2023 Commencement Speaker Dr. Julie Freischlag Returns to MCW to Share What She has Learned

 From the May 19, 2023 issue of the Transformational Times

Newly-minted physicians Bruce Campbell
and Julie Freischlag
May 1980 - Auditorium Theater - Chicago, IL  

“Midwest Nice” and a Force of Nature: 2023 Commencement Speaker Dr. Julie Freischlag Returns to MCW to Share What She has Learned

Bruce Campbell, MD FACS

Dr. Campbell, one of the Transformational Times editors, provides some reflections on why his medical school classmate and friend, Dr. Julie Freischlag, is an exceptional role model. He also offers a sneak peek at her May 19, 2023 Commencement Speech...

MCW-Milwaukee’s 2023 Commencement Speaker, Julie A. Freischlag, MD, FACS, FRCSEd(Hon), DFSVS, has had a remarkable, glass-ceiling and barrier-breaking career. 

Happily, a portion of her world-class calling was spent on the MCW faculty in the 1990s. At MCW, we are delighted that she has returned to inspire our 2023 graduates and send them out into the world. 

I met Dr. Freischlag in August 1976 when we were incoming medical students at Rush University. There was an immediate kinship; both of us had grown up in Illinois and gone directly from large public high schools to the Big 10 (she went to Illinois, I went to Purdue), and were among the youngest members of our medical school class of 104. Whereas I was pretty intimidated, she was energetic, engaging, fearless, and an immediate favorite of the students and faculty. Throughout our four years as students, she was a quick learner, eager participant, friend-to-everyone, and generous listener. When given the opportunity to do something, she always said, “Yes.” She had no problem expressing her well-formed opinions. She was the embodiment of a friendly, accomplished, “what you see is what you get” individual.

A servant leader from the beginning

Over the course of her remarkable career, each institution to which she moved became better because of her presence. After graduating from Rush in 1980, she did her surgery residency and vascular fellowship at UCLA. After two years at UC San Diego and three more back at UCLA, I was delighted when she chose to move to MCW in 1992, although I wondered whether she would thrive in such a male-dominated department of surgery. Before long, though, she was chief of surgery at the VA where she was principal investigator for a national VA aneurysm study. She won teaching awards as an MCW medical student and resident favorite. She was a dynamic, sought-after clinician, a trusted colleague, and an accomplished clinical researcher. 

Her national presence took her back to UCLA to be chief of vascular surgery in 1998 and, from there, she was recruited to be the William Stewart Halsted chair of the surgery department and surgeon-in-chief at Johns Hopkins in 2003. Her tenure at Hopkins was marked by a rapid expansion of the department’s commitment to equity and inclusion, and she enthusiastically mentored residents and students. After Hopkins, she became vice chancellor for human health sciences and dean of the UC Davis School of Medicine in 2014. She has been in North Carolina since 2017, and is currently chief academic officer and executive vice president of Advocate Health, chief executive officer of Atrium Health Wake Forest Baptist, and executive vice president for health affairs of Wake Forest University. She also is the immediate past dean of Wake Forest University School of Medicine.

Despite her critical and demanding administrative roles, she has continued to be a “cutting surgeon,” and has an international reputation for the surgical management of thoracic outlet syndrome. 

Some of her “firsts”

Everywhere she has worked, Dr. Freischlag has challenged the “old boy” status quo and reshaped culture with her positive energy and indomitable presence. 

She was the youngest woman in the Rush University Class of 1980 and then the sixth woman to finish the general surgery program at UCLA. She was the first female UCLA surgery faculty member and, later, the first female chief of UCLA’s vascular surgery division. She was the first woman surgeon at MCW to be promoted to full professor. She was the first woman to serve as surgical chair, and the only woman chair, during her time at Johns Hopkins. She was the first woman to be president of the Society for Vascular Surgery, the first to be president of the Association of VA Surgeons, the first to be president of the Society of Surgical Chairs, and the fifth woman to be president of the American College of Surgeons where, among many other accomplishments, she created and hosted a series on Surgeons Sowing Hope. Her groundbreaking career has been a string of “firsts.”

She has frequently been honored and celebrated. She is a member of the National Academy of Medicine and is an honorary fellow of the Royal College of Surgeons. She was inducted into Alpha Omega Alpha while on the MCW faculty. Among many other responsibilities, she serves on the board of directors of the Association for American Medical Colleges (AAMC), the NIH Clinical Center Research Hospital board, and the Aga Khan University board of trustees.

Her primary interest is people

Titles are important, but Dr. Freischlag’s preeminent commitment is to people who need a leg up. She has driven research, co-authored studies, and advanced policies that have increased the proportion of women and underserved groups in surgical fields and in medicine. She generously offers her experience and voice to individuals and groups. She takes on national roles, knowing that her larger stage benefits future leaders and physicians. She is the embodiment of the servant leader. 

The Commencement Talk: “Be the Spark!”

I had the opportunity to review Dr. Freischlag’s wonderful graduation speech for the MCW-Milwaukee Class of 2023. As I noted a few years ago, attendees and graduates might be a bit preoccupied during the ceremony and possibly not remember all of her words. So, here are a couple of themes for which to listen: 

• You are the one who shapes your story as a doctor. 
• Each of us has the potential to do the hard work and—with courage, compassion, and imagination—be the spark that makes a difference for individuals and entire populations. 
• When entrusted to be part of a team, listen to and learn from your teammates. Take time to know and understand what is important to each of them. Support, elevate, and promote those whose voices are not often heard. 
• As physicians, resilience and “toughness” are important and misunderstood traits. Dr. Freischlag might mention this book. 
• Practice self-care even when it is hard. And treat your patients exactly the way you or your family members would want to be treated.

A couple of quick stories; Ask me for more details ;-)

Life, of course, is not perfect, even for a superstar. As a medical student, she made extra money working as a waitress at a suburban Chicago restaurant. One evening, when I was there as a customer, it is entirely possible that she spilled a full glass of red wine on me. 

On Match Day 1980, the envelope with her name was apparently dropped on the floor. When the dean had apparently emptied the box with the match results and announced, “That’s all of them! Congratulations!” she sent me to the podium to find out what had happened to her envelope. Happily, her match results were quickly located and the rest, as they say, is history. 

While on the MCW faculty in 1995, she was pregnant with her son, Taylor. My wife, Kathi, and I attended a shower for her. One of the greeting cards read, “I would rather be 40 than pregnant!” She erupted in laughter because, at the time, Dr. Freischlag was both. 

Finally, if you have the opportunity to talk to Dr. Freischlag during her visit, ask her about her husband, Phil, her wonderful children, and her amazing grandchildren. 

Thanks, Dr. Freischlag!

On behalf of those of us who work with the Robert D. and Patricia E. Kern Institute for the Transformation of Medicine, we are grateful to Dr. Freischlag for returning to Milwaukee to give this commencement speech, sharing her hard-earned wisdom, and being a role model for the next generation of servant leaders. 

We are grateful for you and for what you have accomplished to make the world a better place. 

Bruce H. Campbell, MD, FACS, is Professor of Otolaryngology and Communication Sciences and the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the editorial board of the Transformational Times.  

What Does a Medical Student Look Like? Social Determinants of Medical Education

From the May 5, 2023 issue of the Transformational Times

What Does a Medical Student Look Like? Social Determinants of Medical Education

Adina Kalet, MD, MPH

In this week’s Director’s Corner, Dr. Kalet muses on what it means that not all, but most, medical students come from high-income households and how this may be the cause of unnecessary struggle and suffering ...

*While this is a true story as I experienced it, I have changed my friend’s name and some of the details to respect her privacy.

It was late on a wintery night when the car’s brakes failed. As we rolled down the steep Upper Manhattan hill the driver, my classmate, Laura, pumped the hand break until we came to a stop by gently bumping the rear of the vintage Mercedes Benz paused at the traffic light. “Shit,” she muttered.

Following Laura’s lead, I got out of the car and gingerly approached the older tuxedoed man who had emerged from the driver’s seat and was now carefully inspecting the rear bumper. No harm done. A moment later, a woman emerging from the passenger seat, wrapping her fur coat tightly around her shoulders as she strode over. She looked us up and down, no doubt taking in our matching server uniforms, poorly fitting black skirts, and polyester white button downs, bow ties askew. She then eyed the rusted 10-year-old baby blue Buick from which we had emerged and screeched, “How can you have this piece of junk on the road? You could have killed us...and my husband is a surgeon!?”

It was chilling. To his credit, the man looked chagrined. Using my best communication skills, intending to diffuse the tension, I said softly, “Ma’am, we are sorry for frightening you. We hope no one is hurt. We are medical students on our way home from a catering job.”

The woman’s tirade revved up. She accused me of lying about being medical students and us of being dangerous menaces, among other things. She was rattled and had cell phones been available in the 1980s, no doubt, she would have called the police. The man coaxed his wife back to the car and waved us on.

Luckily, no one asked for Laura’s insurance information because she didn’t have any.

Clearly, we did not fit this wife-of-a-surgeon’s image of medical students. She could not imagine medical students driving run-down jalopies or being employed in the “service industry.” I was perplexed, aggravated, and embarrassed. But Laura was nonplussed. She was used to this sort of dismissive treatment. After all, she was regular catering waitstaff at NYC gala fundraisers. She was used to being invisible to people like this couple.

Laura’s story

In retrospect, I realize Laura grew up poor. Compared to most of us who had taken loans to pay our tuition and were otherwise fully supported by our parents (I lived with my family in a two- bedroom apartment and commuted to school by subway), she needed the car to get to school and her service jobs from her working-class neighborhood on Staten Island. Public transportation was not an affordable nor easily available option. Both Laura and her mom, who had a serious chronic disease, needed to work to pay the family’s basic expenses. Her car was a mess, clearly in need of repairs, and probably dangerous, but it was all she could afford. While a handful of us occasionally joined her on a catering job to make some extra cash, she had no choice but to work nearly full time. To be clear, medical school is a more than full time endeavor and most medical students do not need to hold down jobs.

Laura’s family likely went hungry or were marginally-housed during the time we were in school together. Maybe they were on public assistance. She might have told me if I had asked. But I didn’t. I hope she asked for—and received—help from the office of financial aid. But I am not certain, knowing her, that she would have.

Even in our highly competitive city university program, dedicated to recruiting a diverse class of local students able and committed to becoming inner city primary care physicians, Laura’s level of financial need was rare. Laura had a few friends and was an excellent school project partner, but she rarely showed up for social outings or joined us when we went out for meals. She couldn’t afford the time or money. I never quite figured out when she studied, but she survived academically, repeating a year of school along the way.

I lost touch with her after we graduated. I know she trained as a surgeon, worked in the community from which she came, and had a child. A few years ago, I learned that Laura died young of cancer.

When we all went off to traditional medical schools to finish our training I was, for the first time in my life, introduced to the fact that most medical students came from relatively wealthy families. Naive as it sounds, I was stunned when a new medical school classmate picked me up in his vintage Aston Martin to drive out to his family’s suburban home, replete with private

swimming pool and tennis court for a weekend barbeque, bringing his laundry along to be done by the maid. I felt like Dorothy in Oz, “Toto, we are not in Kansas anymore.”

The COVID-19 pandemic reveals the Social Determinants of Education

Much has already been written about how the pandemic revealed the stark health and economic disparities in our society. It should not surprise anyone that medical schools were also challenged to recognize and be responsive to the needs of students with fewer resources. It became crystal clear that like Social Determinants of Health that create negative consequences for patients, Social Determinants of Education (SDOE) create disparities among learners. There is a myriad of ways that some student’s lives have been shaped by factors such as socioeconomic stress; bias and oppression; food and housing insecurity; poor access to health care; and unsafe neighborhoods. These challenges put otherwise highly motivated ambitious, capable students at a significant educational disadvantage compared with their peers in terms of access to and success in the health professions.

Because society desperately needs a robustly diverse and excellently prepared pool of future health professionals, the 2022 Josiah Macy Jr. Foundation Consensus Conference on COVID-19 and the Impact on Medical and Nursing Education recommended (among many other things) that, “Health Professions Education (HPE) leaders, educators, and learners—together—must examine and eliminate the detrimental effects of the SDOEs on HPE learners and build equitable learning environments for everyone.” But this is often difficult to do because it is traditionally a hidden problem.

Medical students disproportionately come from high-income households

In 2022, data from an AAMC-Medical Student Questionnaire revealed that 50.5% of all Allopathic medical students come from the top quintile of household income, with 24.0% from the top 5% and less than 6% come from the bottom quintile. This overrepresentation of higher income and underrepresentation of low-income groups—consistent across race and ethnicity— is a manifestation of the fact that access to the profession has been persistently out of reach for those from the lowest socioeconomic strata. This is being addressed in many ways. Long-term upstream targeted investments in the student pipeline through community partnerships can get more students like Laura to feel prepared to apply to health professions programs. Medical schools can, and do, assess socioeconomic disadvantage during the admissions process using essays and the parental education and occupation indicator. And grade point average and Medical College Admission Test scores, can be adjusted for socioeconomic disadvantage.

But more needs to be done. To reduce the unequitable circumstances while in medical school, students from low-income households could be monitored for the accumulation of unexpected expenses and provided with what they need to thrive (e.g., food, clothing, computers and internet access, emergency housing) given that they do not have nearly the same level of family support as most of their peers.

The pandemic worsened every social determinant of education and negatively impacted current and future students. Students from poorer families are much more likely than their peers to have experienced the devastating impact of the pandemic, the death of family members and loss of livelihoods, the serious economic deprivation while having fewer resources to recover from these challenges. In addition to providing concrete support and wellness and financial counseling, schools should monitor policies that inadvertently disadvantage some students like required travel and housing for training and fees not included in financial aid packages (aka “hidden tuition”). Medical schools like ours have restructured large classes into smaller learning communities to build better communal resilience both academically and socially and to enhance our opportunity to look out for each other.

For those of us working for transformation of a medical education that is built around a core of character and caring, the pandemic has “catalyzed a strategic inflection point” (Lucey, 2022) where we now have an opportunity to better address the health care needs of both our patients and students. While Laura’s “journey traveled” from poor kid to surgeon is inspiring, her almost invisible struggles to persevere in the face of hardship makes me wish we had been more compassionate and kinder. We could have done better.

For more reading:

Lucey CR, Davis JA, Green MM. We have no choice but to transform: The future of medical education after the COVID-19 pandemic. Acad Med. 2022(suppl 3);97:S71–S81.

Muller D, Hurtado A, Cunningham T, Soriano RP, Palermo AS, Hess L, Willis MS, Linkowski L, Forsyth B, Parkas V. Social Determinants, Risk Factors, and Needs: A New Paradigm for Medical Education. Acad Med. 2022 Mar 1;97(3S):S12-S18. doi: 10.1097/ACM.0000000000004539. PMID: 34817406; PMCID: PMC8855756

Shahriar AA, Puram VV, Miller JM, et al. Socioeconomic Diversity of the Matriculating US Medical Student Body by Race, Ethnicity, and Sex, 2017-2019. JAMA Netw Open. 2022;5(3):e222621. doi:10.1001/jamanetworkopen.2022.2621

Josiah Macy Jr. Foundation Conference on COVID-19 and the Impact on Medical and Nursing Education: Conference Recommendations Report. Acad Med. 2022 Mar 1;97(3S):S3-S11. doi: 10.1097/ACM.0000000000004506. PMID: 34736279.

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.

Kern Institute Collaboration for Scholarship (KICS): KICS Out the Jams

From the April 28, 2023 issue of the Transformational Times - Issue dedicated to the work of the Kern Institute Collaboration for Scholarship (KICS)

Kern Institute Collaboration for Scholarship (KICS): KICS Out the Jams 

Michael T. Braun, PhD, Amy Farkas, MD, and Kristina Kaljo, PhD 

 

Let me up on the stand 
And let me kick out the jam 
Yes, kick out the jam 
I want to kick 'em out 
—MC5, "Kick Out the Jams" 

As the Kern Institute Collaboration for Scholarship (KICS) wraps up its second school year of supporting scholarly output of the Kern Institute and MCW, the authors highlight what they consider the four biggest challenges and invite readers to join the conversation about what’s next. For no reason other than it’s fun, they chose song lyrics to title each challenge... 

 

The essays in this issue of Transformational Times celebrate KICS achievements and highlight practical approaches to common challenges as we support research projects in medical education and, more generally, in education and the social sciences.  

 

In this opening essay, we ask, “What are the biggest opportunities for growth?” 

 

"It's always been a matter of trust"

—Billy Joel, "A Matter of Trust" 

 

"Hi, I'm from a group of scholars on campus, and I'm here to help you!" Okay, those aren’t Ronald Reagan's "most terrifying words," but we don't blame you if the first thing that pops into your head after this invitation is, "Why?"  

 

For KICS, the answer is simple: It's in the mandate for the Kern Institute to distribute the transformative work happening at MCW. But unsolicited (or generally available) help can feel like a trip to the writing center in our undergraduate days. Merely walking in the door shows you're admitting there's something you can't figure out but are expected to know.  

 

So, here's where we'll encourage everyone: There's no reason anyone on campus should expect themselves to know how to conduct impactful research in education or the social sciences, let alone how to solve tricky problems when they arrive. And when folks come to KICS for help, teaching and learning is split equally: We learn from you just as much as we (hope we can) offer to you. Let's partner for your next project. At least we know we'll learn something from you if you come by.  

 

"You gotta let me know which way to go/because I need to know"

—Marc Anthony, "I Need to Know" 

 

Read further in this issue about the success of our qualitative workshop. We highlight a new KICS initiative to address a specific need on campus. 

 

Now the question is, “What's next? And how will we find out about it?”  

 

One of the best clues we have is the Kinetic3 faculty development program. The data on each session collected over years gives us insight into the development areas that are most impactful. We have started offering more services specifically to K3. This has given us feedback on what's most helpful and a chance to try new education ideas and sessions for an interested audience. 

 

We also appeal to you—the readers—to think about what sessions (in any format) would help move along scholarship the fastest. How should they be structured? A semester-long series, like our qualitative workshops? Stand-alone offerings that take an hour or two? A retreat that fills a full day or more? What should they teach? General philosophies and approaches to research? Hands-on research design? Analysis techniques, both qualitative and quantitative? Writing-centric sessions that move manuscripts out the door?  

 

Of course, one answer to this is, "Yes, that!" And it all sounds good to us, too! So, help us narrow it down. With limited time and resources (including for participants), what session and format would make a difference in scholarly productivity?  

 

"You can write, but you can't edit"

—Regina Spektor, "Edit" 

 

One of the most challenging needs we’ve noted relates to helping people become more proficient and efficient writers, especially in the scholarly style required by academic journals. It's a style that is mockable, even laughable, with its pompous parameters and flatulent forms. It's a style that's intimidating, with its sententious critiques. It's a style that we might be poking a bit of fun at right now with our alliterative allusions.  

 

How do we break people free from their fear of the form, and let them embrace expedient and efficacious expression? One approach we're planning to try is asking folks to work on an individual development plan for their writing. This would provide a set of landmarks we could help people chart toward. We also are looking for more opportunities for participation in the two basic elements of writing improvement: Reading and Writing A Lot. (Note to Self: RWAL? Think of better acronym later.)  

 

To that end, have you read anything great lately? Maybe pass it on to a colleague! We can all help each other read more by sharing great titles.  

 

"Uh huh, I'm worth it"

—Fifth Harmony, "Worth It" 

 

This is a challenge for all programs: How do we measure our impact and demonstrate our success? Think of the semesters you have spent in classes where you felt you learned nothing. Think of the five minutes spent in random conversation that changed your whole life's course. We aim KICS' impact to be somewhere between those two poles, but how can we know?  

 

The first, best answer to "How can we measure that?" is "Ask the people who know." And we endeavor to do just that. For example, our post-Journal Club survey has provided insight into the program's impact and provided us with ideas for future speakers. But beyond that, we’re still thinking about tracking a long-term or institution-wide impact.  

 

We hope you enjoy the essays in this special KICS edition of the Transformational Times. And we hope to see you at a KICS event soon.  

 

Michael T. Braun, PhD, is a program manager with Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.  

 

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

 

Kristina Kaljo, PhD, is an Assistant Professor and Clerkship Co-Director in the Department of Obstetrics & Gynecology at MCW, specializing in curriculum and instruction, educational research, and community-engaged research. She is director of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.