Well-Being in the Education Space

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The second episode of Well-Being at Michigan Medicine with Dr. Elizabeth Harry welcomes Dr. Louito Edje as guest. Dr. Edje is the senior associate dean for medical education at the U-M Medical School.

In the conversation, Dr. Edje speaks to the importance of well-being in the education space. From policy positions to leadership development, Dr. Edje and Dr. Harry touch on ways that Michigan Medicine is empowering and aiding its current generation of learners who are set to be the next generation of faculty with positive well-being messaging and tools. The two also speak to how psychological safety and speaking up in important matters bring people together to provide better outcomes for patients.

Learn more about the host of Well-Being at Michigan Medicine, Dr. Elizabeth Harry.

Episode guest:

Louito Edje, M.D., MHPE, FAAFP

Transcript

Dr. Elizabeth Harry:

I am so excited to have Dr. Edje join us today. Dr. Edje is a board-certified family physician, chair of the Family Medicine Review Committee of the Accreditation Council for Graduate Medical Education and chair of the nominating committee of the American Medical Association's Council on Medical Education.

She was on the writing group for the new requirements for family medicine training. She was the Ohio Academy of Family Physicians 2012 Family Physician of the Year. Dr. Edje was president of her class at the University of Michigan Medical School, and then completed her family medicine training with honors before 13 years in private practice. She was program director and then designated institutional officer for 102 programs at the University of Cincinnati.

Dr. Edje has founded two family medicine residencies and has a master's in health professions education. As senior associate dean for medical education at University of Michigan Medical School, she supports the medical education of 680 medical students, 1300 house officers and 4,000 faculty. Well, Dr. Edje, I am so excited. Tell us a little bit about yourself. Who are you?

Dr. Lou Edje:

So I go by Lou and I'm a Black female. I'm 54 years old. I wear glasses and I have black curly hair. I'm the senior associate dean of medical education here at Michigan, which essentially means that I support the medical education mission of our institution.

So briefly just about myself, I was born in Iowa but spent the first 14 years of my life in South Central Africa. Went to British schools there and so my perspective on so many things is quite different from had I lived here. Went to Michigan State when I was 16 for a Bachelor of Science and Physiology, and then came to Michigan in 1991, got my MD and then came back in 2014 for a master's in health professions education. Subsequent to that was in private practice seeing 2,600 patients of my own who some of them I still take care of now here in Michigan have come back. And I also did hospital leadership in that space, chair of credentials, chair of peer review, and I was a department chair.

And then when I topped out in that leadership space, I pivoted into education fully and became a program director at my former program. Supported other programs as a designated institutional official, started a couple of family medicine programs. I do have two national roles, I'm chair of the Family Medicine Review Committee for the ACGME and also I am an elected member of the AMA's Council of Medical Education.

Additionally, I have a state position, just got to Michigan and won an election to the Michigan State Medical Society Board last month. So underneath the senior associate dean role, I really have three different roles. One is to support the accreditation of the institution, making sure that we're following all the rules of how to train learners at all stages of their education. Advocacy, which is really mainly to make sure that we're advocating for their human and material resources and also for their physical and psychological safety. And then the last A is advancement. And in that space we are really just trying to make sure that they're getting fairly assessed as they move through the process and that we're focusing on their individual advancement, but also advancement for the institution.

Dr. Elizabeth Harry:

Well, it's a huge role. There's also so much about your role that really, I think, impacts the well-being of the learners that are here across both GME and UME. I'm curious how you personally define well-being in the context of our organization as well as your leadership role.

Dr. Lou Edje:

Actually, because of accreditation, which was that first of the three A's that I mentioned, we're beholden to the definitions of well-being that exist in our accrediting bodies. And so for example, with our residents and fellows or house officers, there is something called the common program requirements. And Section 6C basically states that learners should be learning in environments that are physically, psychologically, and emotionally safe. And that gives us the best platform for them to be competent, caring, and resilient physicians.

And so if I were to dive down a little bit deeper, 6C 1A actually talks about making sure we're scheduling appropriately, that we are watching our work intensity and work compression. And then 6C 1C makes sure that we actually have policies in place that help to mitigate overload at work. And so making sure that their well-being is good in that space.

Dr. Elizabeth Harry:

And what I love about those definitions is that it aligns so strongly with our organizational well-being framework that it's not talking about asking the learners to build more resilience, but really thinking about how do we create an environment that supports their professional growth and their well-being. And it strikes me that the role then of the leader around them is so important. And so I'm curious from your perspective, what role leadership development plays in shaping this culture of well-being that creates this environment you're talking about?

Dr. Lou Edje:

So when I think about leadership development, I really think of three different areas within that space. You've got the formal leadership development, which would for example be excellent courses and conference opportunities. I'm going to put a plug in for the Women Leadership Summit that happened this week. We had 500 amazing women in one space, really inspired. They were able to network and gain tools on how to be good leaders and I think provide an environment in which we can thrive. And really there's demonstrated investment in us as women by the institution in that space. So that's more of a formal leadership development piece.

There are multiple other opportunities. For example, the master's in health professions education program that I took here as a program director to help me to teach my faculty. That's just another example and there's so many out there.

Additionally though there, the second piece would be there's a hidden curriculum. And so we have to be very cognizant that learners are observing as we role model the good things and the bad things. And so one of the things that I have as a tagline in my email is, "Don't forget diastole." And for me diastole is that opportunity to take a break and restore. And that doesn't just mean outside of work. That means within your workday as well. How do you refresh and restore within your workday? Do you actually come in and optimize your work time when you are most productive? Do you have the flexibility to do that? I realized fairly early on that I do my best work in the very early morning hours. So I get here at 6 and I can do a lot of work in a space of an hour. More than I would, for example, at 4 P.M.

Then the third part would be the informal curriculum and the informal leadership development. And I think one of the things that is going on this time of year is evaluations, so your annual reviews. And I see that as an opportunity not only to talk about goals and how people are working in their space of their actual formal job description, but it's also an opportunity for me to engage with them as a person and figure out what their goals are as a person, what are their professional goals? And as a leader, I should be able to be comfortable with promoting them even out of the space that they are working for me or with our team. I've been home to do that, to nurture someone's goals out of our space because my job as a leader is to support them in their role, but also as a person, whether that takes them to the next great opportunity or not.

Dr. Elizabeth Harry:

Well, I love that you're also talking about how you're supporting your team because you have a very large team, an amazing team that really helps support the growth and development of all of our learners and particularly in the space of well-being. And you did mention some things, but could you give us some examples of how you do support the growth and development of your team leaders to enhance overall well-being for them and your team effectiveness with the idea that it cascades to all of our learners?

Dr. Lou Edje:

Yeah, I think it's really important for me to take the temperature in the room every time. So there is something that actually Seetha Monrad does, which is excellent. The beginning of her meetings, there's a check-in and she's created a space that's psychologically safe for her team to actually go ahead and let us know how they're doing today. But our job really is to do that for the team continuously as a group, not just as individuals and not just in single meetings.

So for example, when I came in, I had a vision and I still have that vision, but what I will not do in the process of implementing that vision is to just ramrod straight ahead without taking the temperature of the bandwidth in the space in which that vision should play out. And so making sure that if we are down three personnel in one particular location, that that's time for me to consider what do I need to bring to this area to actually help that vision to be fulfilled or does that can get kicked down the road a little bit so that we have better outcomes in that space?

Dr. Elizabeth Harry:

It's almost like how do you as a team take diastole to your point when you need to?

Dr. Lou Edje:

Yes. Absolutely.

Dr. Elizabeth Harry:

That's amazing. One of the things that I love about Michigan Medicine so much is the clearly articulated values that we really try to include in our everyday work. And to your point in the evaluations, we talk to each of our team members about how they are aligning with our values. And so how do you do that process of making sure that our values are aligned with the daily actions and decisions that your team is making?

Dr. Lou Edje:

I'm a fan of this quote. Actually, I'll paraphrase it from Thomas Jefferson, not a full fan of Thomas Jefferson himself, for a couple of reasons. But one of his favorite quotes there is, "On matters of style, swim with the tide. On matters of principle, stand like a rock." And so I think-

Dr. Elizabeth Harry:

I love that.

Dr. Lou Edje:

Yeah, it takes time to sit down as an individual and also as a team to figure out what are your principles, what are your values? And here at Michigan we have integrity, teamwork, caring, and inclusion that are the four corners of that space. What we have to do is three different things when we think about aligning values. Number one, what are the values of our team? We have to know what those are and we have to know what the values are of Michigan. Number two, we have to align those values once we know what they are. So again, a team has to know what they are before they even align with Michigan, and then we have to monitor those values. I think so many times we spend time on mission statements and vision statements and charges for committees, but we don't check in on a periodic basis to make sure we have not deviated from the North star.

Dr. Elizabeth Harry:

I love that keeping the values as part of the everyday discussion to sort of anchor back. So you've given us so many great examples of how your team really creates this culture and supports themselves in one another in aligning with the values and making sure that they have diastole and can model that to others. And I know many of the members of your team and know it's an incredible place to work and the work that you all have done is amazing and oftentimes we do face really big challenges in this space. And I'm curious, what are some of the biggest challenges you faced in promoting well-being in this positive culture that you're talking about and how have you overcome them?

Dr. Lou Edje:

Yeah, so one of the things that has been the most difficult for me to navigate is that I started the week of October 7th of '23. And bar none, the biggest challenge for me had been watching the pain that has occurred in our medical community, primarily at the medical school level, but the dictum, "First do no harm," we typically apply that to patients. As an educator, I apply that to my learners.

And so in this space with respect to this particular pain that's going on, what we want to do is to flip that into a space where it can actually be beneficial. So I think of my job as an educator to make sure that I have pluripotent learners. Once they leave us, they can blossom into any kind of physician they want. My job then is to make sure that they are able to be fully equipped to handle a situation in which they encounter a patient, for example, that has differing opinions and beliefs than them, and still be able to give top shelf compassionate care. And so that's our job. And so we're working on making that a formal curricular component so that that portion of their competency is shored up before they leave us.

Dr. Elizabeth Harry:

What I love about what you're describing is really future ready learners that we don't know what's going to happen.

Dr. Lou Edje:

Absolutely.

Dr. Elizabeth Harry:

We don't know what the next big challenge will be, and this has been a really big challenge and how do we create and help foster learners that are adaptable for the next big challenge and giving them that skill set, which I just think is incredible.

One of the things that I have found most challenging in the well-being space is how many things we're trying to manage at once. We're managing all of these either geopolitical or sort of cultural issues that we're facing and we're managing sort of an ever-increasing cognitive load and difficulty and complexity of the operations that we're facing. And really, to your point, creating learners that are equipped for the future to be able to address all these challenges.

What strategies have you or your team been involved in to really try to look at that operational piece and make sure that the operational workflows support rather than hinder the well-being of our healthcare professionals, including our learners, so that they are emotionally available to provide that top shelf care in a challenging situation like that?

Dr. Lou Edje:

Yeah, so I think to ensure that operational workflows support rather than hinder our well-being, we need to know what support looks like for a learner. We also need to know what barriers are happening in those spaces. We recently had our engagement survey. That is an opportunity to dissect things, but I think the overall key to this whole situation here is making sure that we have psychological safety and specifically within the four different domains there.

So we should have inclusion safety. People should want to belong, they want to be part of the team, they want to be part of the process. We should have learner safety to where people are able to go ahead and free to engage in the learning, to experiment in a space, and maybe even to make a mistake in the space and be safe. And then the third one will be contributor safety where they feel like they are contributing to the team in a meaningful way and able to do that safely. And then the last is challenger safety. And challenger safety is a situation where they feel safe enough to challenge the status quo.

Dr. Elizabeth Harry:

I love that.

Dr. Lou Edje:

Within each team, that psychological safety needs to be nurtured at every step along the way. And so that if somebody comes to me with a completely different idea than I had a completely opposing point that they are like, "Yep, Lou's going to listen to that. Lou's going to take that into consideration and figure out does this make our outcomes better if we go this route or not?"

And I come to this space with no preconceived notions. We have really, really bright people here, and I often am absolutely going to stop and think, "Wow, that bright person sitting right next to me has probably got a really great idea that could actually make this situation better than the one that was being proposed" or whatever the case may be.

Dr. Elizabeth Harry:

Yeah, I mean it's one of the things that I love so much about where we are in Michigan Medicine is that there are so many brilliant minds and there are so many brilliant solutions out there to what are really complex problems.

Dr. Lou Edje:

Absolutely, yes.

Dr. Elizabeth Harry:

We're facing really big challenges here. You mentioned some geopolitical ones, we've talked about operational ones, and one of the things that I've struggled with and would love to hear your thoughts on is how do we get those ideas from these brilliant minds that have them? How do we keep the lines of communication open and really build that bidirectional communication so that we can benefit from all these brilliant, innovative ideas that are coming up through our learners?

Dr. Lou Edje:

Trust is an important piece, and when I say trust it is that your opinion is going to be respected and used in the final solution to see whether it is useful, it's helpful, et cetera. So it's going to be given a good college try as opposed to any platitudes. And so meeting people where they are is really important, and I mean that both physically and figuratively, literally and figuratively.

So I am going to, for example, meet with chairs in their departments and trying to see what things are important, for example, for anesthesiology. What are the key things that are concerning for you within education? And trying to anticipate, I think part of my job is trying to anticipate and be connected to what's going on nationally in medical education so that we are parts of those conversations and parts of making the future better.

And so one of the hats that I also wear, I wear two national hats currently. I am the chair of the Family Medicine Review Committee for the ACGME. What that means is we accredit the 779 family medicine programs in the country and we write the requirements for how you train family physicians. It is a privilege to share that committee. It is also difficult, but it's important to make sure that we are leading in that space. And so when there are national conversations about competency-based medical education or using augmented intelligence or artificial intelligence or generative AI, et cetera in education, that Michigan is at the table in those conversations.

Dr. Elizabeth Harry:

Well, we are lucky to have you as such a champion in all of these spaces. Looking ahead, what are your goals and aspirations for the future of well-being and culture for our learners at Michigan Medicine?

Dr. Lou Edje:

I am a huge fan of Amy Edmondson and the title of her book is the answer to your question, The Fearless Organization. I really want to make sure that our education space is one in which there is true psychological safety and that there are opportunities for innovation where ideas come from medical students and our nurtured into fruition, and a lot of that is already going on, which I'm just very proud of. But I want that we always have work to do to become a fearless organization.

Dr. Elizabeth Harry:

I love that, and I share that goal of the idea that we can't be our best until we are able to have the hard conversations and that everybody feels safe to share their ideas because that's how we're going to solve what are really complex issues that are facing every organization in the country. We are not alone in any of these issues that we are facing, and we really do need a crowdsourced methodology with all the brilliant minds that we have to solve some of these things. So I love that idea and I'm very supportive of it.

Dr. Lou Edje:

One of the things that I am also very excited about working on with you is developing a position of the director of well-being for our graduate medical education, and hopefully we'll be able to expand that into our undergraduate medical education space as well.

Dr. Elizabeth Harry:

I am very excited to partner on that with you as well. Well, this has been incredible. Thank you so much. If people want to learn more about the work that you're doing or follow the work that you're doing, is there a good place for them to get in touch with you?

Dr. Lou Edje:

Oh, absolutely. I am an avid supporter of social media done correctly, so I am on X or otherwise known as Twitter. I've got 5,700 followers and my handle is @LEdje, so @L-E-D-J-E and my website is LouEdjeMD.com. Thanks.

Dr. Elizabeth Harry:

Thank you so much, Lou.