Don't Game Tape Alone

Last week, I was sitting in a hotel conference room in Chicago at the AMA Precision Medicine Conference listening to Dr. Lara Varpio from the Perelman School of Medicine talk about agency. Not the vague "you have more power than you think" kind, but the research kind.

She offered four of the six dimensions of agency:

Discursive — The language and behaviors of medicine define what a "good doctor" looks like. You have more choice than you think about which of those norms you adopt and which you don't.

Temporal — Your agency shifts over time, shaped by where you've been, where you are now, and where you imagine you're going.

Systemic — The structures around you, the EHR, the schedule, the politics, that enable or constrain your agency whether you recognize them or not.

Relational — Agency is co-created. It lives in relationship. You can't fully exercise it alone, and neither can the people around you.

Most of us were trained to think agency was entirely ours to muster. Also that we either had it or we didn't. Which is incredibly disempowering. These four dimensions suggest otherwise and that's actually a relief.

The one that stood out to me most was relational because I've been teaching it for a long time without having a name for it.

The next day there was a learner panel including students, residents and fellows. I asked my burning question: From your standpoint, what would make the ILP more than an administrative burden, not just another checkbox to mark off? What would help it really be what it's intended to be, a developmental tool?

The resident who was a collegiate swimmer, who had already talked about using her precision split time data for growth, answered honestly: something has to be taken away and time devoted to it. The system has to create the conditions. Without that, none of the rest matters. (💡 Systemic agency in its constraining form.)

It’s so true. I've heard that from every resident and faculty I've ever posed the question to.

Over lunch, I was sitting with a resident who had come with our team, herself a former collegiate volleyball player. We got into a conversation about the difference between an advisor and a coach. She'd never heard it framed that way before. In her experience, an advisor was an expert who told her what she needed to do. She didn't need to trust them. Rapport wasn't really part of it.

So I asked her about her volleyball coach. He was also an expert who told her what she needed to do. What was different?

She didn't hesitate. She knew he had her best interest at heart. She trusted him. And he cared how she thought about things.

Then I asked her to imagine her advisor sitting with her and her residency performance data the way her coach sat with her and the game tape. Not telling her what he saw, but asking her what she saw. What she was thinking. What she may have missed and why. Helping her define what was needed. Co-developing the plan.

She could see it. She got a little excited about it actually.

Whether you're a faculty advisor, a leader, or a resident looking for direction, the most powerful thing isn't what someone knows. It's what becomes possible when they're genuinely in it with you, asking questions, helping make meaning, and co-creating what comes next.

That's not just a coaching approach. That's relational agency in action.

And when the system creates the space for it? That's systemic agency at its best.

Reflection:

What might shift in your conversations with learners if you asked what they see in their data before sharing what you see?

Who on your team is sitting alone with data, and how might a thinking partner change what becomes possible for them?

Where in your work right now does a specific relationship make it easier or harder for you to act the way you want to? When you see that your agency in that situation is actually shared, what new options come to mind?