Learning Communities at
the Medical College of
Wisconsin: Past, Present &
Future
Cassie Ferguson, MD, Kurt Pfeifer, MD, Marty
Muntz, MD, Cassidy Berns, Kaicey von
Stockhausen, and Adina Kalet, MD, MPH
This Kern Institute team describes their work on the rapid evolution of Learning Communities at MCW and the proposal for expanding the effort putting the learner at the center of education ...
The new academic year is upon us. New medical students arriving in Milwaukee
will be find a campus than that looks very different from the one they saw on
interview day. Orientation will be mostly virtual. Those unscripted moments and
chance encounters that allow students to make connections with new people in
the first few weeks of school will be few and far between. Everyone will be
wearing masks and sitting at least 6 feet apart in classrooms. There won’t be
the option to wander the hallways or find that perfect place to study. It all must
be scheduled in advance.
These changes to medical education necessitated by COVID-19 pandemic are
layered upon the preexisting challenges of rapidly expanding biomedical
knowledge and increasing time and fiscally constrained clinical environment.
These challenges may have compounding consequences, including burnout and
increasing rates of depression, anxiety, and suicidality. To better support our
students and to help promote a sense of connection and community amidst
social isolation, the MCW School of Medicine (SOM) is implementing learning
communities (LCs).
LCs were first developed on undergraduate campuses to foster professional
growth of students with similar academic interests. LCs partner faculty
members with groups of students longitudinally to promote communitybuilding, academic and personal support, professional development, and
curricular activities. LCs transform the medical school curriculum from coursestructured to learner-centered; putting the student- embedded in cohesive
communities, at the center of the curriculum.
Since the early 2000s, many medical schools have implemented LCs, and a
2012 survey showed that 52.4% had LCs and 48.3% of those without them
indicated that they were considering creating them.1 Studies of LCs have
demonstrated substantial improvements in faculty engagement, student wellbeing, and professional development.2 2018 surveys of MCW students and
faculty conducted by the Kern Institute confirmed strong support for the
implementation of LCs.
With implementation of a pass/fail course grading system for the first two years
at MCW, a strong system of mentorship for students is imperative not only to
identify students who would benefit from additional support and intervention,
but also to encourage students who are already successful to develop goals in
the pursuit of excellence. LCs can promote inclusive behaviors and ensure
effective transitions for all students. Finally, as the COVID crisis persists and
social distancing limits interactions between students and faculty, LCs are an
excellent means of assuring support for students and development of student faculty relationships.
Current State of Learning Communities at MCW
REACH Well-Being Curriculum
As referenced above, LCs can positively impact student well-being. Growing
evidence detailed in the National Academy of Medicine’s 2019 report on
professional well-being indicates that learner burnout may negatively impact
the quality and safety of patient care, the adequacy of the workforce, and the
professionalism and personal health of learners. While system factors are the
major contributors to burnout, attention to well-being in the learning
environment may mitigate their effects.
In Fall 2019 at the MCW SOM with much support from Academic Affairs and the
Office of the Dean, the Kern Institute Student Pillar implemented a well-being
curriculum aimed at teaching well-being skills and providing opportunities to
talk with and learn from peers and faculty members. The REACH (Recognize, Empathize, Allow, Care, Hold each other up) curriculum, which is intentionally
structured as longitudinal groups of faculty, staff, and students, uses an LC
model.
Designed and directed, by Dr. Cassie Ferguson, Director of the Kern Institute
Student Pillar, The objectives of the REACH curriculum are to describe how the
well-being of medical students, trainees, and physicians is integral to becoming
caring and competent physicians; and, to identify characteristics and practice
the skills that will help students thrive in medicine. The curriculum is designed
around research-based best practices across several disciplines, including
psychiatry, positive psychology, and mindfulness; pilot program data; and,
interviews with students. The content emphasizes the importance of several
fundamental concepts: storytelling, embracing vulnerability, nurturing selfcompassion, creating space and opportunity to examine one’s thinking
patterns, developing emotional health, and fostering community. These
concepts are woven into discussion of core topics including seeking behavioral
health help, community building, creating boundaries, mindfulness, meditation,
suicide prevention, imposter syndrome, productive generosity, beginner’s
mind, digital minimalism, and looking for joy in the learning and practice of
medicine.
REACH consists of four didactic sessions and three facilitated small-group
sessions in the first year, and three didactic sessions and three facilitated
small-group sessions in the second year. Each small group comprises 10
medical students and two volunteer facilitators- a clinical faculty member and
either a behavioral health expert (some of whom are also clinical faculty
members) or a student support staff member. Facilitators receive detailed
session guidelines with learning objectives, suggested discussion questions,
activities, and links to related resources (e.g., didactic session videos, podcasts,
articles, books).
Evaluation of the curriculum was accomplished through a 17-question survey
made up of Likert scale and open-ended questions completed by 62 students
at MCW-Milwaukee (30%). 85% of respondents believed that what they were
asked to learn in REACH was important; 70% would recommend that other
medical schools adopt REACH. The REACH small group sessions played a
significant role (>70%) in building relationships with peers and faculty.
Students commented on the benefits of getting to know their peers, realizing
they were “not alone” in how they felt, and feeling faculty were genuine and
cared about them.
4C Coaching Program
The Kern Institute at MCW identified LCs as also having great potential for
pursuing innovations supporting character and caring in medical education.
After exploration of LC-related components and features with Kern National
Network partners and MCW students and faculty, the Coaching for Character,
Caring, and Competence (4C) program was launched in August 2019. 4C is
structured around the core concept of LCs – groups of students and faculty in a
longitudinal relationship to cultivate professional growth. Within this
framework, multiple different components can be implemented to meet specific
objectives (See diagram). Roughly 50 students volunteered for the program during
AY2019. 13 volunteer faculty were grouped with 3-4 students each, and these
groups meet monthly covering character and professional development topics.
In addition, faculty meet individually with each of their students every other
month. The program is directed by Kurt Pfeifer, a faculty member in the Student
and Curriculum Pillars of the Kern Institute.
With its initial launch, 4C centered on longitudinal coaching at the Milwaukee
campus, but in AY2020, near-peer mentorship will also be piloted, and
activities will be extended to the Central Wisconsin campus.
Initial data show great support for the program as a whole and strong impact
on development of mentorship and support for students and sense of faculty
engagement. Students in the program were less likely to have feelings of
isolation and reported strengthening of several character traits, including
perspective, self-regulation, perseverance, and social intelligence.
Incorporating Learning Communities into Curriculum for Fall 2021
The Office of the Dean identified a pressing need to intentionally and
thoughtfully expand on the existing LC structures at the MCW Milwaukee
campus this fall. As detailed above, LCs can mitigate the potential
consequences of social distancing rules by providing a “home” for every student
and built-in opportunities for connection with peers, faculty, and support staff.
Based on discussions between Academic Affairs, Kern Institute faculty, Dr. Lisa
Cirillo, Jennifer Hinrichs, Mary Heim, and Dean Kerschner, a proposal was
created for a longitudinal, tiered structure of LCs, where smaller groups of
students roll up into larger groups of students allowing for intimate discussions
without missing out on interacting with a variety of people. The objectives,
activities, and facilitation of each group will be appropriate for their size and
will enhance students’ experience and learning at MCW.
Class of 2024 will be broken into 5 “On-Campus Learning Groups” each of
which will be broken into three Orientation Groups of approximately 16
students each (again, depending on the size of the class). These groups will be
established during the Orientation week. The Orientation Groups will be broken
into two REACH Groups. The REACH curriculum is currently a mandatory part of
the Clinical Apprenticeship course (conducted in the spring of M1 and fall of M2
years). Dr. Ferguson, Director of REACH, is engaging in discussions with
Academic Affairs and Dr. Cirillo about incorporation of REACH into the
Foundations of Clinical Medicine and Foundational Capstone courses as well.
Students will additionally have the option to sign up for the 4C coaching
program, which has groups of 4 students led by a volunteer faculty coach and a
near-peer coach (M3 student). Current plans are for two 4C coaching groups to
combine to form a REACH group, with the 4C faculty coaches also serving as
those students’ REACH facilitators. Because the 4C Coaching Program is
optional, not all students will receive this content.
Vision for the Future of LCs at MCW
We envision LCs evolving to provide a longitudinal structure that both supports
and challenges each student as they achieve required competencies and
develop and pursue individual goals at MCW. Students will be welcomed into an
intentionally created group of peers, faculty and staff that will provide a sense
of belonging from Day 1 at MCW – with LC faculty leading small group activities
during Orientation and presenting the coats to their group at the White Coat
Ceremony. With consistent expert faculty and staff guidance, LCs will provide
meaningful opportunities for shared learning, peer teaching, and social
connectedness through the challenges and joys of medical school that we are
currently unable to guarantee given our large class size and reliance on a
traditional curricular and advising model. LCs will also enable MCW to more
fully transform to a competency-based education model of learning and
assessment, as each student and their LC faculty share responsibility in
ensuring that progress toward competence and excellence is consistently
pursued. The bond among LC members will grow with time and shared
experiences, culminating with the opportunity for LC facilitators to
meaningfully participate in the Hooding Ceremony and Commencement. Both
faculty and students desire and would greatly benefit from the realization of the
community described in this vision statement.
Cassie Ferguson, MD, Kurt Pfeifer, MD, Marty Muntz, MD, Cassidy Berns, Kaicey
von Stockhausen, and Adina Kalet, MD, MPH are working on the rapid evolution
of Learning Communities through their work at the Kern Institute, Medical
College of Wisconsin.
1 Smith S. Acad Med. 2014 Jun;89(6):928-33.
2 Eagleton S. Adv Physiol Educ. 2015;39(3):158-66. Smith SD et al. Acad Med. 2016;91(9):1263-9. Rosenbaum ME et al. Acad Med. 2007;82(5):508-15. Wagner JM et al. Med Teach. 2015;37(5):476-81.
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