The Kern Institute Announces Publication of the Second Collection of Transformational Times Essays

 Book Presale - Character and Caring: Medical Education Emerges From the Pandemic

The Kern Institute Announces Publication of the Second Collection of Transformational Times Essays

Medical students, residents, physicians, and caregivers have struggled during the pandemic. The times in which we live will transform medicine. These essays, drawn from the Kern Institute’s Transformational Times newsletter, offer glimpses into what we have experienced and what might yet come. 
Each essay reveals remarkable insights and reflects the interplay of the world we inhabit with the present and future of medicine and healthcare.

"Incredibly timely."
—Carol Bradford, MD FACS
“[This book] provides an unparalleled opportunity to bring one’s best self to the bedside and looks for the unexpected opportunities to impact the world.”
—Jesse Ehrenfeld, MD, MPH
“...a ready-made syllabus to embrace social, psychological, spiritual, and humanistic dimensions of medical education.”
—Louis N. Pangaro, MD, MACP
“...the art, as well as the science, of medicine are eloquently delivered, provoking the reader to reflect and see the world from new perspectives.”
—J. Larry Jameson, MD, PhD

In these pages, readers engage with unsettling realities unmasked by COVID-19, including workplace biases, inattention to wellness, residency-related stress, the loneliness of military responsibility, the inequity of the world around us, reproductive healthcare uncertainty, new educational realities, and the imperative for flourishing and practical wisdom in physicians.

To purchase a copy of Character and Caring: Medical Education Emerges From the Pandemic, click here. 

To purchase a copy of our our first book, Character and Caring: A Pandemic Year in Medical Education, click here.

Focus on Genetics: Lessons from Uncle Dave

 From the December 9, 2022 Genetic Counseling Issue of the Transformational Times  

Focus on Genetics:  Lessons from Uncle Dave

By Wendy Peltier, MD

Dr. Peltier shares the candid story of how her uncle brought early inspiration to pursue a career in Medicine, and also opened her eyes to the personal challenges and opportunities of genetic testing as he faced a rare, progressive lung disease …

 

My uncle, Dr. David Pogue, worked as a cardiologist for twenty-nine years in the small community of Wichita Falls, Texas.  He inspired me very early on, to pursue a career in Medicine.  As “Yankees” from Illinois, my family lived far away from Texas, and holiday time together with the Pogue clan was truly a gift. I have wonderful memories of my brother and I connecting with our three cousins, all of similar age, and giggling together around the big table at family meals as our parents had spirited discussions.  At one of these memorable visits, my uncle took me on hospital rounds, where I observed his kindness and generosity with his patients and staff.  There were no Hospitalist services in those days, so “checking in” on his patients was common practice, even on a holiday weekend.  I can bring in my mind’s eye his long white coat, gentle smile, and patience as he carefully listed to heart sounds and reviewed care plans with his patients.  

He answered all my questions, sparked my interest in science, and empowered me that being a doctor was not just far away dream, but in reach if I was willing to put in the hard work.

Fast forward a decade or so, when I was in medical school, we got the news that he was ill.  After exhaustive testing for shortness of breath with exercise, he was found to have a rare form of emphysema, alpha-1 antitrypsin deficiency, a progressive and incurable genetic disorder.  This condition, which is expressed most severely in patients carrying two recessive alleles, causes a spectrum of lung disease that can manifest as progressive emphysema, chronic bronchitis or asthma, and can also affect the liver, pancreas and gallbladder.  Carriers of this gene can pass on risk to their children.  What a bitter irony that Uncle Dave would have emphysema after spending so much of his time trying to convince others to stop smoking!  I had just started learning about genetics and DNA in school, our bodies’ “phone book.”  I was particularly fascinated by how science allowed us to track these missing “addresses” that tied so eloquently to understanding of a disease process.  Genetic discoveries were just starting to have clinical impact, and the thought of gene therapy still a far away dream. 

 It seemed quite unbelievable that a genetic disorder could be in my family.  Could I be a carrier? Would I want to know? Would it impact major decisions in my life?

As was his brave and humble nature, my uncle learned everything he could about his condition, what to expect, and opportunities to contribute to research.  Pre-symptomatic genetic testing was not readily available at the time, but he sought resources for anonymous testing for his siblings.  I keenly remember what it was like to wait for my Mom’s results.  My uncle deeply believed in science and the power of research.  He knew that having this type of information could mean receiving early preventative treatments, once they were developed.  He also actively sought information about his prognosis, so he could make plans for his family to be supported, and to make his own careful decisions about future therapies with a lung transplant or other interventions.  He became very involved in the Alpha-1 Foundation.

As his disease slowly progressed, he made the necessary changes to his medical practice and sought continued opportunities to serve.  Using his background in cardiac rehab, he took a very diligent approach to his own health and was able to far outlive his prognosis, despite declining a lung transplant.  During this time, I was starting my career as a neuromuscular neurologist (despite his multiple attempts to convince me that Cardiology was a superior discipline!) and found myself often in the position of counseling families about genetic testing for muscular dystrophies and other progressive neurologic conditions. 

It was my good fortune to do this shoulder-to-shoulder with exceptionally talented genetic counselors.  Their knowledge, wisdom, and kindness in approach to all our patients and families, regardless of their health literacy, was a true inspiration.  

I knew, first-hand, how challenging decisions about testing could be, and the emotional impact to affected individuals in navigating this, sometimes with complex family relationships.  I did my best to provide balanced options, educate about the cautions of asymptomatic testing, and link families to important resources through the Muscular Dystrophy Association (MDA).  Incredible scientific progress was being made at this time in understanding the molecular biology and genetics of muscular dystrophies, previously named by the famous neurologists who described the syndromes (Becker’s, Duchenne’s, Emery-Dreifuss, etc.) now re-labeled by the specific type of gene defect or “address.”  Genetic testing became more available and allowed diagnostic accuracy without necessarily having patients go through painful muscle biopsies.  Gene therapy seemed closer in reach.

I will never forget attending my Uncle Dave’s funeral.  All of his family members had been carefully prepared for the event.  His favorite band, The Mad Medics, were playing Dixieland music as folks entered the church.  As my Uncle Don stood to give his eulogy he remarked, “I was given very strict instructions as to how this event will be, short and happy.”  And it was. So many people from the community attended to pay respects.  My aunt had a video camera in the church library, where attendees could sit and share a story in remembrance of the beloved Dr. Pogue.  One of my favorites was from one of his former nurses, who was a smoker.  She and her colleagues would occasionally sneak down to the smoking room during breaks.  She recalls seeing little paper airplanes floating down through the ceiling vent, and retrieving them only to see anonymous, hand-written random facts, about the health risks of tobacco use.  There was no electronic record back then, so of course she recognized his handwriting!  She described this as a true act of caring, without being judgmental.

He was remembered by his community and colleagues for his tireless service, a mission trip to Africa with the Peace Corps, starting the first cardiac rehab unit at the Clinics of North Texas, a Distinguished Service Award from the Wichita County Medical Society, and for being a proud charter member of the Wichita Runner’s Club. 

My Uncle Dave remains a steady presence and source of inspiration to me at challenging times, despite the many years that have passed since his death.  

For me, it’s not as much the professional accolades, as the memory of his kind, humble, and funny spirit, and ability to make “good trouble” in his work as a physician.  As a patient, he was always looking for opportunities to help others despite his own personal challenges. 

I recently connected with my aunt Georgia about these memories.  She was touched by this tribute and shared that one of the things she most admired about Dave as a doctor was how deeply he cared for his patients as people and recognized the importance of giving time to them during visits, something that she sees as a rarity now in medial encounters.  

There has been miraculous progress in science since my days in medical school to make gene therapy a reality.  Uncle Dave would be proud.

Wendy Peltier, MD, is a Professor of Medicine in the Division of Geriatric and Palliative Medicine at MCW.  She serves on the Faculty Pillar for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and on the editorial board of the Kern Transformational Times.

The Power of Story--When We Truly Listen

From the December 9, 2022 Genetic Counseling Issue of the Transformational Times

The Power of Story--When We Truly Listen 

 By Jenny Geurts, MS 

 

Jenny Geurts, who is the inaugural program director of the Master of Science in Genetic Counseling (MSGC) training program at MCW, reflects on her community engagement experiences and the impact volunteer work has on learners.  

This year, our genetic counseling program had the pleasure of engaging with the Sisters Network SE WI Chapter which is doing amazing work in the Black/African American community to increase access to resources and information, advocate for change, and provide supportive sisterhood.  While the invitation was for us to provide information about genetics to their group of cancer survivors and thrivers, I found myself on the receiving end of the knowledge….   

So many of our community members reported stories of never being told about genetic counseling for hereditary cancer prevention and early detection.  And worse, several were told they couldn’t have genetic testing, even when they were asking for it, never being referred to genetic counseling to assess their risk.  What use is all our advances in genetic technology, when it is being kept from those in our community who need it the most?   

The persisting health disparities in hereditary cancer faced by the Black/African-American population is the topic of a recent review article by Ambreen Khan, et al published in the Oncologist.   

Our community members have so much to teach us, if only we are willing to listen.  

The topic of my presentation at the 2022 Wisconsin Cancer Summit this year “Genetic Risk and Family History: How Sharing Stories Can Save Lives”, where it was heartwarming to see many members of the Sisters Network in person.  The Summit theme this year was “The Power of Story,” and brought together patients, advocates, care providers, public health workers, scientists, administrators and more. I can attest that the mission of the Summit was met: Together, we learned how storytelling can be used to improve cancer health outcomes, empower patients and providers, and help us connect, transform, learn, and heal. 

Sherri’s Story 

Due to the generous spirit of one our clinic patients, I was able to tell Sherri's story at this year’s Summit.  

A story where listening meant life or death….   

For years her doctors didn’t listen, which resulted in Sherri being faced with death.  

“...my father he was only 26 when he was diagnosed, his mother, brother, sister and my cousin, they all had it young…” 

 “I know this is not my normal — waking up tired, all day tired,” 

“…no, it’s not just about me getting older, it’s more than that…” 

The power of family history for cancer prevention was lost on Sherri, she would become a statistic in the widening health disparities seen in genetics and cancer care. 

However, because of her resolve, determination, and faith, she persisted…. until finally someone did listen.   

And this time listening resulted in the power of additional life to live, importantly a ~quality~ of life. 

Sherri graciously allows us to amplify her voice, how her life was saved when someone listened, because of genetic testing and immunotherapy.   

If your curiosity is peaked and you’d like to learn more, I’d encourage you to check out the Summit Recap to access recorded presentations, view slide content and learn more about the Cancer Stories Performance, which is a powerful stage production from the Wisconsin Story Project that honors the personal stories of people affected by cancer.  The end result is profound, candid, and deeply human. 

Narrative Reflection Exercises  

We ended the two-day Summit event with a narrative medicine activity, led by Dr. Toby Campbell from the University of Wisconsin/Madison, where we attempted to capture the feelings about our experiences during the Summit with a six-word narrative.  I’d like to share my reflection with the Transformational Times readers: 

“Witnessed stories heal them….and me?” 

This experience allowed me to deepen the impact of the Summit experience and forge the patient stories into my consciousness, helping me make meaning of the toll cancer takes on so many families. I hope that the Transformational Times readers will consider the situations where their patients have been generous with them, in the stories they shared, and trust they instilled.  If only we are compassionate and humble enough to truly listen. 

As part of our Genetic Counseling Seminar course in the MSGC program, learners participate in community engagement volunteering to promote a deeper understanding of the patient experience.  Having just learned about another narrative exercise (the 55-word essay) at the Summit, I thought asking the students to try this activity might also help them further process their experiences in the community.  In this exercise the writer must choose exactly 55 words for their narrative, resulting in the need to be extremely intentional about their word choice. The power of the 55-word essay was not only impactful for them, but also for me, as it was a whole new way for me to have a transcendent vicarious experience through reading their reflections.  Several of my learners wrote 55 word reflections after participation in volunteer community events, and are highlighted within the Poetry Corner of this Transformational Times issue. 

Creating a MSGC Mission Statement 

When our program development started in early 2020, we were asked to create a mission statement, it was something we were obligated to do and at first felt very “corporate.”  I certainly couldn’t recall the mission statement of the school I attended, and I didn’t understand the relevance of it, other than “checking the box” of requirements.  But when we brought the team together to start working on it, that is when it really came alive to me. 

The several months of developing the mission statement were painstaking. However, the considerations we took, and process we went through to land on these twenty-one intentional words, was so rewarding to us.  We are delighted with our mission statement as we feel it truly represents what we are here to do.   

Words matter.   

This narrative exercise of creating a mission statement also really helped me understand the power of our words.  

We hope this mission statement resonates with you as well, as either a provider, an educator, a learner, and/or a member of the community.  

Acknowledgements 

Special shout out to the dedicated work of Dr. Sandra Underwood, Debra Nevels, Raul Romo, Sharon Brown, Stephanie Newsome, Gigi Sanchez, Dr. Melinda Stolley, Dr. Charles Rogers, and others who cultivate relationships to ensure the success of community outreach activities. 

Jenny Geurts is an Assistant Professor in the Institute of Health & Equity and serves as the Associate Director of Genetic Counseling in the Genomic Science and Precision Medicine Center at MCW. She has been in practice for over fifteen years and has specialized in a variety of genetic conditions including oncology, cardiology, neurology, gastroenterology, and endocrinology.  She most recently has provided clinical care with an emphasis on inherited cancer conditions at Froedtert and the Medical College of Wisconsin Clinical Cancer Center. She is board certified by the American Board of Genetic Counseling. 

Bike vs. Auto

 From the October 21, 2022 issue of the Transformational Times

Guest Director’s Corner 

Bike vs. Auto 

 By Cassie Ferguson, MD 

Dr. Ferguson discusses how empathy can lead to a deeper connection with patients… 

Two weeks ago, I got a call that no parent is truly ever prepared to get, even those of us who spend much of our lives “dress rehearsing tragedy” (Brené Brown, Dare to Lead). I was driving home from a shift in the Children’s emergency department (ED) when an unfamiliar number popped up on my phone. I immediately got a sinking feeling in my gut and answered quickly. It was my oldest son, Ben. 

“Mom, I got hit by a car but I’m okay. I just kind of hurt my leg.” 

Breathless, I paused and tried to find the next right thing to say. 

“Where are you, Benny? Who is with you?” 

“The police are here. Do you want to talk to them?” 

The police?? Suddenly the image I had in my mind of a minor accident was replaced by one that included lights, sirens, and caution tape and I could feel myself getting pulled into the mode I naturally revert to when I’m running a code: gather information quickly, prepare for the worstcase scenario, plan the next steps. I cleared my throat and spoke with the officer who explained what had happened in far more detail than my brain—now fully in flight or fight mode—was ready to hear. 

When I think back to that day, it is that retelling of exactly how my son was hit, how he rolled up onto the hood of the car, and how he was thrown back down to the ground, that still undoes me. It is hearing from Ben that he was riding his bike home from school and decided to turn to get a chocolate chip cookie from the neighborhood bakery just before he was hit that brings me to my knees. 

That night as my son and I sat in my own ED getting films and waiting to hear about the next steps, I thought about all the mothers whose injured children I’d cared for—children far more seriously injured than Ben. Children whose lives were forever changed by their injuries. Children who had died. I thought of all the exquisitely painful details those mothers had to hear and then live with for the days, weeks, and years that followed. And it struck me how little we do to prepare them for what it will feel like to live with those details. How little we prepare them for the searing anger that will suddenly take hold of you when you see your child wince in pain; for the welling up of sadness when you’re reminded of what your child will miss out on because of their injury; for the intense terror that will grab you when you drive by the scene of the accident. 

We have had so many people reach out to us since Ben was hurt, and the love that has surrounded him and our family has been incredible. I’ve observed that in these encounters the two words I hear the most from those intending to comfort and lift up are “at least.” At least he was wearing his helmet. At least he was not more badly injured. At least the driver stopped. At least… And that is all true. I am extraordinarily grateful that Ben is okay, and that his leg will heal. And I say those same words frequently in the ED intending to support my patients’ families after close calls with tragedy. I believe that while it is not necessarily in our nature, our culture prompts us to seek and point out the positive. As caregivers we are taught to be useful and provide hope—as a profession, we value optimism, grit, and resilience and these values are passed onto our patients. 

With some reflection, however, I can see that this approach is also a way to create separation between me and the person for whom I am caring; a way to put a safe distance between myself or my children and a similar, imagined tragedy. And yet empathy requires we get up close. It requires that we connect with something inside of ourselves that knows what it feels like to be them. This is not a knowing that comes from our own experiences or imagining what it would feel like to “walk in their shoes.” This is a deeper knowing that arises from vulnerability; from a willingness to be open to our own suffering, and to know our own darkness such that our care arises not from pity but from a shared sense of what it really is to be human. 

Up close we can just sit and let our presence be a signal that we are there and that we are paying attention. Up close we can use the sacred gift of touch to heal. Up close we can ask questions like, “What does it feel like to experience this as a mother?” If you asked me that question right now, I would tell you that I feel angry and sad and afraid. I would tell you that during the last two weeks I’ve experienced guilt, overwhelm, and anxiety. 

And we might notice, the two of us, that just by asking and answering that question, we can find some kind of relief, some sense of rest in the knowledge that we are not alone. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics (Emergency Medicine) at MCW and the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Mentorship is a Partnership

December 1, 2022

From the December 2, 2022 Global Health Issue of the Transformational Times

Perspective/Opinion 

Mentorship is a Partnership 

By Laura D. Cassidy, MS, PhD  

Dr. Cassidy, the Associate Dean of Global Health, has been a long-term mentor for the Dr. Elaine Kohler Summer Academy of Global Health Research program.   

Being flexible and resilient are important and unexpected skills that medical students develop as they embark upon global health research. Unlike a highly structured medical school experience, students learn to adapt when things do not go according to plans. They pause, engage in the culture, and practice patience and kindness. 

I learned as much from my medical students as they did from me—if not more.  I have enjoyed mentoring many PhD students and, in 2018, I had the wonderful opportunity to mentor my first medical students in the Dr. Elaine Kohler Summer Academy of Global Health Research Program. We traveled to Kigali, Rwanda to meet with my partners and then to Kampala, Uganda where Sarah Benett (M1) and Brittany Fickau (M1) participated in a research project with my colleagues at the Child and Family Youth Foundation. They learned many important and expected research skills, from how to design an international study, to working with clinicians, to administering the Malawi Developmental Assessment Tool (MDAT) in young children, to analyzing data, and to preparing a manuscript. 

I learned about the pressure that medical students impose upon themselves—their perception of needing to work twelve-hour days to being highly productive—and it was difficult for them to slow down and engage at African speed. An important unexpected skill that they developed was to pause and observe the culture.  In this crowded city in a low- to middle-income country (LMIC), being “punctual” takes on a new meaning. Someone can plan to be early for a meeting or clinic but if there is a bad traffic jam, they may sit for hours in traffic. The meeting may happen three hours later or not at all.  

At first, there was stress because of their internal pressure to be productive and, yet, they were dependent on a system and culture that they could not control. They learned to work with women and children in a clinic that served residents of informal settlements.  They did not speak the same language.  They were dependent on clinic staff and interpreters.  They learned to form meaningful relationships and to network.  There were reflections on how to be efficient with very limited resources and the importance of listening…even when you don’t speak the same language. One of the most import skills we all cultivated was flexibility. When things don’t go according to plan- pivot and be resilient. 

All these experiences became even more important in 2020 when the pandemic hit.  The next two M1 mentees, Lauren Tostrud and Hannah Racicot, were planning to do their summer research program in Rwanda. We did the best we could to zoom there frequently, and they worked diligently with our partners on important literature reviews about the effects of the Hutu genocide against the Tutsis. We stayed in our homes and watched movies about sub-Saharan Africa and the culture and discussed them.  Throughout the pandemic, they never complained, they remained excited about their work, and I learned about the ways they implemented the skills they acquired into their medical school training. 

I am honored to serve as a mentor to these bright and dedicated students and this role does not end after a semester or graduation. Together we learn, we support each other, and we thrive. 

Laura D. Cassidy, MS, PhD, is the Associate Dean of Global Health, Professor and Director of the Epidemiology & Social Sciences Division, and Founding Director of the Master of Science Program in Global Health Equity at MCW. 

Gratitude – Who’s Got Time for Gratitude?

November 18, 2022 Thanksgiving Issue

Editor’s Corner 

Gratitude – Who’s Got Time for Gratitude?  

(AND A RECIPE FOR DATE-FILLED SUGAR COOKIES!)  

By Jeff Fritz, PhD 

As we all head into this season of Thanksgiving, Dr. Fritz celebrates the wonderful benefits of being grateful and offers some ideas for developing habits of gratitude ... 

I hate to admit that I suffer from a strong case of what can be termed as negativity bias. Put simply, I tend to overly focus on the negative and use remembering negative information as a protective habit to avoid pain in the future. It’s a cognitive bias and amplifies the power of losses compared to the power of pleasure obtained from gains. Maybe it is why some coaches over time will state that the losses hurt more than the wins, even when the wins are many and the losses few.  

My negativity bias tends to shine when I’m overly busy and plays out in my impatience with interruptions. Yet as an educator, life is all about stepping into and welcoming many interruptions as an opportunity to teach and learn. Someone stating, "I have a question,” can be viewed as either an interruption or an opportunity to engage. 

Thankfully, one of my mentors suggested I try to flip this recording in my brain by focusing on gratitude and developing practices of gratitude. My mentor started the conversation by challenging me with, “What have you got to lose?” 

Looking back on it, that was a smart move! It forced me to use my negativity bias against myself and challenged me to practice gratitude.  

I encourage you to explore the research on the under-appreciated power of gratitude to transform our lives and our health. I explore three habits that could be practiced to develop gratitude:  

• A gratitude journal 
• Three gratitudes daily 
• Random acts of kindness 

A gratitude journal was not a huge success for me, but the practice of sharing with someone three things I was grateful for on a daily basis worked well around the house. Personally, I found random acts of kindness a big help. Little things like holding a door for someone, serving in the moment to fill an easy need, or just saying thanks became a way to add a boost throughout my day.  

Over time, I have begun to view interruptions in a more favorable light. While this may sound strange, I sort of look forward to interruptions as ways to explore new opportunities or deepen friendships. I was reminded by a dear friend to never let a good crisis go to waste. What an amazing way to transform a major interruption into an opportunity to practice gratitude and service! 

Another reminder that recently came my way was that gratitude is a way we can show we care for others. 

My three gratitudes for today:  

• Fire Alarms 
• The trust of the students I’ve been given the opportunity to serve as an instructor 
• The staff support team at MCW-CW – they have repeatedly made me look so much better than I am, and I thank them for their initiative and energy to help us create team wins. 

Grandma’s Date-Filled Sugar Cookies  

Soft and Chewy Date-Filled Sugar Cookies - Oh My! Sugar High  

I was also asked to share a favorite holiday recipe. Another difficult ask as I’m more frequently the recipient of the recipe than the person following the recipe to produce something amazing. I should have mentioned that I’m really grateful for all those amazing people daily transforming ingredients into outstanding meals. Regardless, one of the holiday favorites that took a while to grow on me but I now look forward to each year around this time is Date Filled Sugar Cookies.  It was my grandmother’s signature dessert that she only made during this season. While she refused to share her exact recipe this one comes close:  

For further reading: 

Vaish A, Grossmann T, Woodward A, Not all emotions are created equal: The negativity bias in social-emotional development, Psychol Bull 2008; 134:383-403. https://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.134.3.383  

Hamlin JK, Baron AS, Agency Attribution in Infancy: Evidence for a Negativity Bias, PLoS One 2014; 9(5):e96112  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011708/    

 

Jeff Fritz, PhD, is an Associate Professor in the Department of Cell Biology, Neurobiology and Anatomy and the Department of Regional Campuses, Central Wisconsin Campus. He serves as the Director of the Kern Scholars Program and is a member of the Student Pillar, Curriculum Pillar, Faculty Pillar and the Philosophies of Medical Education Transformation Lab of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Writing is a Deep Conversation

From the 10/29/2021 newsletter

Director’s Corner

 

 

Writing is a Deep Conversation

 

 

Adina Kalet, MD MPH

 

 

In this special “Authorship” issue of the Transformational Times, Dr. Kalet shares her feelings about the value of writing together with others, and why authorship is among the most complex and critical aspects of what we do. She proposes that, if we can do it well, solid writing opens important conversations and can be deeply satisfying …

 

 

If writing seems hard, it is because it is hard. It is one of the hardest things people do.

-William Zinsser, On Writing Well: The Classic Guide to Writing Nonfiction

 

 

As an early-career physician and clinical educator, I felt none of the traditional “publish or perish” academic pressures because, for most of my working life, I had no particular desire to be promoted. So, you may ask, why do I spend so much of my time writing now? The answer to this has evolved. I write to work things out and begin dialogues, much as Joan Didion hinted when she said, “I write entirely to find out what I am thinking.” Once a concept or project has been committed to the page, I am better equipped to engage in conversations about the things that matter to me. 

 

 

I didn’t always love to write

 

Thanks to a few generous mentors, editors, and spell checkers, I now love to write. This was not predictable. Despite a good-enough elementary education, it never occurred to me that writing could be a deeply satisfying communal experience. Like most of us, I learned the rules of grammar, parts of speech, sentence, paragraph, and essay structure, and how to appropriately use quotations and citations to passively draw on the ideas of others. It was all done in a dry, uninteresting, and lonely way. It wasn’t until I discovered, through writing for publication, that one was entering into deep, complex, and important conversations with others, that I became willing and eager to do the hard work. And it is very hard work. But luckily, it is almost never a solo pursuit. 

 

As medical education scholar, Lorelei Lingard, asserts in her stupendous new book Story, Not Study: 30 Brief Lessons to Inspire Health Researchers as Writers (Springer International, 2021): 

 “Medical education moves forward because we share insights, question methods, argue the relevance of emerging ideas and build on one another’s efforts. All of this is possible in large part because of writing, and it explains why writing is such a highly valued currency ….”

Dr. Lingard has taught me through her “writing about writing” to think of the process as a way of entering critical conversations to clarify our thinking. We converse with those who came before us by reading the relevant literature, we converse with those with whom we work by writing together (not easy by any stretch of the imagination, more on that later), we converse or spar with editors and peer reviewers and, finally if we are lucky, we get to converse with our readers. It is a cacophony of conversations. 

Learning the value of writing with others rather than alone

 

One of my most beloved mentors, medical sociologist Jo Anne Earp, ScD, had a framed picture in her office which, literally, is how I really learned to write.  It is a line drawing of a young child on tippy toes, holding a bright red crayon, caught in the act of crossing out and rewriting the statement, “A good mentor accepts ,expects, respects a first draft.” Sitting in her office, struck dumb by the anxiety of having to write about my work, facing that picture, I truly understood for the first time that writing could be a collaborative process. I was paralyzed as I tried to start writing my very first 300-word abstract to submit to a professional meeting. Recognizing my predicament, Jo Anne took her pen and lined yellow pad in hand and asked, “What should we title this?”  I dictated; she wrote. We switched roles.  Sentence by sentence, we polished the words until we were done. It took one hour, an hour in which I learned the key to collaborative writing—what I now call “yoked pair” writing—a process that I use with my colleagues and mentees almost every day. Now, we sit in front of a computer screen and ask each other, “What do we think?” 

 

Writing is hard. No question. Yet now I see that writing can also be a highly valuable, satisfying, and fundamentally communal experience. Since I learned the value of writing collaboratively with others, my writing partners will tell you I am relentless in extoling its virtues. This is because I believe that writing together is the best way to think clearly and develop ideas. 

 

 

Now, I am an enthusiastic writing coach

 

I regularly share my inner writing nerd. On my shelf is a stack of slim books which I both read and give away. My favorites are the latest edition of Strunk and White’s The Elements of Style illustrated by Maira Kalman (I adore the Basset Hound on the cover), Stylish Academic Writing and The Writer’s Diet both by Helen Sword (where I first discovered that I was a “flabby” writer  - yikes!), the hilarious Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation! by Lynne Truss from whom I finally understood commas; How to Write a Sentence and How to Read One by Stanley Fish and, now, Lingard’s Story Not Study, which is an expansion of a series of papers she edited for the journal Perspectives in Medical Education entitled the “Writer’s Craft.” Of course, writers must also be readers and must have very good editors! 

 

 

Ode to Bruce Campbell

 

This is my sixty-seventh Transformational Times Director’s Corner. Before March 2020, all the writing I had done had been as part of a team. I had never published an essay as a single author. When the newsletter was launched and I committed to writing a weekly column, Bruce Campbell became my editor. It requires great talent and generosity to craft someone else’s words. Bruce has done this for me almost every week for the past eighteen months as an act of kindness and compassion despite his surgical and clinic schedules, the publication of a book, and the responsibilities of a professor of otolaryngology at MCW. 

 

I experience his editing as I do an honest conversation with a close colleague.  What he does is the writing equivalent of “active listening.” By reading and rearranging my words, he is saying, “I hear you. Now let me restate that a bit and see if we can make it truer and clearer.”

 

This has been a profound learning experience. At the beginning, my drafts were “messier” and he had to push up his sleeves, often late at night, to find the wheat and eliminate the chaff. By rereading my words with his edits, I have learned how to write in this short essay format.  Originally, he did a heavy edit, rewriting sentences, reorganizing paragraphs and titling sections to hammer the piece into a readable form. Now he takes a lighter touch, refining the words, aligning the tenses, shortening the sentences, and very occasionally rearranging the paragraphs. We have learned to write together, and this has made all the difference.  

 

 

So, let’s get writing!

 

As the Kern Institute moves the mission to transform medical education forward, we must define, refine, and share our ideas. Writing and publishing are critical to this process. Consider writing as a team sport! I hope you enjoy this issue of the Transformational Times as we examine the highs and lows—and the nuts and bolts—of academic publishing. 

 

 

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.

 

 

 

Chest Pain Relieved by Antacids: My Last Night as a Resident

 From the 7/9/2021 newsletter

Director’s Corner

 

 

Chest Pain Relieved by Antacids: My Last Night as a Resident

 

 

Adina Kalet, MD MPH

 

 

 

In this Transformational Times devoted to transitions Dr. Kalet recalls the final night of her residency at Bellevue Hospital in New York City …

 

 

The astute intern standing next to me, noticing the beads of sweat forming on my forehead and my clenched fist rubbing my breastbone, walked to the medicine locker, grabbed a little blue bottle of antacid and handed it to me. “If this works, I won’t have to admit you on your last night on call as a resident!” he said cheerfully.

 

I slugged the chalky, mint flavored substance and almost immediately felt the chest pain—which I hadn’t even fully noticed until then—resolve. “Thanks,” I said, “You’re gonna be a great resident in a few hours!” I glanced at my watch. 4:00 a.m. on June 30. My last day as a house officer.

 

 

“4344 Stat!!” the crackling voice of the Bellevue Hospital operator cried from one of two cigarette box size beepers hanging off the waist band of my white pants.  This dedicated “code beeper” was calling me to the emergency room where, luckily, I already was standing, ready to help my colleagues who were conducting a cardiac resuscitation on the patient in the “slot.”  This was not the cause of my heartburn. I loved this part. I was trained to do this, my movements were smooth and assured, the decision-making was practiced and honed. I felt competent and proud of my colleagues as we surrounded this patient, a man brought in by ambulance from Pennsylvania Station awake and alert, experiencing substernal chest pain and shortness of breath, who now needed us to save his life. And save his life we most likely would. This was quintessential doctoring, one patient at a time. 

 

My heartburn was a result of the other beeper. The “medical consult” beeper was insisting, with the exact same urgency, that I call “bed board” (the office that managed the 400 adult beds in the hospital) and 17 West and 16 East and the Surgical ICU all at the same time. I added the call back numbers to the pink sheet on my clipboard. I made eye contact with the senior resident running the code to signal I was there if he needed me and picked up the wall phone.

 

This part of the job made my stomach acid churn. After a year of med consult call, all of us senior residents had mastered—but did not have a positive attitude about—what we called the “hotel management” or “traffic cop” aspects of the job. We disliked assigning admitted patients to medical teams and working with the hospital administrator (“bed board”) and nursing leadership to assign beds to those patients. It was a hard and thankless three-dimensional chess game. I didn’t feel particularly good at or prepared for these logic puzzles. But I engaged because it was my job on the team that night. 

 

There was also the “consultation” part of the job, which sounds like an opportunity to engage in erudite conversation with residents on other services about how to best care for patients, but that wasn’t how things worked. The attending physicians did that part. Most often, we residents engaged in tense discussions demanding to transfer patients from their service to ours or vice versa. Too often, we debated whose “job” it was to adjust antibiotics or blood pressure medications. I would argue that any physician could handle this simple task with a little advice from us, but they would argue that their job was complete, and the patient now belonged on our team. We would argue where the patient with ominous abdominal pain should be monitored; our team contending that the physicians who could provide definitive surgical therapy would be best positioned to manage the patient, while they argued that until an intervention was needed, the patient should stay with us. On and on. Over and over.

 

Senior residents developed reputations as being a “wall”—staving off patient transfers by playing expert, impenetrable defense, or being a “sieve”—easily persuaded to accept the transfer. I won’t tell you which reputation I had, except to hint that I did accept transfers to our service only when it was obvious that a patient would be best cared for on our team. This was a judgment call, and I trusted both team to do right by the patient.

 

It was also true that I didn’t have the courage or tenacity to insist that other teams handle problems outside of their comfort zones. I have since gotten over that.

 

Physician professional identity formation, in those days, was in a very tribal stage of development. We worked on teams and, as teams, we defended our boundaries. As soon-to-be attending physicians, our main developmental challenge was to balance team loyalty and identity with a much more subtle discernment about “what is best for the patient.” These situations were very complex; a single correct answer was unlikely. Beyond the formidable technical aspects of our disciplines, we attempted to discern what was really, wholistically best for each patient right now and under these circumstances. Without realizing it at the time, we were developing the practical wisdom needed to thrive as a physician for a lifetime.

 

This critical learning process literally gave me chest pain.

 

Eventually the new consult resident, in a fresh scrub shirt and white pants, came by to take over the beepers. She listened carefully to my recitation, jotting down the names, locations, and vital facts about the consults still to be seen and for those who needed follow up. We reviewed the remaining “bed board” issues. I asked her to check on the freshly resuscitated patient; finding him a hospital bed was a priority. The resident had been at our class’s graduation ceremony the week before, so she knew of my plans for a year abroad for medical education research and my ensuing fellowship. She wished me luck.

 

I found myself wistful and sentimental about her very first med consult shift and envious of her freshness and eagerness to do right and good. I hoped she would develop the wisdom needed to navigate the complexities in the best interests of our patients, without spending much time seriously considering being either a wall or a sieve. But we didn’t have any time to discuss this, both beepers were already sounding.

 

I cleared out my locker and packed up the remaining books, toiletries, and other odds and ends. Gathering up fresh beeper batteries and few single dose bottles of antacid I had pilfered from the nurse’s station, I left them on the table in the on-call room. Someone would need them sooner rather than later.

 

 

 

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.

Advice to Interns from Program Directors

 From the 7/9/2021 newsletter

Perspective/Opinion

 

Advice to Interns from Program Directors

 

Compiled by Kathlyn Fletcher, MD MA

 

 

Dr. Fletcher asked several residency program directors from MCWAH to provide their advice to new interns: practical, funny, or both. Here is what they had to say …

 

 

Chad Carlson, MD, FAAN

Professor and Vice Chair – Education

Program Director, Neurology Residency

Program Director, Clinical Neurophysiology & Epilepsy Fellowships

• If you crave a tasty (soft) cookie, check out the Hub.
• It is never too early to start identifying and talking to potential mentors.
• Completing medical notes is not like enjoying a fine wine; notes do not benefit from letting them age or breathe, so complete them in a timely manner.

 

 

 

Yvonne Chiu, MD

Professor of Dermatology and Pediatrics

Program Director, Dermatology Residency

• Use the same password for your work (MCW, Froedtert, VA, and Children’s) accounts and change them all at the same time. Makes it easier to remember what your current password is when you move between sites.
• Bring your lunch when you can. You eat healthier when you are not relying on cafeteria food.
• For those residents who take home call and need to call patients, download the Doximity app. It allows you to call patients using the hospital name and phone number in the caller ID.

 

 

 

Sriram Darisetty, MD, FACP

Assistant Professor of Medicine
Program Director, Transitional Year Residency Program, MCWAH- St Joseph.

• Try not to be under-confident, but absolutely avoid being over-confident. 
• Autonomy is earned, not given.

 

 

 

Stacy L. Fairbanks, MD

Associate Professor of Anesthesiology

Program Director, Core Anesthesiology Residency 

• Prioritize sleep or you won’t get it.  Sleep 7-9 hours per night whenever possible. 
• Study a little bit every day.  Gaining the knowledge you need to pass certifying exams is a marathon, not a sprint.

 

 

 

Kathlyn Fletcher, MD MA

Professor of Internal Medicine

Program Director, Internal Medicine Residency Program

• Always do what is in the best interest of your patient. I actually borrowed this one from a former mentor, Dr. Arthur Rubenstein.
• The quality of your day is directly proportional to how many people you say “hello” to on your way into work.  I have no data to prove this, but I am pretty sure I am right.
• Patients want to believe that you care about them beyond your professional obligation to care.  I do have evidence to back this up and would be happy to provide it to anyone who is interested.

 

 

Camille Garrison, MD

Associate Professor, Medical College of WI, DFCM

Program Director, Ascension Columbia St. Mary’s Family Medicine Residency Program

• Don’t put emojis in a patient’s chart… 😊
• The patients you see are not a means to an end. It is an honor and privilege to care for them.
• Take advantage of every opportunity to grow while in residency, both personally and professionally. What you get out of residency, has a lot to do with what you put in.

 

 

 

 

Matthew Goldblatt, MD

Professor of Surgery

Program Director, General Surgery Residency

• Find good bathrooms

 

 

 

 

Alisa Hayes, MD

Professor of Emergency Medicine

Program Director, Emergency Medicine

• Give yourself enough time to park and arrive on time. Your PD will get a notification if you park illegally.
• The Froedtert finder app can help you navigate the hospital and find rooms / locations as well as notify security when you are leaving the hospital at odd hours.

 

 

 

Heather Toth, MD

Professor of Internal Medicine and Pediatrics

Program Director, Internal Medicine/Pediatrics combined program

• We are all here for you! Please reach out to us as we have all been interns at some point in our lives.
• Remember to stay in touch with family, friends, colleagues, hobbies and things you love.

 

 

 

 

Kathlyn E. Fletcher, MD MA is a Professor and residency program director in the Department of Medicine at MCW. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.