Reflections on New Beginnings

From the 6/18/2021 newsletter

Perspective/Opinion 

Reflections on New Beginnings 

By Olivia Davies, MD; and Brieana Rodriquez, MD 

 Drs. Olivia Davies and Brieana Rodriquez reflect on moving cross county to begin their new journeys for residency… 

Dr. Olivia Davies: 

I have lived in Wisconsin for most of my life. I did undergrad at Madison and medical school at MCW, when I shut the door on my 20-foot U-Haul and locked it for the long drive out to Boston I couldn’t believe I had fit my whole life in there.

But the truth is, I hadn’t. Leaving Wisconsin meant we were leaving my family and my fiancé’s family behind. When we arrived in Boston, I was nervous, would our apartment look like it did in the photos? Would the movers arrive on time? Would our couch fit? It did, they didn’t, it didn’t. I cried. I wanted to go home. My couch didn’t fit and neither did I. This busy city felt new, too new, and not mine. I woke up from a mattress on the floor the next day and reluctantly pulled on my tennis shoes, we had no food yet and I knew I just needed to go for a walk. I walked for hours that morning, a croissant here, a coffee there, I started to recognize streets I passed, I saw my new hospital, I realized the river path was five minutes from our apartment door and I let a long sigh out. I thought it might actually be ok. And it was.

Dr. Brieana Rodriquez: 

My “most extreme” feelings about moving across the country happened before I left. After match day I was so excited to start a new chapter of my life. I was ready! But after classes had finished and I had already bought my new house I was in this weird limbo state. The best way I could describe it was I felt like I had closed the Wisconsin book, but I wasn’t allowed to open the South Carolina book. My anxiety about moving was at an all-time high but it wasn’t because I was scared, it was because I wanted to move but couldn’t. But since I’ve gotten here there’s been nothing but excitement! Meeting my co-residents (and realizing I’d be able to make more best friends) has been so much fun! Exploring a new city has been so cool! When moving cross country for medical school I learned so much about myself. I grew so much personally and I’m ready to start experiencing that again. One of the reasons I chose to rank MUSC #1. Side note: I know the anxiety about starting work is going to kick in soon, but it hasn’t yet. 

Olivia Davies, MD, begins her Dermatology Residency at the Harvard University Combined Program on July 1st in Boston, MA. During her time as an MCW medical student, she was an associate editor of the Transformational Times. 

Brieana Rodriguez, MD, begins her Emergency Medicine Residency at the Medical University of South Carolina on July 1st in Charleston, SC. 

Remember your residency family

 From the 6/11/2021 newsletter

Guest Director's Column

Remember your residency family

  

 Alicia Pilarski, DO

Kathlyn E. Fletcher, MD MA

 

 Doctors Alicia Pilarski and Kathlyn Fletcher share with today’s residents how their own experiences during residency led to lifelong, supportive, and important relationships.

  

From Dr. Fletcher:

 June is a time filled with so much nostalgia and excitement.  There are so many endings in June.  But of course, endings almost always make room for beginnings. This weekend, I (KF) had a Zoom call with members of the graduating class of 1996 from the University of Chicago’s Pritzker School of Medicine.  How can it have been twenty-five years since I graduated?  But that ending made way for the beginning of my residency which would ultimately become the most formative years of my professional life.  

I remember snippets of my own intern orientation week. In one particular memory, I was sitting on the 7^th floor of the hospital in the Internal Medicine residents’ respite area.  I was in the room that I would go to daily for three next years for morning report.  On that day, I looked around at my class of twenty-five interns, eight of whom had graduated from medical school with me and four of whom were my closest friends of the past four years.  We were doing an ice breaker meant to help us get to know each other, and I thought to myself, “Why am I doing this?  I already have plenty of friends in this program.”  Clearly, I had a lot to learn about the village needed to get me through residency.

Those four people remained close friends throughout residency and beyond; in fact, two of them were at my 50^th birthday party last year.  However, many of the others profoundly influenced me as well.  To call those who walk beside you through residency “friends” seems to be a gross underrepresentation of the role they play.  Co-residents are very much like siblings.  They are part of the daily rhythm of life.  They also bear witness to extraordinarily difficult moments, days, weeks.  My own co-residents ate ice cream with me when I needed it even when they didn’t (thanks Reggie!), patiently double checked my calculation of the rate of hypertonic saline for an obtunded hyponatremic patient in the ICU (thanks Jeff!), and cried with me for patient and other losses during those three years (thanks Erin!).  They debriefed, advised, bolstered, and encouraged.  They were my family.

 

From Dr. Pilarski:

 I (AP) had an incredibly similar experience to Dr. Fletcher during my time in residency. The highest highs and the lowest lows were shared with my seven other Emergency Medicine (EM) residents. Getting my first solo intubation during a code on the floor and celebrating with a margarita that night (thanks, Peter!), late nights in the Trauma ICU trying to keep our sickest patients alive (thanks, Troy!), and experiencing my first medical error and having my co-chief there to help support me through it (thank you, Josh!).

One of my fondest memory was when we created a calendar of photos that we gifted to our faculty and the ED nurses upon graduation. Clearly, we believed our faculty and nurses would always remember us as the “best” EM residency class, and so we felt it was our responsibility to remind them of that fact for at least the next year. We staged photos in various locations throughout the hospital and around town, many of which resulted in hysterical situations and additional photos that were deemed “too inappropriate” for the final product. At the end of the day, our faces hurt from smiling and laughing so hard. But then it became very real that our time together was ending, and in a few short days we would be spread out across the country in new emergency departments. I tried to manage the excitement about the next chapter in my career with the immense sadness I was feeling from being separated from my residency family that I had formed such a unique and special bond with over the past three years. I worried that the bond we had created would be lost to distance, new colleagues, busy schedules, or elapsed time. But I knew it was time to move on for all of us. 

We stayed in touch for the first year via text and then, slowly, our chats became less frequent. It was bound to happen, right? But then, COVID hit. And on March 16, 2020, our first group text in several years started that bond all over again: “Checking in with all of you. We are just starting to get hit with COVID. Thinking of all of you and hope you are all staying healthy.” What followed were numerous texts about our fears and anxieties, what each of our respective EDs and hospital systems were doing, what PPE we had, how we would decontaminate after a shift, how we planned to keep our families safe, and what we knew about this novel virus. And then we shared pictures of our kids, dogs, ourselves in N95s and CAPRs, and other funny pictures from when we were in residency (including some from that calendar we made!). And those texts continued through the year and into this year. They are now more focused on celebratory messages and pictures of things like vacations and group photos with friends.

We had gone through another immensely stressful, challenging, and formative phase of our lives again. What I came to realize was that distance, new jobs, busy lives and time did not break that bond. It was always there this whole time, and it was stronger than I could have ever imagined.

 

In this issue of the Transformational Times, we hear from three graduating residents who tell their stories of the formative experiences of residency, what they learned and what they hope to carry forward.  Like all of us who persevered through residency (or another professional equivalent), they had personal journeys marked by small and big moments.  We also hear from Dr. Ken Simons, who leads the GME enterprise at Medical College of Wisconsin Affiliated Hospitals.  He offers a poignant reflection on the last sixteen months and how that time has shaped the worldviews of all of us, especially the residents.  Finally, Dr. Eric Holmboe, from the Accreditation Council of Graduate Medical Education, offers additional insight into what to carry forward from residency.  There is even a piece of original artwork for you to contemplate.  We hope that you enjoy it!

To all the graduating residents across MCWAH, we are incredibly grateful for your work during residency.  You have healed patients, listened to families, taught students, comforted each other, and grown personally and professionally.  Whether you believe it or not, you are ready for this ending and the beginning that follows it.  Remember your residency family and lean on them when you need to.  Know that many people are proud of you and believe in you.  We can’t wait to see how you move our profession toward the ideal we all know is possible.   

 

Alicia Pilarski, DO is an Associate Professor of Emergency Medicine, Associate Chief Medical Officer of Froedtert Hospital, Co-Pillar Director for Kern Institute GME Pillar, Co-Medical Director for the F&MCW “Supporting our Staff” Peer Support Program.

 

Kathlyn E. Fletcher, MD MA is a Professor and residency program director in the Department of Medicine at MCW. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

 

 

Words of gratitude, encouragement and strength from the Senior Associate Dean for Graduate Medical Education

 Freom the 6/11/2021 newsletter

Perspective/Opinion

 

Words of gratitude, encouragement and strength from the Senior Associate Dean for Graduate Medical Education

Kenneth B. Simons, MD

 

Dr. Simons, MCWAH Executive Director & DIO, MCW Senior Associate Dean for Graduate Medical Education and Accreditation, offers this message of congratulations and best wishes to all of the residency and fellowship graduates, reminding them that, while their knowledge and skills are important, it is their humanity, compassion, and caring that their patients and families will remember …

 

The journey of a thousand miles begins with one step.

Lao Tzu

 

The journey of becoming a physician is a difficult one; quite understandable given the importance of what the responsibilities are. Thus, completion of the residency or fellowship training portion of this journey in “normal” times is a remarkable achievement. In extraordinary times such as this, it is a feat of incalculable proportions. You, the 2021 graduates of our 98 ACGME accredited programs along with our non-accredited GME programs have been tested like no other prior graduates. The COVID-19 pandemic was your crucible and pushed you in every possible way. Professionally, while your didactic education became virtual, your responsibilities to be physically present to care for patients never did, other than some telemedicine encounters. You wore your PPE as battle armor and you came to work every day to do what you were born to do; care for the sick who required your expertise and more importantly, use your compassion as you learned and practiced your craft under the supervision of faculty. Some of you in fulfilling your responsibilities to patients actually developed the disease, and we are all very grateful that you survived in contradistinction to the 597,000+ dead in the US and 3,730,000+ worldwide.  And to your great credit and remarkably, more than 95% of you received one of the vaccines, demonstrating to your patients and the world that science is real and that it matters.

 

Beyond having to deal with a viral pandemic, something that hadn’t happened in more than 100 years, you also had to deal with our country’s latest and critical reckoning with health care inequities and systemic racism. America’s shameful legacy of slavery and the institutionalization of racist behavior was placed on international display as a result of the murder of George Floyd which fortunately, was filmed by a brave 17 year old woman, assisted by others who watched and confronted the officers who forsook their oath to protect and serve, something you never have and would never do, given each of you took an oath to care for all who come to you in need of your expertise. Mr. Floyd was not the only black person who was killed or maimed this past year as a result of excessive force by police and racist thugs and it is incumbent upon us to remember all of them. In addition, you witnessed a rise in violence against our Pan-Asian community as a result of the pandemic and the hateful, ignorant rhetoric spewed by some “leaders.” Through it all, you did the right thing for patients, your communities and yourselves. You participated in peaceful demonstrations, you knelt for nearly nine minutes, you wore pins that said Black Lives Matter and others with rainbows, demonstrating to everyone that you cared about your fellow human beings in a committed, real way and that diversity, equity and inclusion aren’t just words in a mission statement, but words to be lived by in a visible, tangible way, each and every day.  As you leave here, it is incumbent on you to continue making society healthier for all, better for all and to eliminate racism in all its forms. 

 

The word doctor comes from the Latin docere and means “to teach.” Throughout your tenure here, you taught medical and other students, your peers, the staff and the faculty that actions do speak louder than words; all while reading about your patients and their conditions to enhance your knowledge for the benefit of your future patients. And as impressive as all of this is, you accomplished this while also caring for your own families and other loved ones, and as such, they clearly share this august accomplishment with you. In your heart you know better than anyone that without them and their support, this accomplishment would not be as sweet, nor would it have been possible. Their assistance, encouragement and unconditional love during this challenging time was critical to your achievement. They, along with your many teachers and mentors throughout the years, coupled with your own efforts, brought you to this moment and they will always be with you, either in spirit or in reality.

 

So, years from now when you look back on your time in training and reflect on what you did during one of the most difficult times in medical history and that of our country, remember that you stood tall and did far more than you probably thought was even possible. Your legacy in MCWAH is secure and represented by the following two stories: Two upper level housestaff volunteered to form a COVID-19 intubation team to “protect our older faculty and younger, less experienced colleagues” and by a mother, a first year resident, who said “while it will be a hardship to leave my young child for a month, it’s nice to go to a place where I will be needed and can make a difference.”

 

You, the graduating housestaff, are inspiring, and you are going to be amazing doctors to whom your patients will look for assistance during what can easily be considered some of the most trying times in their lives: when they are dealing with and overcoming illness. Always remember that while your knowledge and skills are important, it is your humanity, compassion and caring that your patients and their families will remember during those times. It is now time for you to practice independent of supervision and take the next steps on your journey. Godspeed and know that you are ready and we are with you always. Remember, “Your journey never ends. Life has a way of changing things in incredible ways.” Alexander Volkov

 

Best always,

 

 

Kenneth B. Simons, MD

 

Dr. Simons is the Executive Director & DIO, MCWAH, Inc. and the Senior Associate Dean for GME and Accreditation, MCW.  He is also Professor of Ophthalmology and Pathology (tenure) at MCW.

 

Some Questions for Lisa Grill Dodson, MD - Dean, MCW-Central Wisconsin Campus

 From the 2/19/2021 newsletter

Some Questions for…

Lisa Grill Dodson, MD - Dean, MCW-Central Wisconsin Campus

Rural hospitals have long faced tight funding, declining resources, challenging recruitment/retention issues, and low volumes/reimbursements, yet they are expected to be ready to care for the full-range of health issues including opioid / methamphetamine addiction, obstetrical care, COVID-19, refractory mental health issues, farm machinery accidents, and high-speed vehicular trauma. We spoke to Lisa Dodson, MD, the Dean of the MCW-Central Wisconsin Campus in Wausau, about the challenges facing her campus and the future of rural healthcare …

Transformational Times: How does a regional campus help address some of the challenges of rural health care?  

Dr. Dodson: Regional campuses play several roles as we address the unique challenges of rural health. First and foremost, a regional campus can directly impact workforce availability. Students who grow up away from large urban areas, train in smaller cities, and are accustomed to the lifestyle are more likely to practice in less densely populated, underserved counties. These students have the extra level of resilience needed to survive and thrive and will be ready for the constant challenges in both pathology and policy that have an oversize effect on rural communities. 

TT: What can you tell us about students that are drawn to regional campuses?

Dr. Dodson: First of all, they are truly unique. Students coming from rural areas to medical school are unbelievably underrepresented. Nationally, medical schools  currently have the smallest percentage of students coming from rural backgrounds since records have been kept and most medical students in urban areas will never meet a rural mentor or have any rural experience. So, we actively look for students from rural areas, believing they have a greater likelihood of going back to the same or similar communities. 

The mentors these students meet are critical. They show the students that that they don’t have to be “saints” or “missionaries” to go into rural medicine. These are great, fun, rewarding jobs. Intrinsically motivated, curious, and pragmatic students find great challenge and reward in these settings. 

Because of their backgrounds and the backgrounds of their teachers, regional campus students might be less susceptible to the overt and subtle messages aimed at discouraging them from pursuing smaller community primary care careers. These students tell me that they are often subjected to comments asking them why they don’t want to “aim higher.” They hear that a lot but, fortunately, they also see how satisfied their mentors are. The students learn to say, “Thanks for the advice but this is what I want to do.” They learn to believe in themselves and their choices. Our goal is to support them to make the right choices for themselves. 

Think about the challenge: 

It is nearly impossible to convince a student to enter primary care in a small town if they have come to medical school from an urban/suburban background, have only seen urban medicine, and are convinced they want to be a subspecialist in a large city. The system is designed to take students who want to be family physicians and steer them toward specialties; rarely, does it work in the opposite direction. 

Recruiting students from less populated areas isn’t foolproof, of course. Some students from small towns will see medical school as their “ticket out of Dodge.” Finding students who will commit to return to a small town after having been through medical school and residency training is special. 

TT: What challenges do you see in the rural health care workforce and in rural health care in the coming decade? 

Dr. Dodson: Over the coming decade, we need to better understand and develop pipelines for all rural populations into health care professions. For example, we have an Advancing Healthier Wisconsin grant that is targeted to increasing matriculation for Hmong students. We hope to expand to other groups. One successful example in Wisconsin is the UW-Madison Native American Center for Health Professions which was founded by Dr. Erik Brodt (View the We are Healers website here). 

To attract and retain rural students into our communities, we are partnering with Aspirus, a local health system. The Aspirus Scholars program provides full-tuition scholarships to medical students in exchange for a commitment to return to work in the area for at least five years. There are fifteen current or recently graduated Aspirus Scholars at MCW-Central Wisconsin.

Political and policy changes are imperative. Policy makers must refocus on community engagement, health equity, population health for all populations throughout the state. Unfortunately, the solutions that work in urban regions don’t always work in smaller towns. Both areas need access to equitable public health. Both areas need access to quality care in trauma, medical emergencies, and obstetrics. Even though they might not be needed often and the volumes of patients are low, the systems - and society writ large - need to make certain that these services and properly trained staff are available when needed. When someone is in urgent need, you can’t always just “drive to the next town.” Keeping these services available is a larger problem than any one town or county, and the loss of small-town hospitals across the region is a concern.  

We could think of the need for healthcare in the region the way our predecessors faced the need for electricity when it first became available. In those days, rural areas developed public utilities. There was a societal decision that everyone should have access to electricity because the benefits outweighed the costs of getting wiring to remote regions - a concept with which we all agree. To reach rural areas, utilities required federal and state funding, but still maintained local control. Medicine, like electricity, could be delivered to all people in need, not to the highest bidder.  

We need to advocate for our communities. If school systems are underfunded and failing, it will be hard to recruit physicians with young families. If infrastructure is not maintained, there will not be enough people to support practices and physicians will not have enough resources to provide care.  

TT: What challenges do you see in your accelerated curriculum, and in medical school curricula, in general? 

Dr. Dodson: We do need to build different curricula. A compressed medical school curriculum like ours does not easily fit for someone who intends to enter subspecialty surgery; there just isn’t sufficient time for them to get the exposure they need to be a competitive applicant for residency. On the other hand, not every student needs the same length of time to master what they will need to succeed. We need to stop thinking of medical school duration in terms of  “integers”; curricula should be more flexible than exactly three, four, or even five years. In competency-based curricula, students finish when they have displayed mastery. I have seen students who are close, but not quite ready, after their three years. Some need a few extra months beyond three years to be prepared, but not a full year. Curriculum reform should focus on using time to optimize student preparation and not as “remediation.” 

TT: What has surprised you most in your position? 

Dr. Dodson: Being a dean is a weird job! It’s like having a baby. Nothing is every quite what you planned or thought it would be. You hit surprises. You hit roadblocks. For example, when I arrived, there were great physicians here, but we needed to launch into faculty development to turn them into teachers. It was harder than anticipated but very gratifying.

It has been rewarding to see how much our community physicians clearly enjoy the opportunity to give back to the next generation. Since the classes are small, we find the chance to work with the students to be very engaging. They challenge us. They want to know, Why do you do things that way? The students bring ideas, keep us fresh, and keep the job rewarding. 

I have been surprised by how difficult it can be to recruit physicians. Wausau isn’t that small of a town and we are close to major metropolitan regions. The area is amazing. We really need neurologists, but the system has been unable to get people to look.  It’s hard. So we’ll grow our own. 

TT: Any final words?

Dr. Dodson: I have loved seeing how in rural areas we all depend on each other in ways that aren’t always seen in larger urban areas. A small town will find out what you can do and put you to work. In my first rural practice, the hospital hired my husband (a chemical engineer) to install their first computer system. Once that project was completed, he was been hired to do regional economic development, also something out of his core area of expertise. Rural communities work together. 

I think being part of a regional campus has given me a unique perspective on the current state of medical school education. Too often, schools focus on what doctors need and want. “We want more specialty training!” At our regional campus, we also focus on what the community and society need. That is more rewarding and is, I believe, where medical education needs to turn. When we ask, “What do the neighbors need?” we think about where best to place our resources. Regional campus can demonstrate this. We listen and respond. 

Lisa Grill Dodson, MD is the Sentry Dean and Founding Dean at MCW-Central Wisconsin, a position to which she was appointed in August 2014. She completed her family medicine residency and fellowship at the Oregon Health Sciences University. 

Interview conducted by Bruce H. Campbell, MD.

The Truth About Trust

 From the 10/2/2020 newsletter

Director's Corner

The Truth About Trust

Adina Kalet, MD, MPH

In this Director’s Corner, Dr. Kalet considers the importance and complexity of trust in medical education and encourages us to hone our judgement and have courage …

Anyone who doesn’t take truth seriously in small matters cannot be trusted with large ones either.

-Albert Einstein

The first presidential debate this week has me thinking about the consequences of not being able to trust someone on whom you depend. We rely on our elected officials, like our physicians, to listen, have empathy, engage in respectful - even if sometimes - heated disagreements, make good judgements in very complex situations, have control over intense emotions and, most importantly, consistently tell the truth. To “trust someone” implies that we have confidence in that person, and believe that the individual will be capable, adaptable, and competent now and in the future – even when faced with novel, rapidly evolving circumstances, emotional and physical stressors, and unpredictable challenges.

While always in the background, trust (“entrustment” and “trustworthiness”) has moved to the forefront in the medical education. How we make these trust judgements in medical education – and in life – is worth a hard look.

How do we measure trustworthiness in trainees?

Hodges and Lingard point out that the discourse about what makes a “good” physician – a core responsibility of our work as medical educators – has moved through a series of distinct and overlapping eras over the past seventy years. In the Psychometric Era, we valorized measurable, highly standardized knowledge tests (e.g. MCAT, USMLE Board Exams). The next phase brought great enthusiasm for demonstrable, directly observable, and behaviorally measurable core clinical skills (e.g. oral exams, mini-CEXs, OSCEs). Next, and to the frustration of many program directors, organizations introduced comprehensive, nuanced competency frameworks designed to capture and document each learner’s developmental progress via new standards and milestones.

These changes reflect our evolving grasp of “quality” in medical education. As our understanding improves, we will uncover how to develop rich portfolios of assessment data for each of our trainees. But in the end, data do not make high stakes decisions. We do. And these decisions require making trust judgements and having the courage to act on those judgements.

Trust judgement barriers and opportunities

Unfortunately, clinical faculty are not very good at assigning objective measures of competence. My colleagues and I spent years trying to get experienced clinicians to make reliable (reproducible) measurements of medical student clinical competence. Even with lots of fancy, performance dimension, frame-of- reference, and behavioral observation training, experienced professionals are eccentric and resist standardization. This, I believe, is because there is no single “truth” about clinical competence.

Trust judgments are highly context-dependent and idiosyncratic. We tend to be internally consistent and we know a trustworthy resident when we see one. An experienced professional possesses a highly-honed identity and a strong sense of what a trainee must demonstrate to be trusted to care for “our” patients. Unfortunately, we disagree with our colleagues on when individual trainees can be entrusted to “fly solo” and more independently care for patients. Gingerich has challenged us to embrace this disagreement and see it as a strength rather than a weakness.

Furthermore, experts are also context-dependent! As we collect and collate more-and-more data from larger, diverse pools of experts, we must ensure that trust judgements are appropriately interpreted to protect students from the vagaries of any individual’s bias. This is what van der Vleuten and others call a Program of Assessment for Learning. Ultimately, trained competence“judges” will be charged with making final high stakes assessments regarding decisions such as advancement and graduation. These judges will determine if, based on solid evidence, we can trust a learner to consistently “do the right thing, at the right time, for the right person, and for the right reason” in their next phase of training.

Moving from theory to action

Social and cognitive psychology researchers suggest that competency judges need to both understand the value and limits of the objective data (e.g., exam scores don’t predict clinical skills competence, but they do predict future exam scores) and should explore and develop their judgement “sense.” This sense of who to trust is highly dependent on an individual’s characteristics, experiences and biases. Knowing thyself, in particular understanding one’s biases, is crucialbecause if we are cognizant of them and have integrity, we can make adjustments – “forcing” ourselves to slow down our thinking, toggle to a more analytical rather than intuitive deliberative strategy, when we are in danger of making an error. This takes work, discipline, and practice with feedback.

There is much interesting work to be done to ensure we have trustworthy physicians. Fundamentally, most of us make our trust judgements based not on what students know or can do (we can always teach that stuff), but on who they are as people. Do they always tell the truth even when it leaves them in a “bad light?” Do they admit when they missed a physical exam finding or forgot to check a lab or failed to follow up on something? Do they take the time to listen, attend to details, interact with empathy and kindness, even when stressed emotionally? Do they strive to improve rather than rest on their laurels or test scores? Do they seek to understand the perspectives of others? How do they handle being wrong or making a mistake? Can they sincerely apologize?

We are accountable to society to make defensible promotion and graduation decisions based on each learner’s competence and trustworthiness. These are difficult-to-measure, shifting concepts. We pledge to engage in the ongoing discourses and learn how best to make difficult, discerning judgements.

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. 

Graduation and Family

From the 5/22/2020 Newsletter


Graduation and Family


José Franco, MD – Hepatologist and Associate Dean for Educational Improvement, Medical College of Wisconsin



My daughter graduated from law school last weekend. Listening to her mom talk about mucus and her dad about poop at dinner had long soured her on a medical career. The ceremony was virtual and, I am sure, disappointing to many, but necessary during these challenging times. As the Dean delivered his opening comments, I found myself becoming both proud and teary-eyed.


Graduations celebrate graduates, their numerous accomplishments, and the excitement of the next phase of a life-long journey. Graduations to me have always been about family, their sacrifices, and the support they provide when things are going well but also when times are tough. As I watched my daughter receive her degree (we were not physically with her), my tears were replaced by a smile as memories of my own graduation surfaced.


My graduation from MCW occurred in May 1990. My parents were coming to Milwaukee for the first time. I remember reassuring them about the excellent May weather and that light jackets would suffice. Of course, meteorology not being my forte (nor the weatherman’s), it snowed eight inches two weeks prior.


Details of the graduation ceremony are sketchy after thirty years. The event was held on a weekend at the Milwaukee Exposition Convention Center and Arena (MECCA). This was the home of the Bucks, pre-Bradley Center and Fiserv Forum. Today it is known as the UW-Milwaukee Panther Arena. I do not remember marching in nor marching out of the arena. I recall Leslie Mack, Registrar and Director of Admissions, reading my name as I was instructed to walk across the stage. I do not recall putting on my regalia, who the commencement speaker was (ironic as I am now on the commencement committee and help select the annual speaker) nor, at the time, remembering the words of the Hippocratic Oath – words that would guide me through the years to cultivate caring and respect for my patients as I trained and practiced.

Dr. Franco poses with bamboo growing on the convent grounds in Spain where he grew up, 50 years later.

What I do remember as if it was yesterday was how proud my parents were. As the immigrant son of a carpenter and seamstress, I was the first in the family to graduate college, and now I was a doctor. Throughout the ceremony, I focused on my parents in the audience. They had smiles throughout the duration. I almost wished they could have walked across the stage with me as I realized how much they had given up to make this day possible. I remember the embrace from my father and the hug from my mother once outside of the building. After the ceremony, we joked about how off-base the nuns and my elementary school teacher had been while I was growing up in Spain. The nuns had chased me off the convent grounds. In defense of both, I would occasionally forego school and trespass on the convent grounds to scavenge giant bamboo because it made an excellent fishing pole.


I recall my parents reminding me to send them the formal graduation picture that was taken at the event (I only bought one and proudly sent it to them). My father passed away in 1997 and my mother in 2015. I think about them both every day. When I went through my mom’s photo album after her death, my First Communion picture was on page one and my MCW graduation picture on page two. This fall I will gather with my classmates as we celebrate our 30-year reunion, whether in-person or virtually. My parents will be there with me, with the same smiles they had in May of 1990.


Over the next week our soon-to-be graduates will be taking pictures on our three campuses. Many will have their parents and families with them. 


Graduating in this time of great uncertainty, they will not have the formal ceremony they so richly deserve. Nonetheless, our students will be smiling as will their parents and families. Congratulate them both!




José Franco, MD is a Professor of Medicine and Pediatrics in the Division of Gastroenterology and Hepatology and Associate Dean for Educational Improvement at MCW. He is the Community and Institutional Engagement Pillar Director for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.