What does self-trust look like in academic medicine?

Friends, 

It took me awhile to realize that we almost never hear messages of self-trust in academic medicine. Yes, I have also attended the career development workshop where they mention that what matters most is ‘what you want to do.’ And then what follows is instructions on doing that thing that you want to do just like everyone else. We are to choose what we want based on the prototypes we have seen. But for a field where burnout (or settling, which I call burnout in slow motion) is the default, why in the world would we make decisions based on what we have seen?

The implication underlying this, and the explicit messaging we get all throughout medical and research training, is that you can’t just trust yourself. Let’s be honest, you just got here, of course you don’t know how anything works. So we do what we do best: We look around, we try to figure out the rules, we watch someone else’s highlight reel (aka Grand Rounds) and try to back calculate a career approach from that. 

This is not self-trust. 

Here are some other behaviors that are not indicative of self-trust:
• Using 14 different approaches to get helpful information in a mentor meeting, never getting what you need, and then assuming you are the problem.
• Deriving great satisfaction but also great exhaustion from clinical work and not knowing how to set a reasonable boundary.
• Changing your science to be more palatable to get funded because you can’t find anyone who sees the problem in the way that you do. 
• Dreading the monthly faculty meeting, because the likelihood that something is said that ruins your day is 87.2%.

For women of color, and especially Black women, the messages to not trust ourselves start very early. I am no exception. Exhibit A.

In one of my first mentor meetings with a “VIP-nice and brilliant-have to have this one on your side”-type person, I brought preliminary results from the first paper of a project I had been working on. (In academic medicine we say “a project I had been working on” to sound humble, instead of saying “my project I had conceived, launched, and executed” because that may just start to sound like we trust ourselves….I digress.) I had 10 pages of organized, labeled output from the data, representing my thought process through various considerations I wanted to make prior to running the model for the primary outcome. I started walking, methodically through each page. On page 2 or 3, I was interrupted – “Stop. Where did this come from?” I blinked, confused. What did they mean where did it come from? I said, “The project, this is the data from my project.” “No,” they said, “Who did this output for you?” I said “I did.” Now they were the ones to blink, slowly. “So….you can code in SAS?” Me: “Not as an expert, but yes, I can do this.”

You might imagine what followed. Black women reading this know exactly what followed. I felt a heightened awareness, a worry that maybe there were major mistakes in just this simple (to me) data output. Yes, I was a biomedical engineering major in undergrad who actually really loved learning how to code, but that didn’t mean I knew what I was doing, right? All of a sudden, the questions I had prepared in order to have a thoughtful conversation about how to construct my analysis, felt too lofty, too above me. In real time, I dumbed myself down. I asked obvious questions that didn’t rely on me trusting myself and my work. I let the conversation go where they wanted to take it, which was far from my original goals for the meeting. And of course, I thanked them profusely for their time. 

When we don’t trust ourselves, we waste time confirming facts we already know.

Facts about who we want (and don’t want) to work with, facts about the best way to execute our research projects, facts about what schedule does (and doesn’t) feel sustainable.

Facts about who we can (and can’t) be.

I recognize that most of us are in a profound deficit with self-trust. That’s ok. When it’s between you and you, trust can always be cultivated. Always. 

Start small. 
Find a post-it note. 
Pick a place *at work* where you will see it. 
Write on it: I know what I need. 
Leave it up until that doesn’t sound absurd. 
Leave it up until your actions match your words. 

Much love,
Kemi