort of different to think about the experiences of working in healthcare. And so I just think for interns or for anyone in the next phase, if you find a place where it feels like it opens you up in your ability to see the work you're doing, [00:48:00] I think that can be- Mm-hmm

a really helpful thing on the journey 

Preston: Yeah. So if you're going into medicine, you're going into any challenging field, and you wanna maintain your growth mindset, remember that you liked it at one point. And there's something about it, there's something about it excited you, gave you fireworks.

Yeah. You're gonna have to take a leap, and multiple times, at each step along the way. And each of those big leaps is a chance for you to learn. And as you do in each of these cycles, luxuriate in the fact that you have come a long way. And I see these Instagram reels all the time where it's like, "I'm finally the version of myself that younger me would think is so cool," which is, it's cringe and it's trite, and then they put some, like- I like it

edit over it, but it's true. I like it. Yeah. Younger me would think I'm cool. 

Margaret: Hope core. 

Preston: So, so lean into that. 

Margaret: You just made it sound way better putting it all together. Thank you for making my writing sound good. 

Preston: Hey, [00:49:00] I, just had to, I just had to put a, a voice to it. 

Margaret: That's true. The structure 

Preston: was all there.

Margaret: I... Do you have any thoughts? And in the fi- the finale of Kungu Panda is he actually, defeats the final being, but he did notice his little- Mm-hmm ... victories around the, along the way. 

Preston: I think my final thoughts about the end of Kungu Panda in this episode are when the big reveal that there is no secret ingredient, Po didn't understand that until he was staring at the dragon sco- scroll, right?

Because what his dad told him, he was like, "What the hell, Dad? You betrayed me." 

Margaret: Mm-hmm. "

Preston: There's no secret ingredient. Ah." And then he's, staring at the blank scroll that's just a reflection. He's like, "There is no secret ingredient," because... But there was a secret ingredient, I would argue, and it's that you believe it's special.

That's the secret ingredient. 

Margaret: Right. 

Preston: And that's the s- I think the same secret ingredient in the growth mindset is that you have to believe- 

Margaret: Yeah ... 

Preston: you can do it. You have to believe that good things can happen to you. 

Margaret: Yeah. 

Preston: So [00:50:00] that's, my final thought. 

Margaret: I don't think I have anything to add to that. I don't think I could say it better The references for this episode are for you to watch Kung Fu Panda, and we'll put up the link to the book as well in there.

Preston: Exactly. Have you seen those TikToks where they'll put all of Shrek on 2X speed and it's like- Yeah.

And it's the- Link, link it ... it's literally the entirety of the movie. All the- and the top comment will be like, "One more TikTok before bed." I swear. do you 

Margaret: wanna take us out? 

Preston: Well, that was, fun. Yeah. thank you to everyone who listened. shout out to the Spotify comments. I think we have a new record.

I saw eight Spotify comments in one of our recent- 

Margaret: Amazing ... 

Preston: episodes. and shout out to, Maggie, Them, and Mira. "So awesome solo episode, Preston. Would be curious as well what the default mode network deactivation study would show in adults with ADHD as opposed to children," which was a study I talked about, and also a combination of ADHD and autism.

Very interesting [00:51:00] question. I actually don't know a ton about these attention network modulations in autism, so we could look into that in the future. Which is followed by Mira, who said, "Can we keep the ADHD miniseries going please and thank you? Sincerely, an attentive type." So, we hear you guys. You love the, the neuroscience stuff.

We'll mix it in with the, Kung Fu Panda, just like eating our dumplings in our- 

Margaret: Bluestein approaches, you know ... 

Preston: fried rice. Exactly. so 

Margaret: if you do wanna- We'll see you, for our Patreon listeners, we will see you in a bit, for the bonus part for this one is going to be a me- mindfulness meditation based on this conversation/guided journaling prompt thing.

You can either think about it while you walk or you can write it down. so we'll see you on the Patreon part. 

Preston: Yeah. get your journals ready. I'm out. If you do wanna watch the, full YouTube or video versions, they're available on, at my channel at It's Presro or on Spotify. You just click the button that says Watch Video, which is, pretty much everywhere on Spotify now.

you can, watch videos or music videos of a lot of new [00:52:00] tracks- Yeah ... I think. Pretty cool. Isn't nature amazing and all the things that she can do? Thanks again for listening. We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are me, Preston Roche, Margaret Duncan, Will Flanary, Kristin Flanary, Aron Korney, Rob Goldman, and Shahnti Brooke.

Our editor and engineer is Jason Portizo. Our music is by Omer Ben-Zvi. To learn more about our program disclaimer and ethics policy, submission verification licensing terms, and our HIPAA release terms, go to howtobepatientpod.com or reach out to us at howtobepatient@human-content.com with any questions or concerns.

How to Be Patient is a Human Content Production.

Thank you for watching. If you wanna see more of us or if you wanna see... This is Lilac. She's my cat. She's gonna be [00:53:00] waving her hand at one of the floating boxes, which will lead to more episodes. Lilac, point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They pr- they probably exist for real.

But in the meantime, I'm just gonna pet Lilac, and then I'm gonna go dance in the background