Matt Morgan: Pods and wards—flipping through rotations
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q2022 (Published 17 September 2024) Cite this as: BMJ 2024;386:q2022
- Matt Morgan, consultant in intensive care medicine
- mmorgan{at}bmj.com
Follow Matt on X @dr_mattmorgan
Some readers may remember Kathy. She filled my childhood Sunday afternoons as the main character in my favourite television show. She wasn’t a doctor; she wasn’t even a human. Kathy was an intelligent dolphin who helped solve local crimes like an underwater version of Lassie, in the 1960s series Flipper. But Kathy’s story had a difficult end because of the isolated, captive environment she lived and worked in.
Dolphins, particularly bottlenose dolphins like Kathy, live in “fusion-fission” societies. These social structures have fluid group membership, with individuals frequently changing affiliation. Dolphins swim with one pod for a while before switching to a very different group, forming new alliances and relationships. This dynamic social structure allows them to adapt to changing environments, learn new skills, find mentors, and avoid predators.
This week, as I struggled to learn the names of another large cohort of resident doctors joining my department, it struck me that they too live like dolphins. They move through frequent rotations in new departments, hospitals, and entire specialties. Resident doctors exist in fusion-fission medical societies.
This constant movement may contribute to a broad medical education across specialties. But it can lead to stress, burnout, and a feeling of disconnection from patients and colleagues. Perhaps the example of dolphins like Kathy can help: the key to their success lies in their ability to form bonds quickly and work cohesively in ever changing groups. Despite their fluid social arrangements, dolphins maintain a strong sense of community and collaboration. Strong social bonds and communication help them navigate complex social environments and ensure group cohesion. They recognise each other’s unique whistles, understand social hierarchies, and remember past interactions. This adaptability is crucial for their survival and success in the wild.
Feeling anchored
Just as dolphins have adapted to thrive in fluid social environments, we too must find ways to foster cohesion, communication, and a sense of belonging among doctors despite frequent rotations. Parent organisations such as training deaneries, specialty groups, or member organisations could develop a stronger sense of group cohesion and bonding to provide a constant thread despite the multiple individual roles or teams a doctor traverses.
For example, although you may be an anaesthetist for a short period and then a respiratory doctor for another, you remain in and return to the core group of critical care. Just as dolphins recognise their whistles, doctors could use standardised sets of visual cues to represent their core skills and strengths. In my department we use lanyards of different colours to show group membership reflective of skills, responsibilities, and learning needs. Creating structured support systems and mentorship programmes can help doctors navigate the complexities of frequent rotations. Nominated mentorship can provide a consistent source of guidance and support, helping young doctors feel anchored even when their environments change.
There are dangers in not getting this right. In April 1970 the US animal rights activist and former animal trainer Ric O’Barry visited Kathy the dolphin at the Miami Seaquarium. O’Barry had originally captured Kathy and trained her for the show. Sadly, the dolphin’s retirement was spent alone in a small concrete tank, which was very damaging for such a social animal. O’Barry claims that Kathy swam into his arms after their reunion, before sinking to the bottom of the tank. She refused to resurface, drowning herself.
We too are social animals in a constrained system. Recognising our need for cohesion, communication, and belonging during rotations is key to our survival in captivity and the wild of the wards.
Footnotes
Competing interests: I have read and understood the BMJ Group policy and declare that I have no competing interests.
Provenance and peer review: Commissioned; not externally peer reviewed.
I am an adjunct clinical professor at Curtin University, Australia, an honorary senior research fellow at Cardiff University, UK, consultant in intensive care medicine in Cardiff, and an editor of BMJ OnExamination.