This month we chatted with Dr. Brandon Tang, a PGY-3 in Internal Medicine. Dr. Tang, who sits on our Board of Directors, recently had the opportunity to speak at TEDxBearCreekPark on the topic of assembly line medicine and deep work. We were all too happy to talk to him about his experience.
We last spoke with you in 2018, in a Resident Spotlight during your second month of residency. So many things have happened since then! Most recently, you delivered a TEDx talk titled “Healing Assembly Line Medicine.” How did this opportunity come about for you?
It’s been a life dream of mine to deliver a TEDx talk and I feel so fortunate to have had this opportunity. The entire experience arose organically as I was just following my passion!
Earlier this year, I completed a medical writing elective with Healthy Debate, a national health journalism website. One of the articles I published was about “deep work”, this idea that healthcare providers could deliver better patient care if they had more time and space to think. One example I share is how I actually started hiding in a hospital storage closet because it was the only place where I could find a few moments of silent reflection. After the article was published, friends and colleagues across the country reached out to say that my message resonated with them, with one even saying “I put in words how they had always felt, but had never been able to say.”
A few months later, I was watching a TEDx talk late at night and I realized that this would be the perfect medium to further spread my idea about “deep work” in healthcare. I applied and was ultimately accepted to speak at TEDxBearCreekPark, which is widely regarded as the premier TEDx event in British Columbia – and the rest is history!
What does it take to prepare for a TEDx talk? How has the overall experience been for you?
While TEDxBearCreekPark was recruiting speakers, they showed us the above quotation from the renowned explorer Sir Ernest Shackleton. They wanted to emphasize that the journey to becoming a TEDx speaker is the ultimate speaking challenge.
Five months and over 100 hours of hard work later, I now understand what they meant. It’s been an incredible experience and I’ve grown a tremendous amount, but it was not easy.
The first step was applying to be a TEDx speaker, which consisted of submitting my idea and a draft script of my talk. Taking a complex idea and whittling it down to 1000 words was a huge challenge and feedback from colleagues was immensely helpful at this stage.
After being selected as one of 12 speakers, we embarked on a rigorous training process, akin to training for a marathon. This consisted of biweekly four-hour group coaching sessions in addition to regular meetings with our assigned personal coaches, many of whom were past TEDx speakers. Overall, we dedicated about two months to developing a tight script and another two months to practicing our speaking delivery.
Although most speakers in our group had immense public speaking experience, we all agreed that the road to TEDx was a challenge like no other. The performances I had watched on YouTube all appeared so casual and seamless, but I now recognize the dozens of hours needed to reach that point.
After practicing my talk almost daily for two months, it was finally internalized. I knew the script inside and out, had carefully decided which words I would emphasize, and knew where to emphatically pause to underscore my message.
I even taped an 8 ft. circle inside my living room where I practiced – and it all paid off in the end! I owe a huge thanks to all of my coaches, the entire TEDxBearCreekPark team, and especially my partner, who was has heard my talk so many times that she has memorized it too.
What inspired you to push for culture change in medicine through your TEDx talk? What have some of your personal experiences been like with “deep work” and “assembly line medicine”?
I remember visiting the emergency department for the first time when I was a teenager. The doctor saw me for a few quick minutes, then disappeared until hours later. Everyone seemed rushed and there was an overwhelming amount of hustle and bustle.
When I started clerkship, I was surprised that the hospital felt equally chaotic and disorganized, even from the perspective of a healthcare provider. However, I was new to the system and believed that I was the problem and simply needed to adapt.
Now three years into residency, I hear daily concerns from colleagues that it feels impossible to work without distraction in the hospital. This made me realize that my personal experience was actually a symptom of a system’s problem and inspired me to write about “deep work” for Healthy Debate. As I was developing this message into a TEDx talk, I created the metaphor of “assembly line medicine” to help the audience visualize and understand how the hospital feels. Although healthcare providers clearly suffer from the consequences of this system, I believe that patients are affected most – so culture change in medicine can truly benefit all of us.
Some of the suggestions you present to move away from the “shallow work” of assembly line medicine are to engage with frontline staff in quality improvement initiatives and to triage interruptions through technology and culture change. One example you share is the use of pagers, which limit the ability to triage interruptions. What are other ways you could see viably changing the current culture for the better, be they (seemingly) small changes or something on a grander scale?
Healthcare is infamous for its slow pace in adopting novel innovations. A common estimation is that it takes an average of 17 years for novel research evidence to be translated into clinical practice.
The spirit of quality improvement, however, relies on being nimble and adaptive, making real time adjustments and measuring their impact. I’ve heard innumerable ideas from colleagues about how our workflow can be improved, of all orders of magnitude from rearranging our work stations to redesigning processes to triage emergency department referrals.
My vision is that we can create a culture and system that can capture these ideas, test them, and scale up the ones that work best. A colleague of mine was one of the first faculty members recruited to work at the National Health Service Nightingale Hospital London, an emergency 4,000 bed hospital built in an urban conference center to support the pandemic response in the United Kingdom. Having both the luxury and challenge of creating a hospital culture from scratch, their team emphasized the philosophy of a learning health system in which feedback from frontline workers could be captured and implemented on a systems level, through mediums such as dedicated bedside observers and daily clinical forums with all staff.
I believe that a system where every patient, healthcare provider, and staff member in the hospital feels like they can contribute to meaningful change is an ideal worth striving toward. My idea of “deep work” is just one of many possible changes that can help “heal assembly line medicine.”
In your talk, you discuss how deep work can help address physician burnout, which has been an especially big topic this past year. Do you think that the pandemic will help bring deep work into the spotlight of discussion within medicine?
In my TEDx talk, I both start and end with a discussion of physician burnout, framed by my own experiences. In suggesting that deep work can help address burnout, my goal was to contribute to a larger narrative that solutions to healthcare provider burnout need to be shifted from the shoulders of individuals to the system-at-large.
In healthcare, if someone calls in sick, everyone else picks up the slack and is asked to work harder. For example, when one resident is not available for call, another resident may be asked to do the work of two people. This is clearly not a sustainable solution.
During the pandemic, the narrative surrounding “healthcare heroes” was well-intentioned and underscored the public’s renewed appreciation for healthcare workers. However, I think that the idea of heroism can also be damaging because it suggests that that healthcare heroes can save the system by working harder and doing more. But as I suggest in my talk, “these heroes are burning to keep others warm” and many providers are being stretched beyond their limits.
I do believe that healthcare workers are like heroes for the incredible work they do everyday. But the system can’t rely on heroism to survive and we need broader cultural and systems change, such as deep work, to support the work of frontline workers. The pandemic has put a spotlight on the strain in our healthcare system, but I hope that positive change can arise from this.
Lastly, what’s next for you? Are there any projects or goals you are currently working towards?
At the same time, I’m excited to start my fellowship in General Internal Medicine (GIM) at the University of Toronto (UofT) next year.
During my fellowship, I plan on completing a Master of Education to complement my background in quality improvement and health systems. One project I will continue to work on is “Vancouver Notes”, a book I co-founded at UBC which consists of consult templates to equip learners with key information needed to diagnose, assess, and manage common internal medicine presentations. For example, when you see a patient with chest pain, our book will tell you what questions to ask, what pertinent positives and negatives to look for on exam, what labs to consider, and what main differential diagnoses to think about – all in a succinct template which you can use at the bedside. The need for this book was inspired by my own experiences as a resident and it’s been an incredible experience working with nearly 100 residents and faculty at UBC to make this vision into reality.
They say that “the days are long, but the years are short” – residency has really flown by, but I’m grateful for all of the wonderful opportunities I’ve had, and the support from friends and family during this time. As one door closes, another one opens – here’s to new experiences in fellowship!