Recruitment Season 2021: It’ll all be Worth it!

 From the 3/19/2021 newsletter

Perspective/Opinion

Recruitment Season 2021: It’ll all be Worth it!

Camille B. Garrison MD

Dr. Garrison describes how the Ascension Columbia St. Mary’s Family Medicine residency program adapted to the need for virtual interviews as they recruited their next cohort of residents, relying on social media, entertaining videos, and human interaction …

I had all the right people in place. From the perfect faculty leading the recruitment committee, the most enthusiastic residents set to attend our much-anticipated summer and fall recruitment fairs, the administrative team set with our new interview schedule, and an opportunity to pilot our new ranking system. I remember the heavy feeling of desperation that came over us when we heard that recruitment season and interviews would be transitioning to all things virtual. But once we got over the initial shock of what this would mean for our program, our team became energized and got to work. 

It was refreshing to have residents, faculty and administrative staff who were undaunted by the unknown, as COVID-19 likely prepared us for this moment too. We only had four months to prepare as our first recruitment event would take place in July, so we started to brainstorm which issues to tackle first: website edits, videos, social media and interviewing platforms, recruitment fair participation, visiting students, audition rotations, and finances. Looking back, this was a pretty significant list of issues, but all of the planning and effort that went into each of these areas has truly proven fruitful even without knowing the results of this year’s Match and, for that, I’m grateful.

As Program Director, I know that we have awesome faculty who teach Family Medicine excellently. I also know that we serve an amazing, underserved community and that we meet the community’s needs through clinical care and resident education. We also have a strong reputation of providing high quality care to our patients and their families. I felt like those qualities would not be that hard to convey to potential applicants in virtual format, even after all that the pandemic had brought to us. But the one thing that I was worried about not being able to convey adequately was the sense of family that people feel when they are at our program. 

When I was a medical student, I decided on Family Medicine after I rotated with our program in my fourth year. I remember sitting in rounds one day thinking, I could work with these people! It was the people who helped me see my calling in Family Medicine. It was the people who served as perfect role models for the type of physician I wanted to be. For me, the people included residents, faculty, clinic staff, administrative staff and the patients;  they are “the thing” that makes the program what it is and I wanted to let applicants know this before the interview day. Our goal was to effectively get people to sense “that thing” that I felt when I first came into contact with our program years ago. 

So, we decided to do what we did best, which was to be ourselves as we introduced people to our family. From the quirky, “80s-inspired public service announcement style” clinic tour to the Instagram page created and maintained by select residents, highlighting our team members and their favorite things. Our social media platforms helped us introduce people to our patient population and frequently displayed our commitment to social justice in light of current events. I, along with several residents, spent a lot of time talking with potential applicants during recruitment fairs and scheduled WebX meetings thereafter. We worked closely with our sponsoring institution ensuring that we would have a more professional video to introduce applicants to our hospital wards and clinical faculty, and that our website would be attractive and more appealing than our competition. We worked hard! We banded together as good families do. We were innovative problem solvers and had fun doing it. 

I truly believe that, this year, we interviewed more candidates who were genuinely interested in our program and our offerings and who had already done their research on us. Many of them spoke of how much they appreciated the details we put into our website and were able to vocalize those key details about us during their interviews. It was also great to hear that many of them loved that quirky, 80s-inspired video. Many applicants visited our social media platforms and were able to see the diversity within our program and surrounding community. I believe that the type of candidates we interviewed really seemed to have similar passions and interests which aligned well with our mission and commitment to Family Medicine. 

Overall, my goal is to always recruit individuals who have “that thing” that I was first attracted to when I was a student rotating at our program so I look forward to seeing who will join our team this year. This truly was an exciting recruitment season and I can’t wait until Match Day!

Camille B. Garrison MD is an Associate Professor in the Department of Family and Community Medicine at MCW and residency program director for the Ascension Columbia St. Mary’s Family Medicine Program.

Work and Career in that Order: Residency is Just the Next Step in the Life of a Physician

 From the 3/19/2021 newsletter

Director’s Corner

 

Work and Career in that Order: Residency is Just the Next Step in the Life of a Physician

 

By Adina Kalet, MD MPH

 

Dr.Kalet celebrates Match Day 2021 by exploring how residency, as difficult as it can be, offers opportunities for growth and a path to a rewarding career …

 

Later today, more than 48,000 medical students will find out where they will begin residency training in July.

While the numbers vary, about half of students matched to their top choice, and about two-thirds to one of their top three. About 5% of all applicants did not match and have spent the week working with deans and faculty to “scramble” into open slots. There will be disappointments and not everyone will be thrilled.

In normal times, MCW-Milwaukee would be hosting our 200 students, their families, and their friends in an Alumni Center celebration with balloons, short speeches, finger food, intense excitement, and identical “I MATCHED!!!” t-shirts. Even still, today’s celebration and energy will be shared on social media and over the internet when, at 12:00 noon EDT, students open the e-equivalent of an “envelope” and learn for the first time to which program they have matched.

Today is one of the most significant watershed moments in each of their lives. They will, finally, be able to glimpse more clearly the outlines of their future selves.

 

The importance of “place” in residency training

Where a physician trains does matters. Residency takes each young physician to a city or town where they are committed to stay for a while and, although it varies by specialty, over 50% of physicians end up practicing in the state where they complete training. The shared experience of residency builds profound and lifelong friendships forged during long nights-on-call and the intellectual, physical, and emotional challenges inherent with the transition from medical student to practicing physician. Clinical “habits” are formed and imprinted for a lifetime.

I am amazed how intense the experiences I had during my own residency remain. While I have not drawn blood cultures, done a lumbar puncture, or placed central intravenous line in the subclavian vein in three decades, I still recall the rhythm of each procedure, the proper aseptic techniques, the positioning of the patient, the feel of the cannulas and needles, and the proper documentation. My fingers remember the sensation of the needle overcoming resistance, piercing the skin, and finding the proper space. During my residency, I learned to rehearse “delivering bad news,” and still do so as I walk toward a difficult conversation. Facing an emergency, I still summon courage the same way I did when I was wearing the “code beeper” and running toward, rather than away from, the crisis. Always take the stairs. Never wait for the elevator. Hope the nurses are already there with the cart. Will the medical student by my side be ready to do chest compressions? I learned to be ready when I arrived. 

 

Looking for meaning during residency training

Some things have changed about the match since I was in medical school. While many of my classmates in the early 1980’s applied to only one type of residency, a sizable minority listed more than one type of program on their match lists, allowing the algorithm to determine whether they would end up as an internist, pediatrician, dermatologist, or orthopedist. I share this because I now know how this approach worked out. These peripatetic students understood something the rest of us did not, and here is the lesson: It is much more important to choose what kind of career you want to have, than which clinical discipline or “tribe” you seek to join. They understood that there are, for most of us, many paths to a satisfying life as a physician.

Here are some examples. One friend knew she wanted to spend her career in women’s health, so she applied to and ranked OB/Gyn, family medicine, and internal medicine programs. Another close colleague, hoping for a quiet, suburban, “Marcus Welby” type of practice, applied to both family medicine and internal medicine. They let the match decide their specialty, knowing that each path would lead to their goals. Other classmates were so committed to where they wanted to live that they applied to several different specialties in the same city, believing that the type of residency was secondary.

This type of flexibility seems very old fashioned now and there are reasons for this. Over the past decades, for example, the increase in medical school graduates has far outpaced the increase in first-year residency positions, placing an intense “What if I don’t match?” pressure on students that we never experienced. Today, certain clinical fields are so competitive that students feel the need to plan far ahead, take time off to complete specialty-focused research, concentrate on doing things that will make them more attractive for the few spots, and audition extensively. Back when each residency program had its own pen-and-paper application form, we applied to ten or so institutions and ranked five to eight. These days, the number of electronic applications submitted by each applicant continues to climb, and it is not unusual for a medical student to apply to over sixty programs hoping for a handful of interviews. Different times, for sure. But instructive. Life as a physician has always been a journey with many choices, and residency is just the next step after medical school.

 

“Careers are made in retrospect”

Most of us can look back and see the paths we took, the opportunities we seized, and the roads not taken. But discerning the path that still lies ahead of us is impossible. It is rare to meet someone who, in retrospect, knew where they were going from the very beginning. Nearly half of the students who match today are entering different fields than they had envisioned for themselves when they started medical school. As many as 20% of residents switch fields before the end of their training. Mid-career physicians often retrain into new clinical specialties, seek advanced education, or pursue mid-career fellowships in a wide range of areas.

My woman’s health friend, for example, ended up happily doing groundbreaking immigrant health research. “Marcus Welby” is now a professor and urban health services researcher. Even though they did not end up where they might have predicted, their training gave them the flexibility to build satisfying and meaningful careers.

This is really good news. It means we can each feel free to be fully in the present. With reflection, mentorship, and opportunity, we can redirect our work. As the ancient Greeks advised: Know Thyself. Then move in that direction.

The wonder of a career in medicine is its flexibility and ever emerging opportunities. So how do we make good choices?

 

Residency is a learning experience, but it is also a job. Some advice …

Find work that matters. Look for the aspects of your new careers that intrigue you and get you out of bed in the morning. As novice physicians, you will learn about yourselves and your patients as you engage with both the well and the chronically ill. You will learn to prioritize and lead teams as you work through the daily tasks and confront the patients who decompensate in front of you. You will perform procedures that require significant manual dexterity and employ advanced technology. You will engage with colleagues, team members, and communities. You will collect and analyze data, peer through microscopes, study the results of sophisticated analyzers, and seek the truth and beauty hidden in a radiologic image. You will deal with unimaginable ambiguity. Learn to think, to feel, and to engage at various paces and rhythms — optimally, for your entire professional lifetime.

Take time to reflect and grow. Listen to others as they help you discern how your work impacts you. Find ways to stay well even as you do the hardest work in your life.

 

Residency is only one step on the path to a career

Training is extremely hard, and it can become a life of one challenge after another. Yet, as residents touch the lives of patients, learners, colleagues, friends, family, and the community, opportunities for growth, character development, and changemaking present themselves. Some residents will avoid these occasions while others will seek them out. To some, the work of residency will drive them forward into rich careers, dictating their goals and what they work on. For others, the opportunities will fade into the background while they are “busy making other plans.”

This is what continues to astonish me. While residency is an overwhelming experience, there are those who take full advantage of its opportunities. They learn early that training is only one step toward a career that will take unexpected twists along the way. As faculty, we must recognize their sacrifices, yet help them stop and consider: What do you want to be able to say you have done? How will you know you have done it, influenced others, engaged in those conversations, made the world just a little better? How might I help?

 ___

The next group of residents will arrive soon. This week’s Transformational Times celebrates the agility, flexibility, and compromise inherent in recruiting the next cohort of residents during a pandemic. In this issue, you will read about how our MCW community of residency program directors, students, and residents have faced and embraced the special challenges this COVID-19 year. Airports, hotels, and long visit days filled with hospital tours and interviews were replaced with Zoom interviews, “1980’s style” videos, social media blitzes, all produced to give the potential residents a “feel” for the culture of the programs.

And there have been upsides! Programs saw the numbers of applicants increase. There was a more diverse applicant pool. Web pages were spiffy, social media campaigns were buffed, and all hands were on deck as residents showcased their program’s camaraderie and the wonders of living in Milwaukee. In some ways more exhausting (zoom fatigue) and in some ways more intimate, faculty and applicants got to see each other’s home offices and meet the family dog. No cheese curds, brats, and beer; instead, there were suit jackets, a clean shave, and a new house plant along with scrub pants and sneakers.

Creativity overflows. This is an important moment. Let’s take advantage of it.

 

 

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.

Interviewing for Fellowships - My 2020 Experience

 From the 3/19/2021 newsletter

Perspective/Opinion

Interviewing for Fellowships - My 2020 Experience

David A. Campbell, MD - Department of Otolaryngology and Communication Sciences

Dr. Campbell, who will complete his otolaryngology residency in June 2021, talks about some of the plusses and minuses of interviewing for fellowships during the COVID-19 pandemic … 

“Please tell me you’re not in Atlanta yet!” 

It was March 12, 2020, the day before my first fellowship interview. In the days preceding, interviews dropped off the calendar one by one as travel restrictions tightened and hospital campuses closed their doors to non-essential workers. Some programs switched directly to virtual interviews, while others were hopeful they could have applicants in person by May or June (a wildly optimistic prospect, in hindsight). The Atlanta program finally shut their campus down and the coordinator was frantically trying to stop applicants from getting on flights. After being through medical school and residency interviews, I knew this would be very different. However, as I worked through nineteen virtual interviews spanning five months, I did find some surprises along the way.  

The first thought was how disappointing it was to be unable to visit the cities and hospitals I’d potentially be spending a year at. A very close second thought (in reality, probably a simultaneous thought) was how much money I’d save. Already, credit card bills were piling up and vacation days were evaporating. It was becoming clear that physically getting to 19 interviews was likely going to be impossible. However, on the virtual interview trail, I could attend a morning interview in Florida, an afternoon interview in California, and an evening Zoom social event in New York, all without leaving my apartment or spending a dime. Some programs scattered interviews over several days, meaning I could duck into a hospital workroom for 15 minutes at a time, using no vacation days at all. I’ll admit I did several interviews between cases wearing a suit coat and scrub pants.

Some aspects of the virtual process weren’t immediately obvious. One significant drawback was not meeting the other applicants. Otolaryngology is a small enough specialty that during the residency interview trail, applicants tend to run into each other several times. In the process of comparing notes on past and future interviews at social events or making small talk on the 10th hospital tour, many of us formed connections that only grew as we found each other at conferences throughout residency and will continue to grow as we move through our careers. The graduating ENT class of 2021 got to meet each other during the interview trail of 2016. Now, as I was virtually interviewing to enter the even smaller community of Head and Neck Surgical Oncology, I realized I was missing out on the opportunity to meet my soon-to-be colleagues. 

There were also some unexpected advantages to virtual interviews. As interviews approached, there was concern if programs and applicants could get to know each other as well on the virtual platforms. Similar to the residency match, the 10-to-15 minute interviews themselves are incredibly important for both applicant and program. A single awkward interaction vs. a meaningful connection can have huge impacts on how applicants and programs rank each other. Of course, there were the expected technological hiccups with lots of “I can hear you. Can you hear me?” However, I had several interviews that felt easier because they were virtual. While many physicians interviewed from their offices, I spoke to several world-famous Head and Neck surgeons from their homes. One particularly well-known surgeon was arriving home from work as the interview started. He greeted and introduced me to his wife and showed off the view from his yard (“This could be the type of view you get if you move here!”). From the applicant side, rather than being led into an office at an unfamiliar hospital after sleeping in a hotel bed, I was often interviewing from my apartment with my cats napping on my bed that was just steps away. While some ability to connect was undoubtedly lost with interviews being virtual, my guess is that both parties being in a familiar setting facilitated easier connections in a different way that would not have been possible in-person.  

I’ve heard the sentiment over and over that virtual interviews could never replace in-person interviews. In many ways, I agree with this. However, it was refreshing see people finding new ways to connect with each other when the world was turned upside down.

David A. Campbell, MD is a PGY5 in the Department of Otolaryngology and Communication Sciences at MCW. He will spend the 2021-2022 academic year as the Head and Neck Oncology - Microvascular Reconstructive Surgery Fellow at the Icahn School of Medicine at Mt. Sinai in New York City, a town which he has never actually visited. 

The Transformational Times First Anniversary "Best Essays"

 From the 3/12/2021 newsletter

The Transformational Times First Anniversary "Best Essays"

These are the most read, most important, and most popular essays, poems, and reflections from our first year. They are all on the blog, so feel free to use the "SEARCH THIS BLOG" box in the right hand column to find and explore each of them. 

The Transformational Times has a Birthday and I have an Insight

From the 3/12/2021 newsletter

Editor’s Corner

 

The Transformational Times has a Birthday and I have an Insight

 

Bruce H. Campbell, MD FACS

 

In this Anniversary Issue, we reprint some of the most important and popular essays published during the first year of the Transformational Times. Dr. Campbell, Editor in Chief of the newsletter, reflects back on its origins in March 2020 and believes it will offer a blueprint for the transformation of medical education and the culture of medicine for the coming generation …

 

This newsletter has been around for one year. Safe to say, more than a few things have changed over the months.

In March 2020, in-person classes were being cancelled, medical students were being sent home from their clinical rotations, and the pandemic was starting to become real. On March 16, Dr. Adina Kalet, Director the Kern Institute, presented her vision for a weekly email that would offer support and information to MCW and the wider community. She invited several of us to address a variety of topics, asking us how we might:  

• Keep students connected now that they had been forced off-campus
• Understand what Caring and Character look like during a public health emergency
• Explore how faculty and staff are affected by the ethical issues inherent in balancing work, coronavirus exposure, family upheaval, PPE shortages, and child rearing
• Support the “worried well”
• See how the pandemic might reactivate old wounds
• Find ways to best engage our audience
• Discover what “transformation” looks like when everything is disrupted, and how we should take advantage of this disruption to reinvigorate medical education

We had no idea how to tackle Dr. Kalet’s challenge. On top of it, we all had day jobs and none of us had ever attempted to mount a weekly newsletter. Would we take on the challenge? Sure, we said. What could possibly go wrong?

So, the Transformational Times was born. That Monday meeting led to a newsletter the following Friday. And every Friday since.

 

What we brought to the Transformational Times

We experimented. We learned. We pledged to keep the content relevant, surprising, honest, and edgy. We started this blog to archive many of the essays. Over the subsequent months, we expanded our efforts:

• We requested essays and poetry that addressed reactions to George Floyd’s death, shining lights on systemic racism and the impact of the Black Lives Matter movement.
• We offered platforms for voices we believed were not widely amplified, including students, residents, staff, nurses, persons of color, women, persons identifying as LGBTQ+, and native Americans.
• We published pieces that offered clarity even as polarization threatened the fabric of democracy.
• We included first-person struggles with failure, stigma, mental health issues, and burnout.
• We celebrated the service of military veterans.
• We brought in voices from the regional campuses.
• We added student associate editors to recruit writers, develop poetry and visual arts columns, create content, and be social media experts.

In the process, we aggressively began including the projects and missions of the Kern Institute. The institute’s thought leaders, program participants, and consultants shared insights on many topics, including visual thinking strategies, remediation, medical education transformation, entrepreneurial mindset, entrustable professional activities, educational measurement science, mentorship, mattering, practical wisdom, and professionalism.

Overwhelmingly busy people create our content, and we have been gratified by their willingness to share stories on deadline. We are also very grateful to our readers; of the 6000 who receive this email every Friday morning, over 30% open one or more of the articles. We appreciate the feedback, as well.

 

What the Transformational Times has taught me

Our MCW, Kern, and KNN world is remarkable. I now have even more respect for the accomplished and delightful people with whom we share this space. I have garnered new insights into the extra burden older, male, white folks like myself place on people who identify as “other.” I have been astonished by the maturity and skill of the youngest members of our community. I have seen how concepts such as mattering and the entrepreneurial mindset will soon change how medical educators approach everything they do.

Each week’s issue makes me wonder what will emerge from the ashes and chaos of the past year. The pandemic and social upheaval offer unique opportunities to innovate, lead the way, and develop new paradigms that can guide young adults from being premedical students through the phases of training to becoming character-rich, caring, and healthy practicing physicians and medical educators. By reading the Transformational Times, readers catch hints of what that change looks like.

The Kern Institute was established to “transform medical education.” This past year has transformed medical education and everything else in our worlds.  Editing the newsletter has allowed me to glimpse a better path. If everything returns to the old, comfortable status quo when the masks come off, the classrooms and labs reopen, and the pandemic recedes, we will have lost.

Having read every single article over the past year, I should have insight into all of the topics Dr. Kalet listed during our inaugural meeting last March. And, of course, I do not. But, thanks to the amazing opportunity that being editor has provided, I have learned much, become an optimist, and have glimpsed the future.

 

 

A special thanks to all of our contributors! The newsletter would not exist without the hard work of (drum roll…) Production Editor Julia Schmitt and the rest of the editorial team: Kathlyn Fletcher, MD MA, Adina Kalet, MD MPH, Wendy Peltier, MD, Michael Braun, PhD, and medical students Olivia Davies, Scott Lamm, Eileen Peterson, Sarah Torres, and Anna Visser. You are each amazing!

 

Bruce H. Campbell, MD FACS is a Professor in the Department of Otolaryngology and Communication Sciences and in the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the Faculty Pillar and is Editor in Chief of the Transformational Times newsletter for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Setting the Expectation for a Growth Mindset in KINETIC3’s Excellence in Teaching Track

From the 3/5/2021 newsletter

Perspective/Opinion

Setting the Expectation for a Growth Mindset in KINETIC3’s Excellence in Teaching Track

 

by Alexandra Harrington, MD

 

Dr. Harrington shares that character development in adults seems dependent on having a growth mindset, a frame of mind adopted by the Kern Institute's KINETIC3 Teaching Academy...

As I reviewed the results of my Values in Action (VIA) character strengths survey, I noted the ‘top 5’ of honesty, judgement, love, perseverance and fairness, but was naturally drawn to those strengths ranked at the bottom, self-regulation, social intelligence, and spirituality. For those unfamiliar with this survey, it is a free survey (available at viacharacter.org)- that all KINETIC3 learners take prior to our first course- that ranks your character strengths based on your answers to a series of questions. Can I better control my emotions and reactivity? How do I improve my interpersonal relationships? These questions and other related ones had me reflecting on my mindset. With a growth mindset, I certainly could practice better self-control, but not with a non-acknowledging, resistant fixed mindset. Character development in adults seems dependent on having this growth mindset.  

A growth mindset is defined by Dr. Carol Dweck as the belief that talents and skills can be developed in oneself and/or others. We have adopted this frame of mind in the KINETIC3 program and have set the expectation for having a growth mindset with respect to teaching in the Excellence in Teaching Track. Our learners are asked early in the program to reflect on previous teaching evaluations. We ask learners to share their positive evaluations and reflect on growth opportunities. Then, we ask learners to share any negative feedback on their teaching and again reflect on growth opportunities. We try to explore those opportunities, even if the negativity of the evaluation seems like Jimmy Kimmel’s mean tweets! KINETIC3 learners are given time to reflect substantively on their teaching and character strengths and opportunities for improvement and commit to working on those growth fronts during their coached teaching observations. 

“We’re all a mixture . . . it’s true that you can have a fixed mindset in one area and a growth mindset in another and that it’s a spectrum, not a dichotomy,” Dr. Dweck tells us in a videoed interview that we watch in KINETIC3 (https://www.youtube.com/watch?v=-71zdXCMU6A&feature=youtu.be). 

Learners are asked to reflect and share stories wherein they had a fixed mindset and then situations in which they have had growth mindsets. And as Dr. Dweck advises, we ask learners to reflect on the triggers of the fixed mindset. What puts you in the fixed mindset in that moment? The goal in this exercise is to identify the trigger in hopes of avoiding the rigidity in the future. We stretch our learners to mentor themselves hypothetically then towards a growth-minded belief if they encounter similar scenarios in the future. Lastly, we share examples of fixed and growth mindsets related to our previous educational experiences, such as disregarding student evaluative feedback (fixed) and trying a new active learning exercise (growth). It is imperative we recognize that in the teacher-student relationship, our mindset may influence our learners’ mindsets (and vice versa!).

Alexandra Harrington, MD, MT (ASCP), is a Professor of Pathology and Director of Hematopathology in the MCW Department of Pathology. She serves as Director of the Faculty Pillar and the KINETIC3 Teaching Academy within the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Entrepreneurially-Minded Learning and Teaching: A Core Element of KINETIC3

 From the 3/5/2021 newsletter

Perspective/Opinion

Entrepreneurially-Minded Learning and Teaching: A Core Element of KINETIC3

 

by Bipin Thapa, MD

 

Dr. Thapa provides an overview of what the KINETIC3 program hopes its participants will learn about the Entrepreneurial Mindset …

 

Teachers and educators do different things, but how often do we stop to consider and “What is the value of what I am doing?” or “What exactly are we trying to create?”

We need to think differently if we are to address these questions.

In medicine and education, we shy away from terms like, “Entrepreneurship” because of the incorrect assumption that entrepreneurs focus solely on monetary profit. But entrepreneurship is more than that. It encompasses ways of creating anything of “value” – and can concentrate on things such as services, scholarships, processes, and quality improvements. It can even focus on experiences.

Academic Entrepreneurship creates sustained value in multiple dimensions that are financially and/or logically stable. It is competitive in the “marketplace”; the “market” here reflects a broader platform that includes, but is not limited to, scientific and peer-reviewed venues. Entering this market requires an Entrepreneurial Mindset (EM). EM is, in essence, a collection of mental habits like attentiveness toward opportunities, focus on their impact, and intent to create value. This learned set of values offers a way of thinking about the world and acting upon what we see. EM empowers the practitioner to question, adapt, think differently, and make positive change; it equips one to identify opportunities and create value in any context.

By building on work borrowed from our Kern Engineering Entrepreneurial Network (KEEN) colleagues, we are deliberately creating an entrepreneurially minded learning and teaching culture in the KINETIC3 program. Our teachers and educators start from the big ideas of why our learners need to learn something and then move to what they need to ask to answer the more important questions. We push them to discern how best they can accomplish the goals. We want them to focus on learning objectives that reflect the tandems of mindset and skillset. That is another offer of value. Our instructional methods must be inclusive and respectful of the differing learning styles of our learners; this is critical to excite every learner. Finally, our assessment methods must be practice-relevant, as we know that assessment drives learning. 

The diagram shows the big picture of how the Entrepreneurial Mindset guides the process from identifying big picture themes through instruction to assessment. 

We believe that by training entrepreneurially minded faculty, we will promote long term institutional change. Having a significant number of KINETIC3 alumni teaching students and residents with techniques built on the Entrepreneurial Mindset, can lead to “good” disruption and new ways of developing identity formation. 

Bipin Thapa, MD, MS, FACP, is an Associate Professor in the Department of Medicine (General Internal Medicine) and Assistant Dean of the Clinical Science Curriculum at MCW. He is a member of the Faculty Pillar and of the KINETIC3 Steering Committee of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Social Connectedness and KINETIC3 Medical Educator Track

 From the 3/5/2021 newsletter

Perspective/Opinion

Social Connectedness and KINETIC3 Medical Educator Track

 

 

by Jeffrey Amundson, PhD, Tavinder K. Ark, PhD, and Alexandra Harrington, MD

 

Drs. Amundson, Ark and Harrington share how the KINETIC3 program is producing valuable data for program assessment and publication, but more importantly it is providing opportunity for a mediator of flourishing to exist and develop...

 

It may seem obvious that social connectedness is important, however, understanding its impact in particular environments allows individuals to leverage its benefits to build character and promote flourishing. Moreover, when we think of social connectedness, we often define it in superficial terms as social networking or creating a circle of friends, family, and colleagues. However, we seldom consider the depth of how impactful such connection can be, especially at work. That is, we might only think of work relationships as ways to get ahead, but upon digging deeper into these connections one begins to see the real value. For example, social connections play an important role in professional development and the co-construction of knowledge, by shaping an individual’s access to valuable information, guidance, and overall support. (Baker-Doyle, & Yoon (2011); Wasserman & Faust (1994). 

What does this mean for medical education? 

 The culture of medical education emphasizes productivity and demands excellence given the seriousness of the potential impact on the eventual practicing physician and patient. The stress of this environment can be mediated by social connectedness. That is, if faculty have more connections and more meaningful connections, then their ability to flourish and in turn help emerging physicians flourish is more accessible (Happiness Is 'Infectious' In Network Of Friends: Collective -- Not Just Individual – Phenomenon, 2008; Mere Belonging: The Power of Social Connections., 2012; Learning in Faculty Development: The Role of Social Networks, 2020). 

What we found 

 Social network analysis (SNA) has been used variably in faculty development efforts in medical education to assess effectiveness of learning about teaching, but prospective data from formal programs is minimal. We developed a SNA to understand how social connections emerge, develop, and add value to the learners in our faculty development program for medical educators (Kinetics3). Prior to a workshop on building professional networks at our institution, participants completed a SNA exercise. Participants were asked to sketch the direction (unidirectional- one-way value relationship vs. bidirectional- value provided for both parties) and strength (1-weak/low value, 2-moderate, 3-strong/high value) of relationships to individuals and organizations in and outside of our institution, as they relate to their existing academic educational networks. Text box descriptions of the relationship(s) were encouraged. Individuals were also asked to sketch future connections they hoped to foster over the program duration (dotted lines). For our enrolled participants, the strength of their relationships related to education was dependent on the type of relationship (organization vs. individual). Specifically, faculty rated their unidirectional relationships highest from organizations and lowest from individuals. This suggests that junior faculty use of organizational expertise and resources may be more impactful than any given individual. We plan to monitor faculty SNAs after several curricular interventions in the program as an outcome metric to understand if our faculty development program influences the strength and diversity of connections to people and organizations involved in the educational mission. Junior faculty in our faculty development program tend to have stronger baseline relationships with organizations than individuals for educational-related activities at our institution. This data is unique in the faculty development literature and suggests that our program’s mentorship component and the influence of individual program instructors have the potential to fill voids in faculty relationships early in their careers. Additional network analyses by our faculty will provide data on how connections and community of practices evolve in an academic faculty development program.

KINETIC3 Medical Educator Track and Social Connectedness While what we found is only a part of the story on social connectedness and adds to our overall understanding of such constructs, the real value lies in how the process of experiencing the KINETIC3 program can foster these connections. That is, the process of the KINETIC3 program exists through planning for a capstone project and participating in workshop activities. Planning for the capstone meetings involves identifying mentor(s), collaborators, and working with members of a cohort. Once mentors and collaborators have been identified one is trained in empathetic interviewing to develop networking skills. During workshops leading up to and including identifying mentor(s) and collaborators there are activities to promote thinking about connecting with people. For example, in addition to the social connectedness study mentioned above, a barriers and potential solutions for the capstone activity was implemented that required identification of individuals one would connect with to help solve barriers to the progress and completion of the project. 

The KINETIC3 program is producing valuable data for program assessment and publication, but more importantly it is providing opportunity for a mediator of flourishing to exist and develop. 

Jeffrey Amundson, PhD, is a Postdoctoral Fellow in the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. Tavinder K. Ark, PhD, is an Assistant Professor and Director of the Data Lab in the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. Alexandra Harrington, MD, MT, (ASCP), is a Professor of Pathology and Director of Hematopathology in the MCW Department of Pathology. She serves as Director of the Faculty Pillar and the KINETIC3 Teaching Academy within the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

"At the Most Important Crossroads in our Life there are No Signs"

 From the 3/5/2021 newsletter

Perspective/Opinion

"At the Most Important Crossroads in our Life there are No Signs"

 

by Linda Menck, MA

 

Linda Menck, a faculty member in the Kern Institute’s KINETIC3 program, talks about how she employed the entrepreneurial mindset to recast a communications course at Marquette from a tired offering to a creativity powerhouse…

 

After seventeen years of teaching at Marquette University I found myself at the crossroads. My teaching career felt like the plot of the film Groundhog Day. 

 

As a professional faculty member in the Diederich College of Communication, I was assigned to teach the same classes every semester. It was like eating the same breakfast cereal every morning. While students in my classrooms changed, course content remained the same. 

A course I regularly taught was Introduction to Visual Communication (COMM 2100). This was a required course for all majors in the College of Communication but was demoted to an elective after a college core curriculum review. 

I remember thinking this course was destined to die, and the cause of death would be low enrollment. Students with majors in engineering, the sciences, and business administration had no desire or need to learn theories of visual communication or memorize dates and definitions of major art movements. 

This became a personal and professional prefect storm that ultimately motivated me to disrupt and transform my teaching. Consistent with my character, I didn’t ask for permission, but I knew it was time to redesign COMM 2100, and the redesign would need to be of epic proportion. At the foundation of the redesign would be personal passions, what I knew best, and essential skills research indicated our students needed to practice and become capable of applying.

I gathered my markers and faced the whiteboard to mind map my new course. “Mind mapping” is a visualization method I use and teach to promote and practice divergent and disruptive thinking. The central topic of my mind map was COMM 2100 REDESIGN and the initial major branches or connections were creativity, communication, and innovation. 

From the initial branches, twigs began to grow fast and furious. They included entrepreneurial mindset, defining and exploring creativity, building creative confidence, methods for creative problem solving, human-centered design research methods, inclusive and design thinking, disruptive innovation, and the power of storytelling and visualization to present innovative ideas and solutions. 

There were other crucial components to ensure the course would work. It had to be hands-on and grounded in active learning. This meant identifying an environment designed to untether learners from desks. The course needed to be experiential and focused on challenges in our community and the world. Finally, the content had to be collaborative in nature and applicable to students from diverse majors with a variety of skillsets. While planning it became evident this was a red-hot challenge with a whole mess of opportunity. Flying under the administrative radar screen, I created  content, rewrote the course description, objectives, and learning outcomes, and then settled on a new name for the course. Finally, it was time for the reveal. In the Fall of 2014 my new Creativity, Communication, and Innovation course was ready to be put to the ultimate test and judged by the harshest critics, our students. This was my field of dreams. I built it, but would they come? 

Course registration for the semester began and I waited and watched. The result was shock and awe. Within the first two days of registration both sections of the course filled to capacity.

The course continues to thrive and grow. Over time, it has evolved into a course that fulfills a requirement in our University’s new core of common studies, continues to push students out of their comfort zones, and builds their creative confidence. 

When I arrived at the crossroads, I chose to take the transformative route but I never traveled alone. My journey took me across campus to the Opus College of Engineering and the Kern Engineering Entrepreneurial Network (KEEN). I was welcomed, supported, and taught how to integrate entrepreneurial minded learning into my courses with a framework grounded in curiosity, connections, and creating value. 

Continuing on the road led me to MCW and the KINECTIC3 Teaching Academy. You, too, welcomed me. Collaborating with members of the KINETIC3 Advisory Committee to design and teach bootcamp workshops is an exciting new challenge. Your ongoing support transforms me with character, caring, and competence and keeps me from returning to the crossroads. 

The title of this piece is from a quote attributed to Ernest Hemingway. 

Linda E. Menck, MA, is a Professional in Residence in Strategic Communication in the Diederich College of Communication at Marquette University. She is a member of the KINETIC3 faculty. 

Teaching About Implicit Bias in the Classroom

 From the 3/5/2021 newsletter

Perspective/Opinion

Teaching About Implicit Bias in the Classroom

 

by Sandra Pfister, PhD, and Kerrie Quirk, MEd

 

Dr. Pfister and Ms. Quirk describe the course they co-lead in the KINETIC3 program which helps faculty recognize and mitigate their implicit bias when teaching...

 

The definition of implicit bias is: “the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.” Let's use a True/False question to see what you think: True or False? I have no implicit bias.  Correct answer: FALSE. Every one of us has implicit bias because that's a function of how our brains work. What happens when implicit bias takes over when we are teaching? Maybe you say that women don't have heart disease. Not said with intention, but isn't heart disease a man's disease? Or when teaching about skin disease, maybe you only show images from white patients. Not done with intention, but maybe because those were the same images used when you were a student.

Using a combination of didactics and active learning, our KINETIC3 course is structured to allow participants to explore their own implicit bias. Prework is to take the Implicit Association Test (IAT). IAT begins to connect learners with attitudes and beliefs they may not know they have (unconscious or implicit bias). The IAT website gives this example: "You may believe that women and men should be equally associated with science, but your automatic associations could show that you (like many others) associate men with science more than you associate women with science." Each KINETIC3 learner is given the opportunity to discuss their own experience with the IAT. 

This course also offers a more in-depth discussion on the meaning of implicit bias, and we delve into the role of the brain. Think FAST. Think SLOW. Think FAST involves those parts of our brain outside of conscious awareness. For example, let's say you stop your car at a red light. When the light turns green, you know to go. This mental association requires no conscious or effortful thought. In contrast, Think SLOW is the brain's conscious processing. It's what we use for mental tasks that require concentration, such as a taking an exam. Together, Think FAST and Think SLOW parts of the brain help us make sense of the world. But it is also the Think FAST parts of our brain that contribute to unconscious bias. This session looks at times when unconscious bias is activated in our brains and shows up in our teaching (when we are rushed, when we are fatigued, or when we are unprepared) and offers strategies to help. We also show a video clip from a PBS special to highlight how medical education has contributed to systemic racism and the role of institutions in contributing to implicit bias. Through small group break-out rooms, learners are given the chance to reflect on their own role as medical educators to ensure a diverse and inclusive representation in clinical case-based material.

This KINETIC3 course aligns with a Kern Institute Transformational Ideas Initiative (TI2) project led by Kerrie Quirk to design a reflection check list for faculty to assess the clinical cases currently being used in the preclinical curriculum. The project is called Identifying Bias in Classroom Clinical Cases: A Structured Approach to Make Clinical Cases More Diverse and Inclusive. Since no KINETIC3 course is complete without a chance to spin the Character Wheel, we end the session with discussion on how specific character traits can play a role in mitigating our own implicit bias. 

Sandra Pfister, PhD, is a Professor in the Department of Pharmacology & Toxicology at MCW. She is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Kerrie Quirk, MEd, is a Program Manager in MCW’s Office of Educational Improvement.

Love to teach and recognize that learning is what really matters!

 From the 3/5/2021 newsletter

Director’s Corner

 

 

Love to teach and recognize that learning is what really matters!

 

By Adina Kalet, MD MPH

 

 

In this issue of the Transformational Times, we celebrate the Kern Institute’s KINETIC 3 Faculty Development program. Dr. Kalet thinks about how engaging with a faculty development “Community of Practice” transformed her from just another good teacher into an educator ...

 

 

I have always loved to teach. Ask my little brother about the forced spelling lessons when he was a toddler. In high school and college, I taught dance to peers and little kids at a day camp. But it was not until I became a clinical teacher that I realized that it was not enough to just love to teach. If we want to educate masterful physicians, we needed to focus on learning.

  

One night as an Intern …

 It was the dead of winter. Mr. M was admitted to my care for hypothermia and impending delirium tremens, a life-threatening consequence of alcohol withdrawal.  Joe, “my” medical student, followed me to the ER. As expected, Mr. M smelled rank and was talking gibberish (confabulating), his eyes were bright yellow where the “whites” should have been (icterus). Vitamins had been given to stave off a full-blown encephalopathy, and the first of many milligrams of Librium were already flowing into his veins along with warmed fluids. Blood was drawn and sent to the lab. The ER nurse had donned protective gear ready, on my say so, to give Mr. M a warm water bath that would not only warm him up but also wash away the dirt caked most prominently on his feet and to treat the overwhelming case of pediculosis capitis (“head lice”). As I engaged with his incoherence and gently examined Mr. M, I sensed Joe drift as far away from the bedside as he could possibly get. I was miffed that he did not show greater interest.

 Later in the evening, after ensuring that the now fresh-smelling, no longer tremulous, Mr. M had a close-to-normal body temperature, Joe and I sat side-by-side in the Doctors Station. I wrote the admission note and orders, reviewed Mr. M’s extensive medical chart, and pondered the deranged blood chemistries, his chest X-ray and the ECG. Typically, medical students overflow with questions; Joe, oddly, showed little interest and sat quietly while I worked.

 Irritated with his passivity yet wanting to wake his curiosity to the wonders of medicine, I decided to do some “teaching.” I walked to the green board, took up the chalk, and began a wide-ranging lecture. I discussed alcohol as a direct and indirect toxin, with acute and chronic manifestations in every organ in the body. I “pimped” Joe on the physical exam findings and labs which he dutifully reported. I pressed him to discuss why Mr. M was irritable but still charming even while his words did not make much sense. I pushed on. Why does he have yellow skin, tremors, an enlarged heart, a huge belly, but skinny limbs? Why does he have few red blood cells in a wide range of sizes, altered liver function in that particular pattern, and the irregularly irregular cardiac arrythmia? And finally, Why does he have this the remarkable number of ER visits, abominable hygiene and nutrition, no home, no money, no family? 

 After reveling in a medical textbook’s worth of physiology, toxicology, neurology, psychology, pathology, and dermatology – all knowledge relevant to Mr. M’s care - I plopped down in the chair. Joe was clearly impressed. I was jazzed, astonishing even myself with how much I could recite with great enthusiasm and passion.

 It was a fun, self-satisfying performance but, I know now, that did not make it a great education.

 

Why not? First of all, I never stopped to assess what Joe already knew, what he felt, or what he made of the whole experience. I did not discern if he would walk away from my lecture being any more able to care for patients like Mr. M who disgusted or frightened him. Did he now understand how to approach difficult patients emotionally and intelligently? Would he deal with them employing care, competence, and compassion? I had no idea.

 In addition, I neither tried to understand why Joe was so passive about learning, nor did I have a clue how to help him become a more the engaged and motivated learner.

 The next day, it dawned on me that Joe likely had a powerful emotional reaction to Mr. M. Did he recognize a loved one or himself in the end stage alcoholism? I did not know. Did he question his ability help in the face of such suffering? I never asked. If true, then he could have left that evening emotionally overwhelmed, questioning his career choice. 

 As a result, it is possible that my “performance” lecture had the opposite of my intended effect; rather than filling him with knowledge, I might have left him intimidated and less confident. Although Joe might have given me a glowing evaluation based on the attention I gave him (not a bad thing), I realized that, in the long run, I might have failed him.

 

 The road to becoming an educator

 After that evening, I became much more interested in becoming a better educator. Being an educator would require me to both know a great deal, but also know how to share that knowledge effectively. Although I still cared about what I taught the students, I wanted to be able to ensure they would and could learn.

 It was then that one of my mentors sponsored me to attend a weeklong faculty development program for medical educators. We worked in small groups co-creating active learning tasks (e.g., role plays, bedside rounds, reflection writing, and dialogue) and engaging in facilitated “personal awareness” groups.  I shared the story of my experience with Joe, and we role played alternative versions of that “lecture.” This was a profound experience which prepared me to return to residency as a much more effective educator.

 Ultimately, I joined the Facilitators-in-Training (FIT) program of the Academy of Communication in Healthcare (ACH). A senior member of the ACH faculty served as my “Guide.”  In monthly meetings, she coached me to identify my own learning goals and strategies. Together, we facilitated small group learning at national faculty development courses where I honed my skills with her feedback. We worked together for almost seven years, at which point I went on to serve as a guide to others.

 For over thirty years, ACH had created a community of medical educators who share a passion for communication skills training in medical education. ACH members have created innovative curriculum at many institutions and healthcare systems, conducted key scholarship, published a newsletter, a journal, and textbooks, and continued to conduct faculty development.

  

The value of Communities of Practice (CoP) in medical education; Creating concentric circles

 Most faculty development activities in medical schools consist of lectures or one-off workshops. This strategy simply does not work. Instead, experts suggest that it is best to build a community of practice (CoP) situated in an authentic workplace (See “For Further Reading” at the end of this article or click on the article links: O’Sullivan and de Carvalho-Filho.) A CoP is a group of people who "share a concern or a passion for something they do and learn how to do it better as they interact regularly.”

 CoPs are based on learning theories first proposed by cognitive anthropologist Jean Lave and educational theorist Etienne Wenger who were studying what makes apprenticeships powerful learning experiences. At their best, apprenticeships are complex sets of social relationships in the context of a community which creates a living, dynamic curriculum. CoPs are organized in concentric circles with those most intensely involved and experts at its center. Novices initially participate in the periphery, sometimes simply “lurking,” while listening in without engaging. Facilitators actively communicate with and invite in those peripheral participants. Learning happens at all levels of the organization through structured coaching relationships among individuals. Learning is, however, most intense as individuals engage more and move toward the center of the CoP.  This is one of my favorite learning theories, because it provides evidence to guide the growth of our faculty development practice in the Kern Institute.

  

KINETIC3 and the road to developing MCW’s CoPs

The essays in this issue demonstrate the many ways in which the KINETIC 3 program has established and is enriching a Faculty Development CoP at MCW.  By attracting committed, passionate medical educators to engage together in shared learning and practice, we are building capacity to enhance the learning environment for all our students. We continue learning as we tie ourselves together in learning relationships around our shared work.

 While there are basic “teaching skills” components to the KINETIC3 offerings, the members of the Kern Faculty Pillar, under the Direction of Dr. Alexandra Harrington, are building the skills of faculty that improve teaching performance and develop impactful, life changing educators. KINETIC3 graduates are already sharing their skills with colleagues, creating eddies that will become the concentric circles of our own Communities of Practice.

At the Kern Institute, we hope every faculty member will consider applying for the KINETIC3 program during their career. As faculty, we all hope to be the best educators we can be as we share our knowledge and passions. Only then will we engage, prepare, and support every student, even the ones like Joe, who passes through our doors.

 

 

For Further Reading:

O'Sullivan, Patricia S. EdD; Irby, David M. PhD Reframing Research on Faculty Development, Academic Medicine: April 2011 - Volume 86 - Issue 4 - p 421-428 doi: 10.1097/ACM.0b013e31820dc058

de Carvalho-Filho, M. A., Tio, R. A., & Steinert, Y. (2020). Twelve tips for implementing a community of practice for faculty development. Medical Teacher, 42(2), 143-149.

 

 

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.