Curiosity at Erasmus MC

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Based on Professor Robert J. Baatenburg’s statements, we assume the organization may run a risk of facing a problem with the stimulation of curiosity among the students. Thus, as far as curiosity issues are concerned, there is an implication that this situation might be recognized as a “crisis”. In this aspect, the organization can be placed in the crisis quadrant of the adaptive Cycle.

Figure 3: Erasmus MC Curiosity positioning in the adaptive Cycle

Non-human challenges to curiosity

Guidelines as necessity (balance between practice and creativity)

Philip Backx’s response: It is the safety aspect. It’s like what you say about the protocol. You have got these guidelines how you treat patients. Some people say "well, It is a guideline, you need to adhere to it, you cannot do it any other way ", and then other people say "No, you can do it another way“. And the people that are allergic to them, the real creative people, say: "well...guidelines, I don’t want guidelines, I think for myself". But the truth is in the middle. You need a guideline because it is a best practice but you can always say "this is the guideline, but for this patient I am going to do differently", as long as you motivate why you do that. So in a way, there are limits to creativity and curiosity because we need to deliver best practice care. But you can’t be best practice if you only focus on rules and regulations. You need to have a part of the creativity as well.

Curiosity team reflections: The guidelines are necessary in the medicine field; they facilitate the operations and are a vital part of this working environment. But as a conclusion of the above text, a golden mean needs to be found between guidelines and creativity, because as mentioned before the combination of both is just as essential.

Protocols vs. flexibility (protocols save time and make your life easier)

Prof. Robert J. Baatenburg’s response: Medical protocols are needed and are essential. That’s another issue than being flexible in your mind, responding to external forces. I think the protocols are there because they are evidence based, supporting the choices you make. It has no use to question those protocols ever on a daily basis. Having those protocols gives you some time and makes your life easier. On the other side, if you never question them then you will never make any progress, so these are in parallel lines. You have to be protocoled and you have to be flexible.

Curiosity team reflections: As discussed in the previous point, striking a perfect balance between the protocols and flexibility stimulation does not appear to be the easiest task. However, even in the most rigid or bureaucratic organizations, constant effort needs to be put to tip the scale towards increasingly supple behavior.

Bureaucratic barrier to curiosity (experiments / operations are protocoled)

Prof. Robert J. Baatenburg’s response: Experiments are very much protocollized and there are all kinds of medical boards which you have to pass before you can do your experiment. That is the bureaucratic part of curiosity. Medical protocols are needed and essential. The protocol is there because it is evidence based, supporting the choices you make. It has no use to question those protocols on a daily basis. Those protocols give you time and make your life easier. On the other side, if you never question them, then you will never make any progress. So these are parallel lines. You have to have protocols and you have to be flexible. It is important that you follow strict rules and you follow protocol on one side, and on the other side we actually want to think out of the box. Not following clinical protocols will lead to safety-issues and ultimately to crisis. Non-critical adherence to protocols is however dangerous too and will lead to less innovation. Research protocols on the other hand are essential in all dimensions. All protocols have to be discussed periodically. Curiosity and a safe setting are essential during review of protocols.

Curiosity team reflections: The imminent possibility of a crisis in regards to curiosity inhibitions appears to be recognized by the managing team. Moreover, the department attempts to initiate a less formal culture approach in order to improve the bilateral communication conditions.

Organisational and human challenges to curiosity

Cultural inhibitor to curiosity (first name basis / formalities)

Philip Backx’s response: We have discussed it with the residents why doesn’t anyone have a question. Why don’t they ask me why I am doing this and if they think it is good or not. And it turns out that it is the hierarchy. The students feel that the hierarchy is so strong, especially within medicine. It is like a culture. And we decided that everyone should call each other on the first name bases, not in front of the patients, but when we are not in front of them, they can call us on our first name bases. Even when you tell them: "call me in my first name”, they say "OK, professor". It is tough for them because that is a cultural barrier to curiosity in a way.

Curiosity team reflections: Due to the fact that the hierarchy is so deeply rooted in the organizational culture, it could not be easily overcome. In order to help this process of handling this situation, the doctors try to create an element of informality by being on first name basis but they still haven’t found an effective way to surpass the cultural barrier to curiosity.

Suggestions: Even though already implemented techniques seem not to be effective yet, it needs to be pointed out that cultural change does not occur instantly. It is our belief that the department is heading in the right direction regarding this specific approach and efforts should be continued in order to sustain it and foster it even more in the future. In this respect, contribution to such informal environment should be mutual both from the student as well as the managing team’s side.

Challenging case - Patient (as partner)

Prof. Robert J. Baatenburg’s response: The demands and the way patients want to be treated have been changing over the last ten years intensively. Patients are much more informed and demanding and […] it is conflicting on our old way of doctoring.

I think that the patient as a partner it is an interesting concept, when you have a patient that comes to you with specific needs and demand. We have to respond to that.

Curiosity team reflections: Recently, a new tendency has occurred since the patients are becoming more and more informed and the doctors need to follow up on these expectations in order to sustain their competitive advantage over the other hospitals. In that respect, they are looking for new approaches towards the patients. It is the curiosity that drives the hospital’s staff to explore and to be constantly a few steps ahead of patients’ knowledge.

Students don’t question decisions / teaching techniques

Prof. Robert J. Baatenburg’s response: I think we have benefit from stimulation […]. Especially in medical schools, people study to become a doctor, they have a goal in their future. But very few people are intrinsically curious to how the human body really works. There are curious people but that’s a minority really. The interaction is sometimes very disappointing. That is one way traffic - I deliver knowledge and theory, but there is not much coming from the audience. Maybe our way of working is not stimulating curiosity because it’s quite rare that students and residents ask why do you do things the way you do it. They accept the way you do it as the standard and they don’t question you very much. Curiosity works two ways: If nobody asks you any questions, you will not improve yourself. And there’s another aspect of curiosity, because it works on safety as well. When nobody questions you then you can make mistakes without anybody saying anything of it and in that way when people are curious, they will keep you sharp and they will prevent you from mistakes.

Curiosity team reflections: What could be concluded from the text above is that the Professor expects his students to be more curious and interactive. The fact is that the formality of the environment is not very helpful as it is so strong that the students may not feel comfortable enough to express different or conflicting opinions and question the methods or techniques used by the doctors. Stimulation of these attitudes could improve the used procedures and lead to an environment that fosters new ideas.

Suggestions: What the hospital might take into account are the following suggestions:

  1. One possible way could be enhancing curiosity by changing the teaching techniques in a more creative way. Another aspect could be establishing a more creative environment, in which students will feel more at ease to express their opinions and exchange their knowledge. (i.e. outside activities, student volunteers to chair the next teaching session, reservation of time by the end of each lecture to devote it to more personal reflections)
  2. Another possible way may be the introduction of more informal conversations with the students in order to create a more open environment, preferably on weekly basis.
  3. Finally, the professor could try to acquaint with each PhD student’s personality and interests in order to stimulate their curiosity. This way, students acquire the feeling that their ideas and opinions no matter how extreme, are not dismissed but appreciated. As suggested in the article "Curious about Curiosity?" by Sharon Walsh, some activities that the lecturer could introduce to the students may include: “questioning, increasing awareness, confronting ambiguities and uncertainties, and making the strange familiar or making the familiar strange.”

For further information regarding the Company, the Interviewees, the Interview Structure or Reflections obtained during the process, see Case study Group 2.

For further information regarding the role of Curiosity in the Adaptive Cycle go back to Group 2 Student Lecture.