(upbeat music)
- This is Lab Medicine Rounds,
a curated podcast for physicians,
laboratory professionals and students.
I'm your host, Justin Kreuter, the bow tie bandit,
a transfusion medicine pathologist at Mayo Clinic.
It's April fools day and we have the perfect topic
in store for you all.
Today we're rounding with Dr. Reade Quinton,
an assistant professor of laboratory medicine and pathology,
and an anatomic pathologist at the department
of laboratory medicine and pathology at Mayo Clinic.
Dr. Quinton is also happens to be a magician.
So today we have the pleasure of talking
with him about the magic in medicine.
Thanks for joining us today, Dr. Quinton.
- I'm happy to be back again.
This is, I think my second or third time
with you and these are always fun.
- Yeah. Your second appearance on the podcast,
we're jazzed to have you.
And so what's your origin story?
How did you get started in magic?
- You make it sound like it's the superhero origin story.
- It kinda is, right?
- Yeah. So actually it's a really neat story
that relates to medicine in that most kids,
if you look at most people that get magic,
it's the classic like,
I was about seven or eight years old and I had an uncle
that would do card tricks and that gave me the bug
and got me interested and that was not me actually.
I probably had my first deck of trick cards or something
when I was about seven or eight
but never really thought much of it.
But it wasn't until I was in med school
and I was on my cardiothoracic surgery rotation.
And we had one of the retired surgeons would come in
and do small topic talks
with our small group of med students.
And after about 20 minutes of talking
about pulmonary hypertension or whatever,
he would then turn around and go,
you guys wanna see a card trick
and he'd start doing tricks for us.
Now his name was Dr. Watts Webb.
And last time I checked,
he was still in New Orleans in his nineties
and was still doing magic. It was amazing.
But I realized at that time I got a big kick out of it
but more importantly I knew my next rotation
was going to be pediatrics.
And so I went to him and I said,
you know this is really neat,
how do you learn this?
And that's what got me started.
And so I went down that path a little bit,
bought some books, bought some props.
My wife I thought,
oh, this is a great hobby because it's cheap.
It's just a couple books and decks of cards
and little did she know where that would go.
And eventually I would say my second big credit
in guiding me would be Dr. Ricardo Rosenkrantz
who's actually a neonatologist at Northwestern University.
And he along with several professional magicians
including Jeff McBride, Larry Haass and Eugene Burger,
actually teach a medicine and magic class
through the mystery magic school in Las Vegas.
And so I met Ricardo and all of them through that
and so that was the second part of this.
So I have to give a lot of the topics credit here
in that a lot of the stuff I talk about really comes
from what Ricardo started.
- Wow. I think my thoracic surgery rotation experience
in medical school, I remember it well,
and I remember a lot more adrenal discharge than that,
I imagine that was wonderful for learning,
and then how does this roll into your practice
as an anatomic pathologist?
How do you see this skill?
How does this translate?
- And so when I talk to students about this kind of thing,
we talk about how does that translate
because it was great in medical school,
especially going on into that pediatric rotation,
I could approach the patients in a different way
and engage them before you just go in
and start poking and prodding them.
And so we joke now about,
well, how in the world does that translate to pathology?
Particularly in my field of forensic pathology.
And so there are many of the same concepts,
but they don't necessarily translate to patient interaction.
But essentially what I think of is in terms of,
if you look at our practice, be it forensics or not,
I look at the skillset as being scripting,
costuming and audience engagement, if you will,
those are my big three.
So scripting in magic essentially is,
there are people who perform magic just off the cuff
and do it without any type of script.
But those aren't usually as successful
as the stage magicians who have a very detailed script
and know exactly what they're going to say every time.
And so for me, I translate that into my engagement with,
for instance, a jury,
knowing when I sit on the stand,
I know exactly what I'm going to say every time
and then run through it multiple times.
So there's that scripting and rehearsal
so that when I get on the stand,
I'm actually comfortable saying what I'm gonna say.
Costuming, at some point in our careers I think we've all
had the experience where we run into the doc
who wants to be a little more laid back and they're like,
I don't want my patients to be intimidated by me
so they basically wear the white coat,
but there're sporting jeans
and a polo shirt or something like that.
I'm not saying that's a bad thing,
but costuming is important because it engages the audience
and tells them who is this person.
So there was Max Maven who's a mentalist
and he really would be upset if you called him a magician
but he's more of a mentalist.
- And maybe for our listeners, can you just...
What is a mentalist?
Because I think before I got to really spend
some time with you,
I was unclear about what that meant.
- Sure. So mentalists are basically the guys
who their entire show is based on like mind reading,
predictions, things like that.
So not really what you'd expect
as far as like big stage illusions or things like that.
And that's another thing,
is that magic basically is like medicine
in that there are multiple subspecialties.
So mentalism is a subspecialty
within the larger field of magic.
But anyway, Max Mavin,
when he talks about audience engagement, he says,
as soon as you step out on stage,
the audience has their own internal dialogue.
And they're thinking basically, who is this person?
What do they do? And why should I care?
And he postulated that the faster
you can address those questions,
the more successful you are going to be
because they'll be sort of calm down and go,
okay, I understand what I'm getting into here.
And so we think of that in medicine, in the same terms.
So if I have the appropriate costuming
and I look like a physician,
then when I walk in to see a patient,
that's one less box for them to tick, is who is this person?
Because if you walk in wearing different costuming,
they might go, well, is this the nurse, is this the doctor,
is this a student?
So there's a lot of questions
that they're trying to deal with.
So that's another element of what we do.
So especially in, again, in my field when I'm testifying,
you walk in looking a certain way
because that's what the jury expects you to look like.
And so that's scripting and costuming.
And then audience engagement in general.
Just learning how to engage your audience/jury/patient,
to basically be able to answer those questions quickly,
get to the root of what their concerns are,
understand what is their internal dialogue
that they're having so that you can address their questions
and it's everything from eye contact
to the simple things of public speaking
we always talk about.
Do you project your voice well? Do you mumble?
Do you look down at your notes the whole time
instead of engaging with the patient or the jury?
So I think all of those topics translate very well
between the theatricality of magic
and the theatricality of medicine.
- Yeah. I think for our listeners,
I love how you broke it down to these concepts,
scripts, costume, and audience.
I mean, with regarding script what I hear you saying is,
you're talking about this preparation
that's happening behind the scenes.
And I equate that to how we think
about attribute like some great artists is like,
they're just brilliant.
And we don't see all the years of practice
and failures about that.
And I think for our residents and fellows,
a lot it's times, it just seems like,
wow, Dr. Quinton just always knows the right answer
or he's just really on point.
And we just hope that someday that we can be
that quick with our answers,
but I think it maybe lays ourselves bare
to just highlight that there's a lot of preparation
that goes into being a great physician.
- Yeah. And the funny thing is,
you say you focused on that preparation aspect
and the strange thing about magic is that,
unlike every other form of art,
oftentimes we're trying to hide our skillset.
So if we make it look like something is spontaneous
and natural that's success,
but it doesn't look like we did anything.
So a lot of that preparation and practice
and the hours and hours of anxiety that go behind that,
nobody ever perceives
because the end goal is for them not to see it.
- Wow. And then costuming,
I feel like I'm gonna come to you like with...
This is a great way to explain
how do we think about professionalism and things like that,
that I think in medical education,
sometimes it's more challenging for us to address deficits
and professionalism in contrast
to medical knowledge, for example.
- Yeah, for sure.
- So I really like how you broke that down.
I think that's a lot for our audience to take with you.
I'm curious now about these concepts,
how do you approach teaching our residents
and fellows about how they might think about
and use magic in their practice?
I know you're not necessarily,
maybe there's a couple that have been full converts
and are card carrying members of the brotherhood,
but I imagine too there's also some things that they can...
So these are certainly concepts
that they can take forward in their career.
- Sure. And so much of it is almost by osmosis
and quite frankly oftentimes we're not spelling out
that these are these practices
from what I've learned in magic.
But as we, you, me, all of us interact with students
and residents and all that,
it's those little touches where we engage with them
and they're giving a presentation
and we give them feedback afterwards and say,
oh, I might have done this
or even thinking about a PowerPoint presentation
and how are we critique? How much is on the slide?
Don't read off the slide, all of that is the same skillset.
And so even if they don't know they're learning
some that skillset that it's behind the scenes
that we're teaching it.
In a more formal way, when I first got here to Mayo,
I actually reached out to the...
We have on campus, a center for humanities that engages
and basically uses the arts to talk
about medicine in a little bit of a way.
And when I reached out to them,
they actually connected me with the medical student group.
There's an actual humanities in medicine interest group
for the medical students here.
And so they do basically lunch lectures
with different people who do all kinds of different things
outside of medicine.
And so for three years in a row I've actually gone back
to give them magic and medicine talks
and the med students really enjoy it.
So it's a fun formal way to say,
that's my plan as opposed to with the residents,
oftentimes it's on service and it's sort of secretive
like, yeah, I'm feeding you this knowledge
but you might know it's coming from this place.
- I think our audience knows last time we were celebrating
the fact that you had won teacher of the year award
given to you from the resident class
here in anatomic pathology
and I imagine that being a good teacher right there,
when you're dealing with your...
When you're teaching somebody, who's maybe more junior,
a lot of concepts in medical practice are quite complex
and you almost need a little bit of a suspension
of a lot of the details for that beginner learner
to take those first steps, feel successful,
gain some confidence and get ready to understand
some of the nitty gritty.
I think about that a lot when I'm talking
about these concepts in transfusion medicine
with a resident versus a fellow.
You're covering it in different ways.
I'm curious, do you see that in your practice
and do you see yourself kind of...
How do you... How can we....
I mean, there's a lot of medical educators
that are listening to this podcast.
How can we get better at suspending some of that belief
for our residents and not get caught up
in some of that nitty gritty?
- Sure. The question is fantasic.
And it comes down to that same concept of understanding
what their internal dialogue is.
So when we talk about speaking to a patient,
we're trying to think about and anticipate,
what are their questions behind the scenes?
Why does this hurt? Am I going to die?
Sometimes it's really deep questions.
For the residents obviously it might not be that level,
but I think for us to put ourselves in their shoes,
bring ourselves down a little bit,
you don't necessarily want to...
You need to express your own human humanity too.
So be able to get down to their level
and understand behind the scenes.
Okay. When I was in that position, what did I understand?
And start from that baseline and go from there.
So again, anticipating like, okay, as a first year resident,
what kind of questions would they have
if they don't know they have that question
or maybe they're too afraid to ask that question
and then try to anticipate and answer some of those
as we go even if they haven't been presented to me.
- I love how you're really, it sounds like,
you that beginner's mindset and we need to remember that,
think about that.
This last question is what that,
in the spirit of being transparent
this concept of script
that you've introduced us to Dr. Quinton.
This last question is a little bit of a doozy,
but I gave this to you ahead of time to think about
because it's such a doozy.
So for our listeners this isn't Dr. Quinton off the cuff,
but I asked him and what I'm gonna ask him right now is,
what would an ACGME milestone
on magic in pathology look like?
And so I'm curious for your thoughts
and this isn't the typical final question
but I think it's a neat way for us
to get our arms around these conversations
some of these concepts that you've shared with us
and also make it a little bit more concrete
for our listeners.
- Sure. So I did struggle with this
because honestly there's two ways to look at it.
So one way which I started with was basically,
if I had to write milestones for magic, what would they be?
And then I backtracked from there and said,
okay, now how would I apply this to what we do in pathology?
So just for fun, I actually do wanna share with you
and I'm gonna move this on my screen so I can see it.
But I did create the milestones for magic first.
And I think you'll be amused by these
but basically going for one to five,
one being the lowest beginner all the way up to five.
And hopefully most of our learners know
what the milestones are, but basically...
So number one in magic,
if you were just starting at your baseline milestone,
I just have it listed as perform self-working card trick
that they from their uncle.
So just the very simple basics.
And then the second one is,
that I wrote in that same category is,
aware that you should not expose secrets.
Now, I don't say, don't expose secrets
because pretty much everybody at level one does,
but they're aware you probably shouldn't.
So this is going back to that idea of seven
or eight year old who is learning their first trick.
They're so excited about it.
It's a self working card trick or something like that.
But then of course they immediately show you
how they did it
even though they know something they probably shouldn't.
So level two in the milestone though,
I have identified different types of magic.
So now you're understanding,
oh, there's card tricks, coin tricks,
the kids shows, mentalism that kind of thing.
Aware of resources available, including books,
videos, and mentors can perform basics sleight of hand
with one or two props.
So you're only focusing on one or two things.
Performs for family and friends
and does not intentionally expose methods.
So now you've gotten to the point
where you know I shouldn't give it away,
I'm trying not to give it away,
but sometimes maybe I don't have the dexterity
to not give it away so some people will catch me.
So then milestone number three
would be comfortably performs magic in front of strangers.
So not just family and friends in a close up setting.
Familiar with sleights of several types of magic.
So this would be now you're familiar with coin magic,
card magic, SpongeBob magic, whatever,
but comfortable with one or two types.
And then the third in there is,
engages with other magicians
in order to improve their practice.
So that is you seeking out magicians or mentors
to try to develop better habits or learn something.
Then proficiency number four,
comfortable performing in front of strangers
including table and small stage settings
may occasionally provide, put paid performances.
So now we're get into a whole new level.
And then engages other magicians to both provide
and receive constructive feedback.
And then finally the level five would be comfortable
in all types of performance venues,
may engage in paid performances professionally
or semi-professionally.
And then the last part of that is mentors other magicians
to improve their craft.
So that's where I went with magic
which really made me wish I could just go ahead
and write a whole book of milestones for magic
because that was super fun.
But moving on a little more specifically,
so then I took that and tried to apply it back to pathology.
And so I said, let me go through the framework
of our own pathology milestones
and see how I could rewrite them.
And to be honest with you, Justin,
I ended up going, I don't have to rewrite them.
So I went through and I found two core competencies
that I think really are the most appropriate.
There was in the big picture, patient care and the ICS,
so interpersonal and communication skills.
I thought those two core competencies really could apply
to what we're talking about.
And so as we go through these,
these have nothing specifically to do with magic,
but it goes back to the idea
of the magic concepts or theater concepts.
So for patient care,
actually we have two that I selected out.
One is reporting and the other one is grossing.
So in pathology obviously we develop reports
and we gross specimens.
And if you look at the grossing one,
it's the same level one through five,
basically level two is you're learning how to sample,
you're learning how to document simple cases.
By the time you get to level five,
you can independently gross very complex specimens.
So this translation is the same
as I learned to do a self-working card trick
versus I'm performing on stage.
With the reporting, it's the same as the scripting.
Basically you're just learning how to identify key things
that you would wanna talk about in your report.
And then over the years,
essentially learning how to generate
a very complicated yet concise report,
which the best scripting basically you start
with a very big script and you keep whittling it down
and you take out everything that is superfluous
and get down to the simplest script.
And it's the same thing with our reports,
is you don't want a bunch of extra stuff in there.
And then for the interpersonal and communication skills,
there's two of them I selected out
which I think directly apply to what we're talking about.
One was patient and family centered communication,
and the other one was interprofessional
and team communication.
So looking at the team one,
just reading through it and going for instance,
level three integrates feedback
from team members to improve communication.
So basically you're constantly talking to the team,
learning from them and looping background
and improving what you're doing
by the time you get to level four,
coordinates recommendations from different team members
of the healthcare team to provide optimized patient care.
So basically synthesizing all that.
So as we interact with patients
or as we interact with team members,
or at the same time as we interact with audience members,
there's that constant feedback loop.
So I say something, I get a response then I go,
okay, I need to wrap that back into what I'm doing.
And so I think in theater or in magic,
the audience knows very quickly
if you're not really engaged with them.
So if you seem like you are just rattling off a script
without actually engaging them, they will pick up on that.
And we see it in medicine too,
where somebody's speaking and they're just so formal
about their topic that they can't even adjust
and answer questions because they're like,
well, this is what I'm here to talk about, and that's it.
So same thing with the patient
and family centered communication,
basically establishing relationships,
like level four for that one.
Independently recognizes personal biases
while attempting to proactively minimize
communication barriers.
If that's not theater, I don't know what is.
So anyway, very long-winded answer to tell you
that I think in our milestones
there's already multiple things
that apply to what we're talking about here.
- That's the magic trick
that you just did for our listeners.
We didn't even know that magic was present in our milestones
and you made it appear, you pulled it outta the hat,
which is awesome.
I feel like you've given me a new way to think about
how can I talk about these issues with learners.
Cause you and I were talking
before we got going recording here
and I was sharing that I've been doing some simulation
and thinking about wanting my learners to quote unquote,
think like a pathologist.
And that was a very nebulous thing when I started.
But as I was going forward,
I've noticed through the feedback,
what I really mean when I say that,
is that they are truly listening to the patient,
the team member and I see that reflected
in what you were just saying about,
being authentic, you know your script,
you're prepared for it
but you have to interact with that other person
in an authentic way.
If they ask a question,
you have to really respond meaningfully to it.
Not that no... That's not part of the script.
We're doing the trick.
I see how this goes
and I think this is really something beautiful
for our Audience to think about and reflect.
- In my own experience,
having seen many magicians perform,
I think a big eye opening thing for me
was going to see, I'll highlight,
there's a comedy magician named Mack king
who's in Las Vegas.
He's absolutely spectacular, been doing it a long time.
And if you go see his show, it just seems so spontaneous.
And he brings people up on stage
and has just so much fun with them.
And you're like, wow, I cannot believe
that he has this kind of rapport with these people.
And then you go see his show again
and you realize how incredibly scripted it is.
But every time he brings someone up,
there are those deviations because he does react differently
for different things, what they say, what they do,
but he's actively paying attention
and reacting to what they say and do
but then goes right back to script
and in a way that they can never even perceive it.
It just seems... It flows is so naturally.
So yeah I am still trying to develop
that type of communication skill I think.
- I hear in your answer there,
I hear this is repetition is important.
And I think for us as faculty observing
that repetition so that we can help our learners
get feedback that's relevant,
that's gonna help them fine tune.
We've been rounding with Dr. Quinton,
thank you for taking the time to discuss this topic with us.
- Happy to be here. Thank you so much for having me.
- If you'd like to hear more from Dr. Quinton,
be sure to register for the seventh annual
forensic science symposium.
Dr. Quinton will be presenting on a variety of topics
at this year's symposium to be held April 29th, 2022.
For more information,
visit mayocliniclabs.com/22 forensic.
To all of our listeners, thank you for joining us today.
We invite you to share your thoughts
and suggestions via email.
Please direct any suggestions
to mcleducation@mayo.edu and reference this podcast.
If you've enjoyed lab medicine rounds podcast,
please subscribe.
Until our next rounds together.
We encourage you to continue to connect
that medicine in the clinical practice
through insightful conversations.
(upbeat music)