Start A Journal

Submitted by Dr. David Leach, former executive director of the Accreditation Council for Graduate Medical Education
 
How do you develop the courage to challenge and change institutions?  Begin by just having a daily conversation with yourself.
 
It may help to kick off this process by reading "A New Professional: The Aims of Education Revisited," by sociologist Parker Palmer. 
 
At the end of each day consider journaling on the following four questions:

"How did I do today in . . . “
1. Discerning the truth;
2. Telling the truth once discerned;
3. Putting what is good for the patient ahead of what is good for the health professional;
4. Being creative - that is, harmonizing the best science with the particulars of the patient in a way that made my judgments creative and even beautiful.

Begin by just having a daily conversation with yourself. With practice and experience, strive to find the courage to broaden the conversation to include other learners and sympathetic faculty. Lastly, build on these experiences further to encourage reflection as a habit, using these four questions in each of the microsystems (e.g. wards) and mesosystems (e.g. institutions) in which you work.

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