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September 22: Today on TownHall, Brett Oliver, Family Physician and Chief Medical Information Officer at Baptist Health interviews David McSwain, System Chief Medical Informatics Officer at UNC Health about imposter syndrome in the health IT space. How does he deal with knowledge deficit when jumping into a new role or team? What advice would he give up and coming professionals on dealing with imposter syndrome and feelings of inadequacy?

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Today on This Week Health.

if you say, look, I have my thoughts, but I'd love to hear everyone else's thoughts

let's discuss. And you choose that path collectively. Then you're not coming across as indecisive. You're coming across as inclusive. And Make it clear that others in the room know better than I do in many cases.

And in almost every case that leads to some really engaging and productive conversations.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.

All right. Welcome back. Again, I'm Brett Oliver with Baptist south, the chief medical information officer, and I'm excited today to have with me, David McWayne. David is the chief medical information officer for UNC health in North Carolina, and he's also practicing pediatric intensivist. So welcome to the program, David.

Thank you. I'm excited to be here.

So I wanted to start, you recently joined UNC from another healthcare organization where you're also CMIO. That's where I'd like to start. What were your initial priorities as a CMO from one organization to the next? Were those outlined for you? Did you come in kind of with a 90 day plan, like some kind of standard business approach trial, just curious to what what your thoughts were starting a new job, like.

Well, I really focused on developing my 90 day plan once I got to UNC, because the great thing about coming into this role is that it's a really stable situation and they've been doing a lot of great work for a long time. So a lot of the work of getting adjusted actually happened before I accepted the job.

It's understanding that it was the right fit and that there were some really good colleagues that I got to work with. And, the previous CMIO actually retired after 20 plus years in the role on his own terms, he rode off into the sunset and he had done some really great work and they had a great foundation in place.

So my goal was to come in and build on that. But in order to do that, I had to come in with an open mind with a focus on being a teammate with being a listener, being a collaborator. And so my goal has been to learn the system to learn as much as I can, and to get to know people, to make sure that people understand that I'm there to be a part of this wonderful team and not come in.

Really disrupt or take over what they're doing now. That's not to say that I'm not planning to drive some changes but I'm gonna do it collaboratively and really understanding the lay of the land and the stakeholders that need to be engaged. So that's been my focus as I got started and I've gotten to know so many amazing people in process.

That's awesome. Fantastic. So, but unlike when you started your role before you're coming into a situation, let's call it post pandemic. I don't know if we're ever gonna call it that, but post pandemic, where all of a sudden, maybe you had some hybrid colleagues that were virtual sometimes on site, or maybe all virtual.

Has that been any more of a challenge in starting this role in terms of cuz you're right. I mean, it's all about relationships. Yeah. How have you dealt with that?

Well, I actually had a pretty major advantage from that aspect because I've been running or engaged in a telehealth research network for many years.

And it's a multi-center, multi-site effort. And so. We've been developing collaborations and developing relationships with folks virtually for decade. And so it wasn't actually that big of a transition for me to shift over, into more completely virtual during the pandemic. And as we're shifting back a little bit it's actually worked out quite well.

The key thing though, with the system, as large as UNC, UNC health is 18 hospitals over a thousand clinics stretched out across the entire state of North Carolina which is pretty long east to west. Stretches all the way. We have hospitals from the mountains to the coast. And so the virtual meetings allow everybody at each of those entities to be engaged.

And some of my closest collaborators are actually in completely different parts of the state. And that's great. People argue that in person. Meetings facilitate that meeting after the meeting where things actually get done. But I've never been much of a fan of the meeting after the meeting, because I feel like that's used in a lot of cases to exclude people, to exclude important stakeholders to maybe avoid some transparency, not always, but you know, that's, it can happen whether intentionally or unintentionally, and I'm a big believer that you're really trying to do the right thing for the right reasons.

You do it transparently and openly, and you engage as many people as you can. And so virtual meetings allow you to do that. You're able to develop a good working relationship, and they have a lot of advantages, honestly. The ability to more easily take notes to screen cap images that are of interest to record or to, and know the names of the people in the meeting.

you know, It's funny, I've developed such good relationships with people almost entirely virtually that sometimes the only way that I know that I am meeting someone in person for the first time is if I'm surprised by their height. Yeah.

That's funny you mention that. Yes. A hundred percent.

We. A systemwide meeting not too long ago where I had finally met in person, some team members that I hadn't seen. And you're right. That honestly was one of the first things I noticed. Oh, he's taller than I thought. Oh, she's tall. Yeah. And I think it has to do now with how close did they sit to their camera?

yeah. What came down to shoot? You know, I think we come from similar systems where we're spread across a pretty wide geographic area. And I do think there's some advantages to that because a hybrid kind of some people in person, some people on a zoom call was not new prior to the pandemic.

So you've changed states and teams. And maybe the role itself is a little bit different, at UNC than it was previously. When you got there and I understand you did your residency there, so maybe there's, there's a little bit of caveat to it, but did you find yourself at a knowledge deficit, which is not a comfortable place for many physicians to be in, but , not just what projects they're working on.

I think you came from an epic shop to an, or went to an epic shop. Mm-hmm maybe there wasn't that, but just where was that knowledge deficit? When you come into a new situation like that and how'd you handle.

Well, there was, absolutely a knowledge deficit, and that's actually great.

Like why would you go into a new job where you already know everything? I mean, I, love learning and I, love learning about what people are doing. And I think that's really important. And coming into the organization, you know, it's important to be confident about what you know, but also don't be afraid or embarrassed of what you don't know.

UNC is a large and complex organization. Nobody can know everything, nobody can have every answer. So you wanna surround yourself with the right people and respect their knowledge and their expertise. learn from them and that's incredibly important. And what I've learned is that rather than being embarrassed about or hiding, trying to hide something that maybe you don't understand, or you don't know be open about it because that can actually lead to really great conversations and a better shared understanding amongst your teammates.

A lot of times people. Especially if they're not entirely sure of their own level of knowledge, sometimes they'll talk in code without even realizing it, whether it's jargon or acronyms. And sometimes they do that because they want to seem as knowledgeable as they can be and they make an assumption that everybody else in the room knows what they're talking about already.

And that can have the unintended consequences of making the other people in the room feel like they're supposed to know stuff that they don't know. And so, I think it's important to be open about what you're not sure about the uncertainties. People worry that they'll sound indecisive if they're open about uncertainties, but I think it's actually the opposite.

You sound more indecisive if you don't share your thought process, right. Because if you say, oh, decisively, we're gonna go. If you're not certain, but you say decisively, we're gonna go with plan. And then just a little bit of information comes in and makes you change your mind or makes you rethink it.

And you say, Nope, we're gonna go with plan B. That comes across as waffling and incisive. But if you say, look, both of these approaches have merit. I have my thoughts, but I'd love to hear everyone else's thoughts on the path to go here. There's some things that I'm not quite certain.

Let's discuss. I want everybody to have a voice and you choose that path collectively. Then you're not coming across as indecisive. You're coming across as inclusive. And so I make it a point to ask questions and discuss what I don't know or what I'm not clear on. And Make it clear that others in the room know better than I do in many cases.

And in almost every case that leads to some really engaging and productive conversations.

Yeah. as you were speaking there, it made me think about when you have a medical student that's working with you and, you may throw out an acronym or something, and then they say, well, what is that?

And why is that important? Or, you know, they're just trying to learn. And boy, I found. That's a real good check and on how much, how well do I know something and if I can explain it to somebody I think then that just takes the collective up another notch. And maybe as an analogy, if you're in a meeting and you don't know what someone's referring to to stop and say, let me just make sure I'm clear what you're talking about and if they have to explain it to you, then again, that, that level of understanding, I think for the whole group is confirmed.

I really like what you had to say.

Yeah. And I think from a teaching standpoint, that's incredibly important. It's important to remember what it was like to not know about a certain topic and, not speak as though everyone understands everything, all the nuances of everything that you're saying, just because, you want it to sound decisive and intelligent,

Well, if you start from point a and point B. You forget in your training and all your years of experience, how many different steps there are to get to there? Like you see this you're immediately here, but to be able to explain those things, I think is a, a skill that not everybody has, but should be yeah.


And it helps people become engaged and feel like, they can participate and they have something to say, if you're going through your thought process and you hit on something that someone in the room really has a depth of knowledge on. want them to be comfortable speaking up, adding their thoughts, maybe adding some nuance or even suggesting a change in course, or an adjustment to the plan.

The only way to do that is to, be open about what you know, and what you don't know and not to be worried about coming across as not the most knowledgeable person in the.

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Yeah, absolutely. So kind of along those lines, you and I offline have talked a bit about this, but the whole concept of an imposter syndrome and I mm-hmm I was really don't know if alarm is the right word, but surprised to find out how common that is among physicians.

I guess it makes a lot of sense, a lot of perfectionistic tendencies. And when you don't have the answer to everything, I'll tell you from a generalist perspective as a family physician, I had to get comfortable really quickly of not knowing things and just, telling the patient, listen, I'm not sure, but we're gonna get the answer for you, whether it was a consultant or I'm gonna do some research or what have you, but I'm just curious.

Has that been part of your experience?

Any thoughts there?

Yeah, it is incredibly common and I think it's important not to shy away from this because it is an important conversation to have. I think, some people don't like the term imposter syndrome. I don't know exactly how I feel about it in as a term, but I think it's completely normal and an appropriate thing.

As your career is progressing, certainly. And, especially in health it and in clinical informatics, because if you think about it, we've been brought up for 20 years through medical training, through medical school, residency fellowship, and then on, through our career. Surrounded by people who have a very similar knowledge base, right?

Surrounded by people who are learning very similar things. Even if you're talking about different specialties, even if you're talking about different disciplines, you're still kind of. Learning about physiology. You're learning about chemistry and pharmaceuticals and all of those things, right?

Then you get into health it, and suddenly you're confronted with people who are experts in cybersecurity and programming and AI and machine learning. And every meeting that you are in, you are sitting next to and surrounded by people whose knowledge base is completely different than your own. And you have this sense because you've come up through the ranks of a system where you are surrounded by people.

You're all smart and you all know kind of the same stuff. And suddenly you're in this area where you have no idea what some people are talking about sometimes. And that could be extremely intimidating. If you don't recognize the value that indeed you're bringing value to that equation as well.

And I think the other part of it is, it's the Dunning Kruger phenomenon. People talk about the Dunning Kruger phenomenon on one end of the spectrum where it's people that know the least think they are the most knowledgeable, but on the other side of that, Is, as you learn more and more, you also learn all the things that you don't know.

And for someone that is, very keen on learning and having a level of expertise that can be difficult for people to deal with. The other thing I want to be sure to. Call attention to is this is something that's, it's more prominent, more common for women in minorities. And I wanna address that head on in part,

because I am an old white man. And I think, I have so many incredibly talented, women and minority colleagues, and it's kind of shocking to me sometimes when they tell me that they don't feel confident in their own abilities. And I actually had a conversation recently. I have a lot of mentorship conversations with people talking about their career path in informatics.

And I was just sharing that, their resume, their accomplishments were actually they were better prepared to go into a leadership position in clinical informatics than I was when I was coming into that role. And that I definitely had a sense of imposter syndrome coming in. And she was a little shocked and she looked at me and said, you know, that you're the first male who's ever told me they had imposter syndrome.

And I said, well, I'm the first male who's ever admitted to you that they had imposter syndrome. But I get it. It's, an ingrained thing. And I think that we need to address that head on and be supportive of our colleagues. And so I hope that by talking about it today We're normalizing it and helping folks to understand that, that's not something that should hold them back by any means.

And that it's a normal way to feel, especially in this space.

Yeah. A hundred percent agree with you, you, you think about in our medical upbringing, our medical training, You never trained to be wrong or have mistakes we all do. Right. We all have plenty of them, but you don't go well, when you have these, we're gonna have a top 10 list of your top 10 mistakes from today.

We're gonna go through 'em we're gonna assign teams to it, right? You don't that's. That's nuts. You would never do that yet in it. You roll out an EHR, let's say for instance, and you're planning on having hundreds of issues. Mm-hmm, that like, that took me weeks to even comprehend and get through, I guess.

And so there is that clash. There's the world of, you legitimately don't know, you're sitting in a meeting thinking, what value am I possibly bringing here? And then fortunately, you get a bone and they'd say, well, we're gonna go left here. And you're like, whoa, if you go left here, you're gonna kill the nurses.

You need to go. Right. And I'm like, we don't care. That's. And then you okay. At least calm me down a little bit. I brought some value here cause I didn't understand half of what you guys were talking about, but I think that it's a setup if you're not in informatics from the very beginning. And so to your colleague that brought that up, I think the younger generation leadership and clinical informatics is gonna be better prepared for that, cuz it's not gonna be this clash of training where you're the only person that can do this.

It's the middle of the night versus it's a collaborative team approach from the very get go.

Exactly. And I think, the way that clinical informatics is evolving, I think in some ways it's gonna help. And in some ways it's gonna be even a little bit more challenging because whereas a lot of CMIOs, CMO 1.0 is more about implementing the EHR.

And now it's more about integrating across a lot of different technologies and that means you're expanding the scope of knowledge even more broadly, and you're bringing more experts to the table. And so you really have to understand exactly what you were saying. What am I bringing to the table here?

It's valuable, these people that I'm so in awe of, because they have this deep knowledge of cybersecurity, they're likely looking at me, saying, you have a great knowledge base as well, and May even be a little intimidated to speak up because that's tends to be the case with people who have certain titles or even just doctors in general, there's a certain level of intimidation factor that comes with that.

And the way to overcome that is to be open and transparent, make sure you're inviting people to share their perspective and that you really. Demonstrate how valuable you find their expertise and that you genuinely need their help. And to function as part of a team.

I really like that. One of the last question on this.

What if someone's struggling with that a little bit, they recognize that they're, this, what we wanna call an imposter syndrome, or just feeling inadequate in these meetings that they're not the expert, which I never wanna be the expert in the room. I want to continue to learn. But what kind of advice would you give someone that's struggling with it?

I think, realize that you're there for a reason and don't be afraid to talk about it, a lot of times, you have this internal dialogue going that can be counterproductive to making yourself feel more comfortable in what it is you're trying to accomplish. And. Think about how can I actually externally communicate this in a way that you know, you don't want to say, like, I have no idea what's going on here, but when you start thinking about how you're gonna communicate your own uncertainties, you realize.

We'll start out with here's what I understand, right. Start out with here's what I'm bringing to the table. This is the way I'm approaching it. This is what I understand, but here's what I'm unclear about. And I'd love to get your thoughts on that. And. In most situations, every situation, really people are gonna respond very positively, positively to that.

So I think it's just, don't be afraid of that and recognize your own value as part of the team. And it's part of any initiative

sounds like you've in some of these mentorship relationships that that might be a, I'm not saying key, but a help as well, where you can get. You're not in a meeting, I can talk about this with you and you can say, are you kidding me?

And someone can recognize that value for somebody may not see what their value in that meeting is at that time or at a particular point in their career. And like you no, no, no. You're bringing tremendous value and having that nonpartisan, sort of input I think can be helpful too.

Yeah. I had someone do that for me not long ago.

And I recognized how valuable it is. And, I was engaged in a grant application, focused on artificial intelligence and, it's really high level stuff. And I definitely was sitting there listening to folks talking about some of these. The way that this was being developed and the training of the models and all of these very complex topics and asking myself, why am I here?

Why am I on this grant application? And the PI, I had a call with the PI and she just said, we're so glad you're on this application. You bring with you this clinical perspective and this understanding of electronic health records and how things are incorporated into clinical workflows and an understanding of both the patient and the clinician.

And she just laid it out for me and that was a powerful, discussion for me. And I realized the value of that. So I went from feeling like, I have no business being on this grant application to understanding my role better. To being a lot more excited about contributing.

And I think that's the kind of thing that can be incredibly helpful, especially in a mentor mentee kind of relationship.

Yeah. I was gonna say, and we, as leaders need to remember that exactly what you experience I was that's fantastic. Well, let's, let's end there, David. I really appreciate your time.

This has been fantastic. I think we could keep chatting for a while. I wish you the best of luck and,

and thanks again.

Well, thank you so much for having me on. I really enjoyed it.

Yeah. Take.


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