5. Interview with Brian Uthlaut, UVA IM Residency Director

In this episode I sit down with Brian Uthlaut, the Program Director for the UVA Internal Medicine Residency. We cover tips on how to work well with residents, the challenges of medical education, and even touch on some fun facts (pandemic chickens!).

Topics:
- How to give good resident feedback (4:00)
- Establishing good team dynamics with resident teams (7:00)
- DEI in the UVA IM Residency Program (10:00)
- Challenges facing medical education  (13:00)
- Fun facts about Brian (15:00)

Links:
- UVA Internal Medicine Residency Program
- Follow Dr. Bell on Twitter

Transcript

5. Working with Residents

Intro

[00:00:00] Taison Bell: Hello, everyone! You are listening to This Medicine Life. I'm your host Taison Bell, a Critical Care and Infectious Disease physician at the University of Virginia. And, if you're like me, you may love being an academic medicine, but it's hard, y'all! The goal of this show is to make that just a little easier through the power of connection. We're interviewing medicine faculty, both inside and outside of UVA. Our goal is to connect with each other, to share our stories, our tips for success, and - together - become the best versions of ourselves in life and career. 

Pre-guest Segment

[00:00:39] Taison: If you work in academic medicine, then chances are you work at an institution that fulfills an educational mission. So you may work with medical students, residents or fellows, nursing students all on a regular basis. And if you're an academic physician, then you've also been a trainee at some point. 

[00:00:58] And so we all have an idea of what training is because we've done it. And at least a picture of what training was like when we did it back whenever that was. Regardless of what residency training looks like, the common theme is that it's hard. And it becomes hard in different ways and that means the challenges become different as well over time. There's a lot on the plate for a modern-day residency program director. From wellness, balancing professional/personal development, mentorship, sponsorship, diversity equity, and inclusion. And all this is happening in a busy clinical environment. And I want to talk a little bit about that with our residency program director in internal medicine, Brian Uthlaut. So let's get right to him. 

Taison/Brian Conversation

[00:01:41] Taison: Brian, how are you doing today? 

[00:01:47] Brian: Doing all right, Taison. Getting excited for resident interview season. It's that time again. 

[00:01:51] Taison: Yeah, exciting and nerve wracking and probably all of the above. I can only imagine. 

[00:01:57] Brian: I think if we went in the time machine and you told me it was virtual interview year three (I'd) probably have some questions. 

[00:02:02] Taison: So Brian, if you don't mind, first question, just tell us who you are and how you got here.

[00:02:07] Brian: Sure. So I came here as a resident, from 2003 to 2006 and, um,trained in the categorical program and, after residency. did about four years as a hospitalist here. That's how I got onto faculty and a couple of years ingetting heavily involved in resident education, resident advisor, and core faculty member and then got involved as an Associate Program Director I guess, about four years into my time on faculty. 

[00:02:32] Taison: Gotcha, how's the experience been so far? 

[00:02:35] Brian: Experience has been great. I love our institution, love the Department, love Charlottesville, and I think it's a place that you justcome to grow to love and just great colleagues to work with. 

[00:02:46] Taison: Yeah. So your day-to-day, I'm just wondering, what is it like running a program as complex as internal medicine residency?

[00:02:54] Brian: Yeah, no, I think,day in and day out, I think there's, just the kind of constant flow of trying to support all the different moving parts, in the. in the residency program. So in that it's has a sort of the day in, day out and then the seasonal parts. We're just coming up on the application and recruitment season for me. Residents, that has a life unto its own. Just like the fellowship and job search season, the onboarding of new interns, the outgoing of residents as t hey progress through. So lots of moving parts that as a program director, you're either doing directly orhelping to keep a team on task through different parts of it. And the day in, day out really is managing with the huge support of our chief residents, who, as a re always, phenomenal in terms of both supporting and advocating for residents but really being the glue that keeps a lot of stuff moving. Managing the schedules, the conferences for our residents, and then just all of the various chaos management that comes up in an academic medical center as big as ours. 

[00:03:54] Taison: I think chaos is like the operative word right there. Some of it is good chaos, but a lot of not the chaos that we're used to,or enjoy. 

[00:04:02] One aspect of working with residents that I've found challenging is providing meaningful feedback. Do you have any suggestions for how faculty should provide feedback that residents can actually use to improve? 

[00:04:17] Brian: One of the challenging parts of working In teams is finding a material to comment on and just finding the time to be able to go over it so I, I think advice I'd give faculty. to try to provide helpful feedback with residents. 

[00:04:32] It starts with, I think, understanding again, some of their goals and trying to make sure that you have alignment with, things that they want to work on. And I think when you've started out well and know what they want to work on. it's a lot easier to come back to and give feedback on what people have agreed is this space that you're watching for growth. I think you have to be intentional to make sure that you can see what somebody's doing. I think we've all gotten to a feedback moment and realized, "I don't know, maybe I haven't seen as much as I would've wanted to see." And I think that's what sometimes leads to more generic feedback that is frustrating for all of us. I think residents really want to know how they're doing, where they're at, how to get better. and it can be easy for a faculty member to,not be sure whether that feedback is wanted. And I think residents really do want that, but from the faculty perspective, making sure that the space and you're intentional about seeing stuff that's going to be useful for people and making sure that your feedback fits somewhere into that SMART mnemonic where you're given something that's measurable, something that's relevant, something someone can actionate, and that you're doing in a timely way. I think if you don't anticipate making space to connect with somebody it's just hard to catch up after rotation is ended and give feedback. 

[00:05:44] Taison: Yeah, that is very true and I liked the part about trying to make it timely because when you're in the moment, sometimes it's appropriate to give feedback. Sometimes it might be, especially in ICU, it might be a little too intense, but you do have to circle back and make sure you are able to speak with that resident. 

[00:06:00] One thing that does make it challenging is that it's sometimes hard to know who's rotating in or off. A resident may be gone by the time you might be ready to give feedback. So okay in that situation just to reach out again and have a meeting and then go over... yeah.

[00:06:13] Brian: Totally. Yeah, no. I've definitely heard for residents or from faculty that,even just starting some of that with an email and just trying to find some ways to connect later. I think people always appreciate the effort to help them to see what they're doing how to grow. Think about all of the constant change that our residents have going from rotation to rotation. And in a couple of years, they're trying to figure out about their career path and development. So I think the first thing is just thinking about the people factors and, recognizing, first as you start on a rotation get to know and build personal rapport with the residents that you're working with. Big program, but I think making sure that you start out with knowing your residents on service as people and creating that respectful team environment, I think is one of the most important things I'd say. 

[00:06:57] Taison: Yeah. So how does that look on, let's say, first day or first couple of days of the rotation. Does that look like a sit-down meeting or a team discussion? What do you think? 

[00:07:06] Brian: We have our different styles. How I like to do it and-- I'd love to hear, how you kick things off first day too. But making sure to know people's name, things about them individually, how they prefer to be called. And then,whether that's start of rounds or maybe end of rounds before everybody just takes off and gets busy with the checky boxes and the to-do's. And for faculty, maybe going to see the rest of list that you haven't already seen yet. Just making the time to say that our teamwork and our interactions are important, and getting a sense of where people are in a time in the program. Like you said, I know where everyone is in terms of PGY 1, 2, or 3. Are they an internal medicine resident? Are they rotating from another department? I think just getting a sense of where people are coming from, what they want to get out of time together. And, I'll often spend some just direct time with the upper level resident just getting a sense of some ground rules. Know their expectations and make sure that they know how I want to support them. So just not letting that first day, going back to chaos, just spin out of control. Without connecting as people and connecting about how we're going to work together as a team. 

[00:08:04] Taison: That's a good point, and I really like how you brought up the difference that an intern... the talk they may need versus a senior resident, because there's a lot of change that happens in between that first and that third year. There's different needs at that point. So it's a good idea to be attuned to that and to make sure that you're addressing each person and finding out what their professional goals are and helping them get there. 

[00:08:27] Brian: Yeah. Any tips from you? How,How do you kick off? the team dynamic? 

[00:08:30] Taison: What I usually do is just because, people come from so many different places and they had so many different experiences. I like to ask, classic icebreaker questions, but I've always thought the ones that, Are usually asked or just boring. So I try to ask things that will generate a discussion. So one good one is what's your favorite restaurant in Charlottesville or the best meal that you've had recently out. And then another one is you know, one that's designed to start a little controversy amongst the team. And I ask, among the different ice cream flavors, what's the one you feel like it's just overblown and just should not exist? And you will find, there are some personal feelings about that pistachio ice cream. And why does that exist? And, there's a lot of back and forth, but the back and forth ends up being the best part of that. And I just launched the question out there and just sit back and watch the debate happen. 

[00:09:20] Brian: Back away. 

[00:09:20] Taison: It's it's great. No, but those moments are what really sets the dynamic for the team going forward in there's good research into this showing that, good teams compared with teams that aren't as effective, the good teams meetings will start with completely off topic. banter. And so no, those moments before rounds start up before you gather people together, people were just kind ofhanging out with each other and meeting with each other as people. That's actually valuable and translates to better patient care in my opinion. So I try to embrace those moments and encourage them. 

[00:09:50] Brian: That's awesome. May borrow the ice cream one. 

[00:09:53] Taison: Oh, yeah. People get feelings about it. Nothing's ever gotten close to blows, but you know,it, it generates some debate. 

[00:10:00] Brian: Yeah. 

[00:10:00] Taison: Next question, so diversity and inclusion have become such a major topic of interest lately, and there's certainly a need to increase resident diversity as well as at the junior faculty level as well. So what are some of the ways in which UVA is working on increasing house staff diversity? 

[00:10:15] I think the one of the, as I think back on some of the early work that we were doing, both as an institution and the GME community, because our residency programs at UVA, the residents are all at the main hospital. We're not a program that's sending people out up to two different centers. GME wide and, in our program. one of the first things. we really tried to focus on, I think is examining our interview practices and our evaluation,and trying to really dig into years ago. What does holistic review of applications mean? And, so I think each year as a faculty group that leads the interview process we want to really be inviting great candidates and valuing all the different, displays and demonstrations of excellence and potential and not,doing, I think what was so much the focus years ago: grades and scores and I think valuing diversity of experience, background and, of interest. So I think moving really away from grades and scores and looking more broadly at what are our goals. And I think increasing the diversity of our house staff was you really had to step away from, just some of these and think about how to de-bias your application process. But I think the piece that I think our institutions worked on, really, especially over the last five years is to support our local, community and support underrepresented minority housestaff. We've really tried to create community across the institution. How our Housestaff Council for Diversity and Inclusion, starting about five years ago, and I think has really been an amazing part of our housestaff culture in life. So a lot of career development and a lot of mentorship, the impact of the, on the community. I think our HCDI has been really a unique part of the housestaff experience and our goals are within each year I think is to look at what we're doing and find ways to improve. I don't think that there's any... there's no aspect of our program I think we couldn't try to examine, how can we be more inclusive. and, and to find ways to continuously be growing experience for our residents. So we really want to continue to create more of a sense of programmatic community to build on top of the strong institutional community and, to, to mentor our residents. Just as you were saying I think so much of that applies to junior faculty as well to, fellows. I think creating,an inviting where people are going to then be invested in. and to support their career development. 

[00:12:26] Brian: To me. That's what's great about graduate medical education is just, trying to help each resident that comes into the program to reach their fullest potential and to invest in them. those were the, a little bit what we've worked on and continue to want to do. 

[00:12:39] Max Luna, our department, vice chair for diversity,equity and community engagement. created our department task force,as he stepped into that role and invited residents and medical students into that space to, again, really bring. our learners into the work that our department is trying to do. 

[00:12:55] Taison: Yeah, very important work. And, from the Department's standpoint, having a diverse faculty. What's required of that is to have diverse housestaff. That's a great pool for recruitment. To change gears a little bit. We said, at the beginning of this interview, that graduate medical education has changed a lot. And just wondering what your thoughts are and any sort of major changes that you see in the horizon. 

[00:13:16] Brian: Yeah,I think that with the pandemic. that horizon look and as you manage chaos, just you gets narrower and narrower, and you're just trying to get from moment to moment. I think we're all trying to look at is just that individual focus on training. 

[00:13:30] I think as you look at big picture of program requirements from the ACGME, cause that's so much a part of the, just the trail 

[00:13:37] Taison: That long document with the milestones...

[00:13:40] Brian: Yup. That's the 60, 70 page trail map of just what you need to do. Rules to follow. But like in embedded in all the counting rules and do's and do nots are really at the heart of it is I think this increasingly competency-based in individual focused training environments. Competency-based education is certainly been the the rule for GME for awhile. But I think that focus on the individual and then some of the new aspects that, that we continue to find over the last few years, bringing in you know how to incorporate new technologies and approaches such as point of care ultrasound and figure out how to fit that in. 

[00:14:13] How do you take telemedicine? and just all the ways he can uniquely reach patients and prepare people well for that. So there's always going to be, I think, some new development and piece to fit in there. But, I think the heart of it, really, I think comes back to just that individual focus on our residents. With the pandemic and how it disrupts training. I think we've had couple of years where, you know, your medical students coming through the system. had a very different experience and figuring out where everybody's at when they land in residency how you pick up with each person looking at them uniquely invest, assess their competency and, get them on that trajectory. A lot of work going on nationally to trying to figure out how to standardize that transition from all the different med schools into residency. I think that's a big challenge. People are on more than national and institutional. Always some challenge out there for sure.

[00:15:01] Taison: Before we go, what are a couple of things that most people probably don't know about you? 

[00:15:06] Brian: Oh, okay. what most people don't know about me. I think it's always good to,know about the personal life and home life for folks. I think, my residents probably know some of that, but, I had 12th, 10th and seventh graders as we sit here now in 2022. I think the important part of my family life there. We got chickens for the pandemic. So, um, batting down the hatches there in 2020. We went backyard animals. That's been a fun part for our family to just have that aspect of, our home life that evolves. Just one of the fun parts of my,personal life is, just what? you do outside of work. Now just spend so... 

[00:15:40] Taison: Before you go on, that is contributed to my home life as well. I can attest the eggs are on point from the chickens. 

[00:15:48] Brian: Yeah, that's, one fun fact there. My family and I love to cook. That extends throughout family lineup. And we take lot of joy in baking, cooking at home, and it's something that's been a fun part of our family over the years. And I have a lot of fun traditions around mealtime in the kitchen. So that's, that's a big part of our home life.

[00:16:04] Our family has a fun tradition taking a surprise family vacation every year or so, keep it under wraps for the kids and, the. 

[00:16:12] Taison: I was about to say who's receiving a surprise? 

[00:16:15] Brian: The kids were seeing the surprise. The day before they have to solve reveal a challenge, which they love. So it's fun for the parents to put together as complicated of a reveal as possible the kids to have to figure out. Another fun tradition that we've developed together. 

[00:16:30] Taison: Thanks for sharing that. I just wanted to thank you for the work that you're doing and you know, what's incredible about being a program director is that there's so much growth that happens from the time you enter our residency to when you leave a residency program. 

[00:16:43] And in a lot of ways is really an inflection point. And I remember how instrumental my program director was for my development. And to know that someone like you was having that effect as well, and it helping residents achieve heights they may not even realize they're able to achieve. That's very impactful and very meaningful though. Thank you for what you do here. 

[00:17:02] Brian: Yeah. Thank you.

Post Segment

[00:17:04] Taison: I really enjoy talking with Brian because he's one of these people who's just endlessly positive and just really enjoys what he does. I also think he has one of the most difficult jobs here in the Department of Medicine because, face it: many of us work with trainees, but we don't particularly care what the renal fellows are doing or many other parts of the academic mission.

[00:17:27] But we have a vested interest in the residents. And he's charged to lead a program with several trainees who come in with the goal of ultimately becoming independent physicians and representing UVA well. It's a very difficult job with lots of moving parts, but I think he's doing a great job and I'm so glad that he's an example for our residents. 

[00:17:48] And I plan on using some of his pointers when it comes to interacting with residents and trying to make sure they're achieving milestones that are laid out before them and achieving their goals and fulfilling their potential.

[00:18:00] Starting with when I go on service in the MICU tomorrow. Wish me luck!

[00:18:04] Taison Bell: And that's our show! Thank you for listening to This Medicine Life. If you enjoyed the show, please subscribe, write a review, and tell a friend. We are available wherever you get your podcasts. This show was created, recorded, and edited by - me. Music is by Dr. Malcolm Lex. 

[00:18:24] Views and opinions expressed to not necessarily reflect the view of the University of Virginia or any other entity. Please send me your ideas for topics you want to hear about or guests you want to have on the show. My Twitter handle is my first and last name, Taison Bell. Please stay tuned for the next episode. Until then, I'll see you around.