“There Is No Getting Perfect at It”: Discussing Intellectual Humility with Academic General Internal Medicine Ward Attendings

Background

Physicians face two conflicting goals—demonstrating competence and showing awareness of their limits (intellectual humility [IH]). While competence has been studied extensively in health professions education (HPE), IH remains relatively unexamined, especially in relation to physician and trainee experiences. This gap is important because IH may improve quality of care by mitigating against premature closure in diagnosis and strengthening therapeutic relationships by demonstrating respect for patients’ perspectives.

This study addresses this gap by exploring academic hospitalists’ experiences of IH, to facilitate trainees and clinicians engaging in IH in ways that avoid detrimental emotions (e.g., shame) and negative repercussions (e.g., remediation).

Objective

To explore academic hospitalists’ experiences of IH, focusing on work with students and residents.

Design

Qualitative analysis of semi-structured interviews.

Participants

Twelve hospitalists (6 women, 6 men) at an academic medical center who supervise medical students and residents on general medicine teams.

Approach

We conducted virtual, semi-structured interviews, asking participants to share experiences in which IH was anticipated, experienced, or observed, including when they were aware of personal limitations and when their opinions differed from peers’ or learners.’ Transcripts were independently coded by two team members; regular meetings were held to discuss interpretations. Analysis was guided by Porter et al.’s work; the authors initially applied her six content categories derived through characterizations of IH surveys while remaining open to additional codes.

Key Results

Transcripts contained all six content categories Porter identified, but also additional themes including (1) mitigation of personal limitations, (2) anxiety, (3) arc of career, (4) modeling, and (5) psychological safety.

Conclusions

Lived experiences of hospitalists contain themes substantially different from those of IH surveys. HPE has unique affordances and constraints affecting IH, even for attending physicians. Conceptualizations of competence that include IH provide direction for stronger relationships, shared decision-making, and responsible action in high-stakes situations.