Transcrição completa de Getting Names Right: A Path to Belonging in Medical Education

Dr. James K. Stoller:
Hello and welcome to MedEd Thread, a Cleveland Clinic education podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.
Dr. Tony Tizzano
Hello, welcome to today's episode of MedEd Thread, an education podcast considering the importance of getting people's names right. I'm your host, Dr. Tony Tizzano, Director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today I'm very pleased to have here Helena Baffoe-Bonnie, a fifth-year medical student at Cleveland Clinic's Learner College of Medicine. Welcome.
Helena Baffoe-Bonnie:
Thank you.
Dr. Tony Tizzano:
And Lydia Cassard, also a fifth-year medical student at Learner. Lydia, welcome.
Lydia Cassard:
Thank you for having us.
Dr. Tony Tizzano:
And last but certainly not least, Dr. Monica Yepes-Rios here to join us today.
Dr. Monica Yepes-Rios:
Thank you for having me.
Dr. Tony Tizzano:
To get us started, if you could please tell us a little bit about yourselves, your educational backgrounds, what brought you to Cleveland and your roles here at Cleveland Clinic.
Helena Baffoe-Bonnie:
So as I mentioned before, my name's Helena Baffoe-Bonnie and I am a fifth-year student here. I was originally born in Ghana but moved to the States very young and grew up in the Baltimore County area, and I came to Cleveland Clinic to pursue my medical education and while here, really took a liking to doing worked that helps to foster community engagement, community belonging, and have really enjoyed working with this group.
Dr. Tony Tizzano:
Excellent. Lydia?
Lydia Cassard:
Sure. So my name is Lydia Cassard. I am originally also from the Baltimore, Maryland area. Helena and I actually went to high school together-
Helena Baffoe-Bonnie:
(laughs).
Lydia Cassard:
... and then started here the same year in 2020 at the Cleveland Clinic Learner College of Medicine, and alongside kind of learning medicine have been interested in being involved in several kind of student groups and committees throughout medical school, which has led me to working with these individuals.
Dr. Tony Tizzano:
Excellent. And Dr. Yepes-Rios.
Dr. Monica Yepes-Rios:
Hi. So I'm Monica Yepes-Rios. I'm the assistant dean of our Office of Student Community and Engagement. I've been with Cleveland Clinic and the Cleveland Clinic Learner College of Medicine for seven years now and I'm originally from Columbia, South America. I've been in the United States for many years, but here in Cleveland seven years. And my work has always been very engaged with our students, with the community bringing uh, an element of equity in medical education, in our patient care, in our communities and it has been really terrific to work with our students in a lot of our work, and specifically in this project that we're gonna share with you.
Dr. Tony Tizzano:
Yeah, and I've got to hear you many times. We're lucky to have you. So in today's segment, we will consider the importance of taking the time to learn a person's name and pronouncing it correctly as it relates to identity inclusion among learners. So Helena, if you could please help us frame today's topic by providing our listeners with some context around the important work, and your efforts to shed further light on this area and its impact on belonging and inclusion.

Helena Baffoe-Bonnie:
Absolutely. So we are aiming to create an inclusive environment, that is an environment where everyone can actively engage, and that is important in any organizational structure as we are looking at medical education, but also beyond in terms of healthcare systems. And so from micro sort of interpersonal relationships to classroom settings, to clinical teams, to even larger systems wide sort of platforms, this idea of an inclusive environment is important. And a key theme there is fostering a feeling of belonging, that feeling that you can be your authentic self. And in general, to do that we need to find ways to promote everyone's unique identity, and then also decrease behaviors that prevent people from being their authentic selves. And so there are many ways to go about doing this and tackling this problem, and we thought a great place to start would be looking at one of the most fundamental components of our authentic selves, which is our name.
Dr. Tony Tizzano (03:58):
Yeah, I think that's a really great point, Helena, and I think for our listeners it has to resonate with them. When you're in a group and maybe you're new to the group and someone calls you by your correct name, it makes you feel good. You warm up to it and your willingness to engage and participate has to increase, so I think you're spot on. Lydia, kindly tell us about your work with the Student Community Engagement Committee related to names and plans for integration into Cleveland Clinic's Learner College of Medicine.
Lydia Cassard:
Sure. So Helena and I are both student members of the Community and Engagement Steering Committee and early on in our fourth year of medical school, Dr. Yepes-Rios reached out to both of us as kind of more senior students, wanting to see if we were interested in being involved in a project that she was hoping to get started, kind of educating the Cleveland Clinic community on the importance of learning your colleagues' names. And I think the idea for this project largely came from the fact that I think leadership of Medical School was hearing different reports of students that were on their clinical rotations who were feeling like they weren't necessarily a member of the team, largely because their name was not learned. And whether that was just their name not being learned throughout the week or their name being mispronounced or their name being confused with another person on the team, or each other, and so I think that is where the idea largely stemmed from.
And then we wanted to kind of create some sort of digestible but also impactful method of conveying this information, and we chose a short animated video to do so. And I think by kind of picking the scenarios that went into that video to depict names being mixed up or mispronounced, it certainly applicable to medical students working on a clinical team, but also we hope that it is applicable to kind of the Cleveland Clinic community as a whole. With any healthcare team, any work or professional setting that you're working on with other people, I think it can be extending to that type of education and that type of awareness that we hope to gain by just disseminating it a little bit more widely, and having it available to everyone in within the community.

Dr. Tony Tizzano:
Well said. And you know, it certainly resonates with me that, you know, you're going to all these rotations, they may be two, three or four weeks long, so they're changing up all the time. So it's a challenge perhaps for the preceptor or the attending physician, resident and what have you, but it's so important for the student. So Dr. Yepes-Rios, we're lucky to have you as a scholar in this area to comment on this. So what do you think the impact, immediate and long-term, effect on students when their names are mispronounced or they're mistaken for somebody else?
Dr. Monica Yepes-Rios:
Well the- the impact is big, it's a name, but it... The- the impact is so big. So as you just said, the students rotate, that's part of their clinical experiences, their clinical education, they r- they rotate, sometimes two weeks, sometimes four weeks and then they move on to the next teams, and the teams sometimes also are constantly rotating, sometimes they're more constant. So there's a lot of change and a lot of acuity and a- a lot going on in the healthcare system. So the student shows up, they're eager, they wanna be part of there, they wanna be part of the team, they wanna be there for the- for the patients. And if no one pauses to learn who are you, what- what is your name? And the next day, the same thing. Or maybe they did say their name, but the ne- the next day they don't remember, or they don't... They may get confused with somebody else, particularly if they share, uh, race or ethnicity. It's really disheartening. And if they get called by the wrong name, it kind of s- stops them on-
Dr. Tony Tizzano:
Even worse.
Dr. Monica Yepes-Rios:
... on their tracks. It- it, uh... They lose their stride and it's like, "Oh, kind of what- what just happened there? Am I... Do I... Are- are they seeing me? Am I invisible? Do I belong here?" And then you start questioning kinda long term, "What else do this mean? Like, by the end of the rotation when somebody has to fill out an assessment of how I perform, do they even know whose assessment they're filling out? Do they even know what I did here, if they can't even remember my name day-to-day?" So there's sort of that immediate impact of how hurtful it is that they don't know who am... Who I am-
Dr. Tony Tizzano:
Who I am.
Dr. Monica Yepes-Rios:
... and how I am different from- from the... Another person standing next to me and the long-term impact of what that can have on my education, literally.
Dr. Tony Tizzano:
I can only imagine that listeners are thinking, "Boy, I can understand that. That's how I would feel in any new job, any new situation, even a- a family reunion, you know, that's large and people may not know everybody." So on the flip side of that coin, and it's a bit off-topic, but I'm curious what you would say is for those people who think, you know, "I am an offender. This is a problem I have with names." W- what are s... How do you build that skill set, for any of you?
Lydia Cassard:
Yeah, I think there are a couple of things that you can do kind of right off the bat to try and be better with names, 'cause I think we can all recognize that names are tough and especially in medicine as... Even as students you're learning new names every single day, whether that's patients or colleagues or supervisors, people that you're working with and so I think it's important to kind of remember those tactics that you can apply early on when you've met someone. So I think some things that we've talked about are, like, when a person introduces themselves to you repeat their name back to them and say, "You know, it's nice to meet you, so-and-so." Trying to kind of practice using their name in conversation and making sure that if you have a question about how it's pronounced, clarifying with the person, you know, after you say their name. "Is that how I'm... Am I pronouncing it correctly?" Just because it makes it a little bit more comfortable to have that conversation.
And then I think other times people will try to, like, use mnemonics or just kind of imagine saying a person's name in your head when you see them pass by in the hallway, just to kind of register it in your mind. But I think even with all of those things, it's normal to trip up on people's names here and there. And I think we recognize that it's not an easy task to learn 10 different new names every hour. So there are obviously little things you can try to do to be a little bit better.
Dr. Tony Tizzano:
One step at a time. Were you gonna add something, Helena?
Helena Baffoe-Bonnie :
Yes, I- I definitely resonate with what Lydia said and I also think one important thing is showing the effort to try to get the name correct. We all know that th- there are many different kinds of names from different backgrounds and some may be more familiar than others. But you taking the time to say, "I wanna make sure I'm not mispronouncing your name. Can you say your name one more time for me?" And then right then and there you- you practice it until you get it right. That effort in itself, I think, is something that makes people feel seen and feel like they are being valued. And so the effort is really important as well.
Dr. Tony Tizzano:
And I think that effort begins to build trust. And you know, when you see someone is interested enough that they're actually going to ask again to make sure they've got it right, and I was listening to a discussion on a person talking to medical students about how to interview and they had things like, "You always wear your name tag on the right side because if your people are mostly right-handed, so when some- someone goes to shake your hand, they're looking at your right shoulder so that you have a chance to see that name tag." Little things that we can do, I think on both sides of the coin, to make this a little bit easier. So along, Helena, what you were just saying, you know, how does honoring and pronouncing a person's name correctly impact inclusion and make them feel whole?
Helena Baffoe-Bonnie:
Yes. So you know, at its essence your name is really sort of tied to your identity and a person's name could have lots of implications having to do with their cultural background, their family's, their ethnicity's. And so someone's name is really a reflection of who they are in many different ways. And so when you correctly say someone's name, you are sort of identifying and connecting with them. But then on the other hand, when you mispronounce someone's name or mix up their name, it's saying the- the opposite. You know, "I don't see you as an individual," and it might even signal that they aren't valued, which is against the goals of what we're trying to build here. And so one thing to also think about is that certain people have their names mixed up a lot more often than others. People from different backgrounds tend to encounter this issue of their names being mispronounced, or people trying to take the initiative to give them nicknames that they may not approve of. And that's when we get into the space of, when it happens repeatedly it could be very uncomfortable for people. And that, again, is going against this idea of creating an inclusive environment. And so having someone's name correctly pronounced and making that effort to remember their names, but also correct yourself if you get it wrong, definitely pushes us towards interaction where people feel valued from both sides.
Dr. Tony Tizzano:
Yeah. And when there's multiple names that are the same, like in a school class growing up we had an Anthony, another Anthony and an Antonio.
Lydia Cassard:
Mm-hmm.
Dr. Tony Tizzano:
So one of us became Tony, but one teacher used to call me Toenail and that used to just grate. I know, I just had such a negative connotation.
Helena Baffoe-Bonnie:
Yes.
Dr. Tony Tizzano:
And I said, "Can I just be the Tony? I don't want to be the Toenail."
Helena Baffoe-Bonnie:
(laughs).
Dr. Tony Tizzano:
So yes, I take your point and I didn't mean to be flippant but it... As you said that it just all of a sudden with nicknames, I can remember all the way back and this is 60 years ago.
Helena Baffoe-Bonnie:
Exactly.
Dr. Tony Tizzano:
So- so Lydia, you know, neglecting or refusing to learn someone's name or pronouncing someone's name incorrectly suggests that perhaps we choose our own linguistic comfort over their identity. So would this be considered a step in the wrong direction or a negative and- and if so, how does one respond?
Lydia Cassard:
Yeah, that's a good question. So I think it's definitely going to depend on the context of the error occurring and kind of what group setting you are in and what are the dynamics of- of, like, person-to-person relationships in the group. I think when we think about medicine in particular, there's sometimes a... Quite a clear hierarchy in the team that you're working on, and I think in that case it can be uncomfortable when someone in a more superior role makes a mistake like this and either pronounces a name wrong or mixes two students up for one another. And so it can be even more intimidating to be that student or that trainee that is then feeling like they need to correct the person who is supervising them for that week, or that month or whatever. And so I think there are definitely multiple ways that you can go about kind of rectifying the situation.
Ultimately, I feel like we've discussed as a group that largely we think that the agency should lie with the person who is affected by the name mix-up recognizing that, certainly, if they wanna speak up for themselves that's great and they should feel empowered to do, but they also may potentially want their more immediate supervisor, like a supervising resident help to jump in and help the situation, or they may want no one to say anything and to just kind of deal with it a little bit later, or in a more one-on-one situation. And so I think in taking steps to try to fix that situation or come back from that, it's important to make sure that you are kind of touching base with that person who was affected and see how they would want to proceed.
But there are also roles that you can take if you are the person making the mistake, or the person that's just observing and I think, first and foremost, if you have made that mistake of mixing up someone's name or mispronouncing it or just not even learning it, I think it's really important first to just recognize that that was a mistake and to apologize upfront and try to make a conscious effort to learn their correct name, the correct pronunciation, practice it in your head or pull that person aside and, uh, you know, apologize for what's happened and just make it clear that you do not wanna make a mistake like that again, and that you didn't intend to make them feel less welcomed or as less of a member of the team.
Dr. Tony Tizzano:
All good points. And you know, I know for a person such as myself who I know I suffer from this problem, you know, I try when I have students to say it right off the bat. I have issue with this, I want to be stopped when I make the mistake. I wanna open the door for that feedback and- and I will welcome it, and I'm trying and... But I- I'm gonna need your help. And I also, 'cause I have two students now, one of whom I really have a block with his name and before we start each day I'm with him and I spend time with him alone, so I don't make the mistake in front of a patient and so forth, but I also make sure he has that name badge on that upper right hand shoulder so that I can, before I go in that room, introduce them properly. And uh, it... I know it's a crutch, but I at least, uh, they know for sure I'm making the effort to do it. So Dr. Yepes-Rios, what are the consequences if someone's not taken the time to learn or pronounce someone's name or confuses them with someone else? It makes us look bad, but what else? I think you started on this before, but let's expand on that a little bit.
Dr. Monica Yepes-Rios:
Um, so, uh, certainly I think we- we heard from Lydia and Helena the consequences on the student, like how- how hurtful that is and how isolated and you feel like you don't belong, right? But if you're on the side where you did not take the time to learn somebody's name, did not take the time to pull them aside and say, "I'm... I have- I have a hard time with the name, but let- let me- let me- let me learn." If you didn't do any of that, you're just conveying a message of, I'll just say it very simply, "I don't care," basically. Or, "This is my space and this is not a space that I feel that you belong in." And it's very dismissive of the student or the person it is that you're taking the time to really get to know, to invite into your team.
We know that, uh, when the students are part of a- of a healthcare- healthcare team the team works better if they... There's a relationship, if everybody kind of gets to work together. Name is a huge part of it. It's a huge of, "Who are you? Let's work together." If we even skip that step, I'm telling you I don't kind of care enough about you. So the consequence is really walking away feeling like I'm not investing at all in this, and it's damaging to the student in the moment and really to- to the whole team, like who's next?
Dr. Tony Tizzano:
Sure.
Dr. Monica Yepes-Rios:
Who else is gonna be affected by that?
Dr. Tony Tizzano:
And perhaps even for the offender, it makes them look less capable.
Dr. Monica Yepes-Rios:
Mm-hmm.
Dr. Tony Tizzano:
I mean, I always have to admire someone who can look at a room full of students and call on this one, that one, and they know their names and I always... I admire that right off the bat and it- it puts them another notch up on the pedestal.
Lydia Cassard:
Sure.
Dr. Tony Tizzano:
I think those are two different ways of looking at it. So we mentioned some strategies that one might use and, you know, uh, just in poking around on the internet, you know, mindfulness and mnemonics, do any of you use those sorts of things or do you just find it automatic, that you can pull that together since you've been working on this area for a while?
Lydia Cassard:
I think it definitely is still challenging at times to remember people's names and to make sure that we're pronouncing them correctly. And so I think I have found myself doing some sort of tactic like that, like sometimes when I hear someone pronounce their name correctly, if it is similar to another word that I know, then I will associate those two together and then every time I think of their name, I think of that word and how that's pronounced, how the vowels sound or whatever it is, and kind of pair them together in my mind that way, and that has helped me sometimes. And also just practicing names in my head before I go to speak to someone, I think, can be helpful.
Dr. Tony Tizzano:
Is it a sin to guess?
Helena Baffoe-Bonnie:
I would say yes.
Dr. Monica Yepes-Rios:
(laughs) Yes, yes.
Dr. Tony Tizzano:
Yeah.
Helena Baffoe-Bonnie:
I think one thing that we'd... Would like at least to get across is, admit when you don't know (laughs). I think that goes a lot further than you making the risk, you know, 50-50 and really negatively impacting somebody by calling them somebody else's name. So I think it might be uncomfortable for the person saying it, but I think it's better for you to feel uncomfortable than for the person on the other end to feel even more uncomfortable.
Dr. Tony Tizzano:
That's my wife's take. You know, she will not go to a grocery with me. I live in a small town, I'm an OBGYN there. At one time I delivered one quarter of the kids.
Helena Baffoe-Bonnie:
(laughs).
Dr. Tony Tizzano:
You know, for- for a number of years and, uh, she'd be in the grocery store, someone's coming with the grocery cart and they have a baby. And I'd recognize them right off the bat and my wife would start whispering, she'd go, "Don't you guess. Don't you guess." But, you know, she could also have been the one who was proactive and said, "I'm Cindy Tizzano." And they would then shake that hand and say their name and I'd be off the hook. So, you know, for those of us who suffer on the other side of this, I mean, there is so much of value and we talked earlier about, uh, earlier work done for decades that has, you know, been the mainstay. Dale Carnegie.
Dr. Monica Yepes-Rios:
Oh, Dale Carnegie.
Dr. Tony Tizzano:
Dale Carnegie, How to Win Friends, Influence People, the importance of a name. He spends an entire chapter and that's been put into I don't know how many languages. So it- it's a standard thing to look at.
Dr. Monica Yepes-Rios:
I think there's a lot of things we can all do. Like you were saying, the n- the name tag. Uh, on the signature line maybe put, uh, like audio with how you pronounce your name. So I think there's ways we can help each other. I think one of the things that speaks to me of- of this work is, one, primarily hearing from students just how hurtful this is on their end 'cause, again, they want so much to be part of the healthcare team, we want them so much to be part of the healthcare team but... And many times it works just that way, but sometimes it doesn't and it's just so- so hurtful. But I confess that (laughs) I sometimes have a hard time with names and I don't wanna say, like, "How- how do I- how do I do this and how do I do this?" And I, you know, so you do hope people have grace with you when- when you don't remember those names, but that's not an excuse. I don't want it to be an excuse, and I think we all need to, uh, make the effort to say, like, "Tell me your name. How do I pronounce it? What's that trick that helps me?" For me it's kind of saying it in multiple ways like, "Tony, Tony, Tony, Tony, Tony, (laughs) Tony," however many times.
Helena Baffoe-Bonnie:
(laughs).
Dr. Monica Yepes-Rios:
And we need to find what that is for us and- and stop making excuses. I think that's... We need to be careful. There's a fine line between giving grace on somebody and then making excuses when we haven't even tried.
Dr. Tony Tizzano:
Sure.
Dr. Monica Yepes-Rios:
Mm-hmm.
Dr. Tony Tizzano:
You know, your point about putting the phonetics on the name tag, that not only shows that you may have an interest, but so does the company you work for. So your formal name tags actually have the appropriate phonetics and we can say, you know, "This for us as an organization is important, so we want you to be able to and feel more comfortable by knowing how to pronounce the name." So what do you think lies on the horizon for this work? What's next? You've got Dr. Stoller's magic wand to make it perfect. What would you do?
Helena Baffoe-Bonnie:
Yeah, so I think overall the general goals when we talk about ways to make people feel more included in any setting would be to embed this work in every aspect of the organization. And so keeping this conversation just amongst ourselves isn't really gonna help. It would require us to have this conversation at every level, be it between learners, be it on a broader organizational level. So I think we could expand this work by moving closer to normalizing things like putting phonetics in email signatures, and really building this from the culture up so that it's very second nature to make sure you're putting more effort into people's names. And that's something that I think, also, if we notice that our peers are doing more, it helps. You notice that your supervisors are putting more effort into, it helps. So I think the- the next step would be to sort of spread this message and then have it sort of permeate into every aspect of the organization.
Dr. Tony Tizzano:
Well said. Any other thoughts?
Dr. Monica Yepes-Rios:
I wonder as part of that, when we take care of a patient, we check two forms of identification, who's their name and their birthdate or something else to make sure we've got the right patient. What if every day when we walk into work and there's a new team, we learn everybody's name? What's your name, what's your name, what's your name?
Dr. Tony Tizzano:
Who could... Yeah.
Dr. Monica Yepes-Rios:
And we take the time to make sure that we know our team. And I- I imagine that can only lead to better teamwork, and better patient care too.
Dr. Tony Tizzano:
Absolutely. As a starting point, automatically, I think that goes without saying. So is there anything that I didn't ask that you think might be important for our listeners to know?
Helena Baffoe-Bonnie:
I think th- this is building off a point you actually mentioned earlier in showing that there is interest in pronouncing names correctly, shows sort of like an institutional interest. And I think that's something that can go a very long way, because when we think about having people feel included, that also means retaining people. And that, you know, even if you don't wanna look at it from a purely altruistic way, that improves productivity and that improves sort of outcomes across the board. And so I think that's something that I've personally seen as an attractive factor in me personally looking at residency programs, I just did interviews and there was one program where they asked us the phonetic spelling of our name. And on interview day, everyone who interviewed me got my name perfectly correct. And that just showed me, before we even started talking about their program or talking about any questions, they care enough about me, they respect me enough to check in to see how I pronounce my name and then not just asking, but putting it into action.
So I think these things, it might seem small, it might seem like, "Oh, it's just a name," but it has really tangible impacts and these things altogether is what makes a culture. And so I think we should definitely take it seriously and look at it from a point of optimism. This is how we can further, you know, make our workplace better and not necessarily looking at it as, oh, well this is why we need to, you know, punish ourselves, but this is opportunity for us to do even better.
Dr. Tony Tizzano:
Yeah, that's a great point. I mean, that's evidence of respect without having ever met you before. They get it right out the gate and it- it does make an impression. Well, thank you so much, Helena, Lydia, and Monica Yepes-Rios. This has been outstanding and I think that any listener, no matter what you do, can take away what you've heard today. And you know, Helena, to your last point when you were talking about what it means for an enterprise, the Harvard Business Review looks at belonging and they monetized it. How they did this, I don't know, but when people feel as though they belong for a company of 10,000 people, it is 52 million to their bottom line. So for Cleveland Clinic, about a half a billion dollars a year if people all felt as though they belonged. They get more raises, they have more career advancement, they're more likely to r- recommend their employer to somebody else, they're more likely to stay there. So I think it has enormous impact and we're just beginning to get into this. So to our listeners, if you'd like to suggest a medical education topic to us or comment on an episode, please email us at education@ccf.org. Thank you very much for joining and we look forward to seeing you on our next podcast. Have a wonderful day.
Dr. James K. Stoller:
This concludes this episode of MedEd Thread, a Cleveland Clinic Education podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread and please join us again soon.