Honoring Excellence: Q and A with 2020 ACGME Awardee Abby Lyn Spencer, MD, MS, FACP

This interview is one in a series of interviews with recipients of the 2020 ACGME Awards. The awardees join an outstanding group of previous honorees whose work and contributions to graduate medical education (GME) represent the best in the field. They will be honored at the upcoming ACGME Annual Educational Conference, taking place February 27-29 in San Diego, California.

2020 Parker J. Palmer Courage to Teach Awardee Abby Lyn Spencer, MD, MS, FACP is director for the internal medicine residency program at the Cleveland Clinic.

ACGME: How did you become involved in medicine, and in academic medicine specifically?

Spencer: As the daughter of a university sociology professor and a clinical psychologist—and as an avid tutor of women inmates at the New Orleans penitentiary while in college—I desired a career with a focus on teaching, developing others, mentorship, and service even before I knew I wanted to be a physician. After taking a first semester course on “brain and behavior,” I designed my own undergraduate major in behavioral neuroscience and spent my research time investigating the effects of estrogen on learning and memory. These were the early signs of my future in women’s health and education. As my fascination with the science of learning integrated with my calling to nurture, care for, and develop others, it was clear that academic medicine was my destiny.

Residency program directors wear many hats—each one is engaging, inspiring, rewarding, challenging, and fulfilling. As Simon Sinek shares in his book, “Start with Why,” what and how I do the many different components of my job is not nearly as meaningful as why I do it. My “why” is to find the strengths and potential in others and to cultivate it to help them achieve and become more than they ever imagined. As such, I have dedicated my career to innovating, developing programs, building teams, and developing others in graduate medical education. I am energized by harnessing and igniting potential. Every step of the way I have been blessed with generous mentors who inspire and empower me and invest in my growth and development. They role-modeled the contagious excitement and rewards of a career in academic medicine.

ACGME: What does receiving this award mean to you?

Spencer: This is a deeply meaningful award to me because it honors world-renowned educator and activist Dr. Parker Palmer, and also because it has “courage” and “teaching” in its name. Indeed, being a change agent, and fierce advocate for residents and the patients for whom they care, takes tremendous courage. Carrying the torch for education as health care systems work to honor multiple missions takes courage. Being a woman in medicine driving change and transformation to improve conditions for all learners and especially for those underrepresented in medicine and in academic medicine leadership, takes courage, grit, a community, and unprecedented resilience.

Serving as a residency director has called upon me to summon levels and depths of courage I didn’t know I had. Receiving a Parker Palmer Courage to Teach Award celebrates all of us who dedicate our careers to education, to advocacy, and to speaking truth to power for the betterment of our learners. It validates the incredibly important and critical work that we do in training the next generation of physicians and health care leaders. This award tells the world that the challenging and meaningful work we do day in and day out matters.

ACGME: What do you feel is the most important job the program director has?

Spencer: There is much more to being a program director than may initially meet the eye. Together with my team of talented and dedicated associate directors and chief residents, I recruit residents to our program; design innovative curriculum both locally and nationally; develop clinical rotations; mentor, coach, and teach residents and faculty members; care for patients alongside medical learners on the floors and in the clinic; build and lead teams locally and nationally; set the vision for our local residency education program; and work on national committees to define the future of internal medicine education.

While all critical to the position, the most important job of the program director is to advocate for the residents and their education to ensure we continue to train world-class physicians with exceptional clinical skills, humanism, clinical reasoning abilities, and empathy in a safe, supportive, nurturing, scholarly, and rigorous environment. The program director sets the tone, the culture, the deliberate and the hidden curriculum, and serves the residents, the chief residents, the leadership team, the patients, the community, and the institution. Advocating, celebrating, and supporting the residents’ development is central to all that we do. Another key job of the program director is to develop, mentor, and sponsor aspiring medical educators so that they and the residents benefit. Accordingly, creating a safe environment allows learners (and junior faculty) to truly stretch outside their comfort zone to lean into their learning edge with courage and confidence. This promotes autonomy, mastery, deliberate practice, and resultant pride as learners discover and play to their strengths. Only then can we fully ignite the motivation and curiosity of our residents to learn at their best.

ACGME: What is the most rewarding part of your job?

Spencer: The variety and ability to meaningfully contribute to the success of residents, chief residents, faculty members, innovative programming, and patient care. Seeing, learning, and teaching alongside my residents in the clinic and on the wards; watching the light bulbs go off for them and igniting their curiosity and love for medicine. They are such bright and hardworking young doctors. It’s amazing to watch them at the patient bedside. Curriculum development, program innovation, and teaching are my professional passions, while continuous development of myself and others as educators and leaders has also been central to my journey to allow us to continue to positively impact our residents and our educational programs.

ACGME: What is the most challenging?

Spencer: “Grit is not about being invincible,” Dr. Angela Duckworth shares, “it’s about finding people who love you enough that won’t let you quit when you have a bad day.” Indeed, medical education comes with many bad days. There are patients who will have poor outcomes, despite our best efforts. We will make mistakes that may cause harm to the very people we are trying to help. All of these emotions and complexities confirm that indeed we are not invincible, we are deeply human. The privilege of learning and practicing medicine is like no other. We hear stories from our patients that they may never have shared with anyone before. We are with our patients in their moments of greatest joy and darkest despair. We relieve suffering, provide comfort, and improve the lives of others. The roller-coaster of emotions can leave our residents and colleagues feeling exhausted, overwhelmed and unsure.

To effectively instill the tools necessary for lifelong learning through the highs and lows of medicine, we need a learning community that supports the growth of our learners and won’t let them quit when they feel challenged, unsure or incapable. Whether I’m teaching at the bedside, in the classroom, at the simulation center, or at regional, national, or international conferences, creating a positive learning climate is at the heart of being a teacher. Moreover, program directors are not immune from burnout either; hence, the importance of building our support networks, communities and deliberate gratitude practices.

ACGME: What advice do you have to residents or fellows who may be interested in pursuing a career in academic medicine?

Spencer: It’s the best job in the world! Read teaching and leadership books avidly; reflect often with your mentors and coaches; seek and respond proactively to feedback; provide feedback with empathy, candor and heart; and focus on how learners learn and not on how you teach! Stay curious—start with your “why.” Call me if you need me.