The MedEd Blog Takes a Break

The last post? Maybe or maybe not.

The MedEd Blog Takes a Break

The MedEd Blog is taking a break as the Transformational Times evolves ...  

For two years, I served as the founding editor-in-chief of the Transformational Times newsletter, a project that supported our community as it reeled from—and adjusted to—the COVID-19 pandemic while re-envisioning the future of medical education. 

Three months after the first TT issue in March 2020, I started this blog as a personal project. Although I was a faculty member at MCW, the blog has never been affiliated with either the Medical College of Wisconsin, the Kern Institute, or any of their funders. I held the password, set up the blog, and added every bit of the content. I did all of the work on my own time. 

Here's why I started the blog: As soon as one issue of the TT was released, the previous week's edition all but disappeared into a non-searchable corner of MCW's website. I conceived the blog as a way to give continuing life to some of the most interesting and inspirational essays that appeared in the Transformational Times newsletter. I was able to share links with the authors so they could do the same. 

This blog's format is searchable, although metrics tell me that there have never been many visitors and Blogger (the platform) no longer enables subscribers. Nevertheless, I persisted since the blog gave the essays some online presence and was invaluable when I curated the two Character and Caring books. 

For the few of you who have found this little corner of the Internet, I hope you will continue to use the tags and search function to browse the essays, poetry, images, and articles. They tell a fine story about a period of time when medicine went through a pandemic crisis and emerged. There are voices of strong and resilient people whose viewpoints are not regularly amplified. The blog explores visions of a future medical education that enhances, rather than suppresses, character and the entrepreneurial spirit. 

Reading and editing these pieces taught me much, made me stop and think, and exposed me to new perspectives. I didn't always agree with the essayists but know that I am a better person because I read what is contained here. 

The machinations of the institutions involved are completely opaque to me. Amplifying certain voices, though, might be counterproductive while the powers-that-be discuss the Transformational Times and the people who inspired and maintained it. Rather than inadvertently poking a bear, it seems best to suspend or even shut this down. Therefore, this 366th post might be MedEd Blog's last.

That said, I hope that my family and I will always be able to locate caring, character-driven physicians and healthcare workers. The remarkable accomplishments of the Kern Institute—reflected, in part, by the essays contained here—give me hope that the next generation will be more than up to the challenge. For those of you who spend time with the pieces archived here, I hope you catch the same vision.

Be well, friends. 

In appreciation,

Bruce

Bruce H. Campbell, MD FACS 

MCW Professor Helps Fellow Native Americans Improve Wellness by Reclaiming Culture

MCW Professor Helps Fellow Native Americans Improve Wellness by Reclaiming Culture

This essay and video were produced by MCW about our Indigenous partners in Lac du Flambeau. The video is narrated by Brian Jackson, EdD, an MCW faculty member and enrolled member of the Ojibwe tribe. 

MCW's connection with the community has been featured in previous MedEd Blog posts:

• Take 3 with Brian Jackson, Matt Dellinger and Amy Poupart: Building a Framework to Acknowledge Indigenous Way
• Building Relationships: MCW-Central Wisconsin and the Lac du Flambeau Ojibwe People 
• "To be Understood and Appreciated": A Trip to Lac du Flambeau

Released by MCW Communications Office on November 21, 2023

There’s a major phenomenon growing with Indigenous people, according to Brian Jackson, MS, EdD, an assistant professor at the Medical College of Wisconsin (MCW) and member of the Lac Du Flambeau Band of Lake Superior Chippewa Indians, also known as the “Fish Clan.”

“We’re reclaiming our ways,” Dr. Jackson says. “It’s not about asking permission.”

The ways of his people, he says, include harvesting wild rice in autumn, tapping for maple syrup and spearfishing in the spring, and picking medicine throughout the year.

They include sharing foods like deer and fish.

“Elders first,” says Jackson, who added that the practice reinforces ancestral teachings related to taking only what you need and sharing the rest. “They’ll get a package of fish, then the community folks come after that.”

But before they even enter the water for rice, tap the trees or fish or hunt deer, a give and take must take place – an offering of medicine, usually tobacco.

“Those things are really what shaped us,” he says. “We still practice those ways because that’s who we are.”

Click on the photo of Dr. Jackson to watch the video:

Unfortunately, some of who they are is also shaped by the historical traumas Native Americans endured during attempts to strip those traditions from them. Among the tragedies, Dr. Jackson says, happened throughout the late 1800s and well into the 1900s, when youths were taken from their families and forced into boarding schools, where their hair was cut and they were forbidden to speak their languages.

“That’s what really halted our language during that time,” he says. “We struggle today to revitalize our language.”

A Feeling of Personal and Native Pride

Dr. Jackson says that reclaiming their languages, traditions and ceremonies are key to improving wellness in Native American communities and overcoming the many challenges it faces, including disparities in cancer and diabetes, and drug and other substance use.

“A lot of folks are struggling with wellness and being sober,” he says. “So we get a person to feel proud again about who they are, and that begins their healing journey pretty well.”

Supporting people on their journeys has been a life mission for Dr. Jackson, who grew up in Milwaukee before moving to the Lac Du Flambeau Reservation in northern Wisconsin as a troubled high schooler.

He credits his grandfather, Joseph Jackson, Sr., who retired after working in the automobile manufacturing industry for 35 years, and father, Dr. Alton Sonny Smart, a professor and Vietnam veteran who speaks fluent Ojibwe, for helping him turn his life around and motivating him to follow the path of education and culture — his two journeys.

Engaging Native Youth

He’s filled many different roles along that journey, including working with youth and families at the Boys and Girls Clubs, with 15-and 16-year-old juveniles at the Woodland Hills Correctional Facility, and with participants of the Family Circle Program in Lac Du Flambeau, and by helping develop the American Indian Science Scholar Program at UW-Milwaukee, which serves students interested in health and science.

“I open their eyes to on-campus experiences, to careers they never even thought of,” says Dr. Jackson, who plans to help develop a similar pathway program for high school students at MCW.

He’s also recently led immersion work that brings non-Native Americans into the reservation for a tour of the community, to meet tribal elders, and experience a powwow at the Indian Bowl.

“It’s about providing opportunities to know our neighbors so we can function and get along,” he shares.

Community-Based Participatory Research

Another major component of Dr. Jackson’s journey has been conducting community-based participatory research as part of the Great Lakes Native American Research Center for Health (GLNARCH) Community Scientific Advisory Committee. Conducting research with Native American communities can be a challenge in a community that is understandably skeptical about being studied.

“How’s it going to benefit our communities?” Dr. Jackson asks. “We’re not just numbers; we want people to be helped.”

Dr. Jackson says a key to research with Native Americans is earning trust and sharing stories.

“You have to sit down with them, take the time, maybe have a meal with them, share some tobacco,” he says. “Not just a one time shot, there’s some follow up to it; that goes a long way with Indian people.”

Dr. Jackson also finds it crucial to collect stories from elders to share with young people as a way of supporting cultural connections.

“We connect them with who they are, their ancestors,” he says. “It’s really the core for anybody for that matter.”

Dr. Jackson views his new role at MCW, which began at the beginning of 2023, as an opportunity to elevate the work he’s done in Indian Country for more than 25 years. It’s also a chance to help more Indigenous communities understand how vital it is to return to traditional values as Native Americans as a way to improve wellness.

“Our values are glossed over at times. It’s about the American Dream,” he says. “The more you get, the more important you are. It’s the opposite with Indian people. If you are sharing and elders see you sharing, that’s what it’s all about.”

Brian Jackson, MS EdD, is an assistant professor in the Department of Epidemiology and Social Sciences at MCW. He serves on the Great Lakes Native American Research Center for Health (GLNARCH) Community Scientific Advisory Committee. He is a Family Circles AODA Prevention Program facilitator, providing instruction in language, traditional cultural practices, history, and culture of Native people will be preserved, thereby restoring pride in the identity of Anishnabe.

We Belong to One Another: A Lesson from Dr. Martin Luther King, Jr.

From the January 21, 2022 issue of the Transformational Times (Urban and Community Helath)

We Belong to One Another: A Lesson from Dr. Martin Luther King, Jr.

Cassie Ferguson, MD

In his letter he wrote from a Birmingham jail—the letter that began in the margins of a smuggled newspaper and on found scraps of paper—Dr. Martin Luther King, Jr. shared this:

“Whatever affects one directly affects all indirectly. For some strange reason I can never be what I ought to be until you are what you ought to be. And you can never be what you ought to be until I am what I ought to be—this is the interrelatedness of life.”

The very same stardust

Dr. King suggests that if we would see how inextricably connected we are to one another—if we would see that we belong to one another not only by virtue of being born on the same planet, but also by virtue of the scientific and spiritual reality that we were made from the very same stardust—that then all of us could see how the systems that uphold and protect racism, health and wealth disparities, educational inequalities, and residential segregation dehumanize us all.

That if we understood our interdependence, we would move beyond empathy for those who are suffering the most under the weight of these systems and know in our hearts that when one teenager is murdered, we are all killed. That when a pregnant woman delivers a stillborn baby because her health concerns are dismissed, that we all lose a child. That when one of our students must repeat their first year of medical school because of inequities in medical education and in our learning environment that disproportionately impact students underrepresented in medicine (URiM), that we all fail.

Dangerous unselfishness

This kind of radical compassion is not for the faint of heart. Dr. King understood this. In his very last speech delivered in support of the striking sanitation workers in Memphis, Tennessee, Dr. King rallied the crowd declaring, “either we go up together, or we go down together. Let us develop a kind of dangerous unselfishness.”

At the Kern Institute, our mission has been to inspire and support this kind of unselfishness and this kind of compassion in our learners and educators, such that we might transform the system of medical education to ensure that every one of our patients feels seen and deeply cared for; such that every one of our patients is given the opportunity to flourish. This kind of systemic transformation requires tremendous courage, sacrifice, and love. It demands that we understand compassion not “as a relationship between the healer and the wounded…but as a relationship between equals.” (Pema Chödrön).

Despite these challenges, there are examples of how the MCW community is “showing up.” Here is one example. In the spring of 2020, student doctors British Fields, Jamal Jarrett, Morgan Lockhart, Enrique Avila, and Adriana Perez learned that the Apprenticeship in Medicine (AIM) enrichment program they had been chosen to lead that summer would not be funded because of the pandemic. Led by the incomparable Jean Mallet and supported by the Kern Institute, these students advocated for their program, pivoted, and in three weeks designed and stood up the Virtual Health Sciences (VHS) program. Over Zoom, they provided forty Milwaukee-area high school students from backgrounds historically underrepresented in medicine a meaningful and engaging look at careers in health care and showed them that there is a place in the profession of medicine for them. Our student doctors saw themselves in these high school students and this motivated and empowered them to take direct action.

“The Path of Joy is Connection”

What I have come to realize as a physician and, as someone who teaches medical students about well-being, is that when we become aware of our interrelatedness, we not only wake up to how we might design and redesign systems that assume the humanity of all peoples, but we also feel less alone, less fragile, less anxious; and, like these student doctors, we are empowered to become our best and truest selves. As the late South African anti-apartheid leader and Nobel Peace Prize Laureate Archbishop Desmond Tutu reminded us frequently, the path of sorrow is separation, and the path of joy is connection.

This week, as we celebrate the Reverend Dr. Martin Luther King, Jr., may we cultivate the awareness of our interrelatedness in our hearts, and find the courage to unselfishly redesign our world such that all of us may flourish. 

Catherine (Cassie) Ferguson, MD, is an Associate Professor in the  Department of Pediatrics (Emergency Medicine) at MCW. She is the innovator of the REACH Curriculum, and the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

The Mission of the SCU: The Saturday Clinic for the Uninsured

From the January 21, 2022 issue of the Transformational Times (Urban and Community Health)

The Mission of the SCU: The Saturday Clinic for the Uninsured

Thomas Ritter, MD

Dr. Ritter wrote this essay when he was a fourth-year medical student at MCW.

The highlight of my medical school experience has undoubtedly been working at the Saturday Clinic for the Uninsured (SCU). SCU is a student-run free clinic for patients without health insurance that operates at the intersection of North and Humboldt on, you guessed it, Saturdays. In addition to a name that is quite “on the nose," SCU has been a staple of the Milwaukee community for over twenty years. Our mission is to provide comprehensive, patient-centered, and equitable care to Milwaukee’s uninsured population.

Goal One: Provide high quality care

Uninsured patients in Milwaukee face an array of challenges to access healthcare and we have shaped SCU to meet the needs of our community. We have grown to become a long-term home for our patients to receive healthcare by marshalling resources at MCW and Milwaukee hospitals to provide access to lab work, mammograms, and specialists including ophthalmology, dermatology, and rheumatology. We offer an in-house dispensary of medications at no cost to our patients and have established a partnership with Seton Pharmacy at Ascension Columbia St. Mary’s to provide any medication we don’t have for a low-cost rate. We evaluate and address the social determinants of health for all of our patients, including food insecurity, legal assistance, and housing instability.

Goal Two: Improve cultural humility and clinical competence

In addition to its mission to provide comprehensive, patient-centered, and equitable care, SCU also aims to enrich the cultural humility and clinical competencies of its student volunteers. This second mission has certainly been achieved in my personal and professional life. Early in medical school, I was an eager learner of anatomy, pharmacology, and pathophysiology. While I certainly remain interested in these subjects of medicine, my experience at SCU has revealed to me the broader picture of medicine—to identify and critically examine the ways in which our patients, insured or not, encounter obstacles to receiving care. Whether the obstacle lies outside of healthcare, such as access to affordable transportation, or is an internal obstacle, such as racism in medicine, truly comprehensive care requires intervention on both a personal and societal level. 

SCU has taught me that providing patient-centered care requires grace to meet patients where they are, see the world through their eyes, and act accordingly. Providing equitable care necessitates intentional introspection and the evaluation of my own biases on a daily basis.

I believe SCU’s contribution to the Milwaukee community is difficult to truly measure. While direct patient care can be quantified by the number of patients seen or referrals sent, the impression SCU makes on its volunteers who go out and serve in their own way after graduating, although intangible, cannot be overlooked. I am becoming a family medicine physician because of my time at SCU, and I am only one of many volunteers in SCU’s long history who enter healthcare with a heart for service and dedication for justice. I am grateful to have worked at SCU and encourage all who are interested to volunteer there as well.

To learn more about the Saturday Clinic for the Uninsured, check out the website here.

Thomas Ritter, MD was a member of the MCW-Milwaukee Class of 2022. He followed his heart as is currently a resident in the MCW Family Medicine program at Columbia St. Mary's Hospital in Milwaukee.

Opening the Gate for Student Mental Health Needs

From the September 15, 2023 issue of the Transformational Times

Opening the Gate for Student Mental Health Needs

Kevin Bozymski, PharmD, BCPS, BCPP

Dr. Bozymski, a board-certified psychiatric pharmacist, discusses the mental health stressors faced by health care students, and shares his journey of training future pharmacists to become mental health “gatekeepers” for their peers (and themselves) …

Expanding beyond algorithms

When people ask me what I do for a living, it’s not as straightforward as saying teacher or pharmacist—or even the phrase, mental health pharmacist. It usually involves a back-and-forth dialogue, with me imperfectly describing my winding path as the audience inquires, prompts and clarifies. Upon reflection, the emphasis on one-on-one connections is what got me on my path. 

While healthcare practitioners and researchers value the scientific method (me included), I’ve often found algorithms too restrictive. That’s why psychiatry resonated with me as a student pharmacist, where the right pharmacologic choice cannot be made without considering an individual’s preferences, values, and environment.

It’s also why academia called to me as a resident pharmacist, where a “one-size- fits-all” teaching approach does not meet every learner’s preference, needs, and background. 

Unfortunately, it’s easy to fall into the algorithm trap as a teacher when discussing student mental health, especially when we aren’t taking care of our own mental health. We look back in our own life to how we handled stress as a learner, assuming our experience will translate well to another’s. We worry about finding time to dialogue, looking toward rating scales used in clinic appointments as a model for triaging student concerns. This solutions-first mindset shows in our health care learners, as a recent scoping review of medical student literature found fears of decreased career opportunities, nonconfidentiality and personal stigma as the top individual barriers to care.

Before walking in someone else’s shoes, it’s worth asking about their journey so far and how they find themselves now. 

From stress to burnout to on fire 

As the psychiatric pharmacist on faculty within Medical College of Wisconsin School of Pharmacy, I am invited to give perspective about student mental health on many interdisciplinary councils, committees and workgroups. The most impactful discussions, though, come in one-on-one discussions with my student pharmacist mentees. 

These quarterly meetings have a brief agenda,  and are open-ended for me to actively listen and ask: How is your quarterly session going? What has been a surprise since we last spoke? Where do you want your shoes to take you, and how can I help them do so?

It's no secret that the MCW PharmD curriculum is stressful, with students completing four years of traditional coursework in just three. And while it’s unclear to what extent stress correlates to burnout and mental health concerns, published U.S. student pharmacist surveys identify positive response rates of 19% to 40% for clinical depression (via PHQ-9) and 21% to 41% for clinical anxiety (via GAD-7). (see references 2-5)

Furthermore, the American Academy of Colleges of Pharmacy has released a statement encouraging pharmacy schools to proactively promote overall wellness and stress management techniques.

There’s no easy algorithm to determine who develops clinically significant concerns, but it is near-impossible to do so unless a student is connected enough to their academic community to be asked.

Who’s at the gate for mental health care?

Access and stigma are two driving barriers in psychiatry, and certainly student mental health is no exception. Therefore, gatekeeper training—programs teaching how to identify warning signs of mental crises and connect people to needed services—have been spreading across the globe. Such programs are not just for healthcare practitioners, but for anyone with a desire to improve mental health in their area. Thanks to funding from the Kern Institute, the MCW Pharmacy School, and Advancing a Healthier Wisconsin endowment, I’ve had the honor as a certified Mental Health First Aid instructor of teaching 60 first-year PharmD students (so far) how to open the gate for their peers, their communities, and themselves.

While students over the years have commented on its benefits, one anonymous comment from a course evaluation struck me the most:

“These skills were amazing to learn. It has helped with not only my family and friends but also has been used in practice with my peers. To have the ability to learn about what people go through and how to be able to approach and talk to people about a mental health crisis is something everyone should learn.”

If we cannot break down every systematic gate standing between an individual and mental health resources, we can at least ensure the keepers know how to help passersby. And even if my student pharmacist self from over a decade ago does not fully understand the unique stressors of this generation, I can at least dedicate myself to learning from and conversing with them in a non-algorithmic way - using the information gained to better appreciate, reassure, and connect.

After all, with mental health, an imperfect response is better than no response at all.

Take action:

Interested in becoming trained as a MHFA instructor (or just completing MHFA certification yourself)? Please contact Dr. Kevin Bozymski or Dr. Himanshu Agrawal for more information. 

For further reading:

1. Berliant M et al. Barriers faced by medical students in seeking mental healthcare: a scoping review. MedEdPublish (2016). 2022; 12:70.

2. Koutsimani P et al. The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis. Front Psychol. 2019; 10:284.

3. Fischbein R et al. Pharmacy and medical students’ mental health symptoms, experiences, attitudes, and help-seeking behaviors. Am J Pharm Educ. 2019;83(10):7558.

4. DeHart RM et al. Prevalence of depression and anxiety among student pharmacists. Int J Med Pharm. 2020;8(2):1-8.

5. Shangraw AM et al. Prevalence of anxiety and depressive symptoms among pharmacy students. Am J Pharm Educ. 2021;85(2):8166.

6. American Colleges of Clinical Pharmacy. AACP Statement on Commitment to Clinician Well-Being and Resilience. Accessed https://www.aacp.org/article/commitment-clinician-well-being-and-resilience on September 5, 2023.

7. Suicide Prevention Resource Center. Choosing A Suicide Prevention Gatekeeper Training Program: A Comparison Table. Accessed https://sprc.org/wp-content/uploads/2022/12/GatekeeperMatrix6-21-18_0.pdf on September 5, 2023.

8. National Council for Mental Wellbeing. About MHFA: What is Mental Health First Aid? Accessed https://www.mentalhealthfirstaid.org/about on September 5, 2023.

Dr. Kevin Bozymski, PharmD, is an Assistant Professor with appointments in the MCW Pharmacy School Department of Clinical Sciences and the School of Medicine Department of Psychiatry & Behavioral Medicine. He is a certified Mental Health First Aid instructor, providing training through an Advancing a Healthier Wisconsin endowment. He also provides clinical services at both the MCW Tosa Health Center and Froedtert Hospital Complex Intervention Unit.

Professionalism Lapses in GME: Oops, Can’t, and Won’t

From the August 4, 2023 issue of the Transformational Times

Professionalism Lapses in Graduate Medical Education: Oops, Can’t, and Won’t 

Chad Carlson, MD, FAAN 

Program Director Carlson shares takeaways about remediation in residency training: Intent is important. In broad terms, the categories of “oops,” “can’t,” and “won’t,” divide learners into those who have a lapse in behavior they know and understand, those who currently lack or cannot access a set of skills or tools, and those who choose not to do something, despite having access to and knowledge of the appropriate path forward... 

Anyone involved in medical education, regardless of the level of learners, can relate to issues of professionalism in situations needing to be addressed.  If you are like me, this is followed by a pit in the stomach and concerns about the best next steps: Can I fix this? How do I help? Is this even a “fixable” problem?

These thoughts are often compounded by a feeling of relative isolation; while we all help learners address these issues, we often feel like we are doing so in a relative vacuum. Often, our own experiences and feelings complicate remediation and lead to the belief that these sorts of problems cannot be fixed.  

The concerns and limitations program directors face in addressing issues of professionalism prompted us to focus on this topic at the Medical College of Wisconsin Affiliated Hospitals (MCWAH) Program Directors retreat. A presentation and discussion session led by invited speakers Betsy Williams, PhD, MPH, FSACME (Clinical Director of the Professional Renewal Center) and Karen Warburton, MD, FASN, FACP (Associate Professor of Medicine and Director of GME Advancement and Clinician Wellness Program at the University of Virginia Health System) outlined several key features and highlighted some common themes. The retreat also focused on the potentially daunting topic of remediation of professionalism issues in graduate medical education through interactive and case-based talks. 

Key takeaway: Professionalism issues are not inherently irremediable.

The process of remediation itself can be broken down into: Identification, Assessment, Active Coaching, and Ongoing Evaluation

Identification has already occurred if you have a pit in your stomach about what comes next with a resident. But most medical educators can recall situations where, if they had better documentation or more feedback or input, they would have better understood both the scope and nature of issues with a learner. The earlier that identification occurs, the less likely it will negatively impact the timing of training for a learner. Dr. Williams lamented the frequent occurrence of hearing about a struggling learner in April or May of their final year of training when there is little time to implement an effective coaching plan.  

Within the realm of assessment, intent is important. The difference between an “oops,” “can’t,” and “won’t,” is an important distinction.  

In broad terms, these categories divide learners into those who have a lapse in behavior they know and understand, those who currently lack or cannot access a set of skills or tools, and those who choose not to do something, despite having access to and knowledge of the appropriate path forward. 

A comprehensive assessment also includes looking for potential mental health contributors. Evidence supports that about a third of struggling learners have an underlying mental health concern such as anxiety, depression, and cognitive or learning disorders. It is no surprise these underlying conditions often contribute to a “can’t.” 

The results of the assessment should drive the approach to coaching (or discipline). 

While a program or course director’s approach is often to take the lead on remediation or other issues to spare busy faculty colleagues and team members, in these settings, the program director may not be the best person to do the coaching. 

Involve someone not part of the Clinical Competency Committee (or recuse that person from discussions in the Clinical Competency Committee if this is unavoidable).  

Planning the intervention

In planning the type of intervention, the concept of intent is important. 

• Support with little formal coaching is likely adequate for an “oops." 
• Formal coaching is typically necessary for a “can’t.” 
• In the case of a “won’t,” rapid escalation beyond coaching to formal disciplinary measures may be necessary. 

In thinking about a “can’t,” we need to consider both the realm of teaching about professional norms and recognize when there are barriers (personal or systemic) to following them. 

As educational leaders, we need to look at individual professionalism violations and consider whether the issues represent a broader systemic issue or are related to individual factors alone. 

Ongoing systemic monitoring and intervention is critical 

Importantly, whatever the remediation methods, one cannot think of this as a single episode or course of treatment; a systemic approach for regular monitoring and evaluation must be in place to identify potential lapses in professionalism, prior to them rising to the level of a problem.   

The systematic approach to thinking about issues of professionalism was a welcome discussion during the retreat. But perhaps more important was the recognition that these are challenging, but not insurmountable problems with which we, as educators, all struggle. 

The desire to help our students, residents, and fellows succeed is--and should be--strong. But the frustration and disappointment when those expectations are not met is very real for all involved. This can be particularly true in graduate medical education, where we work closely with small classes of trainees, typically for multiple years. These personal bonds can be both a strength and a liability when professionalism is challenged.   

Our community of educators is our greatest resource

Our community of educators committed to improving learner well-being is, undoubtedly, our greatest resource; learners struggling with professionalism issues are not unique to any one campus, course, or program. We can, and should, make use of the depth of expertise across the institution instead of staying in silos in our individual departments and programs.   

Drs. Warburton and Williams made it clear through their experience and work on this topic that learners who encounter these issues can, in most cases, be helped and put back on a path to success. 

Proper diagnosis and management, just like in patient care, is the key to success. 

Chad Carlson, MD, FAAN, is a Professor in the Department of Neurology at Medical College of Wisconsin and serves as the Program Director for the Adult Neurology Residency, Associate Program Director for the Clinical Neurophysiology and Epilepsy Fellowships, and Vice Chair of Education.  

Whoosh! Goes My Heart

From the December 21, 2023 issue of the Transformational Times

Whoosh! Goes My Heart  

Himanshu ‘Tinu’ Agrawal, MD, DF-APA 

Dr. Agrwawal shared this story from his childhood in the holiday issue of the Transformational Times. You can read other stories by Transformational Times team members, Kathlyn Fletcher, Bruce Campbell, and Karen Herzog.  

From ages six until nine, I lived in London. My mother worked in the Indian embassy there, and one day she brought home a chocolate-filled Santa, sitting on a plastic sleigh. 

“Oh my God!” I squealed. ”Is it from Santa Claus?” I couldn’t believe it; it was finally happening. After hearing so much about the big guy from kids at school, I was finally getting a gift from him!  

"No, it’s from Mrs. Malhotra, she works on the desk next to me, you’ve met her,” my mother responded. 

“No! It’s from Santa Claus. You’re teasing me aren’t you, Mom?” I smiled. I could see through her attempts to trick me. 

“I told you. It’s from Mrs. Malhotra,” she repeated. 

“No! It’s from Santa!” I insisted. 

“No! It’s from Mrs. Malhotra!” she snapped back. My mom wanted to make sure poor Mrs. Malhotra received the credit she deserved. 

“You’re lying, Mom! Why are you lying?!” I yelled. I wanted so much to believe Santa had finally read my letters. 

A slap on my face ended any further arguments, as it usually did back in those days.  

Whoosh! went my heart.  

A couple of years later, we returned to our apartment in India, where Santa did not make pit stops. 

Now, four decades later, I find myself back in the land of Santa.  

Now, my son is 8 years old, and he writes letters to Santa every year. 

Now, every Christmas Eve, we tuck in, and I read him ‘Twas the Night Before Christmas by Clement C. Moore. 

Whoosh! goes my heart. 

Whoosh! Whoosh! goes Krishna’s heart. 

Whoosh! is the sound that magic makes. 

And you can’t snuff it out with a slap on the face. 

Himanshu Agrawal, MD is an Associate Professor in the Department of Psychiatry and Behavioral Medicine at MCW. He is one of the co-Editors-in-Chief of the Transformational Times.