Global Engagement Elicits the 3Cs

From the 12/4/2020 newsletter
 

Perspective 
 
 
Global Engagement Elicits the 3Cs
 
 
Stephen Hargarten, MD, MPH and Tifany Frazer, MPH – MCW Office of Global Health
 
 

In this essay, Dr. Hargarten and Ms. Frazer share how the missions of MCW, the Kern Institute, and the Office of Global Health overlap, and celebrate how students – taken outside of their normal cultural contexts to experience medical care in low- and middle-income countries – return with new appreciations for the value of competence, character, and caring in medicine …  
 
 
A MCW medical student recently reflected on a positive experience with a mentor: 
 

“We can easily forget we are treating a person and not just the disease. Despite feeling like we know best, we sometimes forget to include patients in the decision-making process. The doctor and patient collaborated to help develop their own healing systems outside from dependency on medications. Medications for chronic pain were replaced with relationships.”

As we celebrate MCW’s 10^th Annual Global Health Week, we are reminded that global engagement opportunities expose our students to new healthcare practices, build their character by challenging their personal beliefs, and stimulates the development of innovative solutions for patient care. As one trainee reflected, after observing that access to technology is restricted in low resourced settings, “You have to use and rely on your clinical skills and judgment. You likely become a better steward of resources, and arguably a better clinician.”
 
A report by the Lancet Global Independent Commission on “The Education of Health Professionals for the 21st Century” asked academic institutions to rethink professional education reforms in our century. It stated “the extraordinary pace of global change is stretching the knowledge, skills, and values of all health professionals.” The Commission called for “more agile and rapid adaptation of core competencies based on transnational, multi-professional perspectives to serve the needs of individuals and populations” and sought transformative education to develop leaders for the 21st century. 
 
The transformational gift of Robert D. and Patricia E. Kern validates the belief that the healthcare environment of the 21^st century is a global one, encompassing everything from engaging with researchers worldwide to providing clinical care in culturally diverse local communities. MCW trainees’ reflections following their global health research and clinical rotations are reviewed and demonstrate the following themes: perspective, awareness, ambivalence, and practice. A trainee reflected: 
 

"The list of health disparities I witnessed ultimately would take me hours to describe. As a physician, this experience forced me to alter my expectations and become more flexible in regards to medication compliance, progression of disease processes, and utilization of diagnostics and treatments given these limitations in resources." 

This student experience parallels the Kern Institute’s national movement and vision to transform medical education along the continuum. Engagement with diverse communities, whether local or international, reflects the current and future common realities of healthcare and humanity and what type of doctor is needed for the future. Another trainee reflected, 

 
“I am certain I have been impacted in more ways than I can truly describe. I know that as a physician and even more so as a human being I have been undeniably transformed."

 
Similar to the Kern Institute’s advancement of the Triple Aim of Health Care through its “Triple Aim for Medical Education,” faculty and staff active in global health efforts facilitate stronger connections to become caring, competent, and compassionate physician leaders committed to improving population health and enhancing patient outcomes, locally and globally. Our trainees benefit from experiences in low, middle, and high resourced settings, that compare and contrast health and health care in a variety of complex socioeconomic, political, and cultural environments. As the Kern Institute seeks to develop innovative models to optimize health system performance, physicians who are more comfortable “using a truly globalized approach (integrating therapies and treatment from a variety of resourced settings and cultures)” are more likely to improve health through enhanced care at a better value. 
 
Immersion in clinically and culturally diverse settings allows medical students and faculty to examine their preconceived notions of medicine and their roles as healers. The AAMC posted a story on their website indicating that “global health curriculum and electives provide lessons in patient advocacy, health equity, and humility.” A medical student quoted in the article reflected on a global health rotation in a low resource environment, “Working in this environment requires self-awareness, strength, and humility to accept and then overcome challenges to one’s way of being, thinking, and perceiving the world.” This parallels the Kern Institute’s expected outcome to cultivate physicians with the attributes of “fairness, honesty, kindness, leadership, and teamwork.”  
 
Most of the institutions collaborating in the Kern Institute are, with MCW, fellow members in the Consortium of Universities for Global Health (CUGH) including UW-Madison, Mayo, UCSF, Vanderbilt, and Dartmouth. Our connections to these institutions through CUGH would provide a ready-made platform for us to broaden the reach of Kern innovations, testing our ability to sustain and replicate these initiatives through a global health lens. 
 
As a medical student stated,
 

“As a future provider, this experience has expanded my character and ability to care for diverse patients in several ways. Foremost, it re-enforced that the basic principles of medical care are present across all cultures and peoples. Physicians have a responsibility to help alleviate physical and emotion suffering in all those that seek our care, and to do this, we must establish trust, and show empathy."

As the Kern Institute’s leadership continues to seek broad input on what this transformational gift can impact, we know that continued investment in global health-focused educational offerings is necessary for creating compassionate, caring, competent physician leaders with strong resilient character for the 21^st century.
  

Stephen Hargarten, MD MPH is a Professor of Emergency Medicine, Founding Director of the Comprehensive Injury Center, and Associate Dean of Global Health at MCW. 

 
Tifany Frazer, MPH is the Program Manager of the MCW Office of Global Health. 

Words for these times, a pandemic

From the 12/4/2020 issue


Poetry

Words for these times, a pandemic 

Julie Arthur



Could I write words for these times?
Arrange letters in some fashion
To make the distance bridged.
Writing is a powerful weapon, I am humanity’s soldier,
Words are an offering, a salve.


But nothing I write can unbreak my son’s literal broken heart.
Nothing I can write can sooth the figuratively shattered hearts I see on the floor all around me.


We are masked these days whether
we wear them or not,
and those masks hide the smiles
as well as the frowns, the fear
-that doesn’t just emote from the eyes you know-
and the recognition that these days, which are not for always, are at least for now.


I am not young nor old
And feel I should have wisdom to not feel so breathlessly scared every moment.
Steadfastness escapes me at every turn, I’m left chasing it, just as all are chasing answers
As to how things will end, how we’ll all get out
Of this ok.


These times are not for always.


Something I repeat as a hymn or a hum underneath the terror of the currents of my day.
An oar on this lonely lifeboat to white knuckle
And never let go of.
I wish I could give so many things to others,
Hope, or inspiration, or kindnesses,
Things to pack for the singular journeys we seem to all be on together.


Perhaps these words, these letters, can be
The salve then, used when the wounds are fresh,
When it’s night and things overwhelm,
To read and reread and in the silence to know:
I am there with you too.




Julie Arthur is an Education Program Coordinator II at MCW. “I have worked for MCW for almost 12 years, and have been writing poetry and fiction since first grade! I believe as much as medicine heals, words do too.”

Waiting in Lines

 From the 12/4/2020 newsletter

 
 
Waiting in Lines
 
 
Bruce H Campbell, MD – Transformational Times Editor
 
 
In recognition of MCW’s annual Global Health Week, Dr. Campbell shares some of what he has learned from his global humanitarian trips …
 
 

“At its best, medicine is a service much more than a science.”
- Paul Farmer, MD

Long lines form when the global health team show up. In El Salvador, people arrive in the backs of trucks and then wait hours for one of our provider groups to assess their stomach pains, headaches, or dental problems. The men, all in long pants despite the heat, talk while women in bright dresses tend the children. In rural Kenya, women in cotton print Kanga wraps and men in tattered clothes come from all directions by foot, bicycle, or “boda boda” (the ubiquitous motorcycle taxis), waiting on long benches in the equatorial sun. At the medical center in Eldoret, Kenya, the hallways adjacent to the ENT Clinic are packed with people wearing US-donated t-shirts bearing the names of sports teams, universities, and companies – shirts re-sold to them by roadside vendors.
 
There is no way we could ever operate on everyone who shows up. What could we possibly offer to so many people?
 
 “This is crazy!” I say to one of our hosts. “We’ll never get through them all.” During a typical workday at home, I see several patients, prepare Epic notes, check diagnoses and billing codes, click all of the boxes, and close the charts. If I am lucky, I can get through twenty people.
 
“We told them that the Americans would be here this week, so they showed up.” He shrugs. “No problem.”
 
The ENT Clinic in Eldoret, Kenya is an exercise in controlled bedlam. The handwritten records fall apart as I flip through them. The quality of the scans and ultrasounds remind me of those I saw in my training forty years ago. We jam two or three patients in the same exam room so the Kenyan and US doctors, nurses, and medical students can peer over one another’s shoulders; there is no HIPAA or pretense of privacy. Patients for whom we have something to offer nod and move to the nurse’s desk to schedule surgery. Patients for whom we have nothing nod and head home.
 
At the end of the day, I look down the hallway. There are still several people who have been waiting since early in the morning. “They’ll be back tomorrow,” says my Kenyan colleague. And they are.
 
I wonder how it feels to wait hours for an opportunity – maybe the only opportunity – to see a specialist and then be told to return the next day or, maybe, never at all.
 
My very first humanitarian trip was to El Salvador where we saw dozens of unfailingly gracious patients. At the very end of the final day, there were still many people outside the clinic. My wife, Kathi, who had dusted off her nursing skills for the trip, accompanied an interpreter to talk to those in line. “Lo siento (I’m sorry),” the interpreter said. “We can see no more patients. The doctors and nurses must return to San Salvador before dark and they will not be back until next year.”
 
“That’s all right,” one of the women responded as she shook Kathi’s hand. “Thank you for coming to help us. We will return next year, as well.”
 
The next day, as we waited in Houston for our connecting flight, Kathi told our traveling companions about her encounter with the grateful woman. While she was speaking, the gate agent announced that our flight to Milwaukee would be delayed several hours because of a major storm disrupting air traffic all along the eastern seaboard.  
 
“This is outrageous!” A sunburned man near us angrily strode to the counter and berated the agent. “My family and I are heading back from vacation in Mexico and I must be at work for very important meetings tomorrow morning. I demandthat you re-route us now! We will not wait!”
 
The gate agent, in a remarkable display of self-control, apologized and said there were no options; every airline had been affected by the storm. The man paced the waiting area, yelling into his cell phone and circling back to the counter at intervals to loudly register his displeasure. Finally, he announced that he and his family were heading to a hotel and that the airline had better cover his expenses. “You’ll be hearing from me!” Off he stormed, family in tow.
 
“What a contrast!” Kathi noted. “Imagine if the Salvadorans who waited had reacted that way.” We were not blind to the grinding poverty in El Salvador and had heard stories about the people’s lack of opportunity, safety, services, and health care (a process Paul Farmer terms “structural violence”), but every one of us noted how grateful and gracious the Salvadorans had been during our one-on-one interactions.
 
Later that evening, a plane arrived. It was a long day, but we did sleep in our own beds that night. 
 
As Paul Farmer notes in his book, Pathologies of Power: Health, Human Rights, and the New War on the Poor, 
 

“The voices, the faces, the suffering of the sick and the poor are all around us. Can we see and hear them? Well-defended against troubling incursions of doubt, we the privileged are precisely the people most at risk of remaining oblivious, since this kind of suffering is not central to our own experience.”

Each global health opportunity has allowed me to view life through a brighter, sharper lens. The lines are always long and colorful. My memory is filled with people, each one hoping that they will hear a word of hope and healing when their time of waiting is finally done.
 
 
 
 
Acknowledgement: Thanks to the MCW Moving Pens and to my wife, Kathi, for valuable advice. A previous version of this essay first appeared in my blog, Reflections in a Head Mirror, in 2017.
 
 
Bruce H Campbell, MD FACS is a Professor of in the Department of Otolaryngology & Communication Sciences and in the Institute of Health and Equity (Bioethics and Medical Humanities) at MCW. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for Transformation of Medical Education. He serves as Editor of the Transformational Times. 
 

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.

Fact: Malaria in pregnancy causes 200,000 stillbirths per year in Africa

A poem for Global Health Week

Fact:
Malaria in pregnancy causes 200,000 stillbirths per year in Africa 
 

 
As the shadow attaches to her toes
so the mother slings the still
born over her shoulder until night
when her birthed treasure is buried
with the others under the blankets.
At cock’s crow she presses the pink
of his unformed lips to her breast.
Soon the dead will have another
Birthday, and she will tell him stories.
 
 

Cameron Conaway
From “Malaria Poems” (Michigan State University Press, 2014)
 
 

Cameron Conaway is an adjunct professor in the Professional Communication Program at the University of California-San Francisco. He was the first poet-in-residence at Bangkok’s Mahidol Oxford Tropical Medicine Research Unit (MORU).
 
 

Post a Message of Gratitude on the MCW-Froedtert Skywalk

 From the 11/27/2020 newsletter

Thanksgiving, Kern Cookies, and Gratitude

From the 11/27/2020 newsletter

 

Director’s Corner

Thanksgiving, Kern Cookies, and Gratitude 

Adina Kalet, MD, MPH

This week Dr. Kalet waxes philosophical about Kern Cookies. 

As I write a Director’s Corner for this, our 35^th issue of the weekly Transformational Times, Drs. Alicia Pilarski and Kathlyn Fletcher have organized the distribution of Kern Institute Cookies to our colleagues and trainees who are working in our Milwaukee-based hospitals over the Thanksgiving holiday. As COVID-19 cases continue to surge, we do what we can to remind each other that we care. These cookies are a symbol of our gratitude for our colleagues, trainees, students, and friends’ service, commitment, and sense of duty.

 

Ah, cookies! Try not to smile – even if ironically – imagining handmade three-inch vanilla disks, covered in white royal icing, and decorated in pastel colors with delicately-penned, inspiring words and virtuous character traits: Thankful. Gratitude. Family. Blessed.

 

A local baker, Metcalfes Market Bakery, creates these works of art for us. Because of COVID, each cookie is in its own individual cellophane envelope, ostensibly ensuring everyone’s health and safety, but I think this makes them even more special and transportable. I hope our students and residents put a couple in their pockets and find them later (hopefully still edible!) when they least expect.  We hope their sweetness brings on the smiles and jokes that characterize doctor and nurse’s station camaraderie when the work seems endless and particularly difficult.

 

Kern Institute cookies have been a long-standing popular treat at MCW and we have continued distributing the cookies throughout the COVID-19 pandemic as a gesture of gratitude and to remind our colleagues that we are thinking of and caring about them.

 

We will also deliver some cookies to our generous benefactors at the Kern Family Foundation who have made the work of the Kern Institute possible. We understand that Mr. Robert D. Kern likes these cookies, and we hope to bring something delicious to him, his family, and friends on this strangest of Thanksgiving holidays.

 

I personally am deeply grateful to the foundation for believing and investing their resources and time in us. They have “put wind in our sails” and have made it possible for us to reimagine how we educate physicians. I hope that, in the many accumulated pages of our Transformational Times, we have given our readers a detailed and nuanced sense of how we are approaching this work.

 

There are many of you who, sadly, have yet to taste one of our fabulous cookies. For all of you – our MCW Leaders, those in Academic Affairs who keep the medical school on track, those in MCWAH that keep our residency training programs running, our fellow educators and staff at MCW-Central Wisconsin and MCW-Green Bay, to our students, residents and staff – we are profoundly grateful. We will be sure to have cookies on-hand and ready for you when we can gather again face-to-face.

 

While we all would love to be – and by rights, should be able to be – together this weekend, we will not travel or expose our loved ones to the highly infectious and potentially deadly virus. We will stay home because we want our hospitals and health care professionals to be there, ready, and able to care for those who will need it most. This self-sacrifice is lifesaving! We must all do our part.

 

But, self-sacrifice does not mean you can’t eat some cookies. Our thanks go out to every one of you. 

 

 

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.

 

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