Temperature

From the January 6, 2023 issue of the Transformational Times

Temperature

By David Nelson, PhD, MS

Temperature
36 degrees Fahrenheit.
AM? PM?
Breathe that stands out.
Feet to stand on – cold.
Concrete to stand on – cold.
It rains, and the feet on the concrete – are cold.
Head, shoulders, arms, waist, legs, wet and cold.
You are out and in need of everything.
Gratitude for those that come along to support.
Holding a sign with shaking hands from the cold.
Breathe or fog – we do not know.
AM? PM?
36 degrees Fahrenheit.







Author’s Notes

This day was memorable for all the wrong reasons. There are days in the city that are just glorious. Bluebird days with blue skies and moderate temperatures and a shining sun. Then, there are days like this one. Gray clouds, frosty-just-short-of-freezing air and rain. I do not remember exactly if the forecast predicted a day of the weather, but having been out on the streets doing outreach for many years, I thought it could be just like this all day long. I snapped a picture with my phone of the digital thermometer in the truck while stopping for a coffee up a coffee and it stood out. Only the temperature showed on the digital thermometer. For some reason I thought it might be the same temperature all day long and it turned out to be so. It was going to be a crap weather day.

A recurrent theme of the streets are shoes. Community members walk a lot. It is not unusual to for someone to walk five or six miles on a given day. On outreach, I look at a person’s feet first. The shoes tell me a lot about the person. I can also know their size and if they have feet issues by seeing how they wear their shoes out. Worn heels signify one issue, toe sticking straight up or to the side another issue and so on. The size comes from changing a lot of shoes over the years – the benefit of working in a shoe store for a season.

David Nelson, PhD MS is an Associate Professor of Family and Community Medicine at MCW. He leads many of MCW’s community engagement efforts, partnering with public and private organizations to enhance learning, research, patient care and the health of the community. Much of this work involves leaving campus and going to the places where the people he wants to help live, work and play. He serves on the board of Friedens Community Ministries, a local network of food pantries working to end hunger in the community.

Coaching is Vital to Preventing Burnout in Physicians

From the 5/14/2021 newsletter

Perspective/Opinion

Coaching is Vital to Preventing Burnout in Physicians

Brett Linzer, MD

Dr. Linzer shares how some of his peers suffered, then explains how coaching and intentional support can build resilience, improve the work environment, and restore meaning in our work …

My internal medicine/pediatrics friend Alex Djuricich, MD killed himself a few years ago. He was one of my resident partners and eventually became the internal medicine/pediatrics program director at the Indiana University School of Medicine.  He was a mentor to many internal medicine/pediatrics physicians and a father of two teenage daughters. When he died, I promised myself that I would do what I could to help other physicians.  It has taken me a long time but, with some of the work I am doing, I feel as though I am making good on that promise. 

I spent years trying to figure out why doctors hurt themselves. I am not sure if I have figured out much, but I have learned a lot along the way.  

One of the most important things I have learned is that I do not have all the answers to my life. But, I found a lot of the answers through coaching.

Why is coaching important?

The idea that we, as physicians, can figure everything out on our own and not rely on others to help us is, at best, a poor strategy for success and, at worst, a dangerous myth. Physicians are highly trained and skilled in certain areas but may lack mastery in relationships and communication. After residency, there is little emphasis on personal growth and especially emotional development.

Coaching can bring wide-ranging benefits to any organization. Most experts agree the cost of replacing one physician, including lost revenue, can be around $1M. A well-coached physician is more likely to stay in their current position and, therefore, save the cost of recruiting a replacement. In addition, there is less physician burnout, improved mental health, more effective physician leadership, and more balanced and engaged physicians. When physicians are at their best, everyone wins.

The struggles hit close to home

During my training, I was no stranger to suicide. A medical school classmate killed himself. 

Then, an international graduate with two children and a family in China hanged himself during the second week of our internship. We all knew he was struggling but had not known what to do. We were treading water ourselves.  The next morning, the residency program director brought our group of ten interns into a room and talked to us. "This is bad,” he said. “We care about you.  Here is the card for the psychologist. Call if you need help." I looked around the room at the other confused faces and honestly thought, what does he mean by “need help”?  I said to myself, Look Brett, screw your head on straight. You are on call and have a busy service. You need to get back to work.  

Two years later, my chief resident shot himself. I thought he had all the answers. He was a smart guy and had a desirable GI fellowship lined up. At the funeral, I went up to people I knew. Do you understand this? Can you explain this to me? Can you please tell me he had some label or diagnosis or something that I do not have? Chronic depression, alcohol abuse, or schizophrenia? Something? Anything?  How do I know I am not next in line?  There is always a line. On average, one physician commits suicide every day in America.  Every day!

But I was not next in line. Next in line was my friend Alex. He was considered by many to be the ideal internal medicine/pediatrics academic physician. I went to his wedding.  He met his wife when she was a fellow intern with me and Alex was our resident.  He had a family.  He even looked like me. How are they different than me? How close was I to where they were?

Look Brett, I said to myself. Screw your head on right.  You have a lot of … wait … it is not working.  You cannot figure it out. Who's next in line?

Then, one of my best friends and close partners left our organization. I had difficulty understanding why he left and felt the effects even more acutely when I had to absorb a number of his patients. This was the height of the opiate epidemic and some of the patients were very difficult. I did not know how to manage them well. In addition, I had an unmotivated, depressed medical assistant working with me and I did not know how to communicate with her. The triage nurse in our small clinic was not motivated to do her job. I was not comfortable with conflict, so I avoided her and did extra triage work. The clinic manager was too scared to confront the problems. The administration was well-meaning but not helpful. 

I felt like I was playing a new game and I did not know how to play it well.  I did not even know how to tell if I was successful.  Press Ganey surveys did not do it for me. About this time, Epic came online, and I struggled with efficiency. My wife had chronic debilitating migraines and we had three teenagers at home with no family support. I had extended family challenges. I was cut off from my emotions and I unknowingly built walls to contain them, not knowing I was cutting off my good emotions as well. 

A turning point and finding help

In 2014, my survival skills were not serving me. Life was closing in. I was tired, frustrated, angry, irritable, confused, fearful, and more. I took care of depressed patients and I prescribed SSRIs for them.  Would an SSRI help me?  I did not even have a doctor. Maybe counseling would help, but I did not know where to turn.  I did not have the time. 

I was too scared. During one particularly rough patch, I asked myself if I was suicidal. 

One night, I was sitting at home and finishing Epic charts. My wife handed me a card that said, "I think you need some help." I looked at the card that suggested I contact Dike Drummond, MD from the burnout prevention program,  www.TheHappyMD.com 

I said to her, “Don’t worry.  I just need more time. I can figure this out on my own. I just need to work harder.” 

My wife had heard me say this before. She was losing patience and my words were not as convincing to me as they had been before.

I asked myself, “Am I depressed?” 

I called Dike and set up a discovery session. This is a free one-hour “get to know you” session with the burnout counselor. At that point, I still did not trust him or anyone else. More than once, I almost cancelled the call. I thought, he does not know me. I am a very private, introverted person with my special problems.  

The next week, I completed the call and was shocked to discover within twenty minutes that he could see right through my walls and defenses. He saw the scared kid behind the walls. He saw and knew my patterns of behavior and thought. He knew where that place was, because he had been there. I broke down and agreed to work with him.

Dike explained that many of my patterns of behavior and emotion were not unique to me. There are patterns that are unique to physicians and emerge from our training.  Many of these are survival adaptations. This stunned me and was so reassuring. He told me I was not broken. There were patterns I could learn about and then modify.

Here are some of the typical patterns and misconceptions that Dr. Drummond described that physicians adopt that lead to burnout:

• If I just work harder, things will work out.  
• I am a smart guy/girl, so I will figure it out.
• I need to do it all by myself.
• I do not want to deal with this difficult patient, nurse, etc.
• Compassion is important for other people but not for me.
• My emotions are not safe.  I need to protect myself.
• I feel like an impostor.

My work with Dike centered around twice-a-month one-hour coaching calls where we worked on emotional and skill development. We started every call with five minutes of gratitude and appreciation. What would I like to congratulate myself for?  What did I do right?  This was actually hard for me because I was more in the habit of beating myself up for what I had done wrong. I could easily list all the negatives, but I had trouble seeing the positives. After that, we would complete the work for the day. Some of the emotional work involved processing difficult emotions like shame, fear, anger.  I realized I had a lot of shame. For example, we discussed:

• How to gain better access to my emotions and feelings.  
• How to trust myself and others.  
• How to have more self-compassion and more compassion for others.  
• How to absorb positive feedback and not deflect it away.  
• How to have a soft front and a strong back.

The area of skill development was wide-ranging. Communication skills were huge. I realized if I could be a better communicator, I could save a lot of time and prevent a lot of negative emotions. As I became better, I noticed how ninety-minute disagreements could turn into fifteen minutes. Three meetings could be one if I was more effective. Three-day arguments could be resolved in thirty minutes with deep listening and full presence.  

We did in-depth personality testing and self-awareness, and I learned how to more effectively interact with different personality types. I learned how to deal with difficult people like the nurses and patients. We did role-play and scripting.  

I realized that as I took more responsibility for the interactions, I developed new skills and the nurses changed their behaviors. In the past, I had believed that my role was to give the right answers, but I learned it was more important to develop the art of asking the right questions. I discovered how to run an effective meeting. What is the goal?  How do we know if we achieved the goal?  Can we stop after thirty minutes and consider it a success if we reached our goal?  I mastered Epic documentation techniques, created succinct, appropriate notes, learned stress management breathing techniques, mastered time management/batching approaches, practiced delegation, adopted marriage skills, enhanced my communications, and made firm dates on the calendar. I had been transformed.

Emerging from the other side

Coaching has changed me.  When physicians are at their best everyone wins.  As physicians, we need to trust, ask for help, and be supported along the way.  We need good leadership that makes coaching easily accessible, affordable, and encouraged.  We could spend one-tenth the amount it takes to replace one physician and invest it in the few hundred we already have. 

It is critical to understand that coaching programs are not just for impaired or problem physicians. These approaches are for growth minded, striving physicians who want to improve their lives and the lives around them. Highly achieving people in many fields have coaches.  Every sports superstar has a coach.  Most high-level business leaders have coaches.  Every coach I know has a coach of their own.  And the people at the top   the ones who train the other coaches - have networks of support and growth systems around the country.

It starts with each of us

Here is what you can do.  It all starts with you.  Take care of yourself and trust that others may be able to help you. Realize that you may not have all the answers to your life.  Reach out to others for connection and for mutual support.  Consider coaching for yourselves.   

Brett Linzer, MD is board certified in both internal medicine and pediatrics. He has been in practice with ProHealth Care for over twenty years. He has been a part of the Medical College for 18 years as a preceptor and mentor to 4th year students in his ambulatory clinic in Oconomowoc. He is the recipient of the Marvin Wagner preceptor award, ACP Wisconsin Community Physician and mentor award and the Milwaukee Academy of Medicine award for excellence in teaching. He can be reached at balinzer@phci.org 

Some Questions for … Matthew Hunsaker, MD - Dean, MCW- Green Bay Campus

From the 2/19/2021 newsletter

Some Questions for …

Matthew Hunsaker, MD - Dean, MCW- Green Bay Campus

Dr. Hunsaker, the inaugural Dean at MCW-Green Bay, talks about the regional campus and how its mission will improve the health of Wisconsin’s smaller towns and cities …

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

Dr. Hunsaker: It is atypical for a non-state university medical school to launch regional campuses. Although some might think of our community as small, Green Bay is the third-largest city in Wisconsin (population of 100,000) and has a total metropolitan population of 300,000. We have three health care systems, several institutions of higher learning, and sophisticated hospitals. And, of course, there is the Green Bay Packers football team and foundation that have been philanthropic supports of the school. That said, it does not take long to get from downtown to sparsely populated areas like Door County or Shawano.

As a regional campus, we have several unique opportunities to impact health care. 

First, we can recruit wonderful, talented students who have unique backgrounds. Many of our students are drawn from pools that “traditional” medical school admissions processes overlook. For example, some are non-traditional in the sense that they are the first of their families to enter medicine or even graduate from college. Many come from smaller towns and cities across Wisconsin. Many have graduated from smaller colleges and come from very modest backgrounds. 

Our focus and our approach to interviewing seek to identify those who have an affinity for primary care and psychiatry in non-urban settings. If a student at interview does not align well with those campus goals, we encourage them to consider our Milwaukee campus for other career paths that better align with their personal goals.

Once the admissions office has determined that an applicant has the aptitude to likely succeed in medical school, we rely on our Regional Applicant Advisory Committee (RAAC) to secondary screen and interview candidates and provide recommendations to the Admissions Committee. The RAAC members are trained by the admissions office in screening and interviewing. All are selected from the Green Bay community and represent a broad representation of Northeast Wisconsin. MCW-Green Bay is searching hard for their other qualities in addition to cognitive performance. We have people both the Admissions Committee and the Regional Applicant Advisory Committee screen each portfolio. The results of the local interview process are provided to the admissions committee who makes all the decisions about a candidate's status and extends offers to matriculate. Of the more than 2300 applications we received for Green Bay this year (including 275 Wisconsin) we are nearly finished interviewing eighty candidates from which to build the class. To flatten the inherent biases of one-on-one interviews, we have each applicant interview with a group of seven to ten people from the RAAC. This community-based interviewing approach provides us great feedback and a wonderful cohort of students. 

Next, we leverage our location and faculty to train outstanding physicians who will thrive in their careers, with a special emphasis on primary care and psychiatry in smaller communities across the state. We graduate students with the requisite skills for these practices who are equipped to focus on the central tenet of medicine, which is that a physician is merely a person who happens to have an advanced science degree helping another person improve or regain their health. Central to our program is the idea, nothing we teach should ever work to diminish the student’s ability to talk to another human being with empathy, compassion respect, and clarity. 

We want students to become part of the community. Each student participates in the Physician in the Community Scholarly Pathway. Students complete an IRB-approved Community Orientated Primary Care (COPC) research project while working with community-based organizations, to address local health problems. The student conceives the project, develops it with a local community organization, executes the project, and presents it to the community, their peers, and the local healthcare research forum. COPC requires them to participate in CITI research training, build research skills, community-based health care experience, interprofessional education exposure, and insights into health care challenges unique (and not so unique) to communities located away from academic medical center teaching environments. 

Many smaller communities and hospitals have huge problems with physician recruitment and retention, and a campus like ours can offer a pool of individuals already familiar with the region. Students who have rotated through, for example, Bellin or Prevea, might be drawn to work for these systems after they graduate. They can build connections even as they are in school or residency that lead to future career employment.

By observing their mentors, students recognize that working in smaller communities will allow them to practice closer to their full potential, functioning at the “top of their licensure and appropriate training,” that is, a family physician in a small town is more likely to deliver babies, perform GI endoscopies, and do minor procedures than one who works in the shadow of an urban institution with multiple subspecialists. They experience the satisfaction of providing services that would not otherwise be available in their zip code. 

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

Dr. Hunsaker: Smaller hospitals and their health care systems face many of the same problems faced by their urban counterparts but have fewer resources, less flexibility, and greater risks as they attempt to meet the mandates and challenges. For example, the implementation of computerized medical records, enormous data and reporting systems, and the costs of health care delivery have had disproportionate effects on smaller hospitals. They simply cannot scale up as easily and the larger systems in many cases. As mergers and acquisitions are predicted to continue, smaller systems will likely continue to consolidate; towns like Green Bay which currently has three, might soon have fewer systems at some point in the future and if predictions are correct, alignment with other system-level resources. As physicians, we have seen the intrusion of “business activities” and documentation requirements at the bedside and we need to protect and champion the importance of meaningful interactions that preserve patient respect, dignity, and quality of care. Not long ago, I heard from a community member that they were disturbed that scheduling the visit on the phone took longer than the time spent with their physician. Who we train and how we train them will prevent “transaction” from overtaking the sanctity of meaningful doctor-patient interactions.

That said, all hospitals are facing increased mandated requirements and decreased margins. Rural hospitals will likely continue to adapt, and larger systems should identify the mutual engagements that encourage a healthy state. MCW-Green Bay’s efforts to recruit, train and support a workforce with appropriate primary care specialty distribution and geographic distribution are key to a sustainable future. 

Here is an analogy: 

We, as a society, have made the decision that every community, regardless of size or income, deserves clean water. If the water is bad or tainted, we will not tolerate it. Think of Flint, Michigan. 

We have similar beliefs surrounding public health. Generations ago, we decided that sanitation and clean water were basic rights. Over the past fifty years, we have added vaccination as being critical for human health. Over the past twenty years, we added health care screenings, as well. We began pivoting from disease treatment alone to screening and early detection. We are accustomed to believing that basic interventions like these decrease every person’s morbidity and improve everyone’s wellbeing. 

So, how do we extend this analogy of basic health care services to our rural areas? What types of interventions and sacrifices should we, as a medical school, contribute to ensure care reaches all of Wisconsin’s citizens? How do we assure equity to access and treatment despite where a person lives? How do we deliver services that are not easily scalable? Rural and Urban disparities are often similar in terms of workforce and accessible services.

These are huge challenges for our smaller towns and cities. It is a consideration for each of us to contemplate and participate in developing solutions.

TT: As a Dean, what have you discovered?

Dr. Hunsaker: Since our class sizes are smaller, I can schedule meetings with each of the medical students individually for half an hour each year and twice in their final year, all in addition to their career counseling, mentorship, and future planning provided elsewhere. As I meet with them, I realize we can measure their knowledge, but that we have a much more difficult time measuring and influencing character growth and the non-cognitive aspects of who they are becoming, yet these are critical to their success and happiness as physicians. The development of character and robust mentoring are key factors to success in and beyond medical school. 

TT: Any other advice?

Dr. Hunsaker: I have enjoyed my journey from working as a family physician in a small town in downstate Illinois to my decade at the University of Illinois College of Medicine at Rockford to now my work as Dean at MCW-Green Bay.

 I believe that our task as a physician is straightforward. It is to help people live longer, or feel better. If our advice and care fall outside of those goals, we need to contemplate what forces in medicine or society are driving our decision-making.

I believe that good doctors are the most aware of their biases, judgment, and care outcomes. Less successful doctors, on the other hand, wait for others to criticize or react to concerns from others. Pay attention to where the criticism comes from. As medical educators, we must incorporate this in our educational models so that the future peer is knowledgeable, successful, and one with whom their patients, and we as colleagues enjoy working.

Matthew L. Hunsaker MD, is the founding dean for MCW-Green Bay. Dr. Hunsaker provides overall leadership and management of MCW’s regional campus.

Interview by Bruce H. Campbell, MD

Loving Each Other Through the Darkness

From the 12/11/2020 newsletter

Perspective

 

 

“Loving Each Other Through the Darkness”

 

 

Alicia Pilarski, DO & Cassie Ferguson, MD

 

 

“My patient was talking with me a few minutes ago and then he just coded…we tried everything we could. Breaking the news to his family over the phone was awful.”

 

“I just can’t unsee what happened to my patient. She was so badly abused and injured and I can’t imagine what she went through…”

 

“I made a mistake. I thought our patient was suffering from congestive heart failure, but it was sepsis. I never gave antibiotics and caused further damage from giving diuretics. I’m not sure how I can go back to work tomorrow.”

 

As physicians and learners, we see people suffer with protracted and difficult illnesses. We see lives instantly devastated by a new diagnosis or injury. We are asked to bear witness to the death of patients too sick to be surrounded by their own family. And then we kneel alone, face in our hands, before rising quickly to take care of the next patient. We are not taught or given the space to process these tragedies aloud.

Death, loss, and errors are inherent to the practice of medicine, yet a false sense of separation keeps us from reaching out to one another when their impact becomes too much to struggle with on our own. This sense of separation exists for many reasons, but is certainly driven by the isolating medical hierarchy, our unforgiving culture of blame and shame, and our own sense of exceptionalism; this erroneous belief that we are inherently different from one another, that we are the only one that has struggled in this way, that others have somehow handled it by themselves. Our current social situation exacerbates these issues, offering less opportunity to be physically present with our work family and making resources harder to recognize.

These obstacles to connection fuel our unwellness. They prevent us from seeing that our suffering is not exceptional; it is universal. We hope you know that we see you behind that mask and know that patient’s death made you think of your own mortality and wonder if someone in your family is next. We see you on that Zoom call stretching every ounce of your energy and patience in order to be a mom, a teacher, a researcher, a physician. And we see you sitting six feet away from us in the break room struggling with that last case that shook you to your core.

 

We see you. We are you.

 

We also know that connection is a remarkable force and have witnessed its power in our own lives. Talking openly about our struggles with one another reminds us of our humanity and wakes us up to the reality that we are not so different from one another. It is also a powerful force for healing; sharing our anxiety, grief, anger, and fear with someone who will listen empathically strips these emotions of the shame and paralysis that are often attached. And in turn, your story of how you overcame what you experienced can become “someone else’s survival guide.” (Brené Brown).

We encourage you to ask how you might tap into and add to the incredible power of our community and draw on the collective compassion of your colleagues. We want to be your first line of defense when what you’ve seen saturates your coping mechanisms. We want to be there for you like someone was there for us.

Dr. Rana Awdish phrased it most beautifully in her book, In Shock:

 

“How we care for each other during life is the true restoration—the definition of agency…Our ability to be present with each other through our suffering is what we are meant to do. It is what feeds us when the darkness inevitably looms. We cannot avoid the darkness, just as we cannot evade suffering. Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.”

 

Resources for providers, trainees, learners, and staff:

 

·   Our institution has several resources and opportunities to reach out for support, both for peer support and more advanced support.

 

• For a list of the current Froedtert & MCW Supporting our Staff (SOS) Peer Support team, please visit our website: https://infoscope.mcw.edu/MCP-Medical-College-Physicians/Practice-Initiatives/Peer-Support-Program.htm
• If you need immediate support, please page the SOS Team (414-314-1763) or email Dr. Alicia Pilarski (apilarski@mcw.edu) or Dr. Timothy Klatt (tklatt@mcw.edu).

 

 

Alicia Pilarski, DO is a Associate Professor in the Department of Emergency Medicine at MCW. She serves as the Graduate Medical Education Patient Safety and Quality Officer. She is the Associate Chief Medical Officer at Froedtert Hospital. She is actively involved in Wellness in the Kern Institute, MCWAH, MCW, and the hospitals.

 

Cassie Ferguson, MD is an Associate Professor of Pediatrics (Emergency Medicine) at MCW. She leads the MCW M1 and M2 REACH curriculum focused on promoting wellness. She is the director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

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Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

 From the 10/30/2020 newsletter

Student perspective

 

 Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

  

Morgan Lockhart, MCW-Milwaukee medical student

 

 Ms. Lockhart shares what she has discovered about research gaps, cultural microaggressions, and her vision as a medical student and descendent of the Cherokee Nation …

 

 Boozhoo MCW,

 A novel coronavirus swept the nation and, along with it, many standard summer research opportunities. As a member of the lowest socioeconomic status, unemployment was not an option for me. Since research is one of the forefront pillars of MCW, I decided to pursue research in a field of interest and passion: exploration of my Native American heritage and culture, as I had never had the opportunity to immerse myself previously. After weeks of networking, I found the Great Lakes Native American Research Center of Health (GLNARCH) and was accepted into a research internship created and funded by the Great Lakes Inter-Tribal Council (Glitc). I was the first school of medicine applicant, and I could not be more honored and elated.

 Throughout my life, procuring health insurance, let alone quality insurance, has been an ongoing struggle: I have always been enrolled in public low-income state insurance or been uninsured. This influenced my decision to develop a research project studying health care coverage rates among Native Americans. Based on interest and compatibility, I was partnered with a mentor, Margaret Noodin, MFA PhD, a member of the Ojibwe Tribe and Professor of English and American Indian Studies at the University of Wisconsin-Milwaukee. Due to SARS-CoV-2 disproportionately affecting residents on the reservations, my project needed to be based virtually. My research objectives evolved into a literature review to identify specific barriers that prevent access to and utilization of healthcare coverage and policies among Native Americans.

 In addition to mentoring my research, Dr. Noodin had several other students working on GLNARCH projects. We all convened weekly through virtual meetings. I had the opportunity to network and develop professionally and culturally with my peers. These relationships continue to prosper and we rely on one another, which I found paradoxical because of the importance our society places on egocentrism. The sense of community and proudness of one another goes beyond the individual; it is ethnorelativism, indicative of indigenous culture.

 From Kindergarten to M2 year, I have been one of few, if not the only, Native American in my entire education system. Microaggressions borne out of envy and ignorance have referred to me as a “Native token” or under the baseless accusation that my tuition is financed from “Native American-owned casino profits.” For the first time, I was surrounded by individuals that shared not only my heritage, but unnervingly similar life experiences. For the first time, I was a puzzle piece that was congruent with the edges of those around me.

 After reviewing the literature, I was disheartened to realize how few empirical research studies identified by the NIH National Library of Medicine have focused on the health of indigenous populations in the US. The few articles that have specifically studied indigenous people often amalgamate all tribes into one, despite each being a separate, sovereign nation. It is patronizing and disrespectful to assume the needs of one tribal organization are comparable with another; that is tantamount to claiming the needs of the United States are identical to that of a foreign country.

 Every barrier had a common denominator: profound mistrust that continues to be perpetuated by non-tribal members since 1492. Without a doubt, the most indisputable finding was not the lack of health care coverage illiteracy among Native Americans, but among non-tribal health care providers. The fault of incomprehension always appears to be placed on minorities, but the cultural ignorance should be shared by the majority. To exacerbate the burden imposed by the cultural gap, tribal members often feel invisible and unrecognized by non-tribal health care systems and often do not seek care outside of Indian Health Services and Urban Health Programs.

 Prior to starting medical school, I was optimistic that a culture of inclusivity and diversity would be at the forefront of medicine, but I find that it is still wading in the shallow waters of preliminary stages. As a second-year medical student, I, too, feel invisible and unrecognized; without representation in clinical vignettes, campus organizations, and the racial demographic of all four years of cohorts on all three campuses. In 2019, the AAMC reported that 0.3% of all actively practicing physicians identified as indigenous. According to the MCW Education 2018 – 2019 Report, 0.14% of students enrolled in any program at MCW were American Indian or Alaskan Native. Without indigenous or culturally competent non-tribal health care providers available, we cannot improve the poor health care encounters and outcomes experienced by indigenous people, including myself.

 

 Recently, I had the opportunity to present my findings to the GLNARCH council. My hope is to develop a study that determines the baseline knowledge of non-tribal healthcare providers on Native health care and policy. I aspire to collaborate with tribal leaders, healers, and members to most efficiently educate non-tribal members on the complexity of Native American health care and policy. My priority is to ensure the product of our efforts focuses on the gains that can be provided to tribal nations with education of non-tribal healthcare providers as an added benefit.

 I am now an advocate for the indigenous people, my people, but we are responsible and accountable for actively learning about the culture and needs of all our patients, and it is high time we direct our attention toward the needs of Native Americans. As an initial step, I challenge you to translate the Ojibwe greetings within this text and learn the names of the sovereign nations that reside within Wisconsin.

 Miigwech

 

 Morgan Lockhart is a medical student in the class of 2023 at MCW-Milwaukee.

The Failure Effect: Why we should share our "failure stories" in medical education

Director’s Corner
 
 
The Failure Effect: Why We Should Share our "Failure Stories" in Medical Education
 
 
By Olivia Davies and Adina Kalet, MD MPH 
 
 

For this week’s Directors Corner Dr. Kalet invited Olivia Davies (MCW-Milwaukee Class of 2021) to co-write this piece on the critical importance of failure to learning and introduce The MCW Kern Fail Forward Initiative …
 

As you read this, I (Olivia) am sitting in a testing center taking my USMLE Step 2 board exam – one of the many hoops through which students are asked to jump gracefully. But the truth is, we don’t always make it through the hoops first time, sometimes not even the second. It feels like a long time has passed since I received the score from my first MCAT exam (a 27 by the old metric), and yet it’s also so personally recent. That application year, I was not accepted to medical school. In fact, it would be another three years before I received a solitary acceptance at the Medical College. I tell you this because I was certain I was the only person who ever had to retake the MCAT or who ever had to reapply to medical school, when the truth is, I’m not. 

 
In medical school, success is expected. Medical students, when they struggle — as all do at some point — experience failure in isolation. Classmates seemingly face no setbacks; struggles are stifled, shameful even. 
 
Educational theorists emphasize the importance of working in groups to enhance learning, yet medical students who “fail” often struggle alone. This façade perpetuated and upheld by our culture of perfectionism creates a deafening silence for those who trip and stumble. 
 
This culture of silence is not only harmful, but it fails to celebrate the many failures that shape our individual stories. Perhaps more importantly, it diminishes the potential flourishing that occurs when individuals who have faced failure nurture those acutely experiencing it.  
 
Melanie Stefan, PhD, a lecturer at Edinburgh Medical School, recently called on all academics to publish their own “failure résumés,” listing programs they didn’t get into, missed opportunities, critical feedback, and other rejections.¹ This idea has taken hold and captured the imagination of many faculty in medical schools and other highly competitive and academic fields. 
 
This past May, the MCW graduating class of 2020 was surveyed for “failure stories” with the promise that these stories would be their legacy for years to come. The goal of this project was to create a platform where current students could visit to not only view the number of students before them who faced similar failures, but read their predecessor’s stories of failure and, in them, find a sense of solidarity, optimism, resilience, and growth. Indeed, the pathway to success in healthcare is paved with failure, and the creation of a culture the lifts individuals up in both failure and success is essential in the fight for resilience and against burnout. 
 
 

My own (Adina) failure resume includes; the year I submitted sixteen grants and received three small ones that all added together did not allow me to continue the work I have poured myself into for years; the papers rejected multiple times, with harsh, often personal critiques; and the numerous leadership positions I sought unsuccessfully. And those are just the professional failures. My husband has shared his “failure resume” with his fellow leaders in a large department in a medical school and routinely shares it with his trainees. We are both tenured professors of medicine - successful professionals, by all accounts. We have both learned that sharing our failures – especially with junior colleagues – is a great way to identify, analyze, and articulate how to fail productively and strengthen those skills. 

 
Failure is critical to learning. But this is true only if the individual who fails doesn’t give up or walk away from continued effort. Of course, all failure necessitates a recovery period, a time to lick one’s wounds, but soon, too, comes the re-envisioning. Deliberate struggle, working until you fail, analyzing and learning from the failure and trying again is at the core of deep learning. 
 
Although the concept has yet to be widely embraced, allowing or even encouraging failure should be an important role for medical school faculty.² Psychologist Anders Ericsson, describes the importance of planful and deliberate practice to the acquisition and maintenance of expertise. There are now many streams of thought about concepts such as “productive failure” or “desirable difficulty” that all lead to one conclusion: failure is transformative. 
 
Here’s why. Becoming a physician, like other optimal performance fields (e.g., competitive athletics, world class chess) requires grappling at the “learning edge.” The idea of a “Zone of Proximal Development” — a term introduced by psychologist Lev Vygotsky in the early 1930’s — identifies that an educator’s roles include the creation of an environment in which learners identify the absolute edge of their knowledge or skills and then the provision of scaffolding and coaching toward aspirational learning. As the student explores the limits of their skills and understanding, failure is inevitable. 
 
Therefore, failure is critical to becoming a great physician. And yet our students are often left to fail alone, to feel shame and a sense of being an imposter. While these feelings may be part of what motivates us to work harder, overcome adversity, persist with what Angela Duckworth has called “grit,” these feelings are also likely part of what contributes to unhealthy stress, a sense of depersonalization-a component of work related “burnout”. 
 
So, what can we do to maximize the growth-promoting value of failure? We can talk about it. We can create respectful and thoughtful ways to routinely share failures. We can recognize and cultivate the strength of character it takes to “fail well.”
 
In his lovely essay³, Benjamin R. Doolittle, MD, MDiv uses lessons from JK Rowling, Oprah Winfrey, and the movie, The Best Exotic Marigold Hotel, to muse on why, in medicine, we do not “fail well.” We often hide mistakes, errors, and failures despite the growing realization that failure is important to developing true expertise. When we fail, we do not truly believe that we are worthy of redemption. “Accepting our faults requires courage and moral strength.” 
 
 
Over 130 students from the MCW Class of 2020 shared their failures in an effort to breakdown walls for future classes – are you ready to share yours? Contact us if you are.
 
 
 
The Fail Forward Initiative is in the process of being finalized. Anonymous student stories and data aggregates will be accessible to those with MCW credentials. If you’re interested in submitting your own failure story to share privately to those with MCW credentials or publicly on the forward facing failure site, reach out to odavies@mcw.edu or akalet@mcw.edu.
 
 
 

1. Stefan M. A CV of failures. Nature. 2010;468(7322):467-467.
2. Klasen JM, Lingard LA. Allowing failure for educational purposes in postgraduate clinical training: A narrative review. Med Teach. 2019;41(11):1263-1269.
3. Doolittle BR. Failure in Residency Education: Lessons Learned From Harry Potter, Oprah Winfrey, and the Marigold Hotel. J Grad Med Educ. 2019;11(2):233-234.

 
 
Adina Kalet, MD MPH is the Director of the Robert D. and Patrica 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
 
Olivia Davies is a fourth-year medical student at MCW-Milwaukee who is in the midst of applying for her dermatology residency. She is an associate editor of the Transformational Times. Follow her at @oliviamtdavies.
 
 

The Congruence in My Quest

From the 10/9/2020 newsletter

Perspective/Opinion

The Congruence in My Quest

By Sherréa Jones, PhD – MCW Milwaukee Medical Student

What made you decide to actively pursue your career?

Traditionally, when this question is posed to the majority of people, their response involves seeing someone congruent to themselves in the profession they are seeking. For many Black individuals in this country, our answer to this question is, overwhelmingly, because we do not.

I grew up in the inner city of Milwaukee, WI. I graduated from a severely underperforming school system and I found myself, as a child, pregnant with my very own child. I was raised by a single Black woman in a family where I was surrounded by other single Black women, none of whom were in a career that aligned to the professional aspirations I was captivated by on Thursday night
television. Sure, every child wants to be a superhero growing up, and eventually those dreams become more realistic. In contrast to some other children, these fictional characters served as my only visual source of hope for a career in medicine.

During my first semester at UW-Madison, I found myself engulfed in feeling ridiculous for wanting to be a physician. Here I was, at a nationally recognized research institution, with 40,000 other students of which only 2% were Black. Five years later, I matriculated as the only Black student within the entire Department of Biological Sciences at Marquette University. I remained the only Black student for the duration of my tenure as a PhD candidate. As you might imagine, my scholastic unpreparedness resulted in grave academic struggles. I felt intimidated, shamed, defeated, embarrassed, and increasingly believed myself inferior in intellect compared to my white peers.  

When I was granted the opportunity to join the class of 2024 at the Medical College of Wisconsin, I decided I was going to own this experience. I made the conscious decision to be transparent about my personal and academic struggles, my feelings of ineptness and, most importantly, my intentionality about using my voice as a vehicle to speak for the disenfranchised. Moreover, I desired to utilize the uniqueness of my physical presence to be there for those seeking racial, socioeconomic and/or gender congruence in their aspirations. Being in the racially distinct faction, as a student, was no longer shocking to me, it was the anticipated norm. What I did find resounding was the glaring lack of visible support for Black students at one of the largest teaching hospitals in the state of Wisconsin. A campus with an ever-expanding and commanding presence directly adjacent to the city of Milwaukee, which is nationally referenced as one of the most segregated cities in the United States, and consistently leads the nation in having the largest race-based disparities in health, wealth, and incarceration rates. 

During my first year of medical school, I was introduced to a parade of PhDs and MDs who were facilitating my education, yet only one of them (Dr. Erica Arrington) looked like me. Prior to starting school, I read about well-established mentorship programs in place at numerous institutions that are targeted to help Black students thrive. There was, however, nothing in place here at MCW. Although I did not see a tangible support network for Black students at MCW - except for a small number of individuals (Dr. Jennifer McIntosh, Jean Mallett, Dr. Cassie Ferguson, Dr. Michael Levas, Dr. Greer Jordan, Dr. Marty Muntz and Dr. Malika Siker), I refused to believe there was no interest in its erection. Similarly, I refused to believe that, a hospital that cares for a largely impoverished and disadvantaged population, where many of its children were born, was a hospital that did not care to support the success of its future Black physicians in training. Furthermore, I refused to believe that, an institution that welcomes over 200 students each year (albeit only 4% are Black) did not have a proactive committee to offer resources and refuge to students who found themselves on academic probation - the frightening place I was in at the conclusion of my first semester at UW-Madison. I refused to believe that absolutely no one, within administration, faculty, or staff had a genuine concern about the mental health and well-being of Black students.

Despite the daunting data and the countless conversations with my Black student colleagues surrounding feelings of isolation, frustration, and powerlessness, I am glad I held on to my skepticism. Through our activism and advocacy, we have been introduced to a village of physicians, administrators, staff, and non-Black students who have tremendous concerns about the deficiency of a culture that ensures the support and success of Black students. Through my student leadership roles, I have discovered a team of individuals that have launched a collective effort on shifting the paradigm at MCW built around anti-racist directives. There is a community at MCW that works tirelessly, while facing insurmountable organizational hurdles, against the structural inequalities that are systemically designed to perpetuate the failure of Black students that choose to enroll at MCW based on the advertised supportive nature of the program.

In discovering this assemblage, I have begun a personal quest to bring awareness to this community. Although this quest feels strikingly reminiscent of the imaginary characters I held on to in an effort to catapult me to a realistic place of actively pursuing my dreams, I unequivocally embrace the intangible ideal that, one day, the members of this community will be unapologetically and unashamedly empowered to speak up for Black students, visibly support Black students, and enforce palpable change for the betterment of the Black student experience at MCW. 

It took over 400 years to structure the system that anticipates my failure. I am well aware that I cannot unravel it in four.

Sherrea Jones, Ph.D. is an M.D. Candidate in the MCW-Milwaukee Class of 2024. She serves as a liaison to the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Student and Resident Behavioral Health at MCW: A Personal Perspective

From the 9/4/2020 newsletter

Perspective 

 
Student and Resident Behavioral Health at MCW:  A Personal Perspective
 

David Cipriano, PhD – Director of Student and Resident Behavioral Health
 

Dr. Cipriano describes the challenges and rewards of running the Student and Resident Behavioral Health program at MCW. Sign up here to hear him describe the state of our program at an upcoming Kern Connection Café …
 

I became Director of Student and Resident Behavioral Health about four years ago and I’ve always had a knack for being in the right place at the right time.  At that time, the institution as a whole was really beginning to sit up and take notice of learner mental health and well-being in a comprehensive way.  Now, MCW has always taken care of its students and residents with mental health services and available wellness activities.  But, four years ago, MCW tackled the issues in a really planful and big picture way – looking at curriculum, community, and culture.  Since then, I have been riding a wave of enthusiasm and support for this mission – the mission to increase protective factors for our learners – such as access to care and a supportive community – and to decrease risk factors such as stigma and shame and isolation.  I’ve never had a job where I had so many people coming to offer ideas, suggestions, and resources.  

 
 
Results of the 2017 survey
 
Being a data guy, I wanted to “take the pulse” of our students’ behavioral health (if you haven’t been able to tell already, I am using “mental health” and “behavioral health” interchangeably).  In 2017, we conducted our first Mental Health Climate Survey of our medical students (shame on me for not including our graduate students at the time – and I’m a product of graduate school!).  We found high levels of depressive symptoms among our students (higher than the general population, but actually a little lower than estimates of medical students nationally).  We also found a certain number of our students dealing with suicidal thoughts daily or weekly; not out of line with general prevalence numbers, but still frightening.  Almost 20% of our respondents said that they didn’t know if they had a mental health diagnosis, telling me that I needed to work on mental health literacy with this group.  Finally, it turned out that despite high visibility of our services, a large proportion of students who said they needed help did not seek it.  Barriers to getting help included time, cost, and fear of stigma or – worse – negative implications for licensure.  
 
 
What we did next
 
Since then, we’ve worked hard to break down stigma by having faculty and students share stories of their own struggles.  We’ve tried to address the time issue by setting up special student clinics on Thursday afternoons when they have the most flexibility and a resident clinic on Tuesday evenings.  We’re giving students and residents more opportunities to self-assess, trying to increase that self-awareness and literacy piece.  A new online, self-help, cognitive behavioral therapy program called SilverCloud was brought onboard last year – talk about accessibility – it’s available 24/7!  We re-booted our website (www.mcw.edu/thrive) and rolled out support groups that are drop-in and usually include lunch (when we’re all back together!).  And, new this year we have added a student assistance program with a range of services, including an expanded network of providers (of course our learners can still choose our own MCW providers).  And, perhaps most importantly, the school expanded the benefit for students to ten no-cost sessions per academic year.  
 
Personally, I have never felt so energized and rewarded by a position.  Our learners are an at-risk population.  Healthcare trainees, including those in pharmacy, health sciences, and medicine, have higher levels of depression, anxiety and burnout than their age- and education-matched peers.  With an already stressed healthcare workforce, it benefits us all to see that we turn out the next generation of healthcare workers and scientists primed to be resilient and healthy.  
 
We re-did the Mental Health Climate Survey in early 2020 (actually before COVID-19 struck) and I’ll be sharing the results of that at the upcoming Kern Connection Café on September 17^th.  We’ve seen some improvements and some stubborn findings that simply tell us that we have to keep working at it.  I hope you’ll join us to share in the discussion.
 
 
David J. Cipriano, Ph.D. is an Associate Professor in the MCW Department of  Psychiatry and Behavioral Health and Director of Student and Resident Behavioral Health. He is a member of the Community Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

First-Year Medical Students React to COVID-19: Feeling Isolated, Seeking Knowledge, and Becoming Empowered

From the 6/26/2020 newsletter

Fourteen Medical Student Voices

First-Year Medical Students React to COVID-19: Feeling Isolated, Seeking Knowledge, and Becoming Empowered

 

 

Despite being isolated because of the pandemic, first year medical students came together virtually to hear basic science and clinical information about SARS-CoV-2 and most created written reflections on the session and their pandemic experiences. Here is a summary of the session and excerpts from fourteen of their essays…

 

  

Medical students, like most people in healthcare, are bombarded with questions about the novel coronavirus. Families, friends, Facebook acquaintances all want to know what to do. A group of MCW educators filled in the gaps.

 

On May 15, 2020 – while students were banned from attending in-person classes and ten days before George Floyd was killed in Minneapolis – medical students from all three MCW campuses joined together virtually to hear presentations on the current state of knowledge about SARS-CoV-2. The session was designed by Mark McNally, PhD (Associate Professor of Microbiology & Immunology), Sandra Pfister, PhD (Professor of Pharmacology & Toxicology), and Kern Institute faculty and staff to be interactive, innovative, interesting, and relevant. The session included clinical and basic science presentations.

 

·         Jayshil Patel, MD (Associate Professor of Medicine – Pulmonary, Critical Care and Sleep Medicine) presented the clinical case of a “super-tired” 28-year-old healthy man who came to the hospital with breathing problems. Dr. Patel told the students about his physical examination, describing and demonstrating his bronchial breath sounds and labored breathing. He reviewed the laboratory studies showing evidence of infection and inflammation. He then went step-by-step through the thought processes needed to make a diagnosis.

 

·         Vera Tarakanova, PhD (Associate Professor of Microbiology & Immunology) debunked several popular myths about the coronavirus. Although much remains to be discovered, this particular virus does not seem to mutate, immunity is protective, and it remains transmissible for a long time.

 

·         Sandra Pfister, PhD (Professor of Pharmacology & Toxicology) reviewed the process of drug discovery, noting that it takes years to get effective new drugs to market. Society benefits when treatments are shown to be safe and effective before they are widely prescribed, and even off-label use of established drugs carries risk.

 

·         Dr Patel then returned to tell the rest of the patient’s story. The man, despite being young and previously healthy, worsened and, despite aggressive treatment, died on the fifth day in the hospital. Dr. Patel talked about the effect his death had on the hospital staff. He lamented how the need to keep the patient isolated affected both his family and the caregivers. Every death – especially in this situation – carries collateral damage and leads to moral distress. Dr. Patel also talked about how, as the virus has become more common, physicians can suffer from tunnel vision, thinking that every patient has COVID-19, even when they might not. Dr. Patel finished by telling the students that there have been some triumphs, as well. There is a camaraderie amongst staff. There have been some engineering innovations and the process of repetitive care has sharpened physical exam skill sets. Humanity shows through in the process of caring.

 

 

Students were given the opportunity to obtain one extra-credit point by writing a reflection on the presentation and how the pandemic has impacted their lives. Of the approximately 250 students who were assigned to watch the presentation, 174 took advantage of the opportunity. Several faculty members volunteered to review the essays and were moved by what they read. Those faculty members each recommended essays for this article.

 

 

Below are brief excerpts from several of the submitted essays that reflect the first-year medical students’ concerns, challenges, and dreams. Each author has given permission to share their excerpt and their name.

 

 

 

British Fields – MCW-Milwaukee

 

I am really happy that this lecture was delivered. I have to admit that I [had been] pretty disappointed [that we] are in the middle of a pandemic … being covered [with] no live lectures, so I was very happy that [MCW] did not miss this wonderful opportunity to deliver something different. Speaking from the heart, I was sad that the disparity that we’re seeing in Milwaukee among the African American patients was not even mentioned during the talk prior to me asking [about it in the Q&A session]. I know that there was a lot to include during the hour, but I was hoping that the patient population that is constantly being overlooked would be discussed in some way.

 

I know a lot of people that have either had COVID and have thankfully recovered, but I also know many that have had to bury a loved one that died from COVID. [O]ne of my mentees’ mom is a nurse that contracted the virus and ended up on a ventilator. Thankfully, she is recovering, but I say that to say healthcare workers are risking it all for us. However, the triumph in togetherness does come with a tragedy. I have seen many ignorant people banning together to break laws openly and they are handed a mask by authorities. However, when a Black man takes a jog, he’s murdered, and his murderers were freely walking after the incident. … Or the countless videos of Black gatherings being physically forced to break up by officers. COVID has brought on a sense of togetherness, but it’s also allowed the nasty principles that this country was built on to flourish and has put more fear in my heart about people more than the bug causing this virus.

 

 

 

Megan Quamme – MCW-Milwaukee  

 

This virus has taken a huge toll on me in a very personal way. My roommate, K, went on a trip … in March, right when all of the restrictions were JUST beginning. She just turned 26 and has not had any significant medial history. It was the first weekend of our spring break. [I was still out of town when] K returned. The next day she felt sick and was told to get tested by her workplace. The following day, March 15th, we heard the news that she was positive for SARS-CoV-2. At the time, I thought that she would be in quarantine for two weeks and then I would be able to go home, on April 1st.

 

The following week, K went to the hospital for shortness of breath. A few days later, she had to call 911 on herself to be taken to the ER. Her saturation was 80% when she arrived at the ER. She was given oxygen and some asthma treatments and was sent home with an albuterol inhaler. She said she could barely walk 10 feet down the hall to use the restroom for a few weeks. She went to her PCP 3 times for follow-up chest x-rays after her symptoms would not go away. She was treated for bacterial pneumonia. On April 20th, she finally had her first fever-free day. On May 4th, she officially tested negative for SARS-CoV-2. What started as a week-long [spring break] trip turned into a 7 week quarantine. My roommate was alone. If her situation had gotten worse, she could have ended up on a ventilator or even died, alone in the hospital.

 

I dealt with a lot of guilt during that time, and still am. I wonder if I am the one who gave it to her and just didn’t have any symptoms? I wonder if there was more I could do to support her? I wonder at how I was so lucky to avoid getting infected, and being ill at the same time as her. I wonder how her health will be affected for the rest of her life. Her PCP told her she will likely always have exercise-induced asthma.

 

… I feel that I have a responsibility to tell my story, but it often falls on deaf ears. The only people who want to hear it are those who listen. I find myself in a struggle between trying to be a leader of my community and to be outspoken about evidence and my story and protecting my own mental health and well-being.

 

 

 

Benjamin Hodapp – MCW-Green Bay  

 

The greatest personal challenge I have felt during this pandemic has been the lack of agency in being able to affect positive change for those at risk. I chose to enter medicine for this specific reason. As students, my colleagues and I are in the unique situation of being in a helping profession with little-to-no agency when it comes to serving the public in any tangible way. I have done my best to define ways I can assist those less fortunate, but it feels woefully inadequate. Now that we approach entering the clinic on June 1st, I am concerned for the safety of my ‘soon-to-be’ patients. Will I be the one who possibly transmits the virus to them? The strain of the dichotomy to be involved in the health care response while protecting my patients (after all, I am only a student with little to offer) has been a challenge as we approach the clinic commencement.

 

The main take-away from the three lecturers was simply: while we know a great deal about this virus and its components, we know very little about treatment, disease progression, and how it will proceed in the coming months. Caution is our number one friend in this time of crisis and it was heartwarming to hear rational, incredibly well-educated people that I sincerely respect speak about how we should be approaching future steps with care.

 

 

 

Sarah Steffen – MCW-Central Wisconsin

 

As a medical student, and therefore someone who has committed herself to the idea and importance of scientific evidence and evidence-based practices, and to keep people safe from harm, COVID has brought to reality, perhaps at one of its most nightmarish levels, the idea that a significant portion of our society dismisses science, education, and the universal human need to have empathy and take care of one another. …

 

…I come from a small, rural, and definitely more conservative town in the state of Wisconsin, my social media, in particular Facebook, has been flooded with conspiracy theories and misinformation from people who often post about “not wanting to blindly follow others, and wanting to think for themselves.” But following scientifically proven information is not following blindly. … But how do you get others to realize there is a difference between scientific evidence and an opinion? How do you get them to care? …

 

For me today, the biggest takeaways from this session quite simply revolved around the themes of scientific information and compassion. Scientific information that was from credible sources and experts of multiple fields, and the compassion that went side by side with presenting that information for how we can work towards a better future to take care of one another.

 

 

 

Erica Engstrand – MCW–Milwaukee  

 

… Whether it be a pandemic, medical school rejections, or life in general, I know that anxiety is something that will always be present in my life. You’d think that because screens have replaced so many of the faces I looked forward to seeing every day, it’d be worse. But because of this pandemic, I’ve never felt so supported by my friends and family. While living at home with my family right now isn’t ideal, I am so grateful for the fact that at least there’s no screen between us anymore.

 

I rest easier now. I have enjoyed mornings talking to my dad [who is a general surgeon] about our shared love for anatomy lab. He’s told stories about his own time in medical school and how he met my mom [an anesthesiologist] there. We reminisced about loved ones gone too soon and debated the future of health care. …  Later we made pancakes.

 

 

 

Connor Ford – MCW-Milwaukee  

 

I love sports. I rarely find time to watch them in medical school. … [but] the stars aligned when spring break fell during the same week of March Madness, the NCAA Men’s basketball tournament. … The week prior to spring break … everything was shutting down. … The NCAA tournament, US Soccer games that I had been looking forward to for months, the Bucks soon to be in the playoffs, start of MLB, all of it gone.

 

I know that sports don’t really matter much in the grand scheme of things. … But in the high stress interval of exam week … I was incredibly bummed out by how much I was looking forward to watching ten men try to throw a leather ball through a basket. It all seems so miniscule now.

 

[J]ust about everyone around me has had it worse. I wish I could take on some of others’ burdens. … To think that I was upset about sports being cancelled ... I feel guilty to even admit it.

 

I think the biggest takeaway I’ve had from this experience is that there are so many good people out there - selfless people doing so much for the benefit of all of us. … I’ve read so many stories of giving, of sacrifice, of communities coming together, and those stories give me hope that we will persevere and we will eventually defeat this virus.

 

 

 

Anna Janke – MCW-Milwaukee  

 

So many pieces of information I had previously taken as facts were flipped on their heads, as our panelists separated fact from fiction. … I had not realized that the transfer of information from virology/medical experts to popular press is a bit like the game ‘telephone,’ where facts and terms may get lost in translation. For example, COVID-19 is a disease, rather than an infection; the infection is called SARS-CoV-2. Furthermore, some information spread by the media and laypeople on social media is downright false. Before this presentation, I had no idea that is it unlikely we will see a new strain of SARS-CoV-2, as it mutates slowly compared to influenza due to the proofreading ability of its replicase complex. … I was quite shocked to learn that “social distancing” and “six feet apart” will not, in fact, completely prevent the spread of SARS-CoV-2, as infected aerosols can stay in the air and travel for hours.

 

As my first year of medical school comes to an end, I am left with a lot more … concerns than I started, in all honesty. Partly from the pressures of medical school and partly due to holing up at home in the midst of an unprecedented pandemic, I struggle to find meaning in the monotony of my days. However, I do not have to look hard to find those for whom I care and those who care for me, whether it be my friends, fiancé, family, or faculty at MCW.

 

 

 

Annie Tuman – MCW-Milwaukee  

 

As a medical student during this pandemic I have felt pretty lost regarding knowing what my purpose or role is. Being almost one-quarter of a doctor has put me in limbo of knowing just enough to understand when news outlets/Facebook friends are probably spreading false information, but not knowing enough to be clinically useful or helpful. Lately, I’ve been landing at the conclusion that the most helpful thing I can do right now is to lead by example and practice correct social distancing. However, there has seemed to be a national attitude divergence away from “flatten the curve” and a shift toward an extreme dichotomy of either “self-isolate until there’s a vaccine” or “a virus can’t stop me from living my life.” I’ve heard valid arguments and personal stories in favor of both camps, and I have been left wondering if there really is a correct way to social distance—and if there is, what it should look like.

 

… I have been disappointed that a lot of my friends have not been wearing masks because they think they’ve already been exposed, it doesn’t look cool, or any other number of reasons. I plan on using Dr. McNally’s point that a mask looks a whole lot less cool than a ventilator. I think it’s important to add that we all have a right to do and go where we want, but we do not have a right to put other people’s lives in danger. If people want to go out in public, it is their duty to at least wear a mask.

 

 

 

Dima Jaber – MCW-Central Wisconsin

 

In the beginning I felt like we were all in this together, but then people decided they were just sick of the new rules and started to protest. I am mostly disappointed in those people, some of which are friends, family, and classmates and feel that this experience has placed a lot of strain on my relationships and vision of the future.

 

I have always believed that people are entitled to their own opinions and beliefs, however I have a hard time seeing the viewpoint of those who are spreading false facts about COVID-19 and being reckless around others.

 

… I am sad to say that the nurse who recently went viral for proudly stating she was a nurse while at a bar is one that I used to work with, and while I did not know her very well, I thought I wouldn’t see this type of behavior from her or anyone I knew. This is especially considering my friends in healthcare who are working nonstop to help patients while knowing they are risking their own lives and those of them who have gotten sick. … This type of behavior will bring COVID-19 to the most vulnerable populations of Milwaukee County who are already feeling the wrath of this pandemic.

 

… We all know someone who has been affected by loss during this pandemic and is hurting. I would really hate for all this loss to have been for nothing.

 

 

 

Amanda Wright – MCW-Central Wisconsin  

 

We often learn about countless disease processes in medical school that we could never contract or develop firsthand. Maybe it has been eradicated from the country in which we reside. Maybe it no longer applies to our own age group as we survived the critical time one becomes infected. Maybe we were fortunate enough to receive a vaccine, or perhaps our own functioning immune spotted an infection and prevented its host from ever gaining knowledge that they may have ever became infected. … However, I didn’t realize what true fear of contracting a disease could be until the 2020 COVID-19 pandemic.

 

… I am terrified to begin my clinical experience in just over two weeks. Under most circumstances, the typical med student worries of even knowing which questions to ask or how to perform certain elements of the physical exam or note taking, but these processes pale in comparison to the thoughts that have been occupying my mind in light of this pandemic time. Instead of practicing how to properly stitch a suture, I am sewing my own reusable cloth mask to protect from the spread of this virus. Instead of rehearsing the nuances of the physical exam skills, I am rehearsing how I plan to come home at the end of the day from clinic by changing my clothes in my garage and running immediately to the shower all while avoid the potential crossing of paths with my family or even my dog. The fear of not being able to protect myself anymore from the virus looms over me, especially after doing my absolute best to not come in contact with the virus by not leaving my house for the last two months.

 

 

 

Chase LaRue – MCW-Milwaukee  

 

I actually enjoy personal time and thrive in being able to recharge by myself. But that doesn’t make up for the inability to go outside freely, go to the store without a mask, or the overall tense feeling that fell over everyone. …

 

Nothing really sank in until my friends that are nurses, doctors, and other healthcare professionals started flying across the country to sign short contracts in New York City. I then realized that the emotional trauma suffered by our front line is something that is going to last forever. This isn’t going to be something fondly looked back on in textbooks. It’s going to be as tear-filled and painful as war, famine, and economic crisis.

 

And so, I need to preface my next comment carefully… I’m thankful for the opportunity to develop perspective and mindset. I hope that as people step away from this, they take the personal and public challenges and develop a sense of … community. … How did they respond? How did you respond? Will there be a reflection to make sure that the damages and destruction by nature aren’t done so in vain?

 

 

 

David Wittmann – MCW-Milwaukee  

 

I cannot imagine how I would respond to a patient in clinic demanding immediate, and potentially experimental, treatment that has not at least been approved for clinical trials. As was stated in the lecture, any drug without some sort of benefit will only have negative side effects. It is amazing to me that given this information, some individuals still push for various agents … I am hopeful that a vaccine can be developed as soon as possible, but we must all realize that this process is lengthy, and it would be better to wait for a proper vaccine to be produced than simply take a “trial-and-error” approach with potentially harmful agents.

 

In times that seem like we are constantly pinned against ourselves, I have never witnessed camaraderie as has occurred since the virus spread throughout the country. The solidarity between the public and healthcare works, first responders, and essential workers gives me hope that once this is over, we will be more united than we were previously and we will learn to work together to fight future issues.

 

 

 

Abbie Scheidt – MCW-Milwaukee

 

In my last semester of undergrad last spring, I took an infectious diseases course where we talked about what would be the next pandemic. We talked about a new avian flu, smallpox, a multi-drug resistant gonorrhea, and Ebola. We even talked about SARS/MERS but concluded as a class that the most likely future pandemic would be a flu strain, likely H5N1 or other strains of avian flu. As I write this, I am looking back at my notes from that class session and I laugh a little to myself. My small class of 20 students and our professor, less than a year ago, sat around a classroom brainstorming the viruses that would wreak havoc on the world, not knowing what was to come and how wrong we were. All around the globe, scientists and doctors were having similar conversations. They all knew the world was due for a new pandemic, and soon. In my notes from that class, I have written that “90% of epidemiologists expect there will be a disruptive, deadly, global cataclysmic pandemic sometime in the next two generations.” It wasn’t a matter of if, but when. So, if the scientific community knew that a pandemic was coming, why was the world so unprepared? Why didn’t we all stop and listen to them?

 

… It hasn’t been easy watching from the sidelines as several of my own family members fell ill to SARS-CoV-2, including my cousin who is only a few years older than me. Seeing him require brief hospitalization from coronavirus at such a young age shocked me.

 

…With no end in sight, no one can say how our world and medical community will recover and grow from all this destruction. I can only hope that the world we build after the dust has settled is a better one.

 

 

 

Greta Berger – MCW-Milwaukee

 

I feel frustration, as I see the contrast between facts we know to be true, from evidence based research and public health officials, against the spread of information based entirely in suspicion and angst. I can’t understand the audacity some have to decide they know better than the recommendations from public health professionals. And, I also feel sad. It isn’t often during medical school you allow yourself the time necessary to process the events occurring around you. As Dr. Patel described the tragedy of watching a patient fight this virus, alone, and watch another patient die, alone, without their loved ones, my eyes filled with tears.

 

This last month has become more and more isolating as the studies have continued – feeling disengaged with the material, and far from my classmates. It has started to feel unimportant, studying so much, as the world around me is so loud, with fear and opinions and pain. I want to spend more time on Facetime with my mom and dad, and connect with my friends who are overwhelmed, and go for walks to process this moment.

 

There has … been an overwhelming sense of togetherness. Among my family and friends – we are all reaching out often. I have been exchanging emails and phone calls with my grandma weekly. And I feel so connected to this profession, full of heart, amidst the chaos and fear. It is a scary time to be entering the field, but I know I will be in good hands surrounded by inspiring, compassionate colleagues.