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.