My professional career, as well as my life, has been shaped by my grandfather’s oft-repeated injunction: “Whatever you are doing, do it as well as possible. If you can’t bring yourself to do that, then change what you are doing.” He believed that, if one followed this maxim, work would be rewarding. And it always has been for me. On July 1, 2006, I was privileged to assume responsibilities as Senior Vice President for Medical Education at the Association of American Medical Colleges (AAMC). This seems a capstone position to me, beyond anything I envisioned. Yet, as one colleague remarked, my previous experiences provided better preparation for this role than I could ever have planned. Curriculum design and management, development of assessments, program evaluation, faculty and leadership development, planning, experience with organized medicine, high stakes testing and accreditation (LCME, ACCME, and ACGME)* – I now have the opportunity to apply them all and work with amazing, talented and dedicated people. As an ENTP** who loves learning, synthesis and developing big ideas with others, this is a dream come true.

This wonderful opportunity comes at that fruitful time in life when there is no need to look ahead to career ladders or pathways, just the joy of daily work and the steadiness that comes with lessons learned along the way. For those who have not yet reached this point in life, here are some of the lessons I’ve learned and hope to apply in my current position.

Things I know now that I didn’t know when I started my first big job:

• It takes time – for everyone – to learn the new job. If one already knows everything about the new position, then it’s not advancement. I’ve learned that it usually takes 12-18 months to gain a sense of mastery of the details, appropriate to the new position. There are at least two major learning tasks: creating a mental “big picture” in which to order the details, and determining which details are relevant to new roles. I now know the answer to the question that keeps recurring with each new job – “Will I ever learn enough to be good at this?” – and I enjoy the excitement of being on the steep side of the learning curve.
• Pacing is important and it’s not weakness. During seven years as a full-time consultant, the opportunity to structure my own time taught me much about my biological rhythms. I’m a morning person so it’s optimal to use that time for researching issues and writing, and to use the afternoon for meetings. (I still need to learn to postpone opening email until at least mid-morning.) I also program in brief breaks every 90 minutes or so: a walk around the block, some balance exercises or one chapter of a novel. This is not weakness; research cited in The Power of Full Engagement by Jim Loehr and Tony Schwartz documents the benefits of periodic breaks on mental functioning.
• Understanding one’s preferences is a great boost to self-management. As my understanding of the Myers-Briggs Type Indicator®** (a tool to assess personality preferences) deepens, my ability to manage my energy, my learning and my emotions grow. With my ENTP preferences for extroversion, intuitive perceiving function, thinking deciding function, and perceiving, I need to: engage face-to-face with people, not just on email; talk in order to explore ideas and remind others that I’m just exploring, not ordering; use personal reminders to attend to the feelings of others; and set limits on how much information I’ll gather before making a decision. Knowing that working outside my preferences always demands more energy, I program extra breaks on those days that are dense with detail and ask staff to bring visuals (print or image) when we discuss the details of projects. Understanding my preferences also aids me to honor my preferred learning style: reading is my dominant mode of learning, followed by tactics to process experience (reflection, journaling; recognizing patterns). I’ve learned to put more trust in my own intuition and regularly attend seminars and conferences, more to stimulate my thinking than to acquire information.
• Each day must include some time for reflection. In one of his wonderful books, Max DuPree noted, “Reflection is not a luxury for leaders, it’s a necessity.” Some days the time for quiet solitude and reflection may be only the 15-20 minutes it takes to walk to work or lift weights. On good days, it’s 20 minutes of meditation and time outside or listening (just listening) to music. Without time for reflection, it’s impossible to extract the lessons about self and others from daily experience.
• Self-nourishment is a personal responsibility. A brief but nasty illness 30 years ago taught me that I must be the keeper of my own wellness. In addition to the ongoing challenge of pursuing regular exercise and a healthy diet, I invest regular time in nourishing my spirit. Albert Camus wisely noted that to be happy, a person requires “time in the open air, love for another creature, freedom from ambition and opportunity for creativity.” Being patient with others, showing respect, focusing on the task at hand, developing people – all are easier when one’s spirit is well nourished. There are many ways to do this. For me it’s time outside, music, reading a good novel and a daily spiritual practice.
• Detachment helps. One of the features of process consulting is that the consultant invests creative energy helping the client to develop a process, procedure or program and then must walk away, leaving the implementation, nurturing and tweaking to the client. It’s a great exercise in detachment – giving one’s labor and creativity to the work, and then giving the work over to life. One of the meanings of detachment is separation, in this case, freeing oneself from what is beyond personal control. As one sage observed, “We are responsible for the ingredients, not the results.”

Beginning anew, I’m not certain how this work will develop. In fact, I’ve never been certain what my real work is but I do have a very clear sense of whether or not I’m doing it. Time and experience have taught me that context may vary, but it’s persistence in the process of the real work, even if you can’t name it, that leads to impact. And I hope to make an impact, to help the dreams of others come true.

Carol A. Aschenbrener, MD
Senior Vice-President
AAMC Division of Medical Education
Brief Bio: The AAMC appointed Carol A. Aschenbrener, MD, as Senior Vice President of the Division of Medical Education on July 1, 2006. During the prior two years, she was the AAMC secretariat to the Liaison Committee on Medical Education (LCME). She was twice elected to the AMA’s Council on Medical Education and served for 15 years on the National Board of Medical Examiners, including chairing the entire board and chairing the Composite Committee (which oversees the United States Medical Licensing Examination).
Dr. Aschenbrener‘s medical degree comes from the University of North Carolina at Chapel Hill School of Medicine. After her residency in pathology at the University of Iowa Hospitals and Clinics, she joined the College of Medicine faculty for almost two decades, moving from professor to associate dean for student affairs and curriculum, and then to executive associate dean of medicine. From 1992-96, Dr. Aschenbrener served as the chancellor of the University of Nebraska Medical Center. (Brief Bio taken from a recent AAMC press release. Contact: Nicole Buckley @ 202-828-004; nbuckley@aamc.org)
Additional Information
*LCME: The Liaison Committee on Medical Education is the nationally recognized accrediting authority for medical education programs leading to the MD degree in US and Canadian medical schools. The LCME is sponsored by the AAMC and the American Medical Association. (Taken from the web site: www.lcme.org) (Accessed 8/31/06)
ACCME: The Accreditation Council for Continuing Medical Education identifies, develops and promotes standards for the quality continuing medical education (CME) of physicians for the maintenance of competence and acquiring new knowledge to improve their medical care practice. (Taken from the web site: www.accme.org) (Accessed 8/31/06)
ACGME: The Accreditation Council for Graduate Medical Education provides the accreditation of post-MD medical training programs within the US through a peer review process and established standards and guidelines. (Taken from the web site: www.acgme.org) (Accessed 8/31/06)

**ENTP – the Myers-Briggs Type Indicator (assessment tool) type showing personality preferences for 1) Extroversion, 2) Intuitive-perceiving function, 3) Thinking-deciding function, and 4) Perceiving. (Web sites for further information: www.knowyourtype; www.teamtechnology.co.uk/tt/t-articl/mb-simpl.htm (Accessed 8/31/06)

References
1. http://www.teamtechnology.co.uk/tt/t-articl/mb-simpl.htm
2. Loehr J & Schwartz T. (2003). The Power of Full Engagement. NY: The Free Press (of Simon & Schuster, Inc.)