I am not a sociologist or even a psychologist, but I think an outsider’s perspective can sometimes be helpful. I started to talk about this a bit last week during my quarterly update at Grand Rounds, but I think it’s worth examining this concept of “Iowa nice.” There is no doubt that Iowans are some of the kindest people. I am not a stranger to the Midwest, but what I have seen at Iowa is really unique. The warmth and curiosity I felt from nearly every person I met on my first visit here has persisted to today. Y’all are a welcoming and accepting bunch, no doubt. And that has made this transition so much smoother for my family and me. “Iowa nice” is a story we can and should talk about to faculty and trainee recruits, emphasizing that it is an environment that has to be felt firsthand to be understood. This is no false promise to someone seeking a collegial and collaborative home to work and to grow.

All that said, I wonder if we let the concept of “Iowa nice” hold us back as we tackle complex issues and problems. Does it keep us from being honest with each other? Does fear of seeming disagreeable or contrary close us off from opportunity? I have noticed that in meetings we often prioritize kindness over candor. Problems are presented and solutions are proposed, but I see too little challenge or discussion to those solutions. The first response is rarely the best, don’t you think? Proposed answers often need pushback and debate. I think this stems from the same “Iowa nice” impulse that we cherish and brag about to outsiders. But I will be blunt: this is not the leadership we need now, especially as we handle ever-complex issues in an increasingly uncertain world. Things are upside down and sideways, and things we held as undeniable truths are being challenged and vilified. Especially now, we have to be willing to speak up, to offer new solutions, to consider alternate approaches.

In my last post I talked about how each of us is a leader by merit of our membership within University of Iowa Health Care. I also talked about the importance of vulnerability in leadership. Vulnerability is not about revealing weakness, it is about risk. We have to be willing to risk someone thinking we are disagreeable, even if we are encouraging a robust conversation. What I will suggest, since we all have made a commitment to science, is that we try an experiment. The next time you are in a meeting and someone makes an assertion, even if—especially if!—it is your division director, challenge an underlying assumption or talk out implications. Try these out: “Interesting. Say more.” “Could you explain what you mean by that?” “That’s a good idea, but what do you think would happen next?” And if we are on the receiving end of this kind of questioning, let’s hear it with grace. It is not unkind. It is the opposite; it is a favor. This is how rigor works. Think of it as curiosity with a nudge. As lifelong learners, we should remember that certainty is the enemy of growth and progress.

Photo for Reflection
One more lesson from nature, and this one is about community. I took this one a little more than five years ago, before the pandemic would really challenge our concepts of and commitment to community. When elephants are on the move like they are here, you do not see all the biggest elephants in the lead or just bringing up the rear. Instead the experienced adults are interspersed throughout. Some are responsible for keeping track of the herd’s direction, others for keeping track of stragglers. Still others are there to keep an eye on the younger members of the herd. Each of us has a role to play, and often we are called on to wear different hats depending on the day, the setting, or the task. But no role is less important than any other, whether we are serving as guide, mentor, or that anchoring backstop to ensure nothing gets missed. Each of us is important to keeping the community moving forward together.

Upi’s “Oh, WOW” moment
This is a preview of an “Oh, WOW.” One of the data sets that I was fortunate to share last week was about the scope of our residency’s interview process. They conducted hundreds of interviews from nearly four times as many applicants. It is a monumental task and our education’s leadership team digs deeply to make sure that every candidate gets a clear sense of what Iowa is like and how well their career goals can be met by training here. This is the best use of “Iowa nice”! So, over the next week, whether you are on a well-deserved Spring Break or still hard at work, I encourage you to keep an eye on our department’s social media channels for a recap of what past Match Days have looked like. One week from today we will celebrate our own results as well as those of our graduating medical students. I look forward to sharing in the joy of that harvest alongside my fellow Iowans.