Learners and Justice: Our Present and Future

From the 12/4/2020 newsletter


Learners and Justice: Our Present and Future


Joseph Kerschner, MD – Dean, EVP, and Provost of the Medical College of Wisconsin



In a Leadership Plenary Address as the Chair of the Board of Directors of the Association of American Medical Colleges (AAMC), Dr. Kerschner explains the importance of listening to our learners, creating culture change, focusing on diversity, committing to being anti-racist, and transforming medical education.


Dr. Kerschner gave his address on November 17th, 2020 and the video of his full address is available here and the complete transcript is available here.

The AAMC is a unique organization with a unique position to influence medical education, research, and our nation’s health. I have always tried during my leadership year on the AAMC Board to put learner topics front and center, because at the very core of the AAMC, our organization needs to be about our medical students and residents who, after all, represent – not only our future – but our present. And, when given a voice, they provide important insights and identify solutions to our current challenges. Below are three topics students identified as the most important areas for emphasis by our medical schools, academic health systems, and the AAMC.



The first area we must tackle is learner well-being

This is at the top of my list. We simply cannot be satisfied with the state of our overall learner well-being. Although there are encouraging trends, the level of depression and distress for physicians (and other health care professionals) remains enormously high, and difficulties become manifest early in one’s journey to becoming a physician. There is not a single one of us who does not have a personal responsibility to actively reduce barriers to mental health access and to remove the stigma for those seeking healing as they struggle with mental health, addiction, and other related concerns.


Changes to curricula and assessment are making a difference. We must improve learning environments and assess how we provide instruction and evaluation. I personally believe that the recent change to pass/fail for the Step 1 exam will have a positive impact.

But we must do more to explore access to mental health resources, financial support, and milestone-based curricula that will provide more flexibility to our learners as they progress in their development. I believe we must provide the ability for a student to finish medical school and residency in less time – or more time – than the “standard number of years,” depending upon her or his previous experiences and aptitude.


Changing the culture to address well-being

We can change our cultures, in part, simply by bringing the conversations forward and highlighting the importance of engaging in this manner. The currency of leadership is time — and, as leaders, if we do not spend time on this issue, we will devalue the importance of well-being. Have we stressed the importance of taking time for oneself and one’s loved ones with the same passion that we have stressed completion of the latest research project or preparation for the next presentation on rounds? Do we intentionally “clear the deck” to talk to our struggling colleagues to provide guidance, resources, and support?

Well-being and mental health are broad topics that demand systemic approaches, yet I believe that the most critical systems change we need — throughout medicine and education — is a change in our culture. Until we enable our culture to truly see those who are suffering, remove all negative connotations, and offer what is needed to support our colleagues, we will continue to risk our own and our colleagues’ mental health and wellness.

A favorite saying of mine is, “Our attitudes influence our perceptions, which in turn create our realities.” The message here is that we can change our culture so that the health and well-being of our learners — and, really, all who pursue health and science careers — will improve!



The second area we must tackle is student debt and transition to residency

Often linked to well-being for our learners is overall debt and residency opportunities — or competitiveness. I will focus here mostly on the overall debt of our learners.

The US is an anomaly in the world, in which those who have chosen to dedicate their lives to the practice of medicine are often asked to take on an enormous debt burden before they even begin to see patients. We have resisted solutions, because, the thought process goes, physicians are well-compensated and can afford to pay back loans. In addition, many medical students come from relatively privileged backgrounds. There is some truth in these assertions. However, if we seek to encourage diversity among our medical workforce, how many potential students from less advantaged socioeconomic backgrounds never even consider medicine because, early on, they learn of the overwhelming cost and debt?

I believe that if medical school debt could be limited through means-based support of those with fewer economic advantages, we would see progress in well-being and a more diverse workforce. A legislative solution would require a realization that medical students are a national treasure that deserves our support.



The third area we must tackle is student diversity

Our students view medical school diversity as a critical area to strengthen education, improve health outcomes, and bring much needed racial and social justice to our society. As a nation, we simply have not made enough progress in this regard. For example, the matriculation rate for Black and African American men has not made any appreciable progress in fifty years!

Racial concordance between patients and providers can contribute to better patient communication, satisfaction, and trust — and that these attributes and others can provide at least a part of the solution to the lack of equity in health outcomes. We must construct our admissions processes, pipeline programs, and support systems to enable this reality. I believe that our medical schools and institutions must become truly anti-racist. We must establish institution-wide practices that address unconscious bias in all faculty, staff, and learners.



How I learned a diversity lesson

When I became Dean nearly a decade ago, there were many who were willing to work on equity, diversity, and inclusion; enhanced structures to measure pay equity; changes in policies influencing the manner in which inequities were handled; and institution-wide unconscious bias training for every leader, student, staff member, and faculty. We doubled the number of underrepresented in medicine matriculants. We enhanced our pipeline programs, and students of color specifically shared with me their heightened feelings of inclusion at MCW. Leadership diversity improved, thanks to conscious efforts in faculty hiring and leadership searches. On the financial side, an annual process was instituted to rectify gender-based and other inequities. And we were in the early stages of developing the Center for the Advancement of Women in Science and Medicine, which would soon become a reality. We were gaining momentum.


Then, six years ago, a group of MCW medical students raised their concerns about police brutality, the Black Lives Matter movement, and racial injustice. They requested support from my office for a local “White Coat Die-In” — a national initiative in 2014 that many listening today will remember. My office was supportive and helped arrange for the most prominent location at MCW’s Milwaukee campus for this to occur — the entrance to our Medical Education Building.

The event took place and received some local media coverage. Although I was well aware that MCW still had a great distance to travel, I remember believing that this student-led “die-in” was yet another example of MCW’s progress on its journey to becoming an anti-racist institution.


Fast-forward to 2020: Like the rest of the world, we watched the coverage of George Floyd’s senseless, horrific, and tragic death and read about the ongoing issues of police accountability. We convened a Town Hall meeting and panel, including expert opinions on racial justice and steps to move forward. The conversation was honest and, at times, raw, but action-oriented — qualities that I believe embody a maturing, questioning, and vibrant organization.

One of the panelists, a person of color who had been a student at MCW during the 2014 “die-in,” provided her impressions of the event. She stated that she felt the event was an enormous disappointment. Why? Because of low turnout; the overall lack of dialogue about the event by leaders and the broader MCW community; and a general sense that this issue was not important at MCW.

And she was right.

Hers was the true story — not the one I had told to myself six years before. It was not the “comfortable” narrative which I had constructed at the time of the die-in that rewarded my need to see progress.

I logged off the Town Hall and reflected on the “uncomfortable” place where I now was — and what I should have done differently. I cannot say it any better than did Bryan Stevenson, author of Just Mercy, when he suggested that we must “get proximate” to the issues at hand. My own misinterpretations of student reactions following the “die-in” in 2014 were partly a result of my lack of proximity. I needed to acknowledge the former student’s story and engage in additional dialogue. But, more importantly, I needed to take concrete and meaningful steps forward to make MCW an anti-racist institution.



My challenges to you

My ask of you is threefold:

• First, if you are in an educational leader, always ask, “How will this decision impact our learners?” but, before answering, actually listen to some students to ensure that you have it right. 
• Second, if you are a learner who is worried about not being heard, find faculty allies. It might be hard, and might seem “risky,” but it is important. 
• Third, if you are neither a major decision-maker nor a learner, ask how you can be a better ally for our learners, because they do matter. 

How we listen and provide this support has the potential to change everything in medicine.

Every institution is trying to enhance social and racial justice. We still have a long way to go, and we have made far too little progress, but it is critical that we seize the moment now and not lose this momentum. If we hope to more rapidly “bend the arc of the moral universe toward justice,” as the Rev. Martin Luther King, Jr. so eloquently told us, we must all continue to engage in dialogue, thought, and action.


I would encourage us all to work to elevate the voices of others. We must increasingly see how the judgments we impart, the ways we consciously or unconsciously behave, and the decisions we make, will move us to make progress toward an inclusive, equitable, and healthy environment for all.







Joseph E Kerschner, MD is Dean, Executive Vice President, and Provost of the Medical College of Wisconsin. He is a Professor in the Departments of Otolaryngology & Communication Sciences and Microbiology & Immunology at MCW. These remarks are excerpted from a longer address delivered on November 17, 2020 at the 131st Association of American Medical Colleges (AAMC) meeting in his role as outgoing Chair of the Board of Directors.

Thanksgiving is a Time for Gratitude and a Commitment

From the 11/20/2020 newsletter

 

 

Director’s Corner

 

 

 Thanksgiving is a Time for Gratitude and a Commitment to Making a Difference 

 

By Adina Kalet, MD MPH

 

 

Inspired by virtually attending the AAMC meeting this week, Dr. Kalet reflects on how the medical profession is embracing this transformative moment and why, after expressing thanks and gratitude, it’s time to roll up our sleeves up and do the hard and meaningful work ahead …

 

 

 

It is gratefulness that makes the soul great. 

-Abraham Joshua Heshel

 

How do we endure what we witness? 

-Anne Curry 

 

• Health disparities are a manifestation of structural racism which we must address to save lives and enhance human dignity and flourishing for us all.

• Without Black and Brown physicians, Black and Brown people will not receive the best medical care. 

• There are structural barriers to increasing the number of physicians of color. We must address these immediately.

• The strategies to creating supportive, nurturing academic environments for students of color seeking to become physicians are well known, as Historically Black Universities and Colleges (HBUCs) have educated 50% of all Black physician.

• MCAT scores reflect privilege in access to enriched education, “gap” year experiences, and expensive test preparation. These advantages are not available to all and therefore should not be used to limit access to medical education. European models of access to medical education are instructive here.  

• Zero sum thinking is keeping us from recognizing that investment in diversifying our profession will “float all boats.” Power is not a scarce resource; it is unlimited. 

• For our culture to “bend toward justice,” we must all be actively engaged. 

• Acknowledge the reality of privilege and its impact on maintaining white and wealth supremacy

• Seek expertise outside of the walls of the profession to help us address these issues  Bring our students to the table and listen to them 

• Communicate often and with authenticity and sincerity 

• “Get proximate” to the people we hope to serve and seek to see people as individuals with basic humanity

• Set audacious goals for change and get and maintain accurate data to guide change toward those goals

 

Thanksgiving 2020 will be unprecedented. Traditionally, Americans mark Thanksgiving with deep family connections, too much food, football, and moments of gratitude. This year, though, hospitals will be overwhelmed, and health care professionals will be working harder and under harsher circumstances than ever before. We will all be socially isolated. The adjustments will be difficult and promise to worsen. Because our residents are working incredibly hard, we want them to know how grateful we are for them. In collaboration with MCWAH, the Kern Institute will be providing “to-go” meals for our trainees on Thanksgiving. Oh, and we will be providing those amazing Kern Cookies, as well. 

 

There are many things for which we are grateful. In my family, we will replace the usual West Coast trip to see the in-laws with Zoom games and remote pie baking lessons. I am grateful for the opportunity to avoid airports on Thanksgiving! I might even start my “gratitude journal” because positive emotion is important when the days get short and cold. Expressing gratitude is associated with personal happiness and is, in part, necessary to create human flourishing (eudemonia in Greek), which Aristotle, philosophers, theologians, and psychologists considered the ultimate goal of a good life and a healthy society. 

 

 

I have also been grateful for and astonished by this week’s virtual Association of American Medical Colleges (AAMC) annual meeting, the largest gathering of medical educators in the world. Over the years, I had become disappointed by the diffuse and frankly self-absorbed nature of the meeting. But in this special year, under the leadership of President David Skorton and Chairman of the Board, our own Joseph Kerschner, the AAMC has found its soul! When needed more than any other time in history, there is a movement afoot for a powerful transformation in American medical education.

 

 

AAMC addresses COVID-19 and structural racism

 

Compared with the usual AAMC meeting – thousands of medical educators from around the world in enormous, Jumbotron-enhanced ballrooms listening to leaders and topflight “inspirational” speakers – the virtual version is intimate and stirring. I sit in my living room while “Rock Stars” NIH Director Francis Collins, NIAID Director Anthony Fauci, and  CDC Principal Deputy Director Anne Schuchat remind us that COVID-19 is  far from over. The pandemic is terrible and getting worse. Thankfully, effective treatments are emerging and effective vaccines are in sight. I am grateful that there are world-class scientists and thought leaders at the helm, collecting valid data and communicating simply and honestly. I am grateful to be reminded that our role right now is to be trustworthy, courageous, risk taking leaders. 

 

Thankfully, AAMC also provided us with a conference chock-full of the “Rock Stars” of the national conscience.  Journalists Nikole Hannah-Jones and Ann Curry, educators and historians Ibram X. Kendi and Secretary of the Smithsonian Institute Lonnie Bunch, III, each in her or his own way challenged us to face reality head on and then act, every day in every way, to make concrete changes. 

 

But what to do to create change? Where do we engage?

 

 

If we think of racism as Stage 4 cancer, we would know what to do 

 

When educator and historian Ibram X. Kendi, was 37-years-old and writing his now iconic book, How to be an Antiracist(MCW’s Common Read this year), he was diagnosed with and battling Stage 4, widely metastatic colon cancer. 

 

Kendi is not only a national intellectual treasure, but a human face of race-based health disparities. Black Americans are 20% more likely to be diagnosed with cancer. Luckily, he is now disease-free, unlike Black Panther actor Chadwick Boseman, who died at 43 in August 2020 of  the same disease.  When compared to whites, Black men have a 40% higher death rate from this disease. Professor Kendi formulated the compelling analogy that racism in America is a Stage 4 metastatic cancer, sapping us of our vitality, threatening our lives, and stealing from us the future contributions of our greatest intellectuals and artists. But here is the silver lining: By widely sharing the particulars of his personal story, as well as his life’s work, Kendi allows us to imagine routing racism out of society for good.  

 

We in medicine know how to attack an aggressive disease, how to throw everything we have at it, to declare war on it. We know we must serve up the full commitment of intellectual, scientific, spiritual, and financial resources to prolong life and enhance quality of life while we search for a cure. This is important work, worth engaging in.  

 

But the cancer analogy doesn’t stop there. Kendi also provides guidance on how to create the “good life.” In an essay in The Atlantic, Kendi describes how the act of writing his book literally reduced his suffering and allowed him to put the physical and existential drama of his cancer battle in perspective. Work created a profound experience of well-being even during severe stress. This deep engagement with the act of work, what psychologist Mihaly Csikszentmihalyi calls “flow,” is a characteristic of “optimal” performance and profound well-being. In medicine, when we have such experiences, our work is purposeful and meaningful. 

 

 

Back to the AAMC

 

The meeting has been loaded with meaningful and important moments. Among the realities and takeaways: 

 

 

To make concrete, corrective, and transformative changes in medical education, we must:

 

 

Gratitude and commitment

 

I am now committed to a few, specific actions. This year, we must address equity in the medical school admissions process and we must redouble our efforts to transform the curriculum to both prepare future physicians for the challenges ahead and address the profound challenges to the well-being among our own. This will be hard work and we must face the realities and roadblocks head-on. If, we take on these challenges – in community – we will be rewarded with a sense of pride and thanksgiving for our courage to engage, take risks, and accomplish things that matter.

 

Many among us are profoundly fatigued from the pandemic and hope to feel a whisper of relief at this time of Thanksgiving. Let us take this time to be grateful for what we do have and for each other. Give thanks for and support to our colleagues who are engaged in the hard, hard work of patient care these days. Be grateful for the opportunities we have to change the future of medical education. 

 

Gratitude – and the opportunity to do meaningful, healing, and important work – is good for us all. Happy Thanksgiving.

 

 

 

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

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.

Kaleidoscope is Partnering with the Milwaukee Bucks to Offer a Virtual Session

From the 10/23/2020 newsletter

 

MCW Kaleidoscope Announcement

 

Kaleidoscope is Partnering with the Milwaukee Bucks to Offer a Virtual Session

Adrienne German

REGISTER HERE 

 

Kaleidoscope is back!  After an eight-month COVID-induced hiatus, this first program back looks to be terrific.  While Kaleidoscope events have typically used film as a mechanism to explore diversity, the virtual world allows for new ways to connect and reach a broader audience across all schools and campuses.

Tune in on Thursday, October 29, 2020 from noon – 1:00 p.m. CT for “Confronting Racial Injustice: The Change Begins with You.”  In this virtual session, members of the Bucks organization will discuss the bold decision that the Bucks players made to boycott their play-off game against the Orlando Magic this past summer to demand justice for Jacob Blake and action from the state legislature regarding police accountability. The discussion will be led by Arvind Gopalratnam, Vice President, Corporate Social Responsibility and Kareeda Chones-Aguam, Vice President, Partner Strategy and Management.  

Although not everyone has as large a platform as the Milwaukee Bucks, everyone can still have an impact.  The October 29^th session will align with MCW's mission to becoming an ant-racist institution and teach people how to become an ally/accomplice against racial and social injustice.

 

Adrienne German is the High School Outreach Coordinator for the MCW Office of Academic Affairs.

 

Editor:

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.

What to do when it is your turn [and it is always your turn]

From the 10/23/2020 newsletter

Director’s Corner

 

What to do when it is your turn [and it is always your turn]

 

 Adina Kalet, MD MPH

 

 This week Dr. Kalet celebrates our focus on women in medicine by reflecting on what it has meant to be an underrepresented “minority” in medicine and what to do when it is your turn …

  

 "Women belong in all places where decisions are being made. It shouldn't be that women are the exception."

-Justice Ruth Bader Ginsburg

"There's a special place in hell for women who don't help each other!

-Former Secretary of State Madeleine Albright

 

One of my favorite things to do at MCW is study the class pictures lining the hallways of the ground floor of the medical school building. From the earliest days of the 20^th Century, MCW and its predecessor institutions created photographs of graduating classes – not surprisingly, all white men for decades – year after year – generation after generation. Starting about a quarter of the way along the length of the hallway, a few clusters of white women begin to appear, often wearing the habits of religious orders. Further down the hall, the first Black face, a man, in a sea of white male faces with a smattering of white women. Eventually there are Black female faces. And so, it goes, making starkly obvious that acceptance for women and people of color into the ranks of physicians is a very recent, evolving, and slow phenomenon.

I care deeply about our continued progress, which makes me ask: What was it like for those first women pioneers? How much better did they need to be? How fiercely defiant were they of low expectations for academic achievement? How much effort did it take to resist the pressure to conform to gender role expectations – to be considered “good enough”?

 

Being a pioneer

Over the course of my career, I have learned a great deal about being the “only one.” Early on, I ran the gauntlet daily. I regularly dodged being backed up against the wall while on rounds or touched inappropriately in the OR by male residents and attendings – all in “good fun.” I knew I risked being dismissed as the “bitch” when I insisted that junior teammates be accountable to me as they discharged their patient care duties. Being the “only one,” meant remaining appropriately humble as I informed patients, family members, and colleagues that I “was the doctor” and I “was in charge,” not the very tall, much older (he was an MD/PhD) intern standing behind me. To his credit, he regularly reinforced my leadership!

Once patients accepted that I was the doctor they, as often as not, expressed relief and delight. I had many experiences where men from religious traditions with strict rules against being in a room alone with a non-family member woman came to accept and respect me, allowing me special status as a “healer.” It was remarkable how much being a woman in medicine was a “superpower” my male peers didn’t have.  I thrived in the environments where I could work at my full capacity, and benefited from many “affirmative action” programs, aimed at correcting gender inequities,  focused on giving me – based on my gender – a “leg up”; for example, opportunities such as the Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM®) program. I have worked my whole career to be surrounded by respectful, kind, and loving peers and mentors of all gender and racial identities. 

 

Being a pioneer, again

Daily experiences of frank gender-based discrimination and micro- and macro-aggressions faded into the background until I first joined institutional leadership in mid-career.

When I finally had the privilege of being invited into the “C-suite Boardroom” of a private academic health center, it became clear to me who was in charge. The decision-making tables with opportunities for real change were surrounded by men in gray suits and ties. After years of working collaboratively with women and men, I was again the only one. What I was wearing, how my hair looked, and the age of my then young children were considered acceptable small talk at the beginning of each meeting. I was made to feel self-conscious of my gender and relative youth. In the guise of “complements,” I felt “put in my place,” even by those I had considered role models. This could occur immediately before we were to talk about important issues of educational policy and practice in our department or medical school. After the meetings, my assignments might be stereotyped. For example, when a top performing women medical student (whom I did not know personally) had a body piercing that everyone else (not I) agreed could “upset” patients, the task of calling her in for a conversation fell to me.

I recovered my “voice” and, in relatively short order, there were a few other women invited to these tables. And it has made all the difference. As we diversified, discussions were more substantive, less contentious and less autocratic, more pragmatic, and more creative. Not because women uniquely possess different “ways of being” (although some of us do), but purely as an impact of diversity of points of view and life experience. Diverse leadership in institutions is better. Period. Not just right, but good for us all.  

 

How do we make progress?

Progress has been slow in academic medicine. At MCW, as it is at most other medical schools in the US, there is a problem.  While women have been 50+% of the medical students since 2019 and 43% of MCW faculty are women only 29% of full professors and 17% of chairs identify as female.  Of the traditionally impactful leadership positions (chairs, deans, and other executives), the large majority are men.

Nationally, there have been calls to impose medical school department chair term limits to open up leadership roles to more diverse pools of candidates. While the pipeline is hardy and full of talent, we are not, as of yet, experiencing the value of a fully diversified leadership roster.

Having women leaders, is more important now than ever. I am a fan-girl  of the young Prime Ministers Jacinda Ardern of New Zealand and Sanna Marin of Finland, each of whom has demonstrated leadership leading to lower COVID-19 case and death rates in their countries. They are known to encourage and listen to both dissenting and expert voices. Although each situation is unique and complicated, I say having women and other underrepresented groups at the table is a good thing and accelerates transformation.

 

Linking gender and racial equity

White women, as members of a gender minority with life experiences of bias and discrimination, but also as part of the racial/ethnic majority, are finally in the position to exercise some power. As a result, white women are now over-represented in efforts to address injustices, inequities, and the care of the vulnerable. For example, the leadership of a large, multi-institutional, foundation-funded program to mentor women and URiM early career scientists is overwhelmingly white (79%) and female (87%). This is typical of many such activities. I am not naïve; clearly, some white women (like their male counterparts) have demonstrated shameless entitlement, privilege, and racism.  We are not a monolith, but we do have collective power which we can use for good.

Change is coming. Through the efforts of MCW’s Center for the Advancement of Women in Science and Medicine (AWSM) under the leadership of Libby Ellinas, MD and the Council for Women’s Advocacy (CWA), much has been accomplished and much more needs to be done to achieve and cultivate a diverse and vibrant culture at MCW and elsewhere.

As I walk down the hallway of class pictures, I always say out loud to those pioneers “Thanks, sisters!” They helped to change the “face” of the profession. We must reflect on what they did – and what we must do – to continue the progress. We must be at the forefront, increasing the diversity and inclusiveness of our profession and institution. We must enlist everyone to assume responsibility and play a role to ensure continued transformation.

Our work is not yet done.

 

 

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

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.