Justice Ruth Bader Ginsburg – Losing a Brilliant Voice for Equity

From the 10/2/2020 newsletter

Perspective / Opinion

Justice Ruth Bader Ginsburg – Losing a Brilliant Voice for Equity

Libby Ellinas, MD – Director of the MCW Center for the Advancement of Women in Science and Medicine (AWSM)

Dr. Ellinas shares her perspective on the loss of Supreme Court Justice Ruth Bader Ginsburg at precisely the time when our country needs her most of all ...

Supreme Court Justice Ruth Bader Ginsburg died on September 18, 2020. It felt like a punch in the gut. A wave of loss and a fear for our nation’s future. It brought again to mind a deep concern for the health, safety, and opportunities for women in the United States.

This week, the police officer who shot and killed Breonna Taylor was not indicted. That decision brought about a wave of loss and fear for the health, safety, and opportunities for women in the United States. In the faces of my colleagues, I could see that loss, that emotion.

Justice Ginsburg’s loss was personally devastating to me, not only because she was a superb intellect and a dauntingly hard worker (two traits I admire in anyone), but because she was clever – ingenious even – at helping colleagues and justices gain insight into their own views.

There are multiple examples of RBG’s cases that support her creativity and strategy to “Fight for the things that you care about, but do it in a way that will lead others to join you.” One of my favorites is Weinberger v. Wiesenfeld, a case she litigated (as Weisenfeld’s attorney) at the Supreme Court in 1975.

Stephen Wiesenfeld and Paula Polatschek were married in 1970. Paula, the primary breadwinner, worked as a math teacher. When she died in childbirth from an amniotic fluid embolism, Steven became the sole provider for their son, subsequently applying for social security benefits. At the time, a widow under identical circumstances would have been eligible for those benefits. Steven, a widower, was not. Wiesenfeld sued for benefits, and the case was appealed all

the way to the US Supreme Court against Caspar Weinberger, the Secretary of Health, Education, and Welfare.

During the case, Attorney Ginsburg argued that the Social Security Act discriminated against both Paula’s social security contributions (because she was not a man), and Steven survivors’ benefits (because he was not a woman). The 8-0 decision rendered by eight white male Supreme Court justices agreed that the purpose of social security benefits was to allow for the proper care ofchildren, and that “proper care” was not dependent upon the sex of the parent. Arguing not for women’s rights but men’s rights, this case demonstrates Ginsburg’s ability to work within the biases of her listeners, to bring about decisions that helped erode those same biases.

Bringing us to the connection between Breonna Taylor – the individual case – and the Supreme Court. Weinberger v. Wiesenfeld was not “Weinberger v. Gender Equity.” It was brought on behalf of Steven Wiesenfeld. Father. Widower. Individual. With Ginsburg’s death, a similar case brought on behalf of Breonna Taylor won’t have the same chance, the same advocate, the same writer ofbrilliant “dissents” that RBG was notorious for. Even the likelihood that the case would be brought to the court at all is lessened without Justice Ginsburg. And that is a terrible loss.

Ginsburg’s arguments were often for equal treatment, not equitable treatment, in part because many sexist decisions were ostensibly made to “protect” women. RBG is famous for saying, “I ask no favor for my sex. All I ask of our brethren is that they take their feet off our necks.” For too many black Americans, removing pressure from a neck represents a literal first step toward justice. For many women, freeing a figurative neck is still insufficient, because many women’s feet remain firmly fixed to the floor, hemmed in by structures of racism and sexism.

As we all work to move equity forward, I believe that Justice Ginsburg would have continued to advance her thinking as well. She was open to finding her own mistakes, to being told she was wrong, to being unprotected from the truth. She said, "Women belong in all places where decisions are being made. It shouldn't be that women are the exception." But not just “present” at decisions, she furthered:

"When I'm sometimes asked 'When will there be enough [women on the Supreme Court]?' and I say 'When there are nine,' people are shocked. But there'd been nine men, and nobody's ever raised a question about that."

Once again, RBG illuminates our biases, and helps us to see that a statement that seems at first shocking, may not be so shocking after all.

We have lost a brilliant voice for justice at precisely the time when injustice needs her more than ever. It’s up to us to raise our voices now.

Elizabeth (Libby) Ellinas, MD is a Professor in the Department of Anesthesiology, Director of the Center for the Advancement of Women in Science and Medicine, and the Associate Dean of Women's Leadership at MCW. She is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medicine.

The Unsolvable Tension Behind Good Intentions: Confronting Sincerity and its Shadow

From the 9/18/2020 newsletter
 
Student Perspective/Personal opinion 
 
 
The Unsolvable Tension Behind Good Intentions: Confronting Sincerity and its Shadow 
 
 

Jess Sachs, M3, explores the complex relationship between intentions and actions as she seeks to understand anti-racism and navigate her way toward being a consistent, effective ally. 
 
 
Like many, I have become increasingly motivated to step up and advocate for justice and equity. Also, like many, I struggle to determine where I am most needed and how to strike the delicate balance between white savior and white ally. So, when advocating for Black lives became “trendy” again in May after the death of George Floyd, I decided to do what plenty of other people started doing, which is committing to learning about social justice and anti-racism work and then...posting about it online. Otherwise known as “performative allyship,” or “slacktivism” in colloquial terms, this trend is something that white people like myself have an embarrassing history of participating in—that is, temporarily caring, and engaging in the work of reading, listening to, and advocating for Black people until our own lives become too “important” to continue pursuing meaningful activism. Nevertheless, I was drawn into this engagement, but this time I committed to doing it “right.” This would not be another time loop, another performance of the same pieties we have played out time and time again. What I ultimately intended to learn about was the death of Breonna Taylor. 
 
If you haven’t heard about Breonna Taylor, hers is the story of a Black woman losing her life to police brutality, a tragically common occurrence. Breonna was an EMT who was fatally shot by police officers attempting to serve a no-knock warrant on her home on March 13, 2020. (Brown & Duvall, 2020). The chronicle of her death is senseless, tragic, and heartbreaking. Why I became particularly attached to this specific tragedy, I am unsure. Perhaps it was because of the similarities between Breonna and me. We are the same age and working in the same professional field. Perhaps it was also because the case continues to evolve as new information leaks out - information that is often contradictory and confusing. 
 
Regardless, her story has become a source of painful preoccupation. Much of my time is spent searching twitter and Instagram with the hashtags #Breonnataylor, #justiceforbreonnataylor, #breonnaslaw, in an effort to absorb and learn everything I can about her. I attend Zoom Call to Action meetings. I read stories written by her sister and her mother. I donate to the Louisiana Until Freedom organization. I aim to become an expert in her case, because for the sake of our humanity, I did not want this to be another example of futile action. I vowed that my involvement would be one of the many steps in the proper direction of acknowledging systemic racism and advocating for justice. 
 
Recently, however, I read an article exploring how Breonna Taylor’s trending name has gone from a call to action to an oversimplified meme. Zeba Blay, the author of the piece writes, “Turning Breonna Taylor into a meme, then, risks turning the conversation around what justice looks like for her into a temporary fad.” This was my biggest fear. By reading and posting everyday, perhaps her story and her name were ultimately losing meaning. I questioned if I was becoming desensitized to the true goal of this work and blindly following a fashionable fad that looked like, but had nothing to do with, justice. This was never my intention, I kept thinking. And herein lies the complexity and confusion with our intentions. Below the surface of our rational minds lies a traffic intersection of contradictions, within which we ask this question: Is what we do substantive or simply another manifestation of our hopeless hypocrisy? Were my efforts simply designed to temporarily absolve my own white guilt? Was this true allyship, and is that even the goal? 
 
The answer to these questions? I still don’t know. What I do know is that my intentional actions to dismantle white supremacy will never be enough. What I do know is that my unintentional actions have maintained a culture of oppression and racism. Our personal truth is always far amore complicated than it seems, and reflection is necessary as we confront these feelings of guilt, discomfort, and confusion. But we continue to commit to meaningful causes, even if our motivation remains imperfect and clumsily emerges from a welter of conflicting impulses. It is of little value to attempt to fully reconcile our own emotions and intent after 400 years of unreconcilable damage done to Black people. Writer Tre Johnson says it best when he comments, “The confusing, perhaps contradictory advice on what white people should do probably feels maddening. To be told to step up, no step back, read, no listen, protest, don’t protest, check on black friends, leave us alone, ask for help or do the work — it probably feels contradictory at times. And yet, you’ll figure it out. Black people have been similarly exhausted making the case for jobs, freedom, happiness, justice, equality and the like. It’s made us dizzy, but we’ve managed to find the means to walk straight.” My ncertainty regarding the best pathway to follow in the direction of social justice is of little importance when compared with the uncertainty of not knowing whether calling the police will end in your safety or in your murder. Thinking critically and listening to those who have been doing this work for decades and centuries is indeed necessary when it comes to broadening and deepening the conversation about how to best move our nation towards a more just and equitable society. 
 
I wouldn’t be my father’s daughter if I didn’t mention a Jewish tale that comes to mind as I write this. Once, a wealthy disciple came to the Alter Rabbi, R. Schneur Zalman of Liadi, and said that he had been contemplating opening an orphanage, but had since abandoned the idea. Having mulled over the project, he came to the conclusion that he was only doing it to gain more respect in his community. The Rabbi lifted his eyes and told him firmly to go ahead with the orphanage, reasoning that, “While perhaps you may not mean this sincerely, the poor young orphans who will eat hot meals and sleep in comfortable beds will certainly do so sincerely.” The Rabbi understands that his disciple’s motivations are not entirely “pure”, yet the Rabbi also understands that there is still value to motivations that have a higher purpose even if they are partially spurred by energy that is not entirely rooted in ethical rectitude. Moral aimmaculacy is not a pre-requisite for moral action. Good intentions will not solve the problems of systemic racism and police brutality. Regardless, we commit to action because our lives depend on it and because we must take on the issue of racism as our own. As I continue to reflect on my efforts to pursue this particular summons to action, one point has never shifted-- Breonna’s Taylor life mattered. While it might take more time for all the facts surrounding her death to be revealed, it is an honor to learn her story, and with every action that I take, be it right or wrong, intentional or unintentional, I refuse to let her name and her story be forgotten. 
 
 
References: 
Brown, M., & Duvall, T. (2020, June 30). Fact check: Louisville Police had a 'no-knock' warrant for Breonna Taylor's apartment. Retrieved September 16, 2020, from https://www.usatoday.com/story/news/factcheck/2020/06/30/fact-check-police-had-no- knock-warrant-breonna-taylor-apartment/3235029001/ 
 

Authenticity, Selflessness, Courage, and Team

 From the 9/11/2020 newsletter

Perspective

Authenticity, Selflessness, Courage, and Team

Kathlyn Fletcher, MD MA, Lily Littrell and Luke Littrell

On August 26, the Milwaukee Bucks were scheduled to play the fifth game in their best-of- seven playoff series against the Orlando Magic. But then they didn’t. The team did not take the floor, ready to forfeit an important playoff game. Eventually, we learned that the team had come to the painful decision that they could not play basketball in the wake of another shooting of a black man, this time close to home.

Jacob Blake, a black man from Kenosha, WI, was shot in the back by a police officer seven times on Sunday, August 23, 2020. The circumstances surrounding the shooting are still emerging, but what is clear is that we are once again facing an extreme, violent, life-changing action by law enforcement against a black man. Kenosha, Wisconsin, and the country were reeling. It all felt devastatingly familiar. And then the Bucks stepped in. Or rather, stepped away, firmly, quietly sending the most powerful of messages.

Next, the other NBA teams scheduled to play on that night joined the Bucks in declining to play. Some major league baseball teams, including the Brewers, followed suit as did the WNBA and major league soccer. The message was clear: The status quo is no longer acceptable. The violence and injustice must stop. I wondered, though, how the players would move forward. I asked my 10-year-old son, Luke, what he thought about it. He did not like it that the Bucks had refused to play because he thought that nothing would come as a result. He was glad that the Magic did not accept the forfeit, though. Then the players did something remarkable.

Chris Paul, president of the NBA Players Association and LeBron James reached out to former President Barack Obama for advice. They wanted to make this decision to stop the playoffs matter. Apparently, Obama told them to decide what they wanted, ask for it and then play basketball. The players’ act of resistance resulted in more polling places for the upcomingelection, and the formation of an NBA committee to work on racial injustice issues.

The willingness to forfeit a playoff game to call attention to the moment was a brave act of selflessness on the part of the Bucks. There was a lot at risk. In retrospect, I am not surprised. They have been living this message since the playoffs began. The entire NBA has worn jerseys with racial equity mottos and warm up “Black Lives Matter” shirts for months. Individual players have done more. Several Bucks players led a BLM protest in Milwaukee before reporting to the bubble this summer. And Kyle Korver’s t- shirt selection (often courtesy of the Happy Givers) has created quite the stir, at least in my house. My daughter, Lily, can’t wait to see what the next one will say (see her drawing). The most recent bore the words “When we’re not hungry for justice, it’s usually because we’re too full of privilege.” What has specifically resonated with Lily is that these acts don’t call attention to the individual players, they call attention to the movement. She is drawn to them because they seem authentic and selfless.

This is an important moment, and everyday people might also wonder, as Luke did, what protests will accomplish. While few of us alone have a voice strong enough to demand that our workplace become a polling place, we must find our equivalent of not accepting the status quo any longer. We must do it in an authentic and selfless manner.

Last week, the Bucks taught us about the courage required in taking a stand when it is hard and something is at risk. They also taught us about the power of the team. One player refusing to play would have been a much different statement than the whole team refusing. We also learned that our enemies are sometimes on our side. The Magic had everything to gain in that moment; they could have been down 3-2 instead of 3-1 in the series. But they stood together with the Bucks by declining the forfeit, and the whole league followed. The Bucks have shown us the path forward: Authenticity, selflessness, courage and team.

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Lily Littrell is an up-and-coming artist. Luke Littrell is an aspiring athlete and basketball lover.

On Inclusion, Diversity, and Why Black Lives Matter Too: What our MCW Community BLM Protests Mean to our Colleagues of Color

 From the 9/11/2020 newsletter

Perspective
 
 
On Inclusion, Diversity, and Why Black Lives Matter Too: What our MCW Community BLM Protests Mean to our Colleagues of Color
 
 
Leroy J. Seymour, MD MS - Internal Medicine – PGY1
 
 
Dr. Seymour writes about the recent MCW Black Lives Matter protest and why it is important to create a flourishing, diverse, and inclusive community … 
 
 

On Wednesday, Sept. 2^nd, at 5:11pm, members of the Medical College of Wisconsin community held a Black Lives Matter protest to help shine a light on the frequent propensity for violence against people of color. This latest protest is one of hundreds of protests against police brutality and racial injustice that have been occurring in various cities, states, and countries, most recently triggered by the murder of George Floyd on May 25^th, 2020, in Minneapolis, MN. So many people have demonstrated peacefully and expressed their voices, all vying for the same dream Martin Luther King Jr. expressed to the world. Almost every aspect of the world’s population has provided an overwhelming outpouring of support of the Black Lives Matter movement; taking the baton and relaying the message that “Black Lives Matter too” to widespread media coverage and the political stage.
 
MCW faculty, residents, and medical students alike raised their voices in support of the Black Lives Matter movement. This stance informed the world that MCW and the Froedtert medical community will not tolerate racism, and that racism itself is a pandemic that needs to be eradicated. The Sept. 2^nd protest involved holding 7 minutes of sustained silence, each minute representing every bullet maliciously aimed at the back of Jacob Blake, an unarmed African American man returning to his vehicle, by Rusten Sheskey, a Kenosha WI police officer. Mere seconds after an instinctive proclivity for violence towards nonaggression left a man paralyzed, the world responded with outrage and exhaustion, yet another example of the unfair mistreatment of people of color when interacting with those with a perceived position of authority.
 
Many of us have protested these injustices before. I've protested it before. Our parents protested it before. Our grandparents protested it before. Our ancestors survived and protested it. I’ve stood face to face with the Ku Klux Klan, neo-Nazis, and individuals who have all decided that racial slurs and anger were the best response when asked why they hate people of color or different sexual orientation. Nobody should have to be afraid to walk outside or live in their own homes. People should not be judged by the color of their skin or their sexual orientation, but by the content of their character. People of every ethnicity, background, or creed, should not have to be afraid for their lives when interacting with police. With the many communities, committees, social circles, and groups that I belong to, I can single-handedly attest to the importance of diversity, the inclusive nature of MCW, and why having people of varying backgrounds, experiences, and cultures is so critically important to both the health of a community and a medicine brain trust. 
 
As a new internal medicine resident and as an African American, I have witnessed firsthand the most beautiful sides of humanity, and the darkest corners of vitriol. I have cared for patients who have been incredibly appreciative and receptive of my presence, feeling more at ease with talking about their privileged information because I am a person of color. I have also had patients turn me away for the exact same reason. When I wanted to become a physician, I made a lifelong commitment to improving and protecting my community. I’ve vowed to provide a safe haven for those without a voice, to be a vanguard in the face of hatred, to be the lighthouse in someone else's storm. But when it is you, your family, your friends, or your community who is being harmed, harassed, and violently mistreated, it takes that community to heal the hurt. It is hard to sustain a thriving and supportive community if that same community refuses to break bread with a particular subset of the population, even when everyone shares the same table.
 
I am proud to belong to a program and institution that takes a hard stance against institutionalized racism and is incrementally rolling out educational opportunities for those interested in, and in need of, anti-racism education. It is comforting to know that my colleagues and peers support the Black Lives Matter movement and understand the deeper inclusive meaning behind the statement. However, supporting the movement is only the first step of a marathon many have been running for years. With many cities in various countries now protesting the same cause, only time will tell if our collective voices have resonated, and what changes will result from our collective stance against institutionalized racism and racist ideology. Myself, my colleagues, and my peers at MCW have already decided which path we will walk, and that is hand-in-hand with our flourishing, diverse, and inclusive community.
 
 
 
 
Leroy J. Seymour, MD MS is a first-year internal medicine resident at the Medical College of Wisconsin

Racism is a Public Health Crisis: When Will We Decide It Matters?

From the 9/11/2020 newsletter 

Racial Justice Perspective

 

 

Racism is a Public Health Crisis: When Will We Decide It Matters?

 

 

Kristen Pallok, MD and Shaina Sekhri, MD – PGY2 Internal Medicine Residents

 

 

 

Drs. Pallok and Sekhri, allies as MCW works to become anti-racist, challenge the institution to do better …

 

 

In late June of 2019, we arrived at the Medical College of Wisconsin (MCW) for our internal medicine residency. Two newly minted female physicians arriving at the same institution, struck separately by the same conclusion: a lack of racial diversity. 

 

There is a hallway in MCW that displays a decades-long photographic history of MCW’s medical school classes. As a woman, it’s hard to miss – a long timeline of white, male medical practitioners.  And while some would think we would have long moved beyond this one-sided picture of white, male privilege, it has recently become clear to many individuals that we have not. 

 

Milwaukee is a diverse city with a significant Black population. According to the Milwaukee 2010 Census data, 40% of Milwaukee residents were Black. In comparison, 45% were white. Froedtert and the Medical College of Wisconsin serves this diverse population. Yet, while many of our patients are Black, our practitioners and leadership are not. In fact, the Black:White ratio of our faculty or residency programs is nowhere close to the breakdown of the Milwaukee population. Of the publicly listed members of Froedtert Health’s executive leadership, only 0.25% - 1 in 40 – of the members are Black, while 90% are white. 

 

What does this fact, this lack of racial diversity at MCW and Froedtert Hospital, have in common with our country’s racism and recent acts of police brutality? It is a form of perpetuated structural racism – structural violence designed into our policies, procedures, and our norms that harms our patients and breeds mistrust in our healthcare system. 

 

It’s easy to point at events outside our doors and commiserate about the state of racial equity in our nation. The real difficulty rests on scrutinizing ourselves at MCW and Froedtert to address our own institutional racism.  Our program took its first steps in acknowledging the presence of racism and addressing the Black Lives Matter movement with an hour-long reflection and resident-authored essays. The anonymous responses included an examination of privilege, uncomfortable feelings about the state of our society, fear, anger, and difficult conversations with family and friends. In all honesty, it is disheartening that it took such a large, nationwide movement to realize we must spend time discussing these issues. They have existed long before the events in the media, with thousands of excess Black lives lost each year to healthcare and disparity mortality gaps. Yet, we are hopeful that having finally arrived at a discussion, we can now work to make MCW an equity-driven space that dispels racism from its ranks. 

 

To create an environment that is inclusive and supportive of historically marginalized residents and faculty, we must take steps within our program. We acknowledge that as two non-Black women, we are limited in our perspectives and thus propose creating a racially diverse taskforce willing to identify and address actions such as the following: 

1. Taking an institutional stance against racism and police brutality as a public health issue
2. Asking residency applicants during their interviews how they plan to address healthcare disparities
3. Ending race-based medical practices in an overt manner, including lectures on why certain racist data is no longer used in medical practice
4. Training our residents to become advocates for our patients to receive the equitable care they deserve, which includes implicit bias training, insight into privilege and opportunity, and modules that focus on aiding patients from our communities of historically concentrated disadvantage

 

Yet, most importantly, we believe, for the institution to fully enact such changes, it must change at its roots. It is impossible to fully serve a population which is not reflected in our medical staff. Therefore, we suggest we must racially diversify our residency cohorts. We must focus our efforts on the recruitment of Black residents. We must focus our efforts on the retention and promotion of Black faculty and senior leadership. We must provide examples and mentors for our fellow residents to follow, and we must provide outreach in our Black Milwaukee communities to become members at the table – one which so deeply affects their health and, ultimately, their lives. We cannot fully represent our communities, our patients, if the Black Milwaukee community is not reflected in our medical practitioners and decision-makers.

 

This issue of structural racism is not limited to MCW and our residency program. It spans all of our institutions. And to conquer it, we must take a stance together. In June 2020, thirty-six Chicago hospitals and clinics signed a declarationnaming racism as a public health crisis and made seven commitments to dismantle racism in healthcare. This declaration is now going national through the Healthcare Anchor Network, a group committed to elevating communities and dismantling the effects of racism. In solidarity, we hope we can all sign our names to the list and take a seat at the table.  

 

It is not enough for a program or an institution to say that it is not racist. It must take actionable steps to become anti-racist. This requires us to name anti-racism as an organizational strategy to hold each other accountable, at both the individual and institutional levels. We can do more. If we believe Black lives matter, we cannot be complacent. We are 400 years overdue. We must act now.

 

 

 

Kristen Pallok, MD and Shaina Sekhri, MD are PGY2 Internal Medicine residents at the Medical College of Wisconsin

 

White Coats for Black Lives - September 2, 2020

 From the 9/11/2020 newsletter

White Coats for Black Lives Rally - 9/2/2020

Photos by British Fields

Initiating MCW’s “Community Conversations” about Race and Racism

From the 8/7/2020 newsletter

Racial Injustice & Inequities Perspective 

Initiating MCW’s “Community Conversations” about Race and Racism 

David J. Cipriano, PhD Co-Chair Elect, MCW Diversity and Inclusion Action Committee 

Dr. Cipriano was on the team that launched MCW’s “Community Conversations.” In this essay, he shares the process of that launch and a bit of what the facilitators and note-takers learned …

In early June, soon after the killing of George Floyd and the unstoppable social movement that ensued to end racial injustice, MCW was preparing to address how these issues were impacting our institution. President Raymond committed himself to leading MCW to become an anti-racist institution. The Office of Diversity and Inclusion (ODI) together with the Diversity and Inclusion Action Committee (DIAC) developed Guiding Principles for combatting racism and also laid the groundwork for groups of individuals to get together to have these difficult conversations. These groups, eventually called “Community Conversations” developed out of a close partnership between Dr. Greer Jordan and ODI, the Kern Institute, DIAC, and the Center for the Advancement of Women in Science and Medicine (AWSM). 

Laying the Groundwork 

A rapid mobilization was required to train facilitators, schedule sessions, publicize the initiative and assemble the groups. Dr. Adina Kalet of the Kern Institute and I worked on developing training materials for the facilitators and began to recruit people for this role. Our team also included M. Paula Phillips from AWSM, Charlie Ann Rykwalder of DIAC, and Marina Thao, events specialist for the College. Within a week, we had 160 people signed up to participate. We had also recruited twenty-seven people, made up of faculty and staff, to be facilitators and note takers. We held two training sessions which turned into more of a time for self-reflection and gut check than skills-building sessions. 

Preparing the Facilitators and Note-Takers 

The purpose of the groups was to answer two key questions. The facilitators grappled with these questions, knowing that we needed to be clear on them before we could facilitate groups of our colleagues in a discussion. 

• The first question was, “What does it mean to be an anti-racist organization?” We shared definitions we had found in our reading and self-education. We grappled with the basics: What is the difference between systemic racism and structural racism? Some of us were unclear on the meaning of the term “anti-racist.” 

• The second question, “Where does structural racism exist at MCW?” led to an array of responses amongst the facilitators. I suppose we reflected the MCW community in general in our reactions: “Nowhere! We’re are an organization made up of well-intentioned people who adhere to laws and rules against discrimination” to “Everywhere! We are not aggressively recruiting and hiring people of color. We are not including black-owned businesses in our vendor lists. Our students of color are still getting poor performance evaluations for such subjective, and therefore open-to-bias issues as ‘attitude.’” Over and over, this humble group of facilitators, the great majority of whom were white, expressed concern over their unpreparedness for this task. 

And, what was to be our function as facilitators, to listen or to teach? Most of us are educators by profession or nature. After much discussion, we made the deliberate decision to listen and not teach. We decided to facilitate and not impose our beliefs or values on the group. After all, the purpose of the groups is to gather information to help our inclusion leaders understand where the enterprise is at on these issues, what the concerns are and what the needs are; all in the service of developing next steps. Dr. Jordan was adamant that the objective was not to change people and not to MAKE people learn anything about race and racism. 

We had to consider the language we were using – are we talking about antiBlack racism or racism that affects all people of color and marginalized groups? We were directed to assume good intentions. Even if we heard something difficult or challenging, people are still learning just like we are. They may be asking an honest question without meaning to hurt anyone. We may hear things that don’t align with our beliefs or with the institution’s goal of becoming an anti-racist organization. Implicit bias is the culprit here – it allows people with good intentions to occasionally operate from automatic, or unconscious stereotypes that they hold. 

What we Experienced and Noticed 

So, at times we bit our tongues. But really, all of our participants appeared to be there with the genuine motivation to listen, learn and figure out ways to contribute. 

 As the sessions occurred, the facilitators and note-takers began sharing their experiences in group emails. These became very valuable to all of us as we realized that this endeavor was having an impact on us as well as on the participants. Some of these emails were long, and were filled with heartfelt reactions, questions, and concerns. I believe we all read each and every one of these emails, judging by the number of responses which ranged from “Thanks for sharing,” to “Me, too!” 

We also shared major themes and questions that emerged: 

• Most participants want to be educated on the issues. 
• Why is it necessary to spend so much time educating white people about racism? 
• Do people in the majority culture stay stuck in intellectualizing and defining these issues? 
• Should one of the objectives simply be to learn to tolerate the discomfort of these conversations? 

We wondered why there were separate groups for African Americans to share their feelings. We lamented the fact that there was little diversity in our groups. Some felt that whites need to hear from Blacks about their experiences so that they can learn in a truly impactful way. Others thought that it is not the job of Black people to teach white people about racism. “They can learn about it themselves,” and, “they can consider their own race and all the baggage that it comes with.” These steps take self-reflection, and maybe that is what these groups will trigger. 

We really meant it when we told our participants that we were learning right along with them. We are all on our own journey of confronting our privilege in this unfair and biased system. We came away feeling troubled, nervous, and exalted – all at the same time. 

Next Steps 

When it came time to deal with the fact that over 200 more people from MCW had put themselves on a waiting list for our Community Conversations, every one of our facilitators and note-takers signed up to go another round. We are currently finishing up and waiting for next steps from the institution. We are eager to continue to learn and grow. 

David J. Cipriano, MS PhD is an Associate Professor in the MCW Department of Psychiatry and Behavioral Medicine, the Director of Student and Resident Behavioral Health, and the Co-Chair Elect, Diversity and Inclusion Action Committee. He is a Faculty Member of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

How to Be an Antiracist by Ibram X. Kendi Chosen as the MCW Common Read

 From the 8/7/2020 newsletter 

 

 

How to Be an Antiracist by Ibram X. Kendi Chosen as the MCW Common Read

 

Anna Janke, MCW Class of 2023

Associate Editor

 

Ms. Janke discusses the process and outcome of this year’s search for the book that will be the MCW Common Read…

 

It took us the entire school year to choose this upcoming year’s Common Read selection. Led by then-M4 Sophia Lindekugel, the Book Selection Committee read dozens of books suggested by MCW community members to pick a book that would be timely, readable for a wide audience, and actionable to spark meaningful change. As a lifelong reader and now a member of the Book Selection Committee, I really enjoyed reading books that opened my eyes to topics I had not explored in depth before, ranging from the opioid epidemic, to the Flint water crisis, to the individual and societal impacts of sexual assault.

However, after selecting a book with which we were all thrilled to announce, these plans were pivoted once we noticed, and joined in on, the outcry surrounding the deaths of George Floyd, Breonna Taylor, and far too many others. The MCW Common Read Leadership felt that it was necessary to shift this year’s Common Read to one that would center around race and race relations in America, shelving our previous selection for another year.

While the time allotted to select a book was now much shorter after the decision to pivot, many inspiring voices came forward to recommend titles that would spark discussions throughout the MCW community about race. It was humbling to realize that we have been late to join this movement; The MCW Office of Diversity and Inclusion (ODI), Student National Medical Association (SNMA), and the Center for the Advancement of Women in Science and Medicine (AWSM), among others, have been leading MCW for decades towards progress in health equity, workplace climate, and the dignity of every person.

In the end, we wanted as many community voices to be heard as possible for this year’s Common Read. We met with key stakeholders, including representatives from the aforementioned groups, to select three books from which MCW would vote. After 548 people weighed in, we are thrilled to have How to Be an Antiracist by Ibram X. Kendi as the 2020-2021 MCW Common Read.

While I am both elated and terrified to be a Co-Chair for this year’s programming, I am confident that the Common Read Leadership and the rest of the MCW community will come together to get our hands dirty and make mistakes so we can learn from those mistakes and take important steps forward in the lifelong journey that is Antiracism.

 

  

Anna Janke is an MD Candidate in the MCW Class of 2023. She serves as an Associate Editor of the Tranformational Times.

Milwaukee is Special; Let’s Make Some “Good Trouble, Necessary Trouble”

From the 8/7/2020 newsletter

 

Milwaukee is Special; Let’s Make Some “Good Trouble, Necessary Trouble”

 

Adina Kalet, MD MPH

 

 

Dr. Kalet shares how the message of Representative John Lewis’s farewell letter to the American people resonates with how the Kern Institute must take up the challenge to create inclusive, equitable medical education systems …

 

 

On the day of his funeral, John Lewis, the civil rights warrior and seventeen-term Congressman from Georgia’s 5^thCongressional District, published a love letter to the American people in the New York Times. He wrote his inspired and inspiring essay while dying of cancer, knowing that the country he loved was in crisis. “You filled me with hope about the next chapter of the great American story when you used your power to make a difference in our society.” 

 

Lewis reminds us that “Redeeming the Soul of Our Nation” will require a “long view” which, I believe, is also our approach as we redesign medical education to create a new physician work force. Doing meaningful and important work is a process, not an outcome.  As an ancient Jewish ethicist reminds us, we are not responsible for finishing the work of "perfecting the world,” but neither are we free to stop trying. 

 

 

Our home: Milwaukee is a very segregated city

 

We have some complex work to do in our own hometown.

 

Milwaukee has the long-standing, dubious distinction of being among the worst places in America to be Black. A black child born into poverty in Milwaukee is more likely to continue to be poor than in any other large city in the country. Deeply entrenched, persistent and concentrated poverty, extreme racial segregation, and exclusionary zoning or “redlining” have been blamed for the poor social mobility for our children. There are endless, complex explanations for this “special” status. 

 

Research studies confirm that health disparities are both directly and indirectly linked to these social determinants of poor health. Scientists from multiple institutions have identified that the incremental, accumulated physical effects of racism over a lifetime contribute to health inequities. Recently, this disparity has included the disproportionate illness and death of Black Milwaukeeans from COVID-19. No matter how you assess the current situation, things appears bleak. 

 

Yet, John Lewis – a Black man who lost as many battles for racial justice as he won and who was beaten and arrested over fifty times for engaging in militantly non-violent protest against racial injustice – was optimistic when he died. 

 

Lewis believed in us. He exhorted us to be aspirational. He wrote “Ordinary people with extraordinary vision can redeem the soul of America by getting in what I call good trouble, necessary trouble.” It is time for those of us in medical education to do some significant envisioning. But where do you look for the leadership? Inward? 

 

 

Time to make some good and necessary trouble

 

As the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, I am always on the lookout for opportunities to think boldly and make a bit of good and necessary trouble! 

 

I am proud of MCW and its 125-year history of being an anchor institution in Milwaukee and the region. In John Raymond’s most recent Letter from the President, he reviews a list of the substantive ways in which MCW has been an exemplary institutional citizen of the city, the region, and the state over the past decade. He also invites all of us to join in the conversation and contribute to the MCW 2025 Strategic Framework as we set a new vision and as we rise to current challenges; we must “… think boldly and to share how you would reimagine MCW.” How do we prepare to make changes? 

 

 

Be bold. Set audacious goals. 

 

Many years ago, my mentor diverted me from an unproductive tirade by saying, playfully, “Don’t get mad. Get data.” This admonition literally was the birth of my academic career. Below, I offer an example of people who will change Milwaukee by first gathering data. 

 

The African American Leadership Alliance MKE (AALAM) was founded in 2017 to link influential individuals dedicated to making Milwaukee a place where African Americans thrive. AALAM has set the audacious goal of putting Milwaukee into the top ten US cities for African Americans by 2025! That is when our current first-year students will be interns. 

 

Recognizing the need for benchmarks for their work and seeking to identify the levers to drive positive change, AALAM commissioned the UW-Milwaukee Center for Economic Development (UWMCED) to produce  the study, “The State of Black Milwaukee in National Perspective: Racial Inequality in the Nation’s 50 Largest Metropolitan Areas.” The study was funded by the Greater Milwaukee Foundation. Here is an interview with the study lead, Professor Marc Levine.

 

As part of their work, the UWMCED team created a “Composite Index of African American Well-Being.” The index synthesized thirty indicators of community well-being, typically studied individually – for example, employment, income, poverty, social and community health, and conditions specific to youth and children – into a single number allowing big picture comparisons and holistic analyses across large metropolitan areas of the country. Milwaukee ranked 50^th out of 50. 

 

The study pinpoints three inter-related drivers for change: 

·      Reducing racial segregation

·      Enhancing Black educational attainment

·      Increasing the numbers of Black executives and managers at Milwaukee companies, including MCW

 

These actions will help make strides toward racial equity. For AALAM and the rest of us, it is a call to action, a time to make some good and necessary trouble. 

 

 

Building trust and taking action

 

On July 22, 2020, Drs. Lenard E. Egede and Rebecca J. Walker from the MCW Division of General Internal Medicine Center for Population Health published a perspective in the New England Journal of Medicine identifying six recommended action items for mitigating structural racism. Directly in our Kern Institute lane is the recommendation to “be consistent in efforts by health systems to build trust in vulnerable communities.”

 

How do we build trust? We must commit to long-term, trustworthy partnerships in “pipeline to the health professions” programs that will measurably accelerate the diversification of the health workforce in Milwaukee. We must intentionally and assertively recruit and support students, residents, faculty, and staff from underrepresented minority (URM) communities making special effort to identify those from economically deprived backgrounds. And as our leaders are seeking to do, we must support, listen to, and engage with all of MCW’s URM community-including all levels of staff- to be the kind of employer where everyone feels they belong, have an influence and can create a meaningful work life. This will require carefully examining how we traditionally have approached fairness, as compared with equity, in admissions and hiring processes. 

 

How do we prepare our trainees to practice medicine so that it is experienced by communities as trustworthy? Beyond a curriculum which provides the critical historical context for the distrust of the health care system by vulnerable communities, we must provide meaningful ways for our students and residents to work with and in communities. I have been involved with many “patient-as-teacher” programs. These programs train and employ community members- to be medical school teachers. With their active participation, for instance as standardized patients student can learn clinical material practice skills and receive critical feedback. With community guides and coaches students and residents can contribute to research and engage in  community social action. These experiences need to be substantive, rigorous and longitudinal allowing for the development of strong trustworthy relationships.  This is making some good trouble! 

 

In his essay, John Lewis wrote that he once heard the voice of Martin Luther King on the radio. “He said we are all complicit when we tolerate injustice. He said it is not enough to say it will get better by and by. He said each of us has a moral obligation to stand up, speak up and speak out. When you see something that is not right, you must say something. You must do something. … I urge you to answer the highest calling of your heart and stand up for what you truly believe.”

 

If we are truly committed to transforming medical education – as well as society writ large – we must reshape our own community, focus on character and caring, and offer to partner with organizations, like AALAM, that carry visions of a better, diverse, equitable world. Our entire community will benefit. 

 

 

 

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.

 

 

Racial Discrimination in Academic Surgery: A Webinar Presented by the Association for Academic Surgery

From the 7/24/2020 newsletter

Racial Discrimination in Academic Surgery: 

A Webinar Presented by the Association for Academic Surgery

Eileen Peterson, MD Candidate 2023

Associate Editor

Background

This webinar was one in a series of town halls with the goal of changing the landscape of academic surgery. The town hall was led by two session moderators, Callisia Clarke, MD of the Medical College of Wisconsin and Colin Martin, MD of the University of Alabama Birmingham, and five panelists from across the nation. As the chair of the Diversity, Equity, and Inclusion (DEI) Task Force for AAS, Dr. Clarke stated that the AAS is looking for “not just discussions but solutions” within the academic surgical workforce.

Speaker 1 – Yue-Yung Hu, MD

Dr. Yue-Yung Hu, a pediatric surgeon at Northwestern University, spoke on the prevalence of racial discrimination amongst surgical trainees. Dr. Hu discussed data published in JAMA Surgery in April 2020, which was collected from 6,956 resident surveys after the 2019 ABSITE exam with an 85.6% response rate. Of note, the study found that 41% of non-white general surgery residents reported racial or ethnic discrimination. Of those who reported discrimination, 71% were Black, 46% were Asian, and 25% were Hispanic. In addition, discrimination is associated with higher rates of burnout, thoughts of attrition, and suicidality.

Hu also discussed the SECOND Trial. This is a prospective randomized trial across 215 residency programs to assess diversity and resident well being while providing a toolkit of strategies to improve the learning environment for residents. The SECOND Trial is also currently compiling resources on implicit bias training.

Speaker 2 – Erika Adams Newman, MD 

“We will look back and our children will look back and say, ‘How did we respond, what did we do, what changes were we engaged in?’ both individually, within our institutions, and within our organizations.” Erika Adams Newman, MD, a pediatric surgeon at Michigan Medicine, discussed faculty-level racial discrimination as it leads to barriers to retention and promotion. When looking to improve equity and reduce discrimination, Dr. Newman encourages departments to look at their demographics and ask what message it sends by having only a few people of color and also fewer women within a department.

Newman suggested Grand Rounds as a great way to increase diversity, raise consciousness, and push the envelope. Through the introduction of The Michigan Promise in 2017, Michigan’s Department of Surgery has diversified their recruitment committee, increased mentorship, and implemented bias and cultural competence training in order to seek out sustained change. 

These are just a few ideas for programs. Dr. Newman stated that good intentions are not enough because “how can we achieve excellence without being diverse?”

Speaker 3 – Justin Brigham Dimick, MD, MPH

Justin Brigham Dimick, MD, MPH, the Department of Surgery Chair at Michigan Medicine, posed reflective questions for non-minority audience members on the topic of earning the title of bystander or ally.

1. Have you come to terms with your privilege? If you can see an event in the news and be complicit, returning to work and acting like nothing has happened, that is privilege. Educate yourself. Read any of the bestselling novels about racism and discrimination. Don’t ask the minorities in your department to teach you.

2. Do you see implicit bias everywhere you look? What are you doing to interrupt  and remove these biases from the workplace?

3. Who are you mentoring and sponsoring? Do your mentees look like you? What signals are you sending when broadcasting your mentoring?

4. If you are a leader, are you creating space in your program’s curriculum for discussing implicit bias?

5. Are you able to go beyond the title of bystander and work to become an upstander? As an upstander, you can use your power and platform to change policies and procedures to be equitable.

Speaker 4 – Oluwadamilola “Lola” Fayanju, MD, MA, MPHS

Oluwadamilola “Lola” Fayanju, MD, MA, a surgical oncologist at Duke University, discussed surgeons’ obligation to address healthcare disparities  through research. Dr. Fayanju stated that currently, African-Americans and Latinx are overrepresented in Phase I Trials and underrepresented in Phase III trials, suggesting failure to convey goals of Phase I studies and enrollment bias in Phase III trials. More efforts need to be taken to prioritize recruitment and inclusion of racial/ethnic minority patients who are disproportionately affected by various diseases. In addition, disparities need to be incorporated into  studies at concept inception rather than tacked on during statistical analysis. 

Dr.Fayanju offered three suggestions for researchers going forward: 

1. Be humble: Get more training.

2. Be collaborative.

3. Be intentional: Who are your collaborators, statisticians, and study team members? Who is at the table when decisions are being made?

Speaker 5 – Eugene Kim, MD

Eugene Kim, MD, a pediatric surgeon at Keck School of Medicine of USC and President of AAS, discussed the AAS Commitment to Addressing Racial Discrimination in Academic Surgery. Recent efforts by the AAS include the creation of the DEI Task Force in 2019 as well as implementing open elections and self-nomination for committee chairs. Within the Executive Council,  the AAS has seen increased diversity at the levels of institutional, surgical specialty, and research background, but the AAS still needs to see more diversity  in race and gender within committee appointments and chairs. The AAS is also

increasing their mentorship efforts. They will be hosting sessions for underrepresented minority surgeons-in-training to meet with AAS leadership.

You may email Dr. Kim at eugeneskim@chla.usc.edu with your thoughts and ideas on increasing diversity of AAS.

 

Conclusions

Reach out to Dr. Clarke on Twitter @DrCNClarke with suggestions, ideas, or questions. The full AAS webinar can be accessed at https://www.aasurg.org/racial-discrimination-in-academic-surgery/

Eileen Peterson is a medical student at the Medical College of Wisconsin and serves as an Associate Editor for the Transformational Times.