The Marquette University School of Medicine Aids America in the Time of War

From the 5/28/2021 newsletter

Medical School History 

 

The Marquette University School of Medicine Aids America in the Time of War

 

Richard Katschke, MA

 

In this excerpt from his book, Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019, MCW Chief Historian Richard N. Katschke explains how MCW’s predecessor institution, the Marquette University School of Medicine, responded to the national call to action during World War II …

 

As Europe was embroiled in conflict in the late 1930s, the possibility of the United States’ participation in the war effort impacted the Marquette University School of Medicine and other medical schools nationwide. Beginning in 1940, the Marquette medical school responded to a request from U.S. Surgeon General James C. Magee to sponsor an army surgical hospital. Eben J. Carey, MD, PhD, dean of the medical school, appointed twenty Marquette medical school faculty and staff members to provide administrative and technical assistance to Surgical Hospital #42, based at Fort Campbell, Kentucky. Also, in 1940, Marquette University – including the medical school – was one of twelve colleges nationwide selected to sponsor a Naval Reserve Officer Training Corps.

Following the attack at Pearl Harbor, the United States declared war against Japan on December 8, 1941. Four days later, Germany and the United States went to war. The world conflict triggered significant changes at the medical school. Beginning in July 1942, all teaching activities at the Marquette medical school were accelerated so that medical students could become physicians more quickly and provide medical care on the front lines. Vacations were shortened or suspended. Courses were abbreviated, and electives were dropped. Walter Zeit, PhD, ’39, recalled, “There were several instances where one academic year ended on a Friday and the next one started the following Monday.” Graduation ceremonies were conducted in May and November. Because of the demand for physicians during wartime, the medical school – unlike many other academic programs at Marquette – maintained a strong enrollment.

Norman Engbring, MD, ’51, noted in his book An Anchor forthe Future that the accelerated wartime curriculum placed an additional financial stress on the medical students. In 1942, the W.K. Kellogg Foundation provided $15,000 to the medical school to create a student loan fund. The Kellogg Foundation awarded similar grants to other medical schools nationwide.

Another change that occurred in September 1942 was that the fifth year of medical school - the internship year - was abolished. The requirement had been in place since 1920. Dr. Engbring explained that the fifth year was dropped so that junior medical students could qualify for federal loans that placed a four-year limit on the number of years a student could remain in school. By the end of 1942, only nine of the nation’s sixty-seven medical schools still required the completion of an internship year before medical school graduation. The Army and Navy gave medical students provisional commissions which enabled the students to avoid the draft and stay in school. For example, the Army Student Training Corps and the Navy’s V-12 program were organized, and medical student recruits received a base pay of $50 per month from the military.

“Khaki is now in evidence in the Schools of Medicine and Dentistry as 320 members of the Army Enlisted Reserve Corps in these schools were recently called to active duty by the order of the War Department,” reported the Marquette Tribune on July 15, 1943. “Within the last weeks these Meds and Dents were sent to Camp Grant, Illinois, where they were inducted, issued uniforms, and immediately ordered back to Marquette to continue their education. Roll call at 7:45 am either on the parade grounds or for senior medics, at the hospital, begins the day of the trainees.” Anthony Pisciotta, MD, ’44, recalled that the Army students were organized into the 3665^th service corps under the command of Major Joseph Plodowski, who was based at the medical school. The medical student soldiers became known as “Plodowski’s Raiders” and the “Fighting 3665^th.”

The Marquette Tribune reported that of the 334 male students enrolled in the medical school, 176 were commissioned as 2^nd lieutenants in the army, 104 received navy commissions, thirty-six had applications pending, and eighteen were ineligible for commissions because they were either non-citizens or had a medical disability. Earl Thayer wrote in Seeking to Serve: A History of the Medical Society of Milwaukee County, that nearly fifty faculty members saw active service, as well as a large percentage of alumni.

One alumnus, Lt. William Henry Millmann, MD, ’43, was killed on February 21, 1945, while caring for war casualties in Italy. The Millmann Award, the Medical College of Wisconsin’s highest honor for graduating medical students, was named in his memory. The first recipient of this award was Marjorie E. Tweedt Brown in 1948. John Erbes, MD, who joined the medical school’s surgical faculty in the late 1940s, was the most highly decorated U.S. physician in World War II. As a battalion surgeon, he saw front-line duty in Morocco, Tunisia, Sicily, Normandy, Belgium, and Germany.

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Excerpted from Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019, by MCW Chief Historian Richard N. Katschke, MA. The book is available for online purchase here.

 

 

Richard N. Katschke, MA is the Chief Historian of the Medical College of Wisconsin. He joined MCW as Director of Public Affairs in 1985 and served as the Senior Associate Vice President for Communications. He received MCW’s Distinguished Service Award in 2015 and was awarded an honorary Doctor of Humane Letters degree by MCW at the 2021 commencement ceremony.

The Hogwarts Model: Putting it all Together in Learning Communities is Foundational to the New Medical School Curriculum

From the 5/21/2021 newsletter

Director’s Corner

The Hogwarts Model: Putting it all Together in Learning Communities is Foundational to the New Medical School Curriculum  

Adina Kalet, MD MPH

Dr. Kalet discusses how MCW’s Learning Community (LC) model has the potential to benefit students and faculty members, addressing our desire to build character and caring, while strengthening both academic and social opportunities for our learners …

Last spring, in anticipation of a rough, rapidly evolving, and socially isolating year, the MCW School of Medicine built a learning community (LC) structure for the entering M1 class to ensure social cohesion and engagement. We wanted students to weather the pandemic with regularly scheduled and academically meaningful structured connections with their peers and between students and faculty members. We accomplished this by weaving together the required REACH (Recognize, Empathize, Allow, Care, Hold Each Other Up) Curriculum and the voluntary 4C Academic Coaching Program. We wanted the students to experience a sense of continuity and have sufficient time to establish true collegiality and strong bonds through “cyberspace.” 

A targeted, sophisticated faculty development process was devised and implemented to train over seventy MCW faculty and staff and twenty-seven students to be leaders. Now, a year later, we are in the process of analyzing the data and can report that the experiment was a success. Preliminary student feedback is inspiring. Similar to experiences at other schools with LCs, the participants report that they gained a great deal. The LC has become a central component of the evolving proposal for the new MCW medical school curriculum. 

This issue of the Transformational Times describes the process and amplifies the voices of both students and faculty participants. I hope you will read the descriptions and enjoy the personal stories they share.   

"It matters not what someone in born, but what they grow to be." 

– Professor Albus Dumbledore

The most well-known learning community model is Hogwarts School of Witchcraft and Wizardry, that secondary boarding school administered by the British Ministry of Magic in an unlocatable spot in the Scottish Highlands.  Upon arrival at Hogwarts, new students are assigned by the sorting hat - based on a magical mash up of personality, character traits, and a bit of “destiny” – to one of the four houses, Ravenclaw, and Gryffindor, Hufflepuff, or Slytherin, named for their founders. Just in case you are one of the few people alive who doesn’t know what I am talking about, read the seven volume Harry Potter series by JK Rowling for more details (or watch the movies). You will learn that once assigned to a house, students are pretty much set for years of mostly healthy academic and athletic competition and a great deal of intrigue. At Hogwarts, as in many idealized academic settings, students develop lifelong bonds with housemates by studying, eating, living, and having innumerable terrifying adventures together. 

This identity setting framework is very important to individuals and to the whole Wizarding community. Increasingly, medical schools - as well as many other higher education environments – are embracing this rather “ancient” model to redress the persistent concerns about lack of academic continuity and  inconsistent mentoring, and to provide the healthy social connections that enhance lifelong resilience. 

What are Learning Communities? 

Learning communities are not “extracurricular,” but fully integrated foundational components of the curriculum. Each LC is a group of people who share common academic goals and attitudes and meet regularly to collaborate on learning activities. While it has all of the “student life” benefits in common with advisory colleges, “eating clubs,” dorms organized by affiliations, sororities, or fraternities, an LC goes well beyond simply providing a rich social structure. They are best thought of as an advanced pedagogical design. Medical schools around the world are adopting this model, the highest profile among the early adopters have been Harvard and Johns Hopkins. 

Rather than considering the individual learner as the only relevant unit of instruction and performance assessment, these “communities of practice” explicitly acknowledge that education is a shared cultural activity with a significant communal component. This sociocultural approach is not a new idea, but it remains a challenge to implement effectively. At its best, the LC model provides a means to structure medical education in truly relationship-centered - as opposed to course-centered – ways.   

In our proposed LC model, academic coaching is fundamental. This inextricably links the cognitive and non-cognitive components of learning on the road to becoming a physician, and put relationships among members of the community at the center of that learning and professional identity formation. 

As part of the Kern Institute’s Understanding Medical Identity and Character Formation Symposium (see my Director’s Corner on April 30, 2021), a group of national leaders discussed “The Nature of Learning Communities and the Goals of Medical Education.” David Hatem, MD (University of Massachusetts), William Agbor-Baiyee, PhD (Rosalind Franklin University), Maya G. Sardesai, MD MEd (University of Washington), and our own Kurt Pfeifer MD, explored how their LC structures explicitly address students’ acculturation to both medical school and the profession of medicine. They reported how a healthy learning environment counters the noxious impacts of the “hidden curriculum,” while supporting students on their professional journeys during medical school, aiming to ensure that students are ready for, and will thrive in, a lifetime of practice as a physician.  

The panelists also shared the collective experience of the  forty-seven medical school members of the Learning Communities Institute (LCI), reviewing the essential characteristics LCs must possess to foster character, caring, and the development of a mature and hardy professional identity. These include:

• Committing dedicated medical school resources and time in curriculum 
• Assigning buildings or spaces that allow students to gather to form relationships (Johns Hopkins constructed a building dedicated to their learning communities) 
• Aligning espoused professional values with values that are practiced by promoting the skills of doctoring while intentionally countering the learning climate’s unsavory elements and its hidden curriculum  
• Promoting longitudinal relationships between mentors and students from beginning to end of medical school, thus enabling mentors to simultaneously support learners while holding them to high professional and academic standards
• Supporting character formation through peer mentoring programs and career decision making

With these guidelines to inspire us, and seeking the collaboration with and approval of the MCW’s Curriculum and Evaluation Committee and the Faculty Council, we intend to build LCs tailored to our institutional culture and strengths. For more, see the essay in this week’s newsletter entitled, “Learning Communities at MCW – A Vision for the Future.”  

The critical importance of continuity - Putting it all together

Throughout my career as a medical educator, I have been involved in efforts to structure close student-faculty engagement and mentoring through small group learning structures. This has included decades of teaching in small groups in an introduction to clinical medicine course for M1 and 2s and being an Internal Medicine “Firm Chief” responsible for successive cohorts of clinical clerks (M3s) while leading an Advisory College style program. These learning structures have often been profoundly satisfying for students, my colleagues, and for me as we provided meaningful educational experiences and mentoring. But none of these experiences provided students with truly longitudinal - admission to graduation - integrated coaching or mentoring. I always knew we could be doing better. I fully believe that the LC model promises a real opportunity for the continuity the current system lacks. 

There is benefit to the faculty, as well

There is no better way for faculty to develop wisdom as medical educators than by committing to a longitudinal process. I started my career focused on residency education and got to know wave after wave of trainees as individuals. These relationships showed me the common developmental trajectories and predictors of success or failure and, therefore, made me a more patient, accurate, and persistent coach. For example, I noticed that the first year residents who worked most slowly in clinic, staying later than peers to finish their patient care sessions, often grew into skillful and efficient clinicians, and were more likely to be eventually selected as chief residents. Knowing this made me more patient and kept me from “taking over” to get their patients “out the door.” I let the novices struggle a bit, confident that their patients were receiving better, more attentive care. It was personally rewarding to know that my patience helped to nurture some wonderful, future colleagues, but I only knew this because I had provided years of longitudinal mentorship. 

Medical school should be a guided experience toward a life in medicine. Learning communities offer a framework for “putting it all together,” providing solutions to many of our modern challenges in medical education while enabling the magical relationships with the student’s peers and faculty. Our goal is to create opportunities for discovery and growth because, as Professor McGonagall once noted, “We teachers are rather good at magic, you know.”

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.

Questions for Four of the 4C Students

From the 5/21/2021 newsletter

 Questions for Four of the 4C Students

Trevor de Sibour, rising M2; Radek Buss, rising M3; Julia Bosco, rising M2; and Ryan Power, rising M3

Medical students Trevor de Sibour, Radek Buss, Julia Bosco and Ryan Power discuss their experiences as students in the Coaching for Character, Caring and Competence (4C) Program …

In August 2019, the Kern Institute launched the Coaching for Character, Caring and Competence (4C) Program. This optional four-year longitudinal program pairs students with faculty coaches who will help to foster the student’s professional growth. The students and coaches have individual student-led meetings, as well as small group meetings to discuss topics such as character, professional identity formation and other topics that will help them through medical school and beyond. 

We wanted to hear from students about why they chose to participate in the 4C program and the impact that this program has had on them. 4 M1s, Trevor de Sibour, Radek Buss, Julia Bosco and Ryan Powers, submitted their responses to us on 4 questions about their experience with the 4C Coaching Program. 

What made you sign up for the 4C program? 

Trevor: I signed up for the 4C program because of the mentorship opportunities it provides. I had attended a large university for college where I struggled to find mentorship, particularly pertaining to character and professional development. Moreover, I was concerned about connecting with faculty and potentially peer mentors due to the ways in which COVID-19 has altered our everyday interactions. As such, when I learned of 4C, I immediately decided to apply. I felt it was well structured and an excellent way to quickly connect with a faculty member, peer mentor, and other students in a casual setting.

Radek: As an international, first-generation college graduate, I was faced with a lot of stressful unknowns when beginning medical school. Therefore, when given the opportunity to apply for the 4C program, I did not hesitate at all. I have always been very fond of the mentors I have had as a student, and I realize that I would not be where I am today without their guidance and support. The 4C program was the perfect opportunity to meet new mentors in medicine and form lasting professional relationships along the way. 

Julia: Following a year of medical school applications, April 30th finally arrived, and I began the matriculation process at MCW. Little did I know that the certifications, requirements, and deadlines would not stop coming once they started. As I navigated this process amidst the COVID pandemic, I felt overwhelmed and isolated. As deadlines grew closer and questions accumulated, these feelings of isolation persisted. As the pandemic dragged on, our matriculation process and education became increasingly virtual. First, our Second Look Day was canceled. Then, my CPR class was delayed, then canceled, then moved online. Coming from a small liberal arts college, I was intimidated by the prospect of what was looking like Zoom School of Medicine. With my higher education being entirely in-person (at my college class attendance was mandatory), I knew, in this virtual world, I needed mentorship ASAP, and on a whim and blindly seeking support, replied to Dr. Pfeifer’s call for participants in the 4C program. 

Ryan: At the beginning of medical school, there are suddenly a lot of questions and a lot of options you didn't have time to consider before. Throughout undergrad and the application process, your only real question is "Can I get in?" Then, suddenly, you start medical school and you have so many extra questions like what you'll do for research, how will you study, what information is truly important, how will you function in a healthcare team, what specialties should you pursue, and the list never ends. When I saw an opportunity for a coach and a mentor, I saw an opportunity to meet with someone who had those questions before, too. Not only that, I knew that anyone who signed up to be a mentor for the program obviously had an interest and a passion in helping me find those answers. 

What has been the most beneficial part of the program? 

Trevor: The most beneficial part of the program is the insight I have gained from each group member. I have an excellent coach whose perspective on medicine I find enlightening, a fantastic peer mentor whose medical school advice has been invaluable, and three incredible peers whose distinct viewpoints have helped shape my understanding of what it means to be a medical student. 

Radek: The 4C program has been source of a very different type of education, more closely resembling the one I was accustomed to as a student at a small liberal arts college. Whether one on one with my coach, or during our group meetings, the discussions are focused on topics such as well-being, emotional agility, or personal strengths. While those may not pertain to pathophysiology or pharmacology, they are undeniably an important aspect of medical education as a whole. We must be able to take care of ourselves in order to properly, and to the best of our ability, treat others. The 4C program has filled this gap in my medical education, for which I am grateful. 

Julia: Structured mentorship. As I discussed above, my entire education was in a small and exclusively in-person environment, which I found critical to finding mentorship. Looking back on my first year of medical school, if not for the 4C program, I would not have had the same opportunity to have such a positive mentorship experience early in my medical education. I have been able to connect with peers, mentors, and develop a feeling of belonging at MCW, despite this virtual age. From day one, I was accountable to other people, and they invested in my development. This structured mentorship has facilitated my growth as a student doctor and professional. I have the privilege of receiving one-on-one mentorship from Dr. Ankur Segon, our group coach, where we spend the entire hour developing strategies to overcome obstacles I am currently facing. Additionally, Miranda Brown, our group’s near-peer mentor, invests in my practical clinical skills. For example, last semester, she generously read and provided feedback on my clinical notes. Their input and feedback have been invaluable. I cannot imagine my first year of medical school without their mentorship and the support of my peers in my 4C group. 

Ryan: Medical school can be a bubble sometimes. You're focused on your next exam, or STEP, or rumors you hear from classmates or social media about what's important and what you need to do to be a good student. Having a mentor who has two feet firmly planted in the practicing world of medicine is a really great way to get the unequivocal truth. How are my grades actually viewed by residency directors? How can I grow in personal and professional ways, rather than just academically? There were plenty of things I never considered that were brought up by my mentor, and they've been invaluable both in class and in personal growth.

How has your coach impacted you? 

Trevor: I greatly appreciate the guidance my coach has provided me in regard to my professional development. During our most recent one-on-one meeting, I went in unsure and somewhat cynical of what I wanted the next steps of my professional development to be. Ultimately, we had a really productive and candid conversation that helped me create goals that I found to be meaningful and personally satisfying. Having a mentor who I can be honest with, without having to worry about any repercussions, is invaluable. 

Radek: My coach has significantly impacted my career as a medical student. From the first day of this program, she has been open to my questions, no matter how trivial, and supported/guided me through my first two years of medical school. The opportunity to meet with her regularly allows me to continually monitor my progress and compels me to stay on track in accomplishing my goals; it’s as though she is there to both support me, but also keep me accountable. 

Julia: Dr. Ankur Segon has been an excellent individual and group mentor. In the group setting, he is engaged, provides individual and generalized feedback, and always asks us directly if we are keeping our minds and bodies healthy. For me, this investment and concern keep me accountable to and help me prioritize my health, which is easy to abandon in the chaos of M1. In the individual setting, Dr. Segon has provided support, helped me navigate professional and personal decisions, and provided his insight on the matter. Additionally, he continually demonstrates what it means to be a good mentor, which is a skill I hope to cultivate in medical school. I look forward to my dedicated 4C meetings. Because of the supportive environment Dr. Segon fosters, I know I can bring any stress or concerns to these meetings, and when I need to, I know that my 4C coach, near peer mentor, and peers are willing to help or to help me get the help I need. 

Ryan: My coach has made MCW an incredibly positive place. I always have someone I can message or email with questions, and she is always willing to celebrate successes with the rest of the group and me. It's invaluable to have a trustworthy resource to dispel any confusion or doubts through such an arduous process.

Why would you recommend the program to incoming students? 

Trevor: There are multiple reasons I would recommend the program to incoming students. For students who find seeking out mentorship daunting, 4C is invaluable, as it pairs you with a faculty member who is clearly committed to providing quality guidance. Moreover, the topics discussed at group meetings are not found elsewhere in medical school curriculum, yet have the potential to make students well rounded future physicians. How much students will benefit from 4C is associated with how much they invest. So for those who are ready to invest in the program, I highly recommend it. And who knows? Perhaps along the way, they too will meet one of their best friends through the program. 

Radek: I would highly recommend the program to incoming students because it connects you with a coach whom you meet with regularly, and therefore are able to develop a professional relationship. As a coach who is often heavily involved in medical education, they provide support, share ideas, and guide you through your time at MCW. Medical school can be quite stressful and hectic, especially the beginning, and having a coach who helps you navigate your student life is priceless. 

Julia: I highly recommend the 4C program to incoming students. I have found this program to be genuine and critical in my growth as a professional. Although similar opportunities for growth and support exist in the M1 curriculum, I think that since this program is elective and outside medical education proper, participants want to invest in and learn from each other, and so, this does not feel like just another obligation taking time away from my studies. To incoming students, I would say: you get out of this program what you put into it. 4C could become like other programs if its participants do not commit, so invest in it. As someone who came to medical school looking for accountability and quality mentorship, I found what I was looking for in the 4C program. 

Ryan: The Big Sib program (which is also hugely helpful) is a really great start to get advice and direction on the academics and requirements of your coursework, but throughout your first two years at MCW you likely won't have regular contact with many mentors who are actively practicing and navigating medicine. This is a great way to get paired up with a faculty member who cares enough about helping and developing students that they've volunteered time out of their incredibly busy schedules to do just that.

Trevor de Sibour is a rising M2 from Grand Rapids, MI, and attended undergrad at University of Michigan. 

Radek Buss is a rising M3 from Prague, Czech Republic, and attended undergrad at St. Norbert College. 

Julia Bosco is a rising M2 from Green Bay, WI, and attended undergrad at Hillsdale College, in Hillsdale, MI. 

Ryan Power is a rising M3 from Racine, WI, and attended undergrad at UW-Whitewater.

Learning Communities at MCW - A Vision for the Future

 From the 5/21/2021 newsletter

Learning Communities at MCW - A Vision for the Future

Kurt Pfeifer, MD, Marty Muntz, MD, and Cassie Ferguson, MD

As the Kern Institute continues its work on implementation of well-being into the medical school curriculum and exploration of the use of learning communities (LCs) in medical education, members of the Kern Institute and key stakeholders have met to discuss the larger vision for what LCs might look like at MCW …

Within the next decade, we envision Learning Communities (LCs) being an integral part of the continuum of medical education, spanning from undergraduate (pre-medical) schooling through graduate medical education (residency & fellowship), and encompassing all healthcare professions (including, for example, nurses, physician assistants, nurse practitioners, pharmacists, physical therapists, and social workers). LCs will target multiple critical objectives, both social and academic, and will greatly improve students’ preparedness for their careers in medicine by providing accessible, essential, and longitudinal relationships in the form of mentorship, coaching, support, and advice with faculty, senior colleagues, and/or peers. Moreover, LCs will provide an essential forum for development of character and caring by serving as a “safer space” for individuals to come together and provide multiple different perspectives as each student forms their professional identity. 

In this essay, we outline what a comprehensive LC program could look like at MCW.

General Structure

Learning Communities would include students from each year of education to provide networks of peer support that span the breadth of the medical school experience (Figure 1). Previous experience from the REACH Curriculum indicates that groups of eight peers provide an optimal group dynamic. 

To enhance the network of support and learning, interprofessional education would be coordinated by having groups of learners from other professions work with medical students within their LCs. Broadening the inclusion further would also allow for resident physicians - perhaps even LC graduates if they stay at MCW for residency - to be part of an “extended family” that can participate sporadically in LC activities and serve as mentors. Lastly, students can participate in supporting the development of future medical students by engaging in mentorship activities with pre-medical/undergraduate students, especially underrepresented in medicine (URM) individuals. 

Each LC would have two faculty facilitators as well as two student facilitators. The faculty facilitators would share responsibilities for leading group activities and would divide the responsibilities for individual student coaching. At least one faculty facilitator would be a clinical faculty and, if both are clinical faculty, the LC would also include a foundational science faculty member or course coordinator to provide their valuable perspective. One M3 and one M4 from within the LC would be nominated to serve as student facilitators. They would join select small group meetings and serve as the student leaders of the LC.

The LC is the basic unit of the LCs program, but higher levels of structure facilitate other aspects of medical education. Given the number of MCW students, six LCs will be collected into a House. The House will provide a format for larger learning activities, including coordination of cohorts in the event of restricted in-person coursework and social events. 

The House structure also incorporates mechanisms for remediation and behavioral health support. We propose that a Continuous Professional Development course directors could be assigned to each house and serve as a resource to faculty and students in their LCs to develop and implement remediation plans and provide additional career planning advice. To encourage students’ willingness to discuss behavioral health and reach out for assistance, we propose having a behavioral health clinician assigned to each House. This individual could come to House and LC meetings and therefore encourage students to get behavioral health assistance by connecting with an individual in their personal network rather than an unknown clinician.

Key: Undergraduates [UG], Nursing [RN], Pharmacy [Pharm], Physician assistant [PA], Resident [Res], Other health professionals [Other], Faculty facilitators [Fac], Student facilitators [Stu],Continuous Professional Development director [CPD], Behavioral Health professional [Ψ], Learning Community directors [LCD]

Activities in LCs

LCs would not have their own curricula but would be a venue utilized to achieve the objectives of key curricular threads – foundational science, clinical science, and personal/professional development. By their nature, they would be most heavily used for achieving objectives of the latter, including well-being, professional identity development, and empathy/character enhancement. These could be achieved through different combinations of LC individuals (Figure 2). However, the LCs could pursue foundational and clinical science objectives by maintaining group continuity for activities such as team-based learning exercises, physical exam education, and medical ethics discussions.

Concluding thoughts

LCs have developed a prominent role in modern medical education for good reason. Groups of students and faculty maintain continuity over the span of education, developing longitudinal faculty and near-peer mentorships and a “safer space,” where a growth mindset can be fostered. Such groups are even more important at large medical schools like MCW. LCs will allow us to place the learner at the center of the educational process around which we weave the comprehensive threads of medical education (Figure 3). 

 Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

 From the 5/21/2021 newsletter

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

Kurt Pfeifer, MD; Marty Muntz, MD; and Cassie Ferguson, MD

The team reviews MCW’s experiences with the REACH Curriculum and the 4C Program, each of which has elements of the proposed Learning Community model …

The challenges of training in medicine have never been greater. Medical students are expected to develop a larger fund of knowledge in hectic clinical environments burdened by great financial, social, and public health pressures. This creates can have numerous consequences, including burnout and increasing rates of psychiatric disease. To better support students and reduce these potential problems, many medical schools have implemented learning communities (LCs).

LCs are comprised of faculty members and students who regularly meet together for community-building, academic and personal support, professional development, and curricular activities. Since the early 2000s, many medical schools have implemented these types of programs, and according to the most recent survey of US medical school have LCs or are developing them . LCs have been shown to improve faculty engagement, student well-being, and professional development.

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In the last few years, MCW has embarked on its own exploration of LCs and has implemented programs which, although limited in scope, are based on the philosophy of LCs.

MCW’s REACH Well-Being Curriculum 

LCs can positively impact student well-being, which has become a major priority for US medical schools. In 2018, with the support of the MCW School of Medicine and the Kern Institute’s Student Pillar, Dr. Cassie Ferguson implemented a well-being curriculum aimed at teaching skills related to well-being and providing opportunities to talk with and learn from peers and faculty members. Utilizing longitudinal groups of faculty, staff, and students, the structure of the REACH (Recognize, Empathize, Allow, Care, Hold Each Other Up) Curriculum incorporates a LC model.

REACH consists of didactic sessions followed by facilitated small-group sessions which focus on the content and objectives covered in the didactic sessions. When first implemented, the program included three sessions in the spring semester of M1 year and three in the fall semester of M2 year. Each small group has eight medical students (ten in the first two years of the program) and two volunteer facilitators. One of the facilitators is a clinical faculty member and the other is a behavioral health clinician or a student support staff member. Using session guides with learning objectives and suggested discussion questions, facilitators conduct two-hour sessions with their students. The objectives of the REACH curriculum are to describe how the well-being is integral to becoming a caring and competent physician and practice skills that will help students thrive in medicine. 

Evaluation of the curriculum was accomplished through a seventeen-question survey made up of Likert scale and open-ended questions. Sixty-two students at MCW-Milwaukee (30%) completed the survey. 85% of respondents believed that what they were asked to learn in REACH was important and 70% would recommend that other medical schools adopt REACH. The REACH small group sessions played a significant role (>70%) in building relationships with peers and faculty. Students commented on the benefits of getting to know their peers, realizing they were “not alone” in how they felt, and feeling faculty were genuine and cared about them.

Following its successful first two years, the REACH program was expanded into the Fall M1 semester starting in August 2020. Now the program uses the same groups of students through the first three semesters of medical school, but in the first semester small groups, volunteer M2 students are utilized as facilitators. Evaluation is ongoing but early subjective feedback has been strongly positive.

MCW’s 4C Program 

The Coaching for Character, Caring, and Competence (4C) Program was launched in August 2019. 4C is structured around the core concept of LCs where groups of students and faculty cultivate professional growth within longitudinal relationships. Within this framework, multiple different components can be implemented to meet specific objectives (Figure). 

Roughly fifty students volunteered for the program during AY2019. Thirteen volunteer faculty were grouped with three to four students each, and these groups meet monthly covering character and professional development topics. In addition, faculty meet individually with each of their students every other month. The program is directed by Kurt Pfeifer, a faculty member in the Student and Curriculum Pillars of the Kern Institute. 

Initial data showed great support for the program as a whole. There was a strong impact on development of mentorship, support for students, and a sense of faculty engagement. Students in the program were less likely to have feelings of isolation and reported strengthening of several character traits, including perspective, self-regulation, perseverance, and social intelligence. 

For AY2020, a new group of volunteer students was sought and the response was overwhelming. Greater than 55% of the incoming class desired to enter the program. Based on available resources, the program was able to enlist fifty-six new students along with fourteen new faculty coaches. The program also added a program of near-peer coaching in AY2020 which paired volunteer M3 near-peer coaches with each group of M1s and M4 near-peer coachs with each group of M2s. Furthermore, MCW-Central Wisconsin and MCW-Green Bay incorporated adaptations of the 4C program for their campuses. 

Evaluation of the 4C program is also ongoing, but subjective feedback from students and coaches alike has been strongly positive. 

Next steps

REACH and 4C both continue to move forward with planning expanded activities and refined content with the coming academic year. These programs have been pivotal for informing MCW’s curricular re-design process, and the hope of their directors and coordinators is that they will form the basis for a comprehensive LCs program at MCW in the future.

For further reading:

Smith S. Acad Med. 2014 Jun;89(6):928-33. 

Eagleton S. Adv Physiol Educ. 2015;39(3):158-66. 

Smith SD et al. Acad Med. 2016;91(9):1263- 9. 

Rosenbaum ME et al. Acad Med. 2007;82(5):508-15. 

Wagner JM et al. Med Teach. 2015;37(5):476-81.

 

Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Questions for Three of the 4C Coaches

From the 5/21/2021 newsletter

Questions for Three of the 4C Coaches

Edmund Duthie, MD; Amy Farkas, MD, MS; and David Marks, MD, MBA

Drs. Edmund Duthie, Amy Farkas, and David Marks, who serve as coaches in the 4C Program, discuss their experiences and encourage other faculty members to volunteer in the future …

In August 2019, the Kern Institute launched the Coaching for Character, Caring and Competence (4C) Program. This optional four-year longitudinal program pairs students with faculty coaches who will help to foster the student’s professional growth. The faculty who serve as coaches volunteer their time to the program. The students and coaches have individual student-led meetings, and small group meetings to discuss topics such as character, professional identity formation and other topics that will help them through medical school and beyond. To help prepare the coaches for these discussions, monthly faculty development sessions are hosted where a content expert on each topic gives an hour session. Group meeting facilitation guides are provided for the coaches, as well. 

We wanted to hear from the faculty about why they chose to participate in the 4C Program and the impact that this program has had on them. Three coaches, Drs. Edmund Duthie, Amy Farkas, and David Marks, submitted their responses to us on four questions about their experiences with the 4C Coaching Program.

What made you sign up for the 4C program?

Dr. Duthie: I signed up for 4C program to better connect with our students. A longitudinal approach was appealing. 

Dr. Farkas: Joining the 4C program as a faculty coach seemed like a great way to pay it forward. I was part of a similar program as a first-year medical student at the University of Pittsburgh and I still mentor with my assigned faculty mentor thirteen years later. To offer that to the next generation of students was important to me.

Dr. Marks: The Kern Institute’s recruitment for new 4C coaches occurred at an opportune time. As a physician administrator, I was heavily involved in COVID care as a leader in both the Incident and Recovery Command teams; I recognized the resumption of operations needed to include better care for our patients, caregivers, staff and learners as a whole. In my personal life, my daughter’s medical school graduation was canceled, and though she was hooded “online,” I recognized that this current medical school class would face unique challenges as a result of the pandemic’s impact on education and socialization. I felt called to offer my services as a 4C Coach to pass on my experience and resilience having served many years as a clinician, and as a leader in both medicine and healthcare administration.

What has been the best part of the program?

Dr. Duthie: Getting to know a small group of M1s better and connecting me with the students, their challenges, and the curriculum. 

Dr. Farkas: Getting to know the students and to watch the group dynamic. My students are great supports for each other, particularly in the time of COVID when so many normal social supports are removed. Knowing that they have connected outside of our 4C group is wonderful. 

Dr. Marks: Our 4C group is composed of unique, talented individuals who are progressing remarkably through the challenges of M1 (and M3). Their personal and professional growth is tremendous. Coming alongside them and encouraging/coaching has been terrifically refreshing for me and I look forward to their ongoing formation as good physicians.

How has being a coach impacted you?

Dr. Duthie: I have achieved my goal of connecting with students. Unexpected benefits: getting to work with the near-peer coach has been great. Further, the faculty development has helped me to grow as a thoughtful educator. 

Dr. Farkas: In the rest of my job, I am pretty removed from the first year of medical school. It’s nice to have a reminder of what that time is like, as it provides me insights into where my MS3 and MS4 students are coming from so that I can better support them. It’s also just a lot of fun. 

Dr. Marks: The coaches’ development sessions and curriculum turned my attention to the resources we have in the Kern Institute; exposure to these individuals and resources allowed me to seek new opportunities of study and growth for myself. I was particularly drawn to discussions of character which prompted thoughts on how clinical operations, artificial intelligence (AI), and patient care are at risk by new technology. Adoption of artificial intelligence can pose challenges for safe, compassionate, and ethical health care. I wanted to explore if appropriate implementation and use of these tools could be addressed with character education and wisdom. This path ultimately led me to apply to become a Kern Scholar and pursue additional training in character education. 

Why would you recommend other faculty join the program as a coach?

Dr. Duthie: Definitely would recommend. It is a commitment, but grounds us in why we are a medical school and why we became physicians. 

Dr. Farkas: Absolutely! Seeing the students’ excitement and watching them develop over the last year has been very fulfilling. I look forward to helping them on their journey over the next few years. 

Dr. Marks: I highly recommend the mentor position in the 4C program as a means to give back to learners and to stimulate one’s own understanding of the current challenges faced by our caregivers. The program has proved to be rewarding not only as I provide counsel and guidance, but also as I gain insight and wisdom from my colleagues. Additionally, the tools that the Kern Institute provide are important and relevant to our broader medical and administrative community.

Edmund Duthie, MD, is a geriatrician and Professor in the Department of Medicine at MCW. 

Amy Farkas, MD, MS, is a general internist and Assistant Professor in the Department of Medicine at MCW. 

David Marks, MD, MBA, is an interventional radiologist and Professor in the Department of Radiology at MCW. 

Read this Issue. Your or Your Colleague’s Life May Depend on It.

From the 5/14/2021 newsletter

Director’s Corner

Read this Issue. Your or Your Colleague’s Life May Depend on It. 

Adina Kalet, MD MPH

This week, we focus on suicide and its prevention. Dr. Kalet urges you to read what is likely our most compelling issue ever of the Transformational Times, curated by Dr. Jeffery Fritz and the Kern Student Leadership group. You will learn a few things, be moved, and be better prepared to save a life …

The MCW-Milwaukee medical school graduating class of 2021 has suffered the loss of two of its cohort to suicide. This has been devastating for the families and close friends of these individuals. Their grief, profound and deeply personal it must be, and has been, treated with tenderness and respect for desired privacy. 

As new physicians, this class joins a profession where suicide is all too common. An estimated 300 US physicians take their own lives each year and the rates may be rising. It is likely that each of us have been, or will be, touched by suicide amongst our colleagues and friends. 

For many people who are contemplating suicide, prevention is possible. As colleagues, it requires each of us to be proactive, skillful, and brave in facing our own acculturated barriers to reaching out to others in times of despair. On a personal level, we must all learn to identify and skillfully intervene with friends and colleagues at risk, and vow to accompany those family members and friends who are left to deal with the grief and guilt that suicide leaves in its wake. It is good news that more than 90% of people who survive an attempted suicide never go on to die by suicide. Intervention and treatment save lives.

We also know that, in some cases, there is little that we can do. Some people are committed to ending their lives without intervention and offer no detectable warning or cry for help. With these deaths, we must care for the survivors, enact the self-compassion to digest and deal with our own thoughts and feelings, and develop meaningful ways to acknowledge the loss.  

What we know about suicide

Suicide is among the most common causes of death in those under 55 years of age. The rate of suicide has increased from 17 to 22 per 100,000 over the past twenty years, rising particularly among white and Native American men. Other Americans with higher-than-average rates of suicide are military veterans, people who live in rural areas, and workers in mining and construction. Lesbian, gay, bisexual, or transgendered young people have higher rates of suicidal ideation and behavior compared to their straight peers. There is a rising concern for adolescents who have been socially isolated during COVID-19. Those with mental health diagnoses, such as major depression and bipolar disorder, and those who struggle with alcohol or other substance abuse disorders are at increased risk. Because of their access to lethal weapons, people who live in homes with firearms are at higher risk. About 60% of firearms deaths each year in the US are suicides.

Systemic approaches to preventing suicide include cultural and institutional efforts that eliminate professional burnout and enhance wellbeing. This requires, as Dr. Cipriano points out in this issue, viewing suicide through a public health lens. Meaningful prevention of suicide on a population basis will require comprehensive approaches that strengthen financial safety nets and coping skills, promote connectedness, and enhance access to excellent mental health care. 

What to do when the person in front of you is suffering

Preventing suicide while in the presence of an individual who concerns you requires your active intervention. Learn to ask about suicidality. Be willing to remain present and keep the individual safe. Help the person stay connected to others and follow up. In this issue, our students describe their efforts to disseminate these basic principles. 

The experience of relatives and friends 

I find hearing that someone has killed themselves is always disorienting and unfathomable. While not ubiquitous, it is common for families to close ranks and feel both stigmatized and ashamed for a time. Traditionally, many cultures and religions have created a stigma around suicide although, as a result of work to raise awareness around these issues, most groups have faced down their stigmatizing actions. As one of this week’s authors, Toni Gray, points out, things have changed for the better through research, public awareness campaigns, and the compassion of mental health caregiving.  The key is to try, follow the lead of those who are grieving, and remember that they will be dealing with the loss for their lifetimes. 

Suicide in medical settings gets uncomfortably close

Suicide has touched my personal social circle a few times over the last years, including a teenager and more than one adult with loving families and seemingly rich lives. 

When I was just starting out in medical practice, it was a commonly held (and incorrect) belief that asking someone, especially someone who was desperately fragile emotionally, if they were considering killing themselves might “plant the idea in their head.” This approach likely cost lives. Now we know better. Many people who attempt suicide have seen a physician, usually not a mental health expert, in the weeks prior to the attempt. Physicians and healthcare workers in every specialty must understand their obligation to recognize and intervene.

In medical settings, I have noticed that suicides tend to happen in waves. A few years ago, a medical student, well known and loved by his peers and teachers and who had no known personal or academic troubles, jumped from the roof of a building in New York City. Soon thereafter, two other young physicians in our community died by suicide. Four senior physicians at a hospital where I have worked took their own lives over the course of a year; this was attributed to workloads of over 100 hours a week. 

MCW has been similarly touched. These are profound shocks for any educational institution and, despite having policies, protocols, confidential counselling, and employee assistance offices, deaths still occur. Each suicide is devastating. With each occurrence, we look for answers. We redouble our commitment to reach out if we are concerned about colleagues, friends or patients. We educate ourselves. We plan to simply ask, “Are you thinking about killing yourself?” and then commit to sitting and listening.  Each loss leaves the community diminished.

We hear the voices of people who have struggled

Like our anonymous student essayist, survivors of profound depression and grief often become so focused on their own suffocating isolation that they can see no other option. Shakespeare reminds us that, "Everyone can master a grief but he that has it." It falls to those of us nearby to accompany the person suffering, offering safety, connection, and help. As the student tells us, “As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction.” We might be the one to save a life.

We are deeply grateful to those who contributed pieces in this issue. Students, staff, and faculty members who have struggled personally or vicariously through close relatives and friends, share their stories. We hear from Brett Linzer, a physician who, having experienced the loss of a number of colleagues and friends to suicide, as he faces his own burnout with the help of his loved ones. Although reluctant at first, he seeks the coaching that strengthens him with skills and support, enhances the joy he experiences in his work, and compels him to use his experience to work toward systems change for all of us. We get to know Kerri Corcoran, Student Behavioral Health and Resource Navigator in the MCW office of Student Services, who is committed to providing direct support for our students. MCW-Central Wisconsin students write about their work at self-organizing, with great creativity, to do suicide prevention work. 

This is a difficult, ongoing, and devastating problem that disproportionately touches us as physicians. We desperately want to do this right and welcome your experiences and efforts. 

I urge you to read this issue. You never know when it will be your turn to save someone’s life. 

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.

Many Hands, Many Voices: Suicide Prevention Work at MCW

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 Many Hands, Many Voices: Suicide Prevention Work at MCW

 

 David J. Cipriano, Ph.D. - Director of Student and Resident Behavioral Health and Co-Chair, MCW Suicide Prevention Council

 

 Dr. Cipriano, Co-chair of MCW’s Suicide Prevention Council, describes how the council is approaching this critical topic through the development of peer support, beginning at MCW-CW …

 

 Many hands, many voices – a common call for community collaboration – describes the progress of our Suicide Prevention Council (SPC).  I reported a few months ago on our identification of two risk factors for suicide that we chose to focus on this year:  isolation and stigma.  And, I promised to report back on our progress. 

Last time, I spoke about the culture change needed to reduce these risk factors.  We began to plan for a public health model to promote such culture change.  There are three categories of prevention: Primary prevention focuses on various determinants in the whole population. Secondary prevention comprises early detection and intervention. Tertiary prevention targets for advanced recovery and reduction of relapse risk. Our model utilizes trained peer supporters as the main change agents in the secondary prevention component. 

 We looked to Drs. Alicia Pilarski and Timothy Klatt’s Supporting Our Staff (SOS) program to address “second victim” - or vicarious trauma - amongst clinicians, and our program is closely modelled on theirs. The primary prevention component seeks to raise awareness, educate, and begin the conversation through events, media, and other means.  These are the seeds of the culture change needed beginning with stigma which keeps mental health in the shadows and isolation, perpetuated by shame and pride which keep us from reaching out to peers and colleagues.  Tertiary prevention involves removing barriers to access to care for those who need it.  We have made good progress on this over the past few years, but there is more we can do.

 

A student-led suicide prevention initiative at MCW-CW

So, whose hands and whose voices?  Dr. Jon Lehrmann, Chair of Psychiatry and Behavioral Medicine and co-founder of our Suicide Prevention Council, kept directing us back to the Pilarski/Klatt SOS program.  He saw the benefits of the public health approach and of the peer support component. MCW-Central Wisconsin medical student, Margaret (Meg) Lieb, pointed out the difference between peer support programs that encourage the active outreach of peer supporters, versus passive models where it is the responsibility of those in distress to reach out.  Then, our terrific community member of SPC, Dr. Barbara Moser, jumped in with her wealth of knowledge of training tools and experiences needed to prepare these peer supporters.  

So, what’s coming next?  Meg Lieb has assembled a group of fellow students with a passion for the mental health and wellbeing at MCW-CW.  They will launch a pilot program next month. You will be hearing from several of them in this issue of Transformational Times.  Meg and her team have been putting together the training materials, recruiting peer supporters and have even secured funding through Dr. Lisa Dodson, Dean of MCW-Central Wisconsin from a grant she received.  All this, while Meg is preparing for the Step 1 exam! 

I’ll stop here and let these amazing students tell their story.  I will make another promise here – while they are running their pilot, we on the SPC will continue to make plans for extending this program to our MCW-Milwaukee and MCW-Green Bay, as well.

 

 

David J. Cipriano, Ph.D. is an Associate Professor in the Department of Psychiatry and Behavioral Health at MCW and Director of Student and Resident Behavioral Health. He is a member of the Community Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

What is it like to be suicidal?

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 

What is it like to be suicidal?  

 

 

By an anonymous medical student

 

 

A medical student shares their personal journey with suicidal thoughts …

 

 

To me, being suicidal is a physical place in my mind. I’ve boarded the wrong train, or maybe it’s the right train going in the wrong direction. It’s a vast transit system: all the stops are underground so I can’t see where the train is going, and the doors are locked so I can’t get off. In addition, my vision is too blurry to read the map posted on the door.  

 

As I ride to The Wrong Place, I only know that’s the destination if I pay close attention to myself. There are telltale signs: my hobbies become boring or arduous, my favorite foods taste like saliva, and I avoid eye contact with the mirror. 

 

As another stop goes by, my arms and ankles become heavy—too heavy to lift. Taking a shower sounds like a luxury that I simply do not deserve. I do not have the energy to hurt myself at this point... until the train reaches its next stop. 

 

This next stop is at the most dangerous neighborhood I can imagine. Here, I have the will to get out of bed, say my goodbyes, and seek out my demise. At this point, one of two things will happen. I either tell a friend my plans (you know, so they aren’t surprised; it’s common courtesy really), or I call my mom. Every single time so far, someone, somehow, has listened to my spiel about why I should leave this world. The person I am speaking to invariably disagrees with me, and I can feel the train slowing down. Slowly, I can sense how absurd the idea sounds as I hear my own voice speak this strange manifesto. 

As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction. The train finally stops, the doors unlock, and my vision clears. I choose to walk onto the platform and take the stairs back up to ground level, where the rest of my life is waiting. I am existentially exhausted, having both won and lost an argument that put my life at stake. 

 

Personally, I find the feelings of suicidality are always temporary. They fade away, and I am left to live with myself, knowing that some part of me tried to delete all parts of me. But I am not afraid for the next time I head to The Wrong Place. At this point, I know all the stops and the symptoms that accompany them. I can usually get off the train before I end up at the I-don’t-deserve-to-shower part of the journey. I can’t exactly put that on my resume but, hey, I can still be proud of myself.  

 

It's a skill in self-awareness to know when you’re in trouble and when to get help. When I am faced with an internal struggle, seeking out a third party gives me a perspective I can’t generate on my own. There are wonderfully compassionate people—counselors, therapists—who have dedicated their careers to helping people get un-stuck when they feel stuck. They have given me tools that I can always carry with me; their expertise has been distilled to a few tips and tricks that work for me to navigate stressful situations and life changes. I encourage you to seek inside yourself the will to live, the love of those around you, and most daringly, the point at which to be vulnerable and seek help; for me, it was the most difficult and most rewarding thing I have ever learned. 

 

 

 

Author’s note: After much deliberation, and due to the current climate of resident medical education, this piece will be published anonymously. Special thanks to my campus colleagues for being such an open and supportive community.