Skills That Set You Apart: Becoming a Remarkable Clinician

Hi everybody, welcome. We are going to give people about a minute here to kind of get in. So while you're all coming in, feel free to drop in the chat where you're from, maybe what kind of clinician you are or what kind of clinician you hope to become. We'll get started in just a minute or so. All right, we will go ahead and get started. Welcome everyone to the Osmosis webinar on skills that set you apart: becoming a remarkable clinician. Today, we've got an interdisciplinary team of an NP, MD, PA, and DO here to discuss skills that help you become a remarkable clinician. These are kind of soft skills and non-hands-on skills that help you interact better with patients, your co-workers, improve patient outcomes, and enjoy clinical practice regardless of what path you choose to become a clinician. Each of us is going to go through some skills, some background of how we became clinicians, our schooling, and we'll make sure there's a Q?A at the end. While we're going, feel free to drop your questions in the chat. Feel free to ask them there, and we'll try to address as many as we can before the end of the webinar, though it does sometimes take us some time to get through them. So feel free to do that. Also, we are recording this webinar, so you can always refer back to it or share it among your friends. It's usually up on our Osmosis events page in about a week following the webinar. We'll go ahead and get started. We're just going to start with some introductions. I'll go ahead and begin. I'm Kelsey Lafayette. I am a senior content manager here at Osmosis. I've been here for about four years, but I became an RN in 2011 and then an NP back in 2022. My background is mostly urgent care and critical care. I will go ahead and pass to Britton. Thanks, Kelsey. I'm Britton Zucarelli. I'm an MD. I practice in Central Kansas. I've been in practice since finishing training for about nine years and am happy to be part of the webinar today. Hi everyone, go ahead, Eric. Yeah, sorry, thanks, Britton. I'm Eric Grant. I've been a PA for 20 years. I've always split my time between education and clinical practice with some research on the side. I'm currently a program director for a PA training program in Richmond, Virginia. My clinical practice areas have been HIV medicine, infectious diseases, and then physical medicine and rehab. I've done a lot of research and publishing in IPE and spirituality medicine. That's my background. Over to Dr. Mike. Hi there, I'm Dr. Michael Klug. I'm a psychiatry resident in the Southeast, pretty close by to where Eric is, actually a few hours away. I'm primarily in training. We see a lot of pretty much everything, but my own background is some neuroscience. I was pre-PhD for a bit and switched to med school pretty last minute. I worked as a writer there for a little bit too, so I've done a whole lot of things, but I'm looking forward to sharing some details about the DO pathway. Great, thank you. We can go on to the next slide, which I think is back to me to kind of give a background on what it takes to become a nurse practitioner. Training to become an NP usually starts with an undergraduate degree?four years. You need a Bachelor of Science in Nursing or an equivalent degree, and then you go to grad school. The time for that can really vary depending on the track and if you go part-time or full-time. You can get a master's and be an NP or you can get a doctorate and become an NP. You also have clinical training?500 to 1,000 hours, usually closer to a thousand?with supervised clinical practice. You'll choose a specialty like family, pediatrics, acute care, things like that. Then you'll have examinations and certifications. You do have to maintain your RN license to have an NP. You'll take the NCLEX, which is our state board exam, to get and apply for your RN license. You'll have to maintain that. As an NP, you'll take a certification exam for your NP boards and then get a license for your NP. There's a lot of paperwork, and you'll also have continuing education for your RN and NP once you're licensed and working. Depending on the state, you may be an independent practitioner or you might need a supervisory practitioner, like a physician you work alongside. As you're practicing, you can do patient assessments, diagnose and treat acute and chronic conditions, order and interpret diagnostic tests, prescribe, provide patient education and health promotion, and collaborate with your healthcare teams. There are areas for specialization. A lot of NPs have specialties like family, pediatrics, acute care, but you can also specialize on the job in certain areas. You can go ahead and advance, Britton. Continuing education?I know I told you?you do need continuing ed like most healthcare professionals, typically about 20 to 30 hours every couple years, varies by state. You also have some CE every five years for certification. I'm a certified family nurse practitioner, so I need 100 hours every five years in Iowa for that. Sometimes you have very specific requirements, like 15 hours of farm, or whatever. You also have to renew your certification. What can you do with an NP degree? You can be a clinician at the bedside. I was at the bedside for a little bit, then decided education was more how I wanted to go, so I found a place where my degree transferred. You can be a clinician and provide direct patient care, researcher, work in industry, teach students. There are many options including policy and healthcare administration, public health. It's not just the standard hospital or primary care office that people think about so much. Compensation is pretty competitive. You're often paid higher than as a registered nurse, though I've seen some questionable NP salaries. For the most part, you get paid more and have potential for additional income if you specialize, have more than one certification, or take on an advanced role. That is a very broad 30,000-foot view of pathways to become an NP. If we advance the slide, I'll talk about a clinician skill we all need regardless of path: empathy. Empathy is the ability to acknowledge, understand, and share the feelings of others. It helps connect you with people, enhances cooperation and kindness, and is a predictor of positive behavior and therapeutic outcomes. Many influences affect your ability to be empathetic: genetics, your own mental health, burnout, depersonalization?feeling disconnected from your own thoughts and sensations?and the culture of healthcare. Some influences are modifiable, like addressing mental health and burnout; others, like genetics, are not. The culture of healthcare is modifiable but changes slowly. Poor mental health makes empathy difficult because you might not understand your own emotions, making it hard to understand others'. Burnout, often due to being overworked and tired, reduces energy to empathize. These factors can make you numb to empathy; depersonalization also contributes. The healthcare culture involves too few clinicians, too many patients, limited resources, insufficient time, and often self-care isn't prioritized in schools or workplaces. So, how do you overcome this and practice as an empathetic clinician? Start with self-reflection, which can be informal?journaling, meditating, counseling?or formal with self-assessment questionnaires like the Jefferson Scale of Empathy. Once you reflect on how empathy is working in your life, you can seek to enhance it by acknowledging shortcomings. Acknowledging struggles with empathy is important because unwillingness to acknowledge limits you. When interacting with patients, actively listen?they may not say directly what they need or want. Validation is crucial?acknowledging and evaluating patients' experiences, even if you don't fully understand them. For example, a patient with a new colostomy was resistant to learning care, but a nurse educator said, "This sucks," validating her feelings, which helped her engage with the healthcare team. Validating patients makes them feel less alone, builds relationships, and shows you care. It doesn't take much time or energy, so definitely practice that. Lastly, question patients when unsure about their needs, using closed or open-ended questions depending on your relationship. That is empathy; I'll pass it back to Britton. Sorry, I was muted. Happy to talk about becoming a medical doctor and some soft skills useful for all clinicians. To become an MD in the US, you need an undergraduate degree, which can be in any field. My degree is in Spanish Literature, which helped me as a bilingual clinician and made me stand out in applications. You must complete prerequisites and pass the MCAT. Medical school typically involves two years of didactic learning and two years of clinical rotations across specialties. After that, through interviews and matching, you enter an internship. After graduation, you're a medical doctor but can't practice without completing residency training. Internship is usually one year, often part of your specialty training. Some specialties have separate internship years, e.g., dermatology requires a year in general pediatrics or internal medicine before specialty training. Residency can be two to six years. I did five years in child neurology. Some do fellowships for subspecialty certification. If you go straight from high school through this path, you may be in your 30s before your first job. Along the way, you take exams like shelf exams, USMLE steps, and periodic recertifications. You must maintain state medical licenses and DEA licenses. You can work as a clinician, researcher, in industry, teaching, public health, or legal fields. Compensation is often high, varying by specialty. I hope we all pursue this field out of passion to help people. How to love your medical career involves choosing a path that fits your interests, e.g., age group, procedure preference, attention span, location, teaching interest. Seek support; the job isn't easy. Self-care is crucial to prevent burnout. Physician burnout rates can be as high as 65%, with symptoms like lack of pleasure, wanting to leave the field. How to prevent burnout: good sleep, exercise, hydration, mindfulness, breathing, relaxation, workload monitoring, work-life balance, and support networks. Adaptability is also key: adjusting to new situations with flexibility and grace, balanced with perseverance. Mindfulness and introspection help develop adaptability. Debriefing after difficult changes and accepting constructive criticism aid growth. Ongoing self-assessment of strengths and weaknesses helps set you apart. I'll turn it over to Dr. Mike for the DO perspective. Regarding DOs, osteopathy in Europe and other countries is generally a form of physiotherapy, different from US osteopathic medicine. US DOs are fully licensed physicians with additional manual medicine training. OMM (osteopathic manipulative medicine) is a noninvasive, manual approach helpful in chronic pain and rehabilitation. DOs often match into strong PMR programs and some surgical specialties. The traditional difference of DOs being more holistic is less stark now; many MD programs include holistic care elements. For international DO grads, matching into residencies is now a unified process with MDs, with increasing success. Many DO students are older or have prior careers; the holistic approach attracts those with broader life experience. DO schools often are in underserved areas, offering loan forgiveness and other benefits. Some DO schools use innovative curricula like problem-based learning and pass-fail grading. OMM training is longitudinal, with weekly labs and coursework. There's a two-year OMM residency. DOs can add manual medicine to their skill set, beneficial for pain management. Board exams are similar to MDs, with added OMM components. Many similarities exist between MD and DO pathways. Regarding research, most clinical research is clinician-driven; basic science research is harder to get funding for but possible with clinical relevance. Start with finding mentors and small projects to build experience. Author order is less important than participation. Explore research through partnerships and see if it suits you. Many skills are learned on the job and require practice and self-improvement. Empathy may feel difficult initially but improves relationships and becomes a daily skill. Practice and willingness to improve are key. Like athletes practicing to improve, soft skills can be developed with effort. For NPs, holistic pathways exist but are less common than for DOs, often at larger universities. Functional medicine clinics may offer holistic approaches. Narrative medicine is a clinical study field allowing exploration of emotions in medicine, through writing, art, and reflection?part of integrative medicine programs. We will post some links in the chat. Thank you all for joining. Take advantage of the free two-week trial for participants. Check osmosis.org/events for more webinars. We have a webinar soon on identifying the right mentor. Thanks, everyone. See you soon. Helping current and future clinicians focus, learn, retain, and thrive. Learn more.