Navigators, LCs, and MCWFusion - Kurt Pfeifer, MD, FACP, SFHM, DFPM
The Scalpel in My Pocket - Ashley Pavlic, MD, MA
Student voices
The Good Doctor: Combating Perfectionism - Molly Brennan
The Good Doctor: Between Obligation and Wisdom - Song Kim
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Wendy Peltier, MD
When you learn a little, you feel you know a lot. But when you learn a lot, you realize you know very little… if you can build a muscle, you can build a mindset. -Jay Shetty
This collection of essays shines a light on the unique offerings of The Good Doctor course and MCW Learning Communities, which launched last July. We invited two curricular leaders, Dr. Kurt Pfeifer, Director of Learning Communities, and Dr. Ashley Pavlic, Director of The Good Doctor course, to share their reflections on the curriculum’s first semester. We also invited two M1 students, Molly Brennan, and Song Kim, to share their experiences with the new curriculum.
I am so lucky to have a front-row seat to this evolution as a long-time faculty member who has seen several curricular redesigns (phases), and in my new role as a faculty Learning Community Navigator.
The Good Doctor course and MCW Learning Communities highlight important and evidence-based changes to the curriculum by moving us away from standard, lecture-style teaching methods to experiential, small-group learning formats that promote team-based learning, growth mindset, and discovery. The new curriculum development and evolution has included a shared mission of promoting Character, Caring and Excellence in Medical Education at MCW.
As a faculty navigator, sitting with my group of eight students weekly in The Good Doctor course, change is palpable. This has been an opportunity for me to be close to day-to-day aspects of the curriculum that students experience, and close to this generation of new doctors as they explore concepts pivotal to personal growth and resilience in tandem with learning the basic science and core clinical foundation of medicine.
As Dr. Pavlic so poignantly outlines in her essay, faculty navigators have commented that this type of teaching was not offered in our ‘era’ of medical training, and many of these important concepts were learned ‘on the fly’, perhaps using the ‘See one, do one, teach one’ model, as opposed to truly reviewing and practicing key skills before entering high-stakes clinical situations. There is an authentic sense of faculty and students learning together. Being part of this course reinforces my own growth mindset, as I become a PGY- 26!
It has been a weekly reminder of the joy in learning and the power of connection.
Wendy Peltier, MD, is an Associate Professor of Neurology and Medicine in the Division of Geriatric and Palliative Medicine at Medical College of Wisconsin.
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Kurt Pfeifer: Navigators, Learning Communities, and the MCWFusion Curriculum
Kurt Pfeifer, MD, FACP, SFHM, DFPM
Dr. Pfeifer, director of MCW Learning Communities, shares his experiences and observations since the new MCWFusion curriculum launched in July 2023, creating small Learning Community cohorts of eight students each who progress together through all four years of medical school in sequential courses starting with The Good Doctor. These courses focus on character and both personal and professional development …
What has surprised you the most?
Kurt Pfeifer, MD: While we anticipated that faculty navigators would serve a role in connecting students to resources at MCW, we thought of this as a more secondary goal. It clearly was one of the biggest early benefits. Students get so much information when they start that it's easy for them to miss an important piece of information or resource. Or sometimes, they just don't connect how a particular resource can help them. Navigators have provided frequent assistance in these matters that I don't think would happen without students having such a faculty connection. It was also surprising to see how strongly some groups bonded and dove deep into the challenging material of The Good Doctor course. So much so, that our plans for merging groups to make up for navigator absences had to be put aside because students didn't want to disrupt the rapport they had established within their groups of 8.
What you are most grateful for?
Kurt Pfeifer, MD: How invested the vast majority of students and navigators are in the content of The Good Doctor course, as well as the purpose of learning communities. We aren't even a semester in, and I've heard much feedback suggesting that learning communities have served a critical role in fostering student support of each other through the challenges of transitioning into medical school. Similarly, navigators have shared some inspiring stories of interactions they have had with their students and their students with each other.
What has been most meaningful for you in the outcomes thus far?
Kurt Pfeifer, MD: Since it is too early to have "harder" outcomes, I think the feedback above has been the most meaningful. Launching a new curriculum is daunting. Launching one with the unique focus on character and personal and professional development is even more challenging. I have been so impressed about how people have responded to this challenge by investing themselves in the process.
Kurt Pfeifer, MD, FACP, SFHM, DFPM, is chief of the Section of Perioperative & Consulting Medicine and a Professor of General Internal Medicine at MCW. He created the MCW 4C program as a pilot project that served as a model for the Learning Communities of the new MCWFusion curriculum.
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The Scalpel in My Pocket
Ashley Pavlic, MD, MA
Dr. Pavlic, director of The Good Doctor course, reflects on her journey to develop this offering in the new MCWFusion curriculum and her hopes for our new students as they participate…
What does directing The Good Doctor course – a new, required Phase 1 course on character and professional development – mean to me? A flood of thoughts comes to mind, but one memory stands out:
I’m an emergency medicine intern. My attending and I are hurrying to a patient with severe angioedema. My attending hands me a scalpel and says, “Put this in your pocket, just in case.”
I knew what that meant. If we needed to place a breathing tube but could not do it through the patient’s mouth, this would be the only tool I should need to open their neck to access their airway. All EM residents practice this procedure over and over on plastic models, cadavers, pig models. You don’t want to be in that situation and think, “Oh no, I wish I had seen this before, thought of this before, practiced this before.”
And yet, so many life-altering moments in medicine are like that.
In both medical school and practice, we are confronted with unexpected situations that demand an immediate response. How we respond can have profound consequences for our patients, our teams, and ourselves.
During my general surgery rotation as an M3, I went in to check on a patient whose metastatic cancer was discovered during an operation the afternoon before. It was 5:30 AM, and she looked at me and said, “It’s cancer, isn’t it?” My thoughts began to race: Wait, she doesn’t know? No one told her? Do I tell her now? Would my team be upset if I did? How could I not? I wish I had thought about this before …
Early in my residency, my team received a middle-aged woman in critical condition, transported by helicopter to our facility. She had decompensated en route; she died shortly after arrival. My attending asked me to update her family, who had also just arrived. As I walk into the room, the husband and teenage children were joking with each other. They paused and looked at me with half-smiles still on their faces. With a pit in my stomach, I realized death was not even on this family’s radar: What do I say? And how do I get this out without crying? I wish I had practiced this before …
In late residency, case managers sometimes called us if they could not determine from available documentation whether a patient should be admitted under observation or inpatient status. During one extremely busy shift, a case manager called to ask me about a patient whose note I had not started. (In fact, I had not started notes on any patient.) I was condescending and rude. She became angry with me, and rightly so. As I hung up the phone, I was angry with myself: What kind of physician leadership was that? Who am I becoming? I wish I had reflected on who I want to be before …
When I was an early attending, I had a patient who my entire team thought was faking an injury to get narcotics. I will never forget watching her struggling to leave the ED and thinking this does not seem right. I should stop this. While I deliberated, she was gone. I wished I had practiced going against the grain before I needed to do it. I did call the patient the next day to ask her to come back. I later found out she returned and was admitted, suddenly and unexpectedly got worse, and died within days. I will never forget her: If I had had the courage to change course, would she still be alive? ...
The Good Doctor is a new, mandatory Phase 1 course for all our medical students. It involves weekly meetings to discuss issues surrounding leadership, ethics, character development, well-being, and communication skills.
Students are introduced to topics considered central to the life experience of a physician. They are then given the opportunity to practice in a psychologically safe space what they would do in hypothetical situations related to those topics. It’s been an incredible investment by MCW leadership, an investment with many hopes.
The hope is we can examine who we are and who we want to be. We discuss our character strengths, those that physicians “ought” to have, and how to build ours. We dedicate time to talking through complex scenarios involving bias, personal beliefs, and truth-telling to promote practical wisdom. We practice leadership in our small groups, and the character that comes with respectfully disagreeing with each other. We dig into what it means to flourish and reflect on what a life of flourishing would look like.
Not everyone thinks it’s a great course. It’s hard to start thinking about things that feel far away when a basic science exam is always looming.
We continue to work on doing our best to make it feel more relevant. We continue to chip away at traditional lectures to maximize time in small groups. We continue to modify case scenarios to make them feel more concrete and real. But even with the “perfect” course, some students may not buy in. As I know well, we cannot help everyone who enters our department.
- My hope is that my students feel better equipped than I was to navigate the many ways truth-telling manifests in medicine; that they learn the relevant laws and ethical codes, but also get to think through and practice what they would do when abruptly confronted with an unexpected scenario.
- My hope is that my students have more tools than I had when resiliency was needed; that they have a jump start on developing a “hard back and soft front” when they want to run but their profession demands they stand and bear witness to profound human suffering.
- My hope is my students have more time than I did to think about who they want to be – the type of physician and team leader, and how they want to treat others in times of great adversity.
- My hope is my students have opportunity to develop their character through all the activities of the course, the uncomfortable situations they are put in, and the leadership that we ask of them.
My hope is they don’t make the same mistakes that I made because there were not enough opportunities in advance to reflect, practice, or develop.
Here’s a scalpel; keep it in your pocket. Just in case.
Ashley Pavlic MD, MA, is an Assistant Professor in Emergency Medicine, and Director of the MCWFusion ‘The Good Doctor’ course. In addition, she is Co-Director of the Bioethics and Humanities Pathway and Educational Co-Leader for the Division of Global and Population Health.
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A student's perspective
Molly Brennan
A first-year medical student in The Good Doctor course--the first course of the new, four-year MCWFusion curriculum--reflects on unlearning perfectionism in the organic chemistry lab …
Add Enough Magnesium
Four-and-a-half hours into a four-hour lab, my organic chemistry professor told me to add magnesium to the flask. My lab partner and I were in the dregs of the protocol. The Wisconsin winter sun had set and everyone else had already left for dinner.
“How much magnesium?” I asked.
He shrugged. “Some.”
My insides writhed. “What’s some?”
He shrugged again. “I don’t know. Enough.”
The edges of the metal scoop dug into my fingers. Enough? The wall clock ticked on oppressively. It was already so dark outside. My friends were eating dinner. I didn’t understand what I was doing wrong, or why my classmates moved seamlessly through the lab, adding an unspecified amount of magnesium without question, while I stared at the glassware in a state of frenzied hesitation.
Anything worth doing is worth doing well, was tattooed on my psyche.
The word perfectionist was batted around, and I owned it. Perhaps for some, perfectionism was toxic, but for me, it was the only reason I was successful. And, although I couldn’t speak it yet, I was afraid of who I was without it. Some people, clearly, succeeded without perfectionism. But I—I wasn’t smart enough, diligent enough, or just plain good enough to be successful without perfectionism.
And yet, it was also why I wasn’t finishing lab. Ouroboros.
Enough, I thought, scooping the magnesium sulfate. What’s enough?
Methanol amplifies the problem
In the second term of organic chemistry, I got a new lab partner.
She was wonderfully cavalier. She read a lab protocol once, maybe twice. After she measured, she poured, and didn’t wonder if she’d measured correctly.
During one lab, I had to pour methanol into a flask that was positioned over a heating element. The methanol had to be poured carefully so that it didn’t ignite. I hesitated and looked at my lab partner. “Should I pour it?”
She gave me a look. “Yeah, pour it.”
I gripped the graduated cylinder. “I don’t want to pour it.”
“Just pour it.” She took me very literally by the hand, and before I knew it, the methanol was in the flask. Nothing exploded. We poured the methanol and we lived. The lab carried on. And I began to realize that the perfectionism I clung to like a shield was not a shield at all, but a dead weight. It was an anchor of the worst possible kind, tethering me to old thought processes and habits, and not allowing me to move anywhere.
It was hard to let go of the need to get perfect values and to simply move with the flow of a scientific lab, which is often, by its nature, messy, imperfect, and fluid. But I realized that perfectionism hinders performance in many situations, especially ones where time is of the essence.
Pouring the methanol was not the start of the change, nor, certainly, the end of it, but it was a moment of transformation. (A few years after I graduated, I looked up my old lab partner on Facebook and laughed. It made complete sense that she had become a chemistry teacher.)
One day, I finished lab an hour early—not because I had done well, but because our reaction failed so catastrophically that there was nothing more to do. My high school-self would have panicked. My college-self went to the cafeteria and ate a plate of chicken nuggets.
Carbon breaks free
My organic chemistry class was mostly pre-meds, much to the chagrin of my professor, who knew us to be twitchy students there only to collect A’s and, God forbid, B’s.
In a bid to reach our GPA-addled brains, he explained two things: first, that carbon takes four bonds, except when it doesn’t. And second, that organic chemistry was less important for the content and more important for how it would change the way we thought—most especially, how it would make us work through uncertainty.
I did re-learn how to think that year. Eventually, through trial and, most importantly, error, I came to understand that perfectionism was not a strength. It was paralysis and fear. It was a snake that could only be defeated by starting—by beginning the homework, by adding a vague amount of magnesium, and by pouring the methanol—and accepting whatever outcome amounted.
I developed a new mantra: Anything worth doing is worth doing poorly.
If it was worth anything at all, then it was worth a shaky beginning and even, perhaps, a subpar finish. It was better to do something incorrectly, to create something imperfect, and to be less-than-ideal, than to vacillate in fear in front of an audience of laboratory glassware.
This new mantra carried me as I applied to medical school. When thoughts of delaying my application for yet another year began to surface, I reminded myself that it was worth applying, even though I could never be perfect.
In my first few months of medical school, the course The Good Doctor challenged me to reflect on my history of perfectionism as well as my future. I realized all the ways in which my new mantra continues to support me as I move through this first year: taking tests I don’t feel ready for, answering questions when I am uncertain, and throwing myself into a deep end of new knowledge and new experiences.
I have reflected, too, on my need to continue combating my perfectionistic tendencies as I edge closer toward patient care. I think perfectionism can make patient care difficult, slower, and could contribute to frustration between doctors and patients. For myself, I know that my fear of making a mistake could paralyze me in a critical moment, and it will be important that I continue to challenge myself so that I do not freeze up when action is necessary. Once, I would have been afraid that healing my perfectionism would have led to me becoming overly cavalier; now, I know that the goal is not to be flippant but to be clear-headed, and perfectionism is not necessary to being a careful and dutiful physician.
Revisiting Magnesium
I added too much magnesium, by the way, and it was rather difficult to remedy. I did not get full points for that lab. I did not get an A in Organic Chemistry. And none of it held me back, or ruined my dreams, or did any of the terrible things I once feared they would. Instead, I did many things. I did many of them poorly. And all of them were worth doing.
Mary “Molly” Brennan is a first-year medical student at Medical College of Wisconsin-Milwaukee. She graduated from Lawrence University and is grateful for the many people there who helped her become a more confident learner. In her free time, she writes and crochets, most of it poorly.
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A student's perspective
Song Kim
A first-year medical student reflects on the concept of flourishing as part of The Good Doctor course in the new MCWFusion curriculum...
My friends from college have begun to suspect I haven’t been telling them the whole story of what being in medical school is like. The truth is, there are too many sentiments and far too few words to describe the experience.
A new beginning
I will always remember the day I was accepted to MCW. Hysterically screaming on the phone with my best friend--who had already received 14 acceptances of her own--I printed out my acceptance email, heart pounding while I counted down the seconds until my parents would get home. It would only hit me several hours later that I wasn’t going to have to move to Iowa anymore. I clicked the elusive Commit to Enroll button that had been beating me in a staring contest for the past eleven months. I was met with the very abrupt end to my seven-year-long, self-identification of being “pre-med.”
Continuing to grow when we finally have what we’ve always wanted
I think I can speak for many of my hand-picked classmates in our cohort of 265, when I say I believe from the bottom of my heart that medicine and I belong together. Medical students find deep comfort in knowing we have uncovered a career that will always lead us toward a deeper understanding of the human condition, toward more scientific knowledge, and toward more altruistic versions of ourselves. But when my best friend’s father was diagnosed with metastatic pancreatic adenocarcinoma in October, I found it difficult to grasp how much more I understand about the human body than I did just seven months ago. I’ve realized that while ignorance is bliss and knowledge is power, medicine walks the line between obligation and wisdom. I’m still not quite sure I will ever get used to everything I now know, or if I will ever know enough--I'll be a walking paradox for now.
“But what have you been doing outside of school?”
To be honest, not much. As I’m writing this, I’ve just left school at 10 p.m. on a Friday. I spent the last hour with three of my friends, reviewing musculoskeletal structures in anatomy lab before our exam in three days. We weren’t the only ones there; in fact, we saw the familiar faces of many of our classmates tonight. We exchanged waves, mnemonics, and jokingly questioned out loud what missteps we had taken to end up between the humidors under the moonlight while most of our friends from college would be out celebrating the beginning of a weekend. Together we find a sense of comfort in knowing we are still flourishing, learning, and bonding, in so many ways unbeknownst to most.
Song Kim is a first-year medical student at the Medical College of Wisconsin-Milwaukee. She is an M1 Liaison for the Student Surgical Society and LGBTQ+ People in Medicine.
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