Reflecting on medical school and residency

 From the 6/11/2021 newsletter

Perspective

Reflecting on medical school and residency

By Buba Marong, MD

Dr. Marong reflects on his journey of gratitude through MCW as a student and resident.  

It has been quite the journey, these past seven years. As I conclude what I considered to be the most meaningful endeavor of my adult life, I am filled with a range of emotions, but perhaps the sentiment that overshadows them all is GRATITUDE. I am eternally grateful for the opportunity and privilege to realize this childhood goal of mine in this faraway land. A land so far away from where I grew up, yet it never quite feels foreign to me. America always feels like home to me because I consider myself so lucky to have crossed paths with some amazing human beings; human beings whose impact on my growth - both personally and professionally – has been immeasurable. 

“Buba! Very nice to meet you.” That was how Jennifer Haluzak, then the admission coordinator at the Medical College of Wisconsin (MCW), greeted me during our first encounter when interviewing for a position in the Class of 2018. I usually remark that it doesn’t bother me at all when folks butcher my name, and I mean that. But there was something about how perfectly she pronounced my name that made me feel right at home. That sentiment of feeling right home would stay with me throughout medical school. I am painfully cognizant of race relations in America, and I must admit that I mentally prepared myself to tackle both the overt and covert issues in medical school and residency. Fortunately, it was preparation that I never needed, for all my interactions have been filled with genuine and mutual respectful curiosity and admiration. 

It should be no surprise then that residency selection was an easy choice for me. Medical College of Wisconsin Affiliated Hospitals (MCWAH) was my number one and only choice. I knew if I was willing to put in the work and time, I could garner the requisite skillset necessary to become the kind of physician that I knew I wanted to be. I was lucky to be surrounded by colleagues and educators who are just as passionate about their craft as I am. There is something special about the Internal Medicine residency class of 2021. As a function of my family obligations, I didn’t get to interact with folks that much outside of work, but there is an indescribable warmth about this class and an eagerness to be there for each other. I will greatly miss listening to Curren’s quiet wisdom, catching up with Kam in the hallways about family, and Matt giving me a hard time about that one award that he thought I stole from him.

When I look back at my residency, though, perhaps the turning point for me was formative feedback I received from my favorite attending and mentor, Dr. Jayshil Patel. I had solicited feedback at the end of a rotation, and he told me to be “comfortable with being uncomfortable.” He went on to elaborate that true growth only comes about through putting oneself through intellectually uncomfortable situations. I took that to heart and read the entire Annals of Internal Medicine Clinic Series (for example) to shore up my foundational knowledge. I re-read basic biochemistry again (at least the components with pertinent clinical applicability). I was appreciative of that formative feedback. At the time, I didn’t understand it as being “called out” for becoming complacent, and there was a reason for that, which brings me to my final point and a challenge to all my fellow educators. 

Giving trainees formative feedback should be considered a privilege. A privilege that is only earned after establishing with said trainee that you genuinely care for their personal and professional growth. Take some time to get to know your trainees. What drives them to do what they do? What are their biggest fears? What makes them happy and/or sad? Have they lost someone close to them recently or in the past? Is their family doing okay?  I am fervent believer that if the very first time that you have any meaningful non-work-related conversation with a trainee is to give them feedback, the chance that those tips will land on a receptive ear is slim to none. Instead, the sentiment you expressed will merely serve as a fodder for venting to the next willing listener that the trainee can find. 

To the graduating class of 2021, I challenge you all (myself included) to please use your new-found status and privilege in society for the common good.  Start with the simple things: Be the best friend, partner, son, daughter, parent that you can be and let your north star always be DOING THE RIGHT THING! 

Buba Marong, MD is a PGY3 Internal Medicine resident at MCW. He founded the Marong Health Group with the goal of establishing quality and affordable primary health care clinics in Gambia.  He will be practicing hospital medicine in the Milwaukee area.

Reflection on Residency and the ACGME during a Pandemic

 From the 6/11/2021 newsletter

Take 3 with Eric Holmboe, MD

 

 

Reflection on Residency and the ACGME during a Pandemic

 

 

Eric Holmboe, MD, MACP, FRCP-Chief Research, Milestone Development, and Evaluation Officer, Accreditation Council for Graduate Medical Education (ACGME)

 

 

 

Dr. Holmboe, a leader in graduate medical education, describes an important lesson he learned during training, covers what the ACGME has done to adapt to the pandemic, and gives this year’s graduates some sage advice. He was interviewed by Transformational Times editor, Kathlyn Fletcher, MD MA.

 

 

 

Transformational Times: Tell me a story about something that occurred during residency that was influenced the development of your character as a doctor and a person.   

Dr. Holmboe: One moment that stands out is from my chief residency.  The chief of service at the West Haven VA was Asghar Rastegar.  One day he asked me how the year was going.  I told him that it was great but that I always felt as though I didn’t know enough.  He leaned back in his chair and said, “Eric, I hope you never stop feeling that way.”  I realized then that Asghar was the epitome of that kind of doctor.  He role modeled that desire to always be learning and was explicit about how important it was.  He said “I don’t know” when he didn’t know.  He was a co-learner with others, even though he was brilliant.  I realize now that those are the people that I admire the most.  They are humble and quiet and always learning.  

 

Transformational Times: What do you think was the most important role the ACGME played during the past year?  Was that something you (as a group) explicitly decided?

Dr. Holmboe: The ACGME made an explicit decision to be flexible and to respond quickly as the pandemic unfolded.  We wanted to provide programs with relief and give them flexibility to do what they needed to do, but we also wanted to hold firm on things like duty hours.  We created first a tiered pandemic status, then revised the program to an “emergency status” so institutions could have sufficient flexibility to meet the demands of COVID surges in their communities, including moving residents and fellows around to help with the evolving patient care needs. 

A specific intervention that proved to be very helpful was setting up routine national DIO (designated institutional official) calls by our Sponsoring Institution team to provide the DIOs with information and also to get input and feedback from them about what was happening on the ground.   We also quickly put together a supplemental survey for the annual update so that we could better understand what was happening around teaching and the health impacts of the pandemic.  It was good that we did all that work in the spring because the winter surge was so much worse.

We also routinely asked ourselves, “How can we be more helpful?”  We tried to be deliberate and proactive. For example, we moved our faculty development assessment courses from in-person to online and also made the courses free.  In the end, we know that the GME community made many sacrifices, including residents and faculty that got sick, and some that died.  One faculty member from Geisinger contracted COVID19, was on ECMO and ultimately needed a double lung transplant.  His story can be seen in this public service announcement, encouraging people to get vaccinated.  The ACGME recognizes the loss and sacrifice that occurred in our community.  

 

Transformational Times: What words of wisdom would you share with the residents who are graduating this month?

Dr. Holmboe: Remain curious.  Take care of yourself (I didn’t do it as well).  I do try to avoid nostalgialitis imperfecta profunda (the “profoundly imperfect recollection of or yearning for the past”).  I loved my training but would not repeat it. 

Stay involved.  Your generation has already been amazing in this regard.  Continue with your advocacy for yourselves and others. 

Humility is really important.  Medicine suffers from arrogance.  You are a member of a team, an interprofessional team.  You are not the most important person on a team – the patient and family are and remember they are also part of the team. 

Always remain patient- and family-centered.  Think about your community, outside the hospital walls.  Your goal is to positively impact the lives of others through service.

Co-produce your work; co-produce your assessments; co-create learning. 

 

Small moments of human connection make all the difference

 From the 6/11/2021 newsletter

Perspective

 

Small moments of human connection make all the difference

 

By J. Daren Covington, DO

 

Dr. Covington reflects on the moments of empathy and connection that make a difference for patients.

 

As someone who has been on all sides of medicine as a patient, as a father, and as a physician I’ve tried my best to bring all my life experiences to the table when taking care of my patients. Some of the most meaningful and impactful moments during residency have been during my time in labor and delivery (L&D). A vast majority of these patients are young, healthy women presenting for normal labor pain and might be the very first time they are in the hospital for any reason at all. Several patients that I’ve interacted with were very defensive because of either poor past experiences with medical personnel, horror stories from the internet, and/or other physical or mental abuse and trauma. There have been times when I felt the medical staff in general have judged the patient harshly during their care because of something the patient has said or done upon arrival.  I try to put myself in the patient’s shoes and remember that the patients are doing the best that they can under the circumstances while still trusting in us to provide the best medical care possible.

A recent experience illustrated how we can build connections by being present for patients.  There was a young lady who was being “difficult,” but after sitting down, talking calmly, and really taking the extra minute or two to connect with her, she really opened up and allowed me to help alleviate her pain. She told me that she was just feeling “pushed around and not heard.”

Time and time again I’ve had these experiences on L&D, and they have really shaped my interactions with these young, laboring patients. It quickly became apparent that these small connections I was making in the beginning of our conversations were going much further than I realized.  These connections allowed not only Anesthesia to provide care, but also laid the groundwork to improve all aspects of care, from the obstetrician to the nursing staff. It’s adding the human element that really brings this together and makes each and every interaction a purposeful and meaningful experience for me. I hope that I can impart this insight to future medical students, residents, and staff wherever I go to improve obstetrical care and anesthetic care everywhere.

 

 

Dr. Covington is finishing his anesthesiology residency and will be staff at the University of Pittsburgh Medical Center NorthWest Hospital in Seneca, PA upon graduation.

The Experience That Changed My Perspective on Everything

From the 6/11/2021 newsletter

Perspective/Opinion

The Experience That Changed My Perspective on Everything

Kaitlin Kirkpatrick, MD

Dr. Kirkpatrick writes movingly on how experiencing her own illness had a profound influence on how she sees others who suffer...

Four years of medical school, 2.5 years of residency under my belt, I entered spring of my 3rd year of residency as a confident and competent senior resident. I knew how to manage my inpatient team: which tests and procedures we needed to order right away, how to triage pages from nurses, and how much time we could allot to each patient we rounded - the essentials that kept us efficient and on top of our workload. Then one day I got sick, and everything changed.

Catching a variety of illnesses in residency seems to just come as part of the job, especially when you spend time in the pediatric emergency room. I remember when norovirus wiped out my team intern year, and I’ve had so many mild URIs over the years that I’ve lost count. That’s why when I started feeling ill one weekend, I felt guilty calling in the jeopardy resident but figured it would be quick. What I didn’t expect was to be barely conscious in the Moorland Reserve emergency room with blood pressures in the 70s/40s and the ER staff arguing about whether to start pressors now or let the ambulance take me straight to Froedtert’s surgical ICU.

The following days were a blur of overwhelming exhaustion, confusion, and fear, especially for my husband hearing words like “portal venous gas” and “likely sepsis” with little explanation of what it all meant. My memories come more in flashes. I recall crying when they told me they wanted to get an arterial blood gas. I remembered patients complaining of how much they hurt, but that had never stopped me from ordering them in the past. I've ordered so many nasogastric (NG) tubes during residency, that when they warned me that they were placing one on me, I assumed, “Okay, this can’t be that bad.” I was wrong. I was so tangled up in wires from my central line, a separate peripheral IV, telemetry wires, and a Foley. All of that was tolerable. 

The NG tube was not.

I suddenly became the patient that I used to dread. The surgical nurse practitioner came by and told me that we’d probably be able to take the NG tube out that day, but she had to run it past the attending first (a line I’ve used many times with my patients). Waiting for the attending doesn’t feel as easy when you’re the patient. Finally after telling the nurse I’d pull it out myself, she helped me remove it. For the first time that admission, I started to feel like things might be getting better. It was still another couple of days in the ICU consisting of sleep, echocardiograms, CT scans, more sleep, antibiotics/antifungals, the occasional pathetic walk around the unit, and more sleep before I finally got to transfer to the acute care floor. A few days after that I was able to discharge home, but it wasn’t until we picked up my 9-month-old son from his grandparents and made it back to the safety of our own home that I finally cried and began to process everything I endured. 

I still know the tests and procedures to order on my own patients, but now I’ve started to ask a little more often, “How badly do I need this test?” When my patient has something like an NG tube, I am much more conscientious about when it can come out. Will poking this patient for a lab really change what I’m doing or am I just ordering these tests out of routine? If the nurse is paging me, I try to be quicker to respond unless I truly am in the middle of an emergency. I understand now more how much they really are trying to advocate for their patients. Even now, I spend just a little more time at a patient’s bedside talking to them, to their family, trying to make a little bit of their hospitalization better, because I remember what it was like to be on the other side. 

I’m not the same physician I was prior to this experience, but I’d like to think that I am better than I was before. I do more critical thinking about testing and procedures, I try to be a more involved team player with my support staff. And most importantly, I’m more empathetic towards my patients and their families. I also try to make more time to take care of myself. Sometimes the mental healing takes longer than the physical. I’m lucky my husband and my residency program always supported me in finding the psychological support I needed to recover. I can’t say I’m thankful for having gone through it all, but I am grateful for the doctor it helped me become - the doctor I will continue to be as I graduate from residency this year and begin the next phase of my career. 

Kaitlin Kirkpatrick, MD, is a PGY4 Internal Medicine-Pediatrics resident.

Welcoming the Kern Institute’s Inaugural Medical Education Transformation Collaboratories!

 From the 6/4/2021 newsletter

Director's Corner

Welcoming the Kern Institute’s Inaugural Medical Education Transformation Collaboratories! 

Adina Kalet, MD, MPH 

The word “collaboratory,” a mash-up between “collaboration” and “laboratory,” was originally coined in the 1980’s with the ascendence of the internet and emergence of collaboration software (think Google docs). Cogburn (2003) who states that “a collaboratory … is a new networked organizational form that also includes social processes; collaboration techniques; formal and informal communication; and agreement on norms, principles, values, and rules.” It has come to describe an open space, creative process where a group of people work together - in real-time, often virtually - to generate solutions to complex problems. And there is no doubt that transforming medical education is one such “thorny problem” deserving this kind of focused attention …

The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education at the Medical College of Wisconsin is proud to announce our first cohort of Medical Education Transformation Collaboratories. These seven groups listed below represent cross-institutional, multi- and inter-disciplinary, multiple stakeholder communities of practice that will work together in a sustained effort around a shared project to transform medical education by engaging in both innovation and scholarship. Each of the funded collaboratories was selected after a highly competitive merit review process (See below for the list of reviewers). This group includes forty-five individuals from an array of academic disciplines plus a community representative, affiliated with twenty-two health professions education institutions, including medical and nursing schools in many regions of the United States and Canada. Four of the seven include an MCW partner! Members of these collaboratories will meet together in July 2021 and Winter 2022, as well as having regular subgroups meet throughout the year to share progress and resources, address challenges, plan for knowledge dissemination, and learn together. We will implement a process to determine eligibility for a second year of funding. They will update their progress regularly in the Transformational Times.

I learned early on that true collaboration is very challenging and worth doing

In 2005, I found myself co-principal investigator on a medical education research project funded by the National Science Foundation. By this time, I had already participated in a number of large scale multi-institutional collaborations among (only) medical educators, and I thought I knew what it meant to effectively collaborate. Boy, was I was wrong! My co-PIs on the WISE MD project, included a world class computer scientist (CS) from West Germany, an educational psychologist who led a lab exploring the use of technology in K-12 STEM education who was born in East Germany. Our project was focused on building a distributed network information system (with technology originally designed for the pornography “industry”) which would enable both delivering and studying the impact of a rich multimedia core surgery clerkship curriculum. Our team included CS and education graduate students from Korea, Turkey, and Israel, a MD/PhD in Medical Education from Canada, two fine artists (one Russian and one from New Jersey with a culture all its own), a British qualitative informatician (yes, that is a thing), a mostly US-based team of videographers and multimedia editors, surgery clerkship directors from seven medical schools from across the country, and advisory groups from the American College of Surgeons and the Association of Surgical Educators. 

Leading this project required that I danced as fast as I could. Although we were all fluent in English (at least the non-US born members were!), when we began, our team did not share a common scientific language (e.g., clinical surgery, medical education, computer science, learning science, technology, fine art, video production) or a common set of assumptions about what constituted education, learning, or successful research. We had widely divergent approaches to knowledge management (e.g., What do we name and where do we keep our shared documents? What are those funny formulas and code snippets? How the heck do we write about our work together?), or what it meant to do research and disseminate it (e.g., Do we meet in person? Teleconference? Email? IM? Use Slack? Write blogs, proceedings, or papers?). Oh, and we didn’t all sit in the same location. Some of us were one mile apart (which in Manhattan, could mean an hour commute), or across the country or overseas.

It was a remote Tower of Babel for the first year. It was also endlessly fascinating - interpersonally, culturally, politically, intellectually. Technology helped, but it was our commitment to spending the time to get to know each other as people, to have the patience to listen to all points of view before making decisions, define terms, write glossaries, and to tryand-fail, try-and-fail, and try-and-fail, that made this the most impactful project any of us have ever worked on. 

Despite going well down many blind alleys and surviving a good number of tense culture clashes, we figured it out. We had to, because we were accountable to our funders and each other to do innovative and creative work. In the end and as a team, we successfully garnered R01 funding from the NIH to conduct a randomized controlled trial to study WISE MD outcomes (WISE Trial). And consequently, the WISE MD program was one of the first rigorously studied, widely distributed digital medical education curricula in the world. This sparked building of many such curricula in wide use today. Whew! As they say, what doesn’t kill you makes you stronger. 

What it will take to transform medical education

Despite knowing how very difficult it was, the WISE Trial experience is why I believe that the key to transforming medical education will require a large number of intentional, and savvy collaborations across diverse groups of stake holders. While it is much easier to work with a group of like-minded people with whom you share a culture, background, and values, these small-scale projects are less likely to produce sustained meaningful change. It is just true. When you step far outside your comfort zone the risks are higher but so are the potential benefits.

The specific outcomes of the WISE Trial (which was a negative randomized controlled trial, by the way) were diverse and unexpected. We demonstrated the importance of context (Ellaway) and the difficulty conducing intra-institutional work (Sarpel). In addition, there were many sustained research, innovation and business collaborations that resulted. But, most important to me, were the close, life-long, intellectually stimulating relationships across a wide range of academic disciplines, world views, and working styles that developed. These colleagues keep me honest and brave enough to question assumptions. I learned to keep trying and failing until something wonderful happens. 

Why we need to transform medical education now 

We must take advantage of the available pedagogical principles and educational research to move the training of physicians from a 20th century to a 21st century model. Technology is irrevocably altering the practice of medicine. Artificial intelligence and robotics are disruptive. It is essential that our trainees need to engage with the technology and know both how to think and what to think about. 

In the US, despite having the most expensive health care system in the world, our health outcomes are poor. There is an unconscionable maldistribution of physicians - both in specially and geography - such that a great many of our citizens do not have access to or are able to afford basic medical care. There are many problems to address that we are not well prepared to address at this moment. It is time to pivot. We need to do this together, in collaboration. 

Collaboratory Titles, Descriptions, and Members

Here are the seven newly launched collaboratories:

Laying a Strong Foundation: How Do Medical Schools with and without Learning Communities Promote Character, Caring and Professional Identity Formation During Students' Pre-Clerkship Years? 

Team Lead: David Hatem, University of Massachusetts Medical School

Description: 
This project will “develop a greater understanding of the phenomenon of PIF as experienced by medical students early in their medical education” by including the voice of medical students and the role that organizational frameworks play in promoting PIF. 

Collaborators: 
Jennifer Quaintance, University of Missouri Kansas City
Marjorie Dean Wenrich, University of Washington
William Agbor-Baiyee, Chicago Medical School at Rosalind Franklin University
Mrinalini Kulkarni-Date, University of Texas/ Austin-Dell Medical School
Megan A McVancel, University of Iowa/Carver College of Medicine
Alejandro Moreno, University of Texas/ Austin-Dell Medical School
Thuy Lam Ngo, Johns Hopkins School of Medicine
Kurt Pfeifer, Medical College of Wisconsin
Elizabeth Yakes, Vanderbilt University School of Medicine

The Data Science of Character 

Team Lead: Debra Klamen, Southern Illinois University School of Medicine

Description: 
This project will establish a multifaceted, multi-level definition of character, a corresponding collection of behavioral measures of character, and draft a set of recommendations for cultivating character at the at the individual and institutional level.

Collaborators: 
Anna Cianciolo, Southern Illinois University School of Medicine
Collin Hitt, Southern Illinois University School of Medicine
John Mellinger, Southern Illinois University School of Medicine
Bridget O'Brien, UCSF
Robert Treat, Medical College of Wisconsin
Crystal Wilson, Southern Illinois University School of Medicine

Educating Educators to Serve as Change Agents through Professional Identify Formation 

Team Lead: William T Branch, Jr, Emory University

Description:
This project will create, implement, and evaluate a new longitudinal curriculum for interprofessional healthcare leaders based on five content areas associated with higher-order professional development and education leadership among faculty participants.

Collaborators:
Corrine Abraham, Emory University
Richard M. Frankel, Indiana University School of Medicine
Debra K Litzelman, Indiana University School of Medicine
Calvin Chou, University of California, San Francisco
Elizabeth A Rider, Harvard Medical School

NYU-UCSF Collaboratory to Advance URiM Faculty in Academic Medicine 

Team Lead: Richard E. Greene, NYU Grossman School of Medicine

Description:
This project will examine the impact and outcomes of a Faculty Leadership Development Program (FLDP) designed for junior faculty who are underrepresented in medicine (URiM) developed using a novel theory-based framework.

Collaborators:
Sarah Schaeffer, UCSF School of Medicine
Tiffany E. Cook, NYU Grossman School of Medicine
Joseph Ravenell, NYU Grossman School of Medicine
Walter Parrish, NYU Grossman School of Medicine
Sonille Liburd, NYU Grossman School of Medicine

Characterizing Cultures of Mattering in Health Care Education 

Team Lead: Julie Haizlip, UVA School of Nursing & Medicine

Description:
This project will learn how nursing and medical students matter, defined as adding value and feeling valued, in their learning environments. 

Collaborators: 
Natalie May, UVA School of Nursing & Medicine
Karen Marcdante, Medical College of Wisconsin
Caitlin Patten, Medical College of Wisconsin
Rana Higgins, Medical College of Wisconsin

Creating a Collaboratory to Map Medical Education’s Blind Spots 

Team Lead: Sean Tackett, Johns Hopkins Bayview Medical Center

Description:
This project will help the medical education community see its blind spots with clarity, identify structures and barriers that prevent progress, and define strategies to address blind spots.

Collaborators:
Scott Wright, Johns Hopkins Bayview Medical Center
Cynthia Whitehead, Wilson Centre
Yvonne Steinert, McGill
Darcy Reed, Mayo

A Model for Integration of Clinical Performance Measures into Residency Training Programs (Policy Paper) 

Team Lead: Abby Schuh, Medical College of Wisconsin

Description:
This project will address policy related to the challenges of linking educational innovations with clinical outcome measures through the use of meaningful clinical performance measures, harnessing the potential of the electronic health records to capture these data, as well as bridging the silos of medical education and health care quality improvement.

Collaborators:
Dan Schumacher, Cincinnati Children's Hospital Medical Center
Alina Smirnova, University of Calgary
Saad Chahine, Queens University

For further reading:

Ellaway, R. H., Pusic, M., Yavner, S., & Kalet, A. L. (2014). Context matters: emergent variability in an effectiveness trial of online teaching modules. Medical Education, 48(4), 386-396.

Sarpel, U., Hopkins, M., More, F., Yavner, S., Pusic, M., Nick, M., ... & Kalet, A. (2013). Medical students as human subjects in educational research. Medical Education Online, 18(1), 19524.

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 Healer’s Art Course: Preparing M1 Students for What Lies Ahead

From the 6/4/2021 newsletter

Perspective/Opinion

The Healer’s Art Course: Preparing M1 Students for What Lies Ahead

Julie Owen, MD

Dr. Owen, who co-directs MCW’s M1 Healer’s Art Course, describes the value of having students address wholeness, grief and loss, awe and mystery, and service as a way of life early in their medical school careers. She also talks about how important it was when an empathetic physician “bore witness” to grief and uncertainty in her own life …

“The core tasks… are helping the patient acknowledge, bear, and put into perspective feelings and painful life experiences.”

- Glen Gabbard, MD (Gabbard’s Treatments of Psychiatric Disorders, 2007) speaking about Elvin Semrad, MD, renowned psychiatrist at the Massachusetts Mental Health Center in Boston from 1956-1976, one of the nation’s oldest psychiatric hospitals

By the time I entered medical school, I had built an almost decade-long career as a professional actor, performing in regional musical theatre productions around the country after completing my undergraduate degrees. By the time I entered medical school, my professional identity had been firmly established as an “artist,” and transitioning to medicine precipitated a bit of an identity crisis. I happily discovered and immersed myself in the invaluable MCW Medical Humanities Program, recently described by Art Derse, MD, JD, in the Kern Institute’s Transformational Times. A prominent component of this program is the Healer’s Art elective course, introduced to MCW in 2007 by Dr. Derse and Julia Uihlein, MA.

The Healer’s Art curriculum was designed by Rachel Remen, MD, and the course was first taught at the University of California-San Francisco (UCSF) in 1992. Since 1992, it has been offered annually as a fifteen-hour elective, and its reach has expanded to over 100 medical schools across the country. It is currently offered at all three MCW campuses.

The Healer’s Art curriculum was designed as an antidote to physician (and medical student) burnout. As Bruce Campbell, MD, noted recently, a significant body of literature has demonstrated that empathy in medical students precipitously declines throughout the duration of their medical education. After medical school and training is complete, physicians not infrequently leave the practice of medicine, unable to maintain a sense of meaning, personal/professional satisfaction, and commitment to the profession. 

Topics explored during the Healer’s Art 

The topics covered in depth by the Healer’s Art course include maintaining one’s wholeness, grief and loss, awe and mystery, and service as a way of life. Faculty physicians gather with M1 students in a “Discovery Model,” process-based curriculum, in which the mutual sharing of personal experiences and beliefs create a unique professional support system and a safe space of “harmlessness” to explore these fundamental principles of life and of healing. 

One of the core principles of the course is the concept of generous listening. Our medical education teaches us to listen analytically, to ask questions that will allow us to generate a differential diagnosis. Dr. Remen emphasizes that generous listening is practiced not to diagnose, evaluate, fix, or even to understand the speaker; rather, it is the practice of listening only to know what is true for another person and to bear witness to that moment. 

As a psychiatrist, this brings to mind Dr. Semrad’s characterization of our work with patients — to acknowledge, bear, and put into perspective the (often painful) experiences of our patients. When I hear medical students remark that they feel they have little to offer patients, especially in their most vulnerable moments, I hope educational experiences like the Healer’s Art illustrate and nurture the tremendous power we all have as healers, no matter our level of training or practice, simply when we are present with the patient.

My own family’s experience with an artful healer

My husband and I recently “celebrated” the five-year anniversary of his cancer diagnosis and treatment initiation. As an M3, he was diagnosed with a large right frontal lobe tumor, a grade II-III oligodendroglioma, after he had a grand mal seizure during the last day of his surgery clerkship rotation (he fondly recalls that day as “going out with a bang”). His neurologist called us into his office during the lunch hour the day after he had his MRI, the final piece of his outpatient seizure work-up. I remember walking into Froedtert Hospital from the parking garage thinking, “This is one of those life-changing days… and I will never feel this way (read: blissfully ignorant) again.” 

During one of the moments seared into my memory, I am sitting with my husband hearing the news we feared most, and his neurologist is sitting silently with us, tears in his eyes, as we took it all in. Bearing witness. Acknowledging our pain. That moment, more than any other from that whirlwind time period, is forever imprinted in my brain; this physician showed his compassion and his humanity merely by giving us the gift of his quiet. These are the superpowers of a true healer… ones we all possess, if we have the courage to use them.

Julie Owen, MD is an Assistant Professor in the Department of Psychiatry and Behavioral Medicine at MCW. She codirects the M1 Healer’s Art course. 

The MCW Healer’s Art course runs each year over five Wednesday evenings during January through March. Faculty who would like to discuss volunteering as facilitators can contact Dr. Owen through her MCW email address. 

“Proceduralists” Do Care!

From the 6/4/2021 newsletter

Perspective/Opinion

“Proceduralists” Do Care!

Harvey Woehlck, MD - Professor, Department of Anesthesiology

Dr. Woehlck reminds us that doctors whose main task is to perform procedures can break from their molds and have fulfilling roles as caring physicians, as well …

What does a caring academic proceduralist look like in today’s modern medical environment?  

We can imagine that the modern proceduralist descended from the surgeon of ancient times.  In the second century, the expression of “laudable pus” was a common procedure which, of course, required incision.  [Excuse the digression, but laudable pus was staph-related and often survivable with incision and drainage as the only treatment, as opposed to what we now call necrotizing fasciitis, which was uniformly fatal at the time.]  Amputations were described a century earlier, where lack of anesthetics required the proceduralist to be as fast as possible. 

in that era, caring may not have been a meaningful virtue; completing the amputation – and allowing the patient to survive – was meaningful.  Unfortunately, this may have selected for what we could today call a psychopathic trait in proceduralists of the preanesthetic era.  Just how could you have empathy when the goal was to amputate as quickly as possible?  

Nitrous oxide was synthesized in 1772, but was mostly used as a party curiosity, not for procedural pain relief.  Anesthetics like ether gradually increased in use from the 1840s to the present day, but “modern” pain relief is something we would recognize only in the twentieth century.  Prior to the era of anesthetics, lay literature, newspaper accounts, and battlefront stories from numerous wars and conflicts described eager but cruel doctors sliding down the slippery slope of brutality themselves, amputating, when possible, on the most minor of injuries as if to draw the biggest possible crowd as part of a spectacle. 

Flash forward to the present.  With a history like that, what does a caring academic proceduralist look like in today’s modern medical environment?  

High-tech procedural platforms require numerous people for support.  Housekeeping, instrument processing, lab services, anesthesia services, proceduralists and assistants, nurses, technicians, and more are part of the team.  Let’s not kid ourselves. All of these people and resources need to work together. They are expensive to operate and maintain.  We need to be mindful of RVUs created, payer mix, and the effect on dollars generated, turnaround times, expense units utilized (which includes choice of drugs and equipment). You wind up with a dizzying array of competing factors.  Add to that teaching of students, residents, fellows, and it’s amazing that we’re not reduced to robotic, unemotional, protocolized efficient machines in an environment devoid of empathy focusing on getting patients in and out faster and cheaper. Without efficiency, modern infrastructure could not exist.

And then, there’s caring and the patient’s best interests.  

Many people equate a caring physician with a good bedside manner. While that is important, some might argue that caring is secondary if the patient is asleep or sedated for the most critical part of one’s procedural interaction. As an anesthesiologist, the life-or-death part of most interactions with a patient occur when the patient is unaware. Stolid efficiency might be supportive of the infrastructure that allows us to provide an optimal level of care by today’s standards, but it doesn’t end there.  

The epitome of proceduralism transcends efficiency and a low complication rate. But it differs for patients receiving their definitive procedure versus those at the beginning of their diagnostic journey.  

What about the lost patient, trying to find the mountain pass to Erewhon?  I’d argue many nontraditional opportunities exist for caring, some of which could be hard to explain.  And notice that I used the word “argue” in there.  People who know me personally know that I am frequently contrary and argue a lot.  I pride myself on being one of those “competing factors.”  

Let me exemplify:

As a proceduralist – an anesthesiologist – I recently had a patient with a mundane problem having a common procedure, and I was part of the anesthesia team.  This is what Kikuko Tsumura might call an “easy job” for me.  Or what I imagine the late economic anthropologist David Graeber might have berated as a job where any interchangeable person with minimal competence sufficed.  

But I noticed the patient had multiple co-morbidities that didn’t substantially alter anesthetic care. Those anomalies happened to fit a pattern for a diagnosis that was neither listed nor treated by any of the dozen qualified healthcare providers he had seen in the prior six months. In addition to performing the dull, boring anesthetic, I took it upon myself to arrange some screening tests for this potential undiagnosed problem that would tie together the co-morbidities into a single diagnosis and change treatment 180 degrees.  

The test came back positive for what the textbooks call a “rare disease.”  After a referral and more procedures, the patient thanked me for figuring out, and finally solving, the underlying issue that caused years of suffering and, untreated, would have taken decades off of his life.

Why didn’t others find the problem?  Did we unknowingly allow ourselves to wear the mask of tunnel vision and be compartmentalized into that mechanical state of efficiency?  Was it production pressure?  Protocols?  A nebulous bureaucratic expectation that we maintain our defined roles?  

Many opportunities existed to look the other way and perform only up to minimum acceptable standards.  Breaking from this mold is what I call caring.  I am sure nobody would have noticed the difference had I only done the minimum.  For some, caring could mean providing emotional comfort, but for others, it may mean taking the extra time to solve a problem, even if it opens the uncomfortable door of crossing boundaries of specialties or roles, or advocating for the rare and unpopular.  

Tsumura might summarize this approach by arguing that caring encompasses the dignity of work.  Or becoming more invested and engaged as the job becomes increasingly routine or trivial, extracting from context nuances that defy description.

For me, in my procedural world of the unaware, caring transcends the routine and encompasses the intangible.

For further reading:

Kikuko Tsumura. There’s No Such Thing as an Easy Job. Bloomsburg Publishing, 2020.   ISBN: 9781526622242 To find the book, click this link.

David Graeber. Bullshit Jobs: A Theory. Simon & Schuster. 2018. ISBN: 9781501143342 To find the book, click this link. 

Harvey Woehlck, MD is a Professor of in the Department of Anesthesiology at MCW. In addition to multiple educational, clinical, and administrative responsibilities, Dr. Woehlck is an accomplished concert pianist. 

Poppies on the Grave – Symbolism and Memorial Day

 From the 5/28/2021 - Memorial Day - newsletter

Perspective

Poppies on the Grave – Symbolism and Memorial Day

By Capt. Tej Ishaan Mehta MD - United States Air Force Medical Corps and Internal Medicine Resident Physician

Dr. Mehta reminds us why Memorial Day is such a unique holiday and how commemorating all fallen military personnel can bring us together as one nation…

One-million, three-hundred and four thousand, six hundred and eighty-four. At the time of writing, that is how many United States military personnel have perished in in the line of duty. How many mothers have wept at the sight of Death Notifiers walking to their door? How many fathers have broken down upon receiving that terrible phone call? How many lives have been ruined by the loss of a loved one in service to our country? How many lives have been saved? This Memorial Day, I urge you to consider these questions.

Memorial Day is unique amongst American holidays. All other major American holidays are marked by celebration, but Memorial Day is marked by mourning, by remembering the fallen. Memorial Day honors and mourns the United States military personnel who died in the performance of their duties. The establishment of Memorial Day is complex and uncertain, but general trends are clear. After the end of the Civil War, citizens across the United States recognized the importance of honoring those who had fallen in combat. With the death of Abraham Lincoln in 1865, commemorations were widespread. The National Cemetery System was established for casualties of war and the practice of Memorial Day became common. Across the North and the South, the fallen from both sides of the war were honored, respected, and remembered, continuing their service even in death by helping to reunite the country.

At any National Cemetery today blooms of scarlet are seen. Red poppy flowers are placed on the graves of many war dead, a tradition that dates to World War One. In 1915, after the Second Battle of Ypres, red poppies grew over the graves of some 120,000 casualties. A sea of red, to cover the blood that had been shed. The poem, “In Flanders Fields” by John McCrae, was written about the battle describing the flowers growing on graves. With it, the practice of placing red poppies on the graves of the fallen became common. The practice holds in many other countries as well, serving as an international symbol to honor the fallen.

During the Vietnam War, another somber Memorial Day tradition developed. To recognize those soldiers who were missing in action or had become prisoners of war, military dining facilities set a Missing Man table. The table is usually set for one, to symbolize their isolation. A slice of lemon is placed on the plate, to represent their bitter fates. Salt is sprinkled on the plate to represent the tears of their families. The drinking glass is inverted, to represent that they cannot partake in the meal. The chair is empty to represent their absence. Lastly, a single candle is lit to represent hope and illuminate their way home. This tradition reminds us that while we may enjoy the freedoms in our lives, those freedoms are earned by the protection and sacrifice of others.

One-million, three-hundred and four thousand, six hundred and eighty-four. As I sit here, tallying the scores of fallen soldiers I am reminded of an apocryphal quote from Josef Stalin, “The death of one man is a tragedy. The death of millions is a statistic.” The point of Memorial Day is to stand in stark contrast to that statement; to make the deaths of millions into one tragedy at a time. Memorial Day has helped mend the wounds of the Civil War, of World War One, of the Vietnam War and of countless other conflicts by bringing disparate sides together in their common loss. This Memorial Day, let us remember the good that so many sacrificed for and in so doing find that which brings us together.

Tej Ishaan Mehta, MD, is an Internal Medicine Resident at MCW and a Captain in the United States Air Force Medical Corps.

Rituals Stir our Memories and Push us toward Transformation

 From the 5/28/2021 - Memorial Day - newsletter

Director’s Corner

Rituals Stir our Memories and Push us toward Transformation 

Adina Kalet, MD MPH

In this week’s Director’s Corner, Dr. Kalet asks us to both attend to our need for commemoration of the very difficult time with rest and reconnection while we also work to sustain hard won transformative gains …

Memorial Day weekend is especially poignant this year. As a nation, we are exhausted. We have collectively experienced fourteen months of a frightening, isolating, unpredictable pandemic, an eye-opening year since the murder of George Floyd, widespread calls for social justice, and a nail-biting presidential election. We have been irrevocably changed and are emerging - in fits and starts - into a new post pandemic reality. Now that many of us have been vaccinated against SARS-CoV-2, we are eager for the summer season to kick off.

In many ways, the past months have forced us to innovate, create, and find new ways to conduct our lives. It is not yet clear which of these changes are good or sustainable, but we are different now than we were then.

Rituals and gratitude are important as we honor those who have served

In this Transformational Times issue, Capt. Tej Ishaan Mehta MD, who is an Internal Medicine resident at MCW, movingly recounts how Memorial Day came to be after the Civil War, when our deeply divided nation emerged from that awful, bloody conflict. He writes, “Across the North and the South, the fallen from both sides of the war were honored, respected, and remembered, continuing their service even in death by helping to reunite the country.”  He reminds us that ritual and symbolism have the power to bridge our gaping chasms and heal our festering wounds. 

This issue also features a fascinating excerpt from Richard N. Katchske’s new book, Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019. Mr. Katschke, MCW’s Chief Historian, describes our medical school’s mobilization during World War II.  Our faculty and students served the nation by embracing a dramatically accelerated curriculum to ensure a supply of physicians prepared to go to war. And go to war they did. Many served with great distinction, and one made the ultimate sacrifice. I plan to read Katschke’s entire book (I will share some highlights) and recommit to a favorite pastime of studying the class portraits that line the hallways on the main floor of the medical school building. I will inspect the faces and uniforms, knowing that many served overseas or at home in a war effort. How many were impacted by WWI, WWII, Korea, Vietnam, Iraq, and Afghanistan? Who went on to have careers touched by the influenza pandemic of 1918, by HIV/AIDS, or by other national challenges?  I will wonder. 

On this day, we honor the individual soldiers who made the ultimate sacrifice to protect and defend our many precious freedoms.  It is important to commemorate them, and we must support their grieving families and the loved ones who were left behind. It is a somber but awesome opportunity to take time to honor their losses, recognize their sacrifices, consider what they have taught us, and pledge to make a difference in the world they shaped. 

An evening ritual in New York and beyond

The response to COVID-19 inspired its own rituals. Starting mid-March 2020, at 7:00 p.m., everyone on my block in Brooklyn, NY came out on their stoops to make “noise” (some had musical instruments) for a good twenty minutes to celebrate the health care and essential workers who went to work every day at the hospital around the corner. This nightly ritual, which was occurring at 7:00 p.m. all over the globe, continued daily for many months, and evolved into a means for neighbors to check in with each other and socialize. It was so joyous and silly, that I found that I missed it when it petered out. 

Although not a part of our national Memorial Day commemoration, those of us in health care, and those whose families have been touched, also remember relatives and friends who died from COVID-19. The rituals to honor front line health care workers and first responders remind us that, as a society, we must address the unconscionable health disparities and social ills that put so many, particularly our Black and Brown citizens, at outsized risk.  As of yesterday, an estimated 3,511,748 worldwide have died of COVID-19, and it isn’t over yet. In many parts of the world, hospitals resources are overwhelmed, oxygen is not available, and vaccine supplies and infrastructure are inadequate. Despite the circumstances and at enormous personal risk, our international health care colleagues face the pandemic and do their duty with character and compassion. Heroes are everywhere. Perhaps someday soon, there will be a COVID-19 Remembrance Day.

Medical Education will continue to transform 

How will we remember these pandemic times? Will they change our work when things return to something resembling “normal”? I suspect that there will be many tell-tale signs stamped on our educational practices. We have new levels of savvy with technology-enabled education, admissions processes, international conferences, and performance-based assessments. We have narrowed the “digital divide” between us and our applicants and students to address issues of equitable access. Even if a significant proportion of medical education remains remote, we will be better at enhancing face-to-face sessions with meaningful, integrative faculty-led small group experiences. While fancy equipment and simulators might be irreplaceable for some types of teaching, expanded use of low-cost virtual reality devices and mobile apps offer areas of untapped potential. As we harness new educational practices, what we discover will become endlessly scalable. 

Emerging from the pandemic will also help us re-commit to preparing our trainees to practice in, and influence, health care systems. How do we help our students and trainees see the “big picture” of medicine in society? How do we enable our trainees to provide outstanding, equitable health care to the marginalized? How do we prepare for future pandemic and health crises? Can we embrace technology, yet keep medicine humane? We will need to integrate the transformational goals of the Kern Institute into a constantly evolving medical education landscape.

Wars and pandemics have lead to unspeakable, senseless horror. Both, however, have also resulted in opportunities for innovation. Battlefield medicine during WWII led to life-saving civilian improvements in trauma care, limb salvage, reconstruction, and antibiotic use. The pandemic offers opportunities, as well and, as we commemorate the many losses of the past year, we will fiercely embrace the future. 

Too many have died both in battle and from preventable, treatable disease. We insist that they did not die in vain, and pledge to learn something good and important in their honor. 

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.

Stand Up for What You Believe In

From the 5/28/2021 - Memorial Day - newsletter

Perspective/Opinion

Stand Up for What You Believe In

Chad Kessler, MD

Dr. Kessler is the National Program Director, Emergency Medicine, Department of Veterans Affairs.  He is also a professor at Duke University and a staff physician at the Durham VAMC. He is the epitome of charismatic and inspiring VA leadership.  Here is an essay that he generously let us share from one of his twice weekly newsletters ...

So, I was sweating through my Thomas Pink button down shirt this late Friday afternoon and eon or two ago.  I was still in the hospital at 6:00 that day, stewing in this tiny, windowless room…not only because of the jungle like temperature, but the unfamiliar and frankly unnerving environment. As a young chief, this was all very new to me, and having to sit with these top leaders was terrifying, and only intensified by the news I had to share. We were short on coverage, I felt that we were teetering on unsafe care in our Emergency Department, and I needed to advocate for staff in a miserable budget year.  That word…I didn’t realize how much power was in that single word.  I literally remember the second when the Boss stopped the meeting in mid-sentence, and said, “Kessler, did you say we have an ‘unsafe’ environment?” Like I had uttered a profanity in Temple or put ketchup on a hot dog.  I looked around, realized everyone was staring at me, and said prophetically, in my best Homer Simpson voice, “uh…yes.”  I’ll be honest, I don’t remember much after that, except feeling like I said or did something wrong (even though I knew I wasn’t wrong), that people were mad at me, and that I truly may get fired…but I got home, gave my wife a hug, the kiddos jumped into my arms, grabbed myself a two liter chai and thought in my head, I did the right thing, right?     

 

Here’s the moral of my tale…Stand up for what you believe in, even if you’re standing alone! It may be pressure from your boss to not open your mouth, it may be your team telling you everything is fine or it may be that little voice (you know, the easier wrong voice) whispering to you how much you really like your job...and don’t really feel like updating your CV.  But whatever it is, make sure you’re doing what is right in your mind.  It’s your name on that memo, on that patient chart, it’s your voice they will hear, and it’s your conscious you will live with for years to come.  So, make sure you do the right thing, take the harder right, and stand up for what you believe in…even if you’re standing alone.

 

Just for closure sake, we did end up getting that additional coverage for the ED, and I did not get fired.  In fact, I specifically remember one of the senior leaders coming up to me later that week, telling me how brave that was…and was indeed the right thing for patient care. If only he was standing with me during that meeting…but nonetheless, alone or together, we need to stand strong for what we believe in.

Dr. Kessler curates an amazing series called “C20” or Covid in 20, which currently has over 100 informative episodes on a variety of topics from “COVID and the law (Episode 63) to COVID and delirium (Episode 28).  Some are VA specific, but many are not.  Click here to check them out. 

The Marquette University School of Medicine Aids America in the Time of War

From the 5/28/2021 newsletter

Medical School History 

 

The Marquette University School of Medicine Aids America in the Time of War

 

Richard Katschke, MA

 

In this excerpt from his book, Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019, MCW Chief Historian Richard N. Katschke explains how MCW’s predecessor institution, the Marquette University School of Medicine, responded to the national call to action during World War II …

 

As Europe was embroiled in conflict in the late 1930s, the possibility of the United States’ participation in the war effort impacted the Marquette University School of Medicine and other medical schools nationwide. Beginning in 1940, the Marquette medical school responded to a request from U.S. Surgeon General James C. Magee to sponsor an army surgical hospital. Eben J. Carey, MD, PhD, dean of the medical school, appointed twenty Marquette medical school faculty and staff members to provide administrative and technical assistance to Surgical Hospital #42, based at Fort Campbell, Kentucky. Also, in 1940, Marquette University – including the medical school – was one of twelve colleges nationwide selected to sponsor a Naval Reserve Officer Training Corps.

Following the attack at Pearl Harbor, the United States declared war against Japan on December 8, 1941. Four days later, Germany and the United States went to war. The world conflict triggered significant changes at the medical school. Beginning in July 1942, all teaching activities at the Marquette medical school were accelerated so that medical students could become physicians more quickly and provide medical care on the front lines. Vacations were shortened or suspended. Courses were abbreviated, and electives were dropped. Walter Zeit, PhD, ’39, recalled, “There were several instances where one academic year ended on a Friday and the next one started the following Monday.” Graduation ceremonies were conducted in May and November. Because of the demand for physicians during wartime, the medical school – unlike many other academic programs at Marquette – maintained a strong enrollment.

Norman Engbring, MD, ’51, noted in his book An Anchor forthe Future that the accelerated wartime curriculum placed an additional financial stress on the medical students. In 1942, the W.K. Kellogg Foundation provided $15,000 to the medical school to create a student loan fund. The Kellogg Foundation awarded similar grants to other medical schools nationwide.

Another change that occurred in September 1942 was that the fifth year of medical school - the internship year - was abolished. The requirement had been in place since 1920. Dr. Engbring explained that the fifth year was dropped so that junior medical students could qualify for federal loans that placed a four-year limit on the number of years a student could remain in school. By the end of 1942, only nine of the nation’s sixty-seven medical schools still required the completion of an internship year before medical school graduation. The Army and Navy gave medical students provisional commissions which enabled the students to avoid the draft and stay in school. For example, the Army Student Training Corps and the Navy’s V-12 program were organized, and medical student recruits received a base pay of $50 per month from the military.

“Khaki is now in evidence in the Schools of Medicine and Dentistry as 320 members of the Army Enlisted Reserve Corps in these schools were recently called to active duty by the order of the War Department,” reported the Marquette Tribune on July 15, 1943. “Within the last weeks these Meds and Dents were sent to Camp Grant, Illinois, where they were inducted, issued uniforms, and immediately ordered back to Marquette to continue their education. Roll call at 7:45 am either on the parade grounds or for senior medics, at the hospital, begins the day of the trainees.” Anthony Pisciotta, MD, ’44, recalled that the Army students were organized into the 3665^th service corps under the command of Major Joseph Plodowski, who was based at the medical school. The medical student soldiers became known as “Plodowski’s Raiders” and the “Fighting 3665^th.”

The Marquette Tribune reported that of the 334 male students enrolled in the medical school, 176 were commissioned as 2^nd lieutenants in the army, 104 received navy commissions, thirty-six had applications pending, and eighteen were ineligible for commissions because they were either non-citizens or had a medical disability. Earl Thayer wrote in Seeking to Serve: A History of the Medical Society of Milwaukee County, that nearly fifty faculty members saw active service, as well as a large percentage of alumni.

One alumnus, Lt. William Henry Millmann, MD, ’43, was killed on February 21, 1945, while caring for war casualties in Italy. The Millmann Award, the Medical College of Wisconsin’s highest honor for graduating medical students, was named in his memory. The first recipient of this award was Marjorie E. Tweedt Brown in 1948. John Erbes, MD, who joined the medical school’s surgical faculty in the late 1940s, was the most highly decorated U.S. physician in World War II. As a battalion surgeon, he saw front-line duty in Morocco, Tunisia, Sicily, Normandy, Belgium, and Germany.

 _____

Excerpted from Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019, by MCW Chief Historian Richard N. Katschke, MA. The book is available for online purchase here.

 

 

Richard N. Katschke, MA is the Chief Historian of the Medical College of Wisconsin. He joined MCW as Director of Public Affairs in 1985 and served as the Senior Associate Vice President for Communications. He received MCW’s Distinguished Service Award in 2015 and was awarded an honorary Doctor of Humane Letters degree by MCW at the 2021 commencement ceremony.