Career and Life Planning Guidebook for Medical Residents

Identifying Objectives This is the let-it-loose step. There is no concern about ordering the objectives or rating them in any way. In this step, the goal is to discover as many objectives as possible. Redundancy is to be expected. Wild ideas are just fine! Note: It greatly helps the elicitation process to have someone other than the decision maker lead the process (asking the questions) and write down the decision- maker’s responses. Think of it as generating the biggest “zebra-filled” differential diagnosis possible: everything and anything is on the board at this morning report. Though this step is unstructured, it is not a complete free-for-all. The main principle here is to discover the reasoning for each objective and its relationship to the other objectives. Yes, let the decision maker's imagination run, but keep asking questions to determine what the decision maker thinks are the desirable and undesirable consequences. Discovering why a consequence is desirable or undesirable is one of the principal ways of identifying an objective. Even the most outlandish diseases on that differential have to have some tie to the chief complaint. The question you ask the decision maker most frequently is “Why?” You are to repeatedly ask why something is important or not important. At some point, the decision maker will answer “just because” it is. This means you have found a fundamental objective or a core objective of the decision maker. Consider the following exchange between the decision maker John and his friend Ann, who is writing down all of John’s responses. John: “It is important to me that I have a flexible work schedule.” Ann: “Why?” John: “Because I want to spend time with my family and ride my bike at the times of my choosing.” (Here, we can ask about either family or cycling and Ann choose cycling.) Ann: “Why is it important to ride you bike?” John: “Because I like to.” Ann: “Okay, but why? John: “Becauseof theexerciseandcomradery from riding with a group.” Ann: “Why is exercise important?” John: “To be healthy.” Ann: “Why is being healthy important?” John: “Because it is.” SECTION II: T MINUS TWO YEARS CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 272