ThriveOn, a Community-Centered Collaboration, has Broad-Reaching Focus Areas

 

From the 9/25/2020 newsletter

ThriveOn: A Community-Centered Collaboration has Broad-Reaching Focus Areas

The community-centered collaboration led by the Medical College of Wisconsin (MCW), the Greater Milwaukee Foundation (GMF), and Royal Capital Group has chosen the name of the ThriveOn Collaboration as the organizations continue deep resident and stakeholder engagement together to inform priorities and investments for supporting a thriving King Drive corridor and its connected neighborhoods.

The ThriveOn Collaboration champions a vision for a Milwaukee that is equitable, healthy and thriving for all. Achieving this vision will require durable partnerships with the community, focus on places where investment has been scarce, and supporting people of color, especially African Americans, who are disproportionately affected by health and economic disparities.

The ThriveOn Collaboration is built on the fundamental understanding that where a person lives has a tremendous impact on their health and wellbeing because housing, education, jobs, health resources and social connections are the underpinnings of healthy lives and communities. Consequently, a key component of the ThriveOn Collaboration is a place-based investment in the redevelopment of 2153 N. Martin Luther King Jr. Dr. into a community hub with neighborhood amenities, and offices for key MCW centers, institutes and programs and the Foundation’s new headquarters.

Extensive dialogue with residents, deep analysis of local and national data, and years of expertise in their respective sectors has shaped the collaborators’ approach to identifying priorities and developing thoughtful contributions that will add value to the community. The ThriveOn Collaboration’s corresponding strategies are designed to counter systemic racism and disinvestment that has negatively impacted black and brown communities in Milwaukee for generations.

The ThriveOn Collaboration has identified five priority areas. Many of the priorities directly relate to MCW’s 2025 goal of “Health of Our Community.” The long-term goals under this overarching goal includes ensuring all subsets of our community thrive, enabling the greatest positive engagement with our community to faculty, students and staff and demonstrating improved health of vulnerable populations and overall health of our community by leveraging MCW’s strengths.

The priority areas of the ThriveOn Collaboration are informed by the social determinants of health, factors that contribute significantly to health such as where people live, access to healthy foods and affordable housing, and social support networks. 

• Housing – invest in the availability of safe, quality and affordable housing for area residents. The long-term goal is to increase the number of residents leasing, purchasing, and maintaining homes with a focus on keeping long-time residents in the neighborhood.
• Early Childhood Education – invest in the quality, access and sustainability of early childhood education in the city. The long-term goal is to improve education outcomes for youth.
• Health & Wellness – investing in access to health and wellness facilities, healthy food options and preventive health services in the area. The long- term goal is to reduce rates of chronic disease and increase quality and length of life.
• Social Cohesion – support the community in building positive social and business relationships, celebrating diversity and promoting a sense of belonging among neighbors. The long-term goal is to increase resources for resident-led events and organizations.
• Economic Opportunity – support small business and enhance equitable economic opportunities for entrepreneurs and the local workforce. The long-term goal is to increase the stability of the small business community and increase access to quality jobs.

“Health of our community and moving toward health equity is more important than ever before, as demonstrated during the global pandemic of COVID-19,” said Greg Wesley, Senior Vice President of Strategic Alliances and Business Development for MCW. “By building upon MCW priorities, honoring this community's history, culture and people, and by listening and collaborating every step of the way, we are moving forward with GMF and Royal Capital Group to inspire change and action.”

The ThriveOn Collaboration reflects the values of the community shared through continuous dialogue and participation among residents, the collaborating organizations and other community leaders. The feedback helped shape the collaboration’s goals and how the work moves forward. Community engagement for the ThriveOn Collaboration remains active. Staff members currently are holding virtual office hours, and the team is establishing a Community Advisory Council (CAC). The goal of the CAC is to further integrate community perspective and participation by ensuring residents have additional decision-making power within the collaboration. The role of the CAC is to include a community voice in grantmaking and program initiatives that promote an equitable, healthy and thriving community with a focus on the Harambee, Halyard Park and Brewers Hill neighborhoods.

The ThriveOn Collaboration has been working to implement its vision and priorities. Its commitments in community have included:

• Helping to prevent resident displacement through partnership in the MKE United Anti-Displacement Fund. Housed at the Foundation, which contributed seed funding, the Fund so far has provided about $37,000 in property tax relief to 114 homeowners in the Harambee, Halyard Park,Brewers Hill and Walker’s Point neighborhoods, the majority of whom were over 60 years old.
• Approving approximately $100 million for joint investment in building improvement and development, including streetscaping and exterior art and green design.
• Providing more than $13.2 million in grants through the Foundation and in support of COVID- 19 relief, response, and recovery related to food, shelter, health, education, economic stabilization and more.

When redeveloped, the collaboration’s corresponding Milwaukee location on King Drive and, adjacent to Dr. Vel Phillips Avenue, will support health and growth, and be a destination where Halyard Park, Harambee and Brewers Hill neighbors can interact, learn and share.

MCW feels this is a return to its roots. For 34 years, from 1898 to 1932, MCW’s predecessor institutions (Wisconsin College of Physicians and Surgeons, which became the Marquette University School of Medicine) were located in Halyard Park in a building located on the southeast corner of Fourth Street and Reservoir Avenue. Next to the medical school was its dispensary (now called outpatient clinics) where medical students observed faculty physicians treated indigent patients. Across the street from the medical school was St. Joseph’s Hospital, the medical school’s primary teaching hospital.

For more information or to get involved with the ThriveOn Collaboration, please visit our website atthriveoncollaboration.org.

Kevin Newell from the Royal Capital Group, Ken Robertson and Ellen Gilligan from the Greater Milwaukee Foundation, and Dr. John Raymond from MCW were instrumental leaders for this initiative.

RBG and Dad

From the 9/25/2020 newsletter

Director’s Corner
 

RBG and Dad

 
Adina Kalet, MD MPH
 
 

In this Director’s Corner, Adina Kalet tries to reconcile the awesome vulnerability of being a patient, the potential transformative power of our profession, and the lessons learned from the life of an American hero.
 
 
This week, the death of Justice Ruth Bader Ginsberg has been on my mind and, as I considered what to share in my column, I realized how important she has been to us. I have benefited from, and been moved by, her critical and prophetic message that, “Women belong in all places where decisions are being made.” For women of my generation, this was not the norm and it is still far from a guarantee. Thanks to the work of RBG and a handful of others, some of us now find ourselves “at the table,” making decisions and expanding our spheres of influence as we attempt to make the world a better place. Her work led directly to transformative change. Many of us who would have otherwise been sidelined are now heard in ways that would never have been possible without her. 
 
Ruth Bader Ginsberg was an American hero and transformational leader, par excellence. People on all points of the political spectrum have noted her uncanny ability to listen, her impact on society, her brilliance and courage, her prophetic legal mind, her ability to see things as they should be for all people, and her perseverance. I have medical colleagues who take on the challenges inherent in medicine the same way.
 
 
This week, the chance to be heard became personal.
 
 
I am writing this column while sitting in a hospital waiting room, the daughter of someone suddenly thrust into the medical system. In my new unwelcome role, I feel vulnerable and less assured of the value of my personal “power and influence.” I had planned to write about RBG’s life and legacy. Instead, I find myself searching for parallels between how she leveraged her knowledge of the legal system for change and my need to exercise my familiarity with the medical system to make certain my father stays safe. Like her, I remain vigilant, paying attention to everything that is happening around us, and advocating on my father’s behalf. It can be exhausting.
 
My dad is a remarkably fit 84-year-old retired engineer who presented this past Tuesday to his internist with classic symptoms of exertional angina in a crescendo pattern. Dad’s EKG had developed non-specific T-waves that suggested something amiss. He was walked down the hall to the cardiologist who then called the interventional cardiologist who scheduled a cardiac catheterization. He was admitted to the ER for monitoring. His first troponin levels (an indicator of heart muscle cell damage) were equivocal, suggesting heart muscle cells were spilling their contents but he didn’t appear to be having a full-blown heart attack. 
 
For context, my dad sees a doctor in the large academic medical center where I did my residency training and spent the first thirty years of my career. I know this place and these people – warts, glory, and all. Even though I had confidence in his care team, I was terrified. I knew too much. I never left his side because, over the years, I have seen all of the things that can go wrong even when everyone is well meaning and highly qualified. 
 
From the patient’s (and the daughter’s) perspective, hospital care separates individuals from everything familiar. There are endless streams of humans with uncertain duties, repeated handoffs between nurses, physicians, and other staff, long (ten hour!) waits in the ER until a “clean bed” becomes available, no proffered food, malfunctioning cardiac monitors for a patient with a heart problem, a mix of disturbingly poor and remarkably skillful communications, and moments of caring and compassion juxtaposed with moments of “ghosting.” Even as someone who knows medicine and trained in the hospital where we now sat, the experience was dehumanizing.  
 
Further, I could see the contrast between the technical, sophisticated wonders of modern medicine – cardiac catheterization suites with cutting-edge technology and physicians with impeccable expertise – and the troubling implications of the corporate commodification of healing in healthcare systems. Some patients in the city are offered luxurious private rooms with gourmet meals and spectacular views of the river while others – in the public hospital down the street – are offered no amenities. The public hospital’s professional expertise is, fortunately, comparable, but is also distinguished by the staff’s ability to offer excellent care despite their lack of resources. 
 
What’s the bigger picture here? How might we make healthcare more equitable? RBG had a wider vision of society, and she pushed the legal system to treat everyone equally no matter their gender or status. In the same way, visionaries in medicine envision a future where every person is entitled to safe, high quality, compassionate, cost-effective healthcare. We must include the most vulnerable patients, even as she fiercely advocated for all members of society. We will face challenges along the way, just as she experienced blatant interpersonal and institutional sexism during her career. 
 
She demonstrated that to be transformational, we need to be persistent. There was a moment, early in her time at Harvard, when RGB and the small group of women classmates were challenged by the law school dean to defend why she “took” a man’s spot in law school. They demonstrated their value with their actions and dedication. They showedthat they belonged. Later, despite graduating at the top of her class and being part of the law review, she could not get a clerkship or even a job with a law firm. She chose an alternative path, doing comparative international law research, joining a law school faculty, and creating her own way forward. She ended up changing the world. 
 
To achieve transformation, we will need to engage – like RBG did – in necessary, nuanced, and difficult conversations. She had a clear moral compass. She was able to change her mind, to be influenced by others, and to learn deep and abiding truths about human dignity from those whom she loved and especially from those she didn’t know. With these character traits, it is possible to engage in respectful, caring, civically responsible, and sometimes fierce dialogues on contentious issues, including the inequities in health care and society. “You can disagree without being disagreeable,”she said. “Fight for the things that you care about but do it in a way that will lead others to join you.” Although being patient enough to work through issues can be a huge challenge, her long view of history allowed her to dissent while remaining part of rich, mutually respectful, humble relationships with those with whom she fundamentally disagreed. Her ability to persuade without fracturing human connections is one of her most important legacies and lessons. 
 
 
I accompanied my dad on his journey this week. Happily, he had the best possible care and had a wonderful outcome despite the frightening situation. I advocated for him, speaking up and influencing the system when it faltered. But mostly, we realized that the outcome was a result of the fundamental commitment of his medical professionals to care for someone in need. 
 
RBG, too, depended largely on the goodness of people working in the legal system, although she did not allow that faith to keep her from being a vigilant advocate when she felt it was needed. She believed in the goodness of others, but also that she had the responsibility to drive the change. She persisted and the world is a better place because of it. May we all be inspired by her courage and passion. 
 
 
 
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.
 
 
 
 

The Unsolvable Tension Behind Good Intentions: Confronting Sincerity and its Shadow

From the 9/18/2020 newsletter
 
Student Perspective/Personal opinion 
 
 
The Unsolvable Tension Behind Good Intentions: Confronting Sincerity and its Shadow 
 
 

Jess Sachs, M3, explores the complex relationship between intentions and actions as she seeks to understand anti-racism and navigate her way toward being a consistent, effective ally. 
 
 
Like many, I have become increasingly motivated to step up and advocate for justice and equity. Also, like many, I struggle to determine where I am most needed and how to strike the delicate balance between white savior and white ally. So, when advocating for Black lives became “trendy” again in May after the death of George Floyd, I decided to do what plenty of other people started doing, which is committing to learning about social justice and anti-racism work and then...posting about it online. Otherwise known as “performative allyship,” or “slacktivism” in colloquial terms, this trend is something that white people like myself have an embarrassing history of participating in—that is, temporarily caring, and engaging in the work of reading, listening to, and advocating for Black people until our own lives become too “important” to continue pursuing meaningful activism. Nevertheless, I was drawn into this engagement, but this time I committed to doing it “right.” This would not be another time loop, another performance of the same pieties we have played out time and time again. What I ultimately intended to learn about was the death of Breonna Taylor. 
 
If you haven’t heard about Breonna Taylor, hers is the story of a Black woman losing her life to police brutality, a tragically common occurrence. Breonna was an EMT who was fatally shot by police officers attempting to serve a no-knock warrant on her home on March 13, 2020. (Brown & Duvall, 2020). The chronicle of her death is senseless, tragic, and heartbreaking. Why I became particularly attached to this specific tragedy, I am unsure. Perhaps it was because of the similarities between Breonna and me. We are the same age and working in the same professional field. Perhaps it was also because the case continues to evolve as new information leaks out - information that is often contradictory and confusing. 
 
Regardless, her story has become a source of painful preoccupation. Much of my time is spent searching twitter and Instagram with the hashtags #Breonnataylor, #justiceforbreonnataylor, #breonnaslaw, in an effort to absorb and learn everything I can about her. I attend Zoom Call to Action meetings. I read stories written by her sister and her mother. I donate to the Louisiana Until Freedom organization. I aim to become an expert in her case, because for the sake of our humanity, I did not want this to be another example of futile action. I vowed that my involvement would be one of the many steps in the proper direction of acknowledging systemic racism and advocating for justice. 
 
Recently, however, I read an article exploring how Breonna Taylor’s trending name has gone from a call to action to an oversimplified meme. Zeba Blay, the author of the piece writes, “Turning Breonna Taylor into a meme, then, risks turning the conversation around what justice looks like for her into a temporary fad.” This was my biggest fear. By reading and posting everyday, perhaps her story and her name were ultimately losing meaning. I questioned if I was becoming desensitized to the true goal of this work and blindly following a fashionable fad that looked like, but had nothing to do with, justice. This was never my intention, I kept thinking. And herein lies the complexity and confusion with our intentions. Below the surface of our rational minds lies a traffic intersection of contradictions, within which we ask this question: Is what we do substantive or simply another manifestation of our hopeless hypocrisy? Were my efforts simply designed to temporarily absolve my own white guilt? Was this true allyship, and is that even the goal? 
 
The answer to these questions? I still don’t know. What I do know is that my intentional actions to dismantle white supremacy will never be enough. What I do know is that my unintentional actions have maintained a culture of oppression and racism. Our personal truth is always far amore complicated than it seems, and reflection is necessary as we confront these feelings of guilt, discomfort, and confusion. But we continue to commit to meaningful causes, even if our motivation remains imperfect and clumsily emerges from a welter of conflicting impulses. It is of little value to attempt to fully reconcile our own emotions and intent after 400 years of unreconcilable damage done to Black people. Writer Tre Johnson says it best when he comments, “The confusing, perhaps contradictory advice on what white people should do probably feels maddening. To be told to step up, no step back, read, no listen, protest, don’t protest, check on black friends, leave us alone, ask for help or do the work — it probably feels contradictory at times. And yet, you’ll figure it out. Black people have been similarly exhausted making the case for jobs, freedom, happiness, justice, equality and the like. It’s made us dizzy, but we’ve managed to find the means to walk straight.” My ncertainty regarding the best pathway to follow in the direction of social justice is of little importance when compared with the uncertainty of not knowing whether calling the police will end in your safety or in your murder. Thinking critically and listening to those who have been doing this work for decades and centuries is indeed necessary when it comes to broadening and deepening the conversation about how to best move our nation towards a more just and equitable society. 
 
I wouldn’t be my father’s daughter if I didn’t mention a Jewish tale that comes to mind as I write this. Once, a wealthy disciple came to the Alter Rabbi, R. Schneur Zalman of Liadi, and said that he had been contemplating opening an orphanage, but had since abandoned the idea. Having mulled over the project, he came to the conclusion that he was only doing it to gain more respect in his community. The Rabbi lifted his eyes and told him firmly to go ahead with the orphanage, reasoning that, “While perhaps you may not mean this sincerely, the poor young orphans who will eat hot meals and sleep in comfortable beds will certainly do so sincerely.” The Rabbi understands that his disciple’s motivations are not entirely “pure”, yet the Rabbi also understands that there is still value to motivations that have a higher purpose even if they are partially spurred by energy that is not entirely rooted in ethical rectitude. Moral aimmaculacy is not a pre-requisite for moral action. Good intentions will not solve the problems of systemic racism and police brutality. Regardless, we commit to action because our lives depend on it and because we must take on the issue of racism as our own. As I continue to reflect on my efforts to pursue this particular summons to action, one point has never shifted-- Breonna’s Taylor life mattered. While it might take more time for all the facts surrounding her death to be revealed, it is an honor to learn her story, and with every action that I take, be it right or wrong, intentional or unintentional, I refuse to let her name and her story be forgotten. 
 
 
References: 
Brown, M., & Duvall, T. (2020, June 30). Fact check: Louisville Police had a 'no-knock' warrant for Breonna Taylor's apartment. Retrieved September 16, 2020, from https://www.usatoday.com/story/news/factcheck/2020/06/30/fact-check-police-had-no- knock-warrant-breonna-taylor-apartment/3235029001/ 
 

The Life Bus Project: How two MCW Medical Students engaged in Social Innovation

From the 9/18/2020 newsletter

Student Perspective

The Life Bus Project: How two MCW Medical Students engaged in Social Innovation

Medical Students Kelli Cole & Gopika SenthilKumar describe how they partnered and utilized their passion, ingenuity, entrepreneurial mindsets, and community support to design a real-world public health solution which gave them a transformative learning experience.

We remember March 2020 clearly. The two of us, were looking forward to getting started on our Kern Institute TI2 project and finalizing our summer lab rotations. Suddenly, there were constant news updates about rising death tolls around the world and an incoming sense of doom as the pandemic spread to the US. As we watched the initial responses, we could not help but notice all the ways that our healthcare systems were not prepared - personal protective equipment (PPE) shortages, disproportionate impact on vulnerable and low-income communities, intensifying health disparities, fear amongst frontline healthcare workers. In an effort to help, we put together a grassroots team of students, physicians, scientists, and engineers for the Johns Hopkins COVID19 Design Challenge held in early April. Life Bus, the solution that sprouted from the competition and evolved since, has not only allowed us to persist towards improving healthcare delivery and access starting in our own MKE community, but has also been an incredible opportunity for growth and reflection.

In this article, we hope to share our story and reflect on our key takeaways/learnings thus far.

During the competition, our team (click our link here) conducted a rapid needs assessment and identified three key needs:

1. Protecting frontline healthcare providers 
2. Reaching vulnerable populations
3. Conserving PPE

Our solution was designed to meet all three of those needs by temporarily repurposing city buses into mobile COVID19 testing and triage centers. Life Bus incorporated key design solutions (physical barriers with gloves to overcome PPE shortage, indoor/outdoor models, creative vital sign collection, existing infrastructure/routes of city buses) that were truly made possible because of the multidisciplinary nature of our team and mentors. The 5-day challenge opened our eyes to the impact of the pandemic on various aspects of our society and uncovered avenues for improvement/change.

The Kern Institute provided invaluable support and local connections to further the project.

After the competition, we showed our idea to front-line providers, healthcare administration, and the Kern Institute. Given the overwhelmingly positive response and incredible support from the Kern Institute, our team decided to continue working on Life Bus. For the rest of the spring semester, we improved our design, added valuable team members, and identified other key stakeholders who could help refine and implement Life Bus. Balancing our roles as early-career professionals in this project while also juggling medical school courses challenged us to improve practice in these areas that we may not have otherwise gotten this early in our medical education.

Over the summer and at the beginning of our second year of medical school, the two of us participated in the National Science Foundation I-Corps program to develop a sustainable business model for Life Bus. We conducted 50 interviews with community partners, Wisconsin’s COVID19 testing committee, students, physicians, transit companies, outreach organizations, manufacturers, and private and public health systems. We are beyond grateful for the time and advice from everyone we interviewed and are honored that many of them are still involved and supportive of our initiative. Our conversations helped confirm the need for sustainable (i.e. not depleting PPE or straining our healthcare workforce) mobile healthcare and highlighted the feasibility of our project. Through this process, we developed entrepreneurial skills such as hypothesis-driven interviewing, synthesizing subjective feedback into tangible ideas, and asking for buy-in from higher-level executives. This opportunity taught us how to vet an idea based on customer discovery and pivot based on the information learned to create a refined solution. Moreover, we were mentored by inspiring local entrepreneurs who continue to provide us with constructive feedback and guidance as we move forward.

Life Bus is addressing ‘real-time’ issues from the pandemic in Milwaukee

All through this project, a common theme that kept arising was how ‘healthcare access has been a long-standing challenge in the Milwaukee community, and the pandemic merely intensified the problem.’ It became clear to us that Life Bus needed to not only provide COVID19 testing and triage but also focus on addressing basic health needs, building sustainable mobile care, and establishing a model for long-term continuity of care. This way, Life Bus is not just a “band-aid” for the time being, but rather a solution to the underlying etiology. We now envision our work as a necessary extension of our current healthcare delivery model, and we view it as a sustainable method for bringing care to the patients rather than relying on their ability to come to us.

There is still a lot of work to be done before Life Bus becomes a reality in MKE and beyond, but we are excited to see what the future holds. Our work has further exposed us to the innovation, engineering, public health, and business sides of medicine. It has allowed us to integrate our individual backgrounds (in basic science and education for Kelli, and in engineering and design thinking for Gopika) as well as our passion for medicine and public health, into a cohesive initiative that has the potential to tackle some of the challenges in healthcare delivery that have been exacerbated by the COVID19 pandemic. Someday, we hope contributing to real-world challenges becomes a part of our medical education. Not only does it expand our understanding of the numerous aspects of healthcare and its impact on our patients, but it also allows us to hang on to a sense of meaning and purpose even when feeling overwhelmed with coursework.

These few months have opened our eyes to the extent of health disparities and access deserts plaguing the Milwaukee community. As we move forward in our medical education, we plan to do our part in helping increase sustainable healthcare access in our community - through Life Bus and beyond. We would like to thank everyone who has contributed to our work thus far; it truly takes a village! This project would not be possible without all of your hard work, support, and mentorship! Please visit our website for more information on the project and team: https://covidlifebus.wixsite.com/website.

Kelli Cole & Gopika SenthilKumar are both M2 students in MCW’s MD/PhD Program.

"Questions from Milwaukee” Q & A with Reed Colling, MCW-Green Bay M4

 From the 9/18/2020 newsletter

Student Perspective

Life as an MCW Regional Campus Student

"Questions from Milwaukee” Q & A with Reed Colling, MCW-Green Bay M4

Associate Editor Olivia Davies (MCW-MKE M4) asks Reed Colling (MCW-GB M4) questions about what it’s like to be a student at one of MCW’s regional campuses.

Olivia: “Regional campus students have a different curriculum than MKE students. Refresh me on how that works, and what do you like better about it?”

Reed: “The curriculum during the M1 and M2 year are actually identical. The main difference is earlier clinical exposure and less time for electives. On the Green Bay campus, we start our core clerkships during the summer after M1 year. While it is challenging to start clinic before learning all the pathophysiology presented in the M2 year, starting to develop our clinical skills early on is super helpful as we progress through our education. One downside is there are only six weeks available for electives. By graduation, the difference between the main campus and the regional campuses is actually only twenty weeks of instruction.”

Olivia: “I know you’re applying Emergency Medicine (EM) this year and decided to do a fourth year, what does that process look like at a regional campus? How is your fourth year different than an M4 student on the MKE campus?”

Reed: “While the goal of the regional campus is to graduate as many students in three years as possible, the administration is very supportive of students pursuing whatever specialty fits them best! After you take USMLE Step 1, you submit an application requesting a fourth year outlining why it is necessary for your career path. In EM, you typically need to complete two EM rotations at a program with a residency which would not be possible during the accelerated curriculum. The application is then reviewed by both the MKE and regional campus. After a fourth year is approved, there is very little difference between an M4 student on the MKE campus and the regional campuses! We complete a mixture of rotations in MKE, on the regional campus, and away rotations.”

Olivia: “What’s one thing you wish Milwaukee students knew about being a student at a regional campus?”

Reed: “I think there can be a misconception that because the training does not take place in an academic center that it is less rigorous. Having done rotations at both campuses, neither is more or less intense, just different!”

Olivia: “What’s it like to be a part of a LARGE class (>200) but have a cohort of ~30 students you know really well? What benefits have you experienced as a part of a smaller regional cohort?”

Reed: “The smaller class size is one of my favorite things about being a student on the regional campus! The comradery that developed was really special and it wasn’t long until we were more like family than classmates. With a smaller group, it is easy to learn each other’s strengths and weaknesses so that we can all come together to succeed as a class.”

Olivia: “What challenges have you faced as a regional campus student?”

Reed: “The biggest challenge being a student on the regional campus is time management. Because of the truncated timeline and accelerated curriculum, it is easy to get overwhelmed. For example, within an approximately six-month time frame we take USMLE Step 1, complete core clinical rotations, fill out and submit ERAS, enter interview season, and take USMLE Step 2 CS and CK. I’m tired just typing it!”

Olivia: “What’s your favorite thing about being in Green Bay?”
Reed: “The people. Everyone really goes above and beyond to make us feel welcome and like

we are an integral part of the community. The occasional free Packers ticket doesn’t hurt either!”

Reed Colling is a fourth year medical student at MCW-Green Bay applying to residency in emergency medicine. He is passionate about public health advocacy and improving diversity and inclusion in medicine.

May I Drink Coffee?

 Student Perspective 

Interviewing in the COVID-19 Era

May I Drink Coffee?

Olivia Davies – MCW-Milwaukee medical student Class of 2021

I’ve tried three different zoom set ups, four if you count the one from my couch that I joke about. One of my friends has a bouquet of flowers set stage left on her screen, just in sight. I play with the tilt of my monitor to see if I can show the top leaves of my split leaf philodendron which sits on the floor next to me. Staring at the white wall behind me through the screen monitor I catch a glisten – is that grease? I turn around to examine it in real time, yup, grease. How did that even get there? To be fair, I am sitting next to the wall where our dinner table was just a mere two days ago before I declared it my new interview spot.

“Do you have the Milk Street Cookbook?” my fiancé calls from the other room. I sigh, removing it from the stack underneath my laptop. I know I should be grateful he’s making the grocery list this week (like he does almost every week), but doesn’t he understand we only have so many laptop-sized books in this apartment to elevate the built-in camera? I realize using Milk Street as my laptop prop probably won’t be sustainable.

One of my friends asked if I was planning to wear heels ... I guess I hadn’t thought of that. She smiles matter-of-factly and says, “I am, they make me feel put together, even if no one will see them.” She has a point, I think. I stand up shimmying out of the screen to go look for my suit jacket. Finally unearthing it from my closet I gasp at how dated it looks, were flashy gold buttons “in” five years ago? This won’t play well on camera. I sit back down and start to look for a simple suit jacket online.

Reaching for my phone to text my friend back, I glimpse my half hunched over frame in the monitor. “I think I’ll wear heels, too,” I say, un-pretzel-ing my feet from beneath me and placing them firmly on the ground. Before setting down my phone, I fire off one more text, “Do you think it’s OK to drink coffee?”

Olivia Davies is a fourth-year medical student at MCW-Milwaukee who is in the midst of applying for her dermatology residency. She is an associate editor of the Transformational Times. Follow her at @oliviamtdavies.

Front Line Adjacent: A Reflection on being Removed from Clinical Rotations

 

From the 9/18/2020 newsletter

Student perspective

Front Line Adjacent: A Reflection on being Removed from Clinical Rotations

David Lambert - M.D. Candidate, Class of 2021

I was just over two weeks into my internal medicine clerkship when I first heard the news that medical students would be removed from rotations due to COVID-19. I was filled with a flood of emotions. I was sure by then that I wanted to go into internal medicine, so of course I was disappointed I would not be able to finish our rotation. But I was mostly sad to say goodbye to the team. In just two weeks, we had already experienced late nights, challenging call shifts and difficult cases. We had experienced a range of emotions together and formed a deep sense of trust that made them feel like more than just coworkers. These are the very elements that are important for providing quality care. These elements also made it very hard for me to say goodbye. I realized that a team that I had come to genuinely care about would be facing a global pandemic that we still knew very little about.

As our rotations moved online, my days were filled with uncertainty. Each day, we would receive updates from the school and hospitals. Everyone was trying to react, to do the right thing, and to ease our anxiety. Third-year medical students are used to adapting to changing environments-we are never in the same rotation for more than four weeks. However, moving online felt profoundly different. In some ways, I felt like an imposter-not knowing when we would see another patient made me feel like I was just pretending to be a medical student. I had become accustomed to finding ways to be helpful in my rotations and seeking every possible opportunity to learn how to be a good physician. However, now as I sat at home with my laptop in front of me watching the coronavirus numbers rise, I felt helpless. I was fearful for the world, our nation, and my colleagues in the hospitals.

As our country went on lockdown, I watched as COVID-19 cases and deaths rose. I also watched as personal protective equipment became scarce, as unemployment rates rose, and as people began to fear losing their homes or becoming evicted. In some ways, I was fortunate as a medical student. Although my education looked different, I did not need to worry about feeding a family or finding a new job. A break in my education meant my anxieties centered around whether I’d be prepared for residency, whether I was falling behind my peers, or whether I would graduate on time. However, this felt selfish compared to the experiences others in our country were facing. When we commit to medical school, we commit to the very principles that guide physicians to do right by their patients and their profession. I felt a deep sense of guilt in not being able to do anything meaningful to help my team or fight the pandemic.

After nearly three months of not seeing a real patient, I was so excited to round on my first day back. It has been incredibly special to be able to continue to see patients and be a part of the teams that lift each other up again. I feel lucky to be going into the field of medicine and this pandemic has made me prouder than ever to be working alongside the dedicated and passionate people that continue to care for patients. I am also grateful to the dedicated staff at the Medical College of Wisconsin who worked incredibly hard to help us rapidly shift our rotations and courses completely online, all while working from home and managing their own personal and family challenges. Faculty made me feel like my education was a priority, even when this was not easy to achieve. I am proud to be part of the MCW community.

The future of our profession must find their voices

  

From the 9/18/2020 newsletter

The future of our profession must find their voices

Adina Kalet, MD, MPH

Dr. Kalet celebrates the 25^th and first student edited issue of the Transformational Times and argues for the critical importance of strengthening student voices in the transformation of medical education. 

“I write entirely to find out what I'm thinking, what I'm looking at, what I see and what it means. What I want and what I fear.”

- Joan Didion

COVID-19 and the events of the last 6 months has provided us all with a classic disorienting dilemma. According to Mezirow’s transformative learning theory, disorienting dilemmas occur when people have experiences that do not fit their expectations and that they cannot resolve without changing their world views and challenging basic underlying assumptions and beliefs. This perspective transformation is not a common event, but when it does happen, theory has it, profound learning occurs. A strong professional identity is facilitated by these uncomfortable or distressing experiences when coupled with an ability to reflect on what one has learned- usually in writing- and expert support from coaches, mentors, faculty, peers, or others (Kegan & Lahey, 2009).

There is a great deal of evidence that cultivating an ability to write reflectively, expressively and stylistically well is critical to “locking in” learning experiences for the long run- especially if those experiences are emotionally intense. But good reflective writing requires effortful practice. Even for those who do it for a living and find it pleasurable, good writing is never easy. In these very stressful times- given the potential for transformative learning- I believe we should encourage our trainees to cultivate a habit of reflective writing.

These early years of their professional lives in health care will shape them as individuals and as a generation. This current crisis is not over and there are more crises ahead. Hearing from, listening to and engaging with our junior colleagues will be vital to ensure a physician workforce not only ready to serve with expertise, character and passion, but also that as individuals they will be hardy enough to learn from crisis.

Here are my considerations and wonderings for our students in these tumultuous times:

• How will this moment in history imprint on them? What will it mean that they entered our profession during a respiratory virus pandemic, a time of unprecedented political polarization, inescapable consequences of racism, and looming climate disasters?
• What are they learning about the role of physicians in society? How do they imagine their own futures? Are they becoming braver and or more fearful in the face of these challenges? Do they hear and trust their inner voices? Do they perceive their own moral compasses? How do they discern which role models to emulate and which to ignore? 
• How will this moment in history imprint on them? What will it mean that they entered our profession during a respiratory virus pandemic, a time of unprecedented political polarization, inescapable consequences of racism, and looming climate disasters?

In this, our 25th issue of the Transformational Times, hopefully the first of many student-led issues, we highlight stories of profound learning. We now have five students on the editorial board - Olivia Davies, Scott Lamm, Eileen Peterson, Sarah Torres, & Anna Visser - who have worked to bring forth a range of student voices. 

• Kelli Cole & Gopika SenthilKumar describe how their plans for their TI2 and summer projects rapidly evolved -because they courageously and adventurously allowed them to- toward a cutting edge, mentored experience in design for healthcare. 
• Jess Sachs shares her inner struggles and “true north” sources of inspiration as she navigates the extreme discomfort of trying to do right thing as a White woman in the face of racism. 
• Reed Colling describes his experience as an MCW student on the Green Bay campus and Hayden Swartz, from the Central Wisconsin campus shares a beautiful, deceptively simple poem. 
• David Lambert (a Milwaukee M4) describes the uncertainty of being pulled from the wards in March and the exhilaration of returning in June. 
• Olivia Davies ponders the particulars (heels? coffee?) of her upcoming momentous professional transition from medical student to Dermatology resident in a two-dimensional, waist up virtual world. 

With courage, effort and beauty our students share their thinking with us.

Students who view themselves as subjects of oppressive educational structures will not find the joy in the medical profession. In a transformed world of medical education students are active partners in and co-creators of their own education. To do this we must all hone our thinking and ability to communicate. Writing does just this, the act of writing makes things happen, inspires others, clarifies facts and encourages healthy mind-expanding transformational learning.

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Ref: Kegan, R., Kegan, L. L. L. R., & Lahey, L. L. (2009). Immunity to change: How to overcome it and unlock potential in yourself and your organization, Harvard Business Press.

Authenticity, Selflessness, Courage, and Team

 From the 9/11/2020 newsletter

Perspective

Authenticity, Selflessness, Courage, and Team

Kathlyn Fletcher, MD MA, Lily Littrell and Luke Littrell

On August 26, the Milwaukee Bucks were scheduled to play the fifth game in their best-of- seven playoff series against the Orlando Magic. But then they didn’t. The team did not take the floor, ready to forfeit an important playoff game. Eventually, we learned that the team had come to the painful decision that they could not play basketball in the wake of another shooting of a black man, this time close to home.

Jacob Blake, a black man from Kenosha, WI, was shot in the back by a police officer seven times on Sunday, August 23, 2020. The circumstances surrounding the shooting are still emerging, but what is clear is that we are once again facing an extreme, violent, life-changing action by law enforcement against a black man. Kenosha, Wisconsin, and the country were reeling. It all felt devastatingly familiar. And then the Bucks stepped in. Or rather, stepped away, firmly, quietly sending the most powerful of messages.

Next, the other NBA teams scheduled to play on that night joined the Bucks in declining to play. Some major league baseball teams, including the Brewers, followed suit as did the WNBA and major league soccer. The message was clear: The status quo is no longer acceptable. The violence and injustice must stop. I wondered, though, how the players would move forward. I asked my 10-year-old son, Luke, what he thought about it. He did not like it that the Bucks had refused to play because he thought that nothing would come as a result. He was glad that the Magic did not accept the forfeit, though. Then the players did something remarkable.

Chris Paul, president of the NBA Players Association and LeBron James reached out to former President Barack Obama for advice. They wanted to make this decision to stop the playoffs matter. Apparently, Obama told them to decide what they wanted, ask for it and then play basketball. The players’ act of resistance resulted in more polling places for the upcomingelection, and the formation of an NBA committee to work on racial injustice issues.

The willingness to forfeit a playoff game to call attention to the moment was a brave act of selflessness on the part of the Bucks. There was a lot at risk. In retrospect, I am not surprised. They have been living this message since the playoffs began. The entire NBA has worn jerseys with racial equity mottos and warm up “Black Lives Matter” shirts for months. Individual players have done more. Several Bucks players led a BLM protest in Milwaukee before reporting to the bubble this summer. And Kyle Korver’s t- shirt selection (often courtesy of the Happy Givers) has created quite the stir, at least in my house. My daughter, Lily, can’t wait to see what the next one will say (see her drawing). The most recent bore the words “When we’re not hungry for justice, it’s usually because we’re too full of privilege.” What has specifically resonated with Lily is that these acts don’t call attention to the individual players, they call attention to the movement. She is drawn to them because they seem authentic and selfless.

This is an important moment, and everyday people might also wonder, as Luke did, what protests will accomplish. While few of us alone have a voice strong enough to demand that our workplace become a polling place, we must find our equivalent of not accepting the status quo any longer. We must do it in an authentic and selfless manner.

Last week, the Bucks taught us about the courage required in taking a stand when it is hard and something is at risk. They also taught us about the power of the team. One player refusing to play would have been a much different statement than the whole team refusing. We also learned that our enemies are sometimes on our side. The Magic had everything to gain in that moment; they could have been down 3-2 instead of 3-1 in the series. But they stood together with the Bucks by declining the forfeit, and the whole league followed. The Bucks have shown us the path forward: Authenticity, selflessness, courage and team.

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Lily Littrell is an up-and-coming artist. Luke Littrell is an aspiring athlete and basketball lover.

On Inclusion, Diversity, and Why Black Lives Matter Too: What our MCW Community BLM Protests Mean to our Colleagues of Color

 From the 9/11/2020 newsletter

Perspective
 
 
On Inclusion, Diversity, and Why Black Lives Matter Too: What our MCW Community BLM Protests Mean to our Colleagues of Color
 
 
Leroy J. Seymour, MD MS - Internal Medicine – PGY1
 
 
Dr. Seymour writes about the recent MCW Black Lives Matter protest and why it is important to create a flourishing, diverse, and inclusive community … 
 
 

On Wednesday, Sept. 2^nd, at 5:11pm, members of the Medical College of Wisconsin community held a Black Lives Matter protest to help shine a light on the frequent propensity for violence against people of color. This latest protest is one of hundreds of protests against police brutality and racial injustice that have been occurring in various cities, states, and countries, most recently triggered by the murder of George Floyd on May 25^th, 2020, in Minneapolis, MN. So many people have demonstrated peacefully and expressed their voices, all vying for the same dream Martin Luther King Jr. expressed to the world. Almost every aspect of the world’s population has provided an overwhelming outpouring of support of the Black Lives Matter movement; taking the baton and relaying the message that “Black Lives Matter too” to widespread media coverage and the political stage.
 
MCW faculty, residents, and medical students alike raised their voices in support of the Black Lives Matter movement. This stance informed the world that MCW and the Froedtert medical community will not tolerate racism, and that racism itself is a pandemic that needs to be eradicated. The Sept. 2^nd protest involved holding 7 minutes of sustained silence, each minute representing every bullet maliciously aimed at the back of Jacob Blake, an unarmed African American man returning to his vehicle, by Rusten Sheskey, a Kenosha WI police officer. Mere seconds after an instinctive proclivity for violence towards nonaggression left a man paralyzed, the world responded with outrage and exhaustion, yet another example of the unfair mistreatment of people of color when interacting with those with a perceived position of authority.
 
Many of us have protested these injustices before. I've protested it before. Our parents protested it before. Our grandparents protested it before. Our ancestors survived and protested it. I’ve stood face to face with the Ku Klux Klan, neo-Nazis, and individuals who have all decided that racial slurs and anger were the best response when asked why they hate people of color or different sexual orientation. Nobody should have to be afraid to walk outside or live in their own homes. People should not be judged by the color of their skin or their sexual orientation, but by the content of their character. People of every ethnicity, background, or creed, should not have to be afraid for their lives when interacting with police. With the many communities, committees, social circles, and groups that I belong to, I can single-handedly attest to the importance of diversity, the inclusive nature of MCW, and why having people of varying backgrounds, experiences, and cultures is so critically important to both the health of a community and a medicine brain trust. 
 
As a new internal medicine resident and as an African American, I have witnessed firsthand the most beautiful sides of humanity, and the darkest corners of vitriol. I have cared for patients who have been incredibly appreciative and receptive of my presence, feeling more at ease with talking about their privileged information because I am a person of color. I have also had patients turn me away for the exact same reason. When I wanted to become a physician, I made a lifelong commitment to improving and protecting my community. I’ve vowed to provide a safe haven for those without a voice, to be a vanguard in the face of hatred, to be the lighthouse in someone else's storm. But when it is you, your family, your friends, or your community who is being harmed, harassed, and violently mistreated, it takes that community to heal the hurt. It is hard to sustain a thriving and supportive community if that same community refuses to break bread with a particular subset of the population, even when everyone shares the same table.
 
I am proud to belong to a program and institution that takes a hard stance against institutionalized racism and is incrementally rolling out educational opportunities for those interested in, and in need of, anti-racism education. It is comforting to know that my colleagues and peers support the Black Lives Matter movement and understand the deeper inclusive meaning behind the statement. However, supporting the movement is only the first step of a marathon many have been running for years. With many cities in various countries now protesting the same cause, only time will tell if our collective voices have resonated, and what changes will result from our collective stance against institutionalized racism and racist ideology. Myself, my colleagues, and my peers at MCW have already decided which path we will walk, and that is hand-in-hand with our flourishing, diverse, and inclusive community.
 
 
 
 
Leroy J. Seymour, MD MS is a first-year internal medicine resident at the Medical College of Wisconsin

Racism is a Public Health Crisis: When Will We Decide It Matters?

From the 9/11/2020 newsletter 

Racial Justice Perspective

 

 

Racism is a Public Health Crisis: When Will We Decide It Matters?

 

 

Kristen Pallok, MD and Shaina Sekhri, MD – PGY2 Internal Medicine Residents

 

 

 

Drs. Pallok and Sekhri, allies as MCW works to become anti-racist, challenge the institution to do better …

 

 

In late June of 2019, we arrived at the Medical College of Wisconsin (MCW) for our internal medicine residency. Two newly minted female physicians arriving at the same institution, struck separately by the same conclusion: a lack of racial diversity. 

 

There is a hallway in MCW that displays a decades-long photographic history of MCW’s medical school classes. As a woman, it’s hard to miss – a long timeline of white, male medical practitioners.  And while some would think we would have long moved beyond this one-sided picture of white, male privilege, it has recently become clear to many individuals that we have not. 

 

Milwaukee is a diverse city with a significant Black population. According to the Milwaukee 2010 Census data, 40% of Milwaukee residents were Black. In comparison, 45% were white. Froedtert and the Medical College of Wisconsin serves this diverse population. Yet, while many of our patients are Black, our practitioners and leadership are not. In fact, the Black:White ratio of our faculty or residency programs is nowhere close to the breakdown of the Milwaukee population. Of the publicly listed members of Froedtert Health’s executive leadership, only 0.25% - 1 in 40 – of the members are Black, while 90% are white. 

 

What does this fact, this lack of racial diversity at MCW and Froedtert Hospital, have in common with our country’s racism and recent acts of police brutality? It is a form of perpetuated structural racism – structural violence designed into our policies, procedures, and our norms that harms our patients and breeds mistrust in our healthcare system. 

 

It’s easy to point at events outside our doors and commiserate about the state of racial equity in our nation. The real difficulty rests on scrutinizing ourselves at MCW and Froedtert to address our own institutional racism.  Our program took its first steps in acknowledging the presence of racism and addressing the Black Lives Matter movement with an hour-long reflection and resident-authored essays. The anonymous responses included an examination of privilege, uncomfortable feelings about the state of our society, fear, anger, and difficult conversations with family and friends. In all honesty, it is disheartening that it took such a large, nationwide movement to realize we must spend time discussing these issues. They have existed long before the events in the media, with thousands of excess Black lives lost each year to healthcare and disparity mortality gaps. Yet, we are hopeful that having finally arrived at a discussion, we can now work to make MCW an equity-driven space that dispels racism from its ranks. 

 

To create an environment that is inclusive and supportive of historically marginalized residents and faculty, we must take steps within our program. We acknowledge that as two non-Black women, we are limited in our perspectives and thus propose creating a racially diverse taskforce willing to identify and address actions such as the following: 

1. Taking an institutional stance against racism and police brutality as a public health issue
2. Asking residency applicants during their interviews how they plan to address healthcare disparities
3. Ending race-based medical practices in an overt manner, including lectures on why certain racist data is no longer used in medical practice
4. Training our residents to become advocates for our patients to receive the equitable care they deserve, which includes implicit bias training, insight into privilege and opportunity, and modules that focus on aiding patients from our communities of historically concentrated disadvantage

 

Yet, most importantly, we believe, for the institution to fully enact such changes, it must change at its roots. It is impossible to fully serve a population which is not reflected in our medical staff. Therefore, we suggest we must racially diversify our residency cohorts. We must focus our efforts on the recruitment of Black residents. We must focus our efforts on the retention and promotion of Black faculty and senior leadership. We must provide examples and mentors for our fellow residents to follow, and we must provide outreach in our Black Milwaukee communities to become members at the table – one which so deeply affects their health and, ultimately, their lives. We cannot fully represent our communities, our patients, if the Black Milwaukee community is not reflected in our medical practitioners and decision-makers.

 

This issue of structural racism is not limited to MCW and our residency program. It spans all of our institutions. And to conquer it, we must take a stance together. In June 2020, thirty-six Chicago hospitals and clinics signed a declarationnaming racism as a public health crisis and made seven commitments to dismantle racism in healthcare. This declaration is now going national through the Healthcare Anchor Network, a group committed to elevating communities and dismantling the effects of racism. In solidarity, we hope we can all sign our names to the list and take a seat at the table.  

 

It is not enough for a program or an institution to say that it is not racist. It must take actionable steps to become anti-racist. This requires us to name anti-racism as an organizational strategy to hold each other accountable, at both the individual and institutional levels. We can do more. If we believe Black lives matter, we cannot be complacent. We are 400 years overdue. We must act now.

 

 

 

Kristen Pallok, MD and Shaina Sekhri, MD are PGY2 Internal Medicine residents at the Medical College of Wisconsin