In assessing their own competency, resident physicians tend to focus on what they don’t know. That might not be the most effective, or important, method for becoming a complete physician, according to Ami L. DeWaters, MD, MSc.

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More “intentional effort” should be put into helping “residents understand that medical knowledge is really not the be-all and end-all of the competencies,” said Dr. DeWaters, associate professor of medicine at Pennsylvania State University College of Medicine, a member school of the AMA Accelerating Change in Medical Education Consortium.

“The more information that's out there under the medical knowledge umbrella, the less possible it is to memorize it,” she noted. “It's far more important that you have the critical thinking skills to actually analyze the information.”

Instead of aspiring to be a medical encyclopedia, resident physicians should be aiming for what’s called system citizenship. The concept is loosely defined as having the critical thinking skills and mindset to contribute to the holistic needs of individual patients, populations of patients, and the health system to achieve the best outcomes.

Physicians who are system citizens, the thinking goes, are going to be the most effective in the evolving system of care.

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To reinforce the importance of system citizenship to residents, Dr. DeWaters and a team of educators from Penn State, Virginia Tech, Kaiser Permanente, Allegheny Health Network and Geisinger sent out a survey asking residents across 10 training institutions to nominate core faculty members they work with who they found to be exceptional system citizens.

From 289 nominations, 11 physicians were selected as standouts and interviewed about their work by a team of researchers.

The who is important, but the why is instructive. A recent poster on the topic, co-written by Dr. DeWaters and presented at the AMA Health Systems Science Summit, identified eight characteristics of an exceptional systems citizen.

Such physicians:

  • Are generous, selfless, humble, adaptable and resolute.
  • Express values that drive behaviors “above and beyond” their colleagues’ expectations.
  • Are intentional about—and experts at—teaming.
  • Are calm in the “eye of the storm.”
  • Employ a wide array of creative systems thinking skills to solve problems.
  • Have exemplary interpersonal and communication skills.
  • Teach systems-based practice as part of clinical care.
  • Identify personal and professional mentors as key to their development.

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Residents who want to emulate what is seen as a stellar system citizen should start by getting a knowledge of their own skills, particularly on some of the less tangible domains, said Dr. DeWaters, a hospitalist. She used teamwork as an example of how residents can seek to understand their weak points. 

“There's a certain amount of emotional intelligence that's required to have the self-awareness to know where you stand,” she said. “You can sit and get feedback from your attendings and say, ‘Do you think I'm a good teammate? How was I to work with?’” Dr. DeWaters believes the highlighted skills can be learned with the right approach.

“People have internal intrinsic drivers that push them towards being good physicians,” she said. “People can grow into that, but there needs to be an openness towards what those characteristics are.

“Take, for example, humility. The need for intellectual humility is discussed frequently in med school. Some would argue that humility is a personal characteristic you either have or don't. I wouldn't agree with that, necessarily.

“You can learn how to question yourself and approach a situation in a more intellectually humble manner by doing things like asking ‘how would a colleague in a different field approach this case?’” Dr. DeWaters noted. “What assumptions am I making that I should challenge right now? So, even though there are a lot of personality traits here, there are still skills you can learn to help grow into them.”

The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, and handling medical school student loan debt other essential tips about succeeding in graduate medical training.

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