The Value of Student-Run Free Clinics for Patients, Students, and the Community

From the February 3, 2023 issue of the Transformational Times

The Value of Student-Run Free Clinics for Patients, Students, and the Community

By Rebecca Lundh, MD, SCU Medical Director  

and Staci Young, PhD, SCU Research and Finance Director 

 

Supporting tomorrow’s leaders in healthcare equity, these clinics offer patient-centered care and rewarding experiences for students... 

 

Saturday Clinic for the Uninsured (SCU) is MCW’s student-run free clinic. Under faculty supervision, medical and pharmacy students are responsible for day-to-day operations and participate in providing patient care and education. Our motivation and inspiration for supporting and advising students at SCU stem from a commitment to health equity and social justice. We believe people have a right to quality healthcare, which means providing holistic and comprehensive care that addresses the diverse health needs and goals of each patient. Through the years, we strive to do this, together with thousands of medical and pharmacy students and hundreds of faculty members full of energy and passion.  

 

 

Some History: 

 

SCU began in 1991 as the Isaac Coggs Saturday Clinic for the Uninsured, housed in a federally qualified health center to meet primary healthcare needs of Milwaukee patients without access to healthcare because they lack insurance and financial resources. In 2001, SCU affiliated with community partner, Columbia-St. Mary’s, now Ascension Wisconsin, to continue this mission. Support and collaboration with health systems and other organizations is critical for free and charitable clinics to connect patients to clinical and community resources. SCU has been very fortunate to have these partnerships to provide care.  

 

Over the past 30 years, the clinic has shifted from providing care on a first-come, first-served basis to patients who would spend hours waiting in lines outside the clinic before it opened, to care that is more patient-centered – meeting patients where they are and providing what they need for their health. Through student-led efforts, SCU has expanded its clinic services. It now provides telemedicine and many specialty services in-house, including pharmacy, ophthalmology, psychiatry, dermatology, neurology, and many others. 

 

 

Student Experience:  

 

MCW students have operated the clinic since the beginning, performing tasks from administration to direct patient care under the supervision of volunteer physicians, pharmacists, and faculty advisors. Even though they do not receive academic credit, hundreds of medical and pharmacy students still volunteer on a rotating basis each school year. 

 

SCU holds incredible value as one of the first, and commonly the only, opportunity early medical students get to work one-on-one with patients. Students learn to apply their medical knowledge and skills in a supervised learning environment without the added pressure of educational or time restrictions in clerkships. Students also learn how to care for patients of different cultural, racial, or socioeconomic backgrounds. Many SCU patients have complex needs, and although addressing these can be challenging, it can be highly rewarding and useful for their training. For many students, the clinic provides their first experience addressing social determinants of health (SDOH) and is a tangible reminder of why they are working diligently on their education. 

 

 

Student-led Research Efforts: 

 

The research arm of SCU has grown and become stronger over the years. Student projects have demonstrated that health and wellness needs vary across patients and populations. Research findings add value and community benefit by providing evidence for tailoring resources and care toward the specific needs of patients.  

 

For example, identifying and addressing SDOH are important aspects of healthcare and wellness. However, without appropriate screening we may not know the extent of patients’ needs, such as financial or food insecurity. Thus, we become focused on medical management of the condition rather than the root cause of the problem. Years ago, we supported a pathway project to address SDOH that has evolved into a robust program with trained volunteers to screen and assist patients in real time with SDOH using an organized resource bank. This program also includes patient follow-up to evaluate the utility of these resources and to make changes to the resource bank as needed.  

 

Another student-led initiative is the newly formed Patient and Family Advisory Council (PFAC) that has been a growing source of feedback on current services we provide at the clinic and proposals for the future. The (PFAC) has helped provide ideas to improve patient understanding of SCU services and processes and input into student volunteer training. We will evaluate the experiences of individuals in the PFAC to inform future recruitment and meaningful participation.  

 

We will continue to support research efforts and translate findings into innovative ways of delivering care to uninsured individuals to promote overall health and wellbeing. Through these projects (and others), we aim to be a holistic, community-engaged clinic that is welcoming and reliable for our patients. Our vision moving forward is to amplify our work that benefits both the community and MCW. 

 

 

Envisioning the Future:  

 

We consistently see that many of our students value delivering care for patients with a multitude of needs, and SCU provides this opportunity. We are grateful for the enthusiasm and dedication of these students and constantly inspired by their commitment and ideas. The articles shared in this issue showcase student leadership and reflections, and some of their initiatives.  

 

As mentors in clinical care, research, and community engagement, our hope is that students remember their time at SCU and hold on to the values and lessons they learned as they continue in their training and future practices. In time, we are optimistic that we will see changes in the healthcare system that promote health equity and provide quality care for all individuals as we support tomorrow’s leaders in healthcare and medical education.  

 

 

Rebecca Lundh, MD is an Assistant Professor of Family and Community Medicine and Medical Director for the Saturday Clinic for the Uninsured at MCW. She previously volunteered at SCU as a medical student and resident. 

 

Staci A. Young, PhD is a Professor of Family and Community Medicine and Director of Research and Finance for the Saturday Clinic for the Uninsured. She is also the acting Senior Associate for Community Engagement at MCW. 

 

We would like to acknowledge Suma Thareja, PhD for collaborating with us to write this article and facilitating the compilation of the February 3, 2023 issue of the Transformational Times. 

 

  

Gold Foundation Essay Contest Open - Deadline March 13, 2023

2023 Hope Babette Tang Humanism in Healthcare Essay Contest is now open Deadline: March 13, 11:59 p.m. PT

Medical and nursing students are invited to enter The Hope Babette Tang Humanism in Healthcare Essay Contest and engage in a reflective writing exercise around an experience of humanistic care. This year’s essay prompt is an excerpt from "How Far Away We Are," a poem by U.S. Poet Laureate Ada Limón: "I want to give you something, or I want to take something from you. But I want to feel the exchange, the warm hand on the shoulder, the song coming out and the ear holding onto it.”  Six winners (three medical students and three nursing students) will receive a monetary award ($1,000 for first place, $500 for second place, and $250 for third place). Their essays will be published in Academic Medicine, the journal of the Association of American Medical Colleges, and The Journal of Professional Nursing, of the American Association of Colleges of Nursing.

Learn more

About Dr. Hope Babette Tang The essay contest was named in honor of Hope Babette Tang-Goodwin, MD, an Assistant Professor of Pediatrics. Her devotion and generosity to the care of the children and infants with HIV infection in New York City was an inspiration to her colleagues and her students. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor and deep compassion for her patients. In sum, Dr. Tang-Goodwin was an exemplar of humanistic care.

Essay Contest Details Essay contest participants engage in a reflective writing exercise that illustrates an experience where they or a team member worked to ensure that humanism was at the core of care. Submissions that touch upon students' personal experiences of humanistic care or stories of family and friends will also be accepted. Essays should be 1,000 words or fewer. Judges will be looking for essays that connect strongly to the Gold Foundation’s mission of humanism in healthcare for all. Winning essays will illuminate how the human connection can make a meaningful difference in care. The essay contest is open to medical students at accredited schools of medicine in the U.S. and Canada and nursing students at AACN member schools. Students at international medical schools that have a Gold Humanism Honor Society (GHHS) chapter are also eligible. For more information on contest rules and eligibility, please visit our website. Submissions are due Monday, March 13, at 11:59 p.m. Pacific Time.

Submit your essay

13,000 Days on the Hamster Wheel: Finding Meaning on the Way to Retirement

Adapted from a version in the 8/21/2020 issue of the Transformational Times

 

 

13,000 Days on the Hamster Wheel: Finding Meaning Before and After Retirement

 

 

Bruce H Campbell, MD, FACS 

 

In this essay first published in the Transformational Times in 2020, Dr. Campbell reflects on how the self-care trajectory on which we place our students and residents will carry them beyond their careers …

 

Medicine differs from many other professions. Once a physician joins a practice, it is possible to become a perpetual-motion machine, working day-after-day, seeing patients and generating revenue. As long as the physician directly or indirectly generates enough cash flow to pay salaries, keep the lights on, and move the enterprise forward, the process can continue unabated. Theoretically, this hamster-on-a-wheel activity can continue for around 13,000 days. That’s thirty-five years. Then the hamster retires, and another is recruited to keep the wheel turning. 

Of course, I don’t usually view myself, our students, or our residents as hamsters, but there have been days when the thought crossed my mind. Still, what can medical educators do to prepare the next generation of physicians in ways that will enrich – rather than deaden – their lives and careers? And how do we help our trainees step back and begin to grasp the arc of their journeys from graduation to retirement?

 

Talking with trainees about their careers

A couple of years ago, I held a session on retirement with our otolaryngology residents. We read an article where the authors asked brand-new Johns Hopkins internal medicine interns to write down and then share what they thought a colleague would say about them at their retirement celebration many years down the road. I asked our residents to do the same. We also discussed which of their character strengths would be most noticeable in their careers (from the list at www.viacharacter.org/), what they think they will miss about their careers after they retire, and what aspects of retirement they are thinking about now. 

Not surprisingly, the Hopkins medical interns in the article and our MCW otolaryngology residents all see the distance from where they are now to retirement as being an incredibly long time. The brand-new interns hoped that their colleagues would see that they had lived out their core values, been accomplished in their careers, and been good teammates. Among possible character traits, our residents hope that they would have been most admired for their dedication to teamwork and their humility. They anticipate that they will find their greatest personal satisfaction–and what they think they will miss the most–from being part of a team focused on helping others in times of great need. Like the interns in the study, our residents worried about retirement but, being so far off in the future, they could not imagine what it will feel like to get there.

 Our otolaryngology residents did differ from the internal medicine interns. Although they know they will miss many things, they believed they will be able to replace professional relationships, the joy of helping others, and stimulating conversations with other post-retirement activities. As surgeons, though, they worried that they will have difficulty replacing the unique privilege of performing surgery. As one resident said, “I can’t imagine not operating again. That’s why we went into this.” Many agreed. 

 Our otolaryngology residents, who had been in training much longer than the brand-new interns in the Hopkins study, focused on how quickly time passes, even in training. “I am already realizing how much I will miss my fellow residents,” one of senior resident noted. “I’m sure my career will seem to pass by just as quickly.”

 

The challenges of helping students, residents, and faculty gain insight into themselves and others

There are data that strong relationships and lifelong self-care habits can yield benefits much later in life. MCW faculty members and the Kern Institute are building a portfolio of curricular and extracurricular opportunities that encourage resilience and insight.  The challenge is to make these types of offerings available, appealing, and effective. Baking caring and self-care into the institutional culture and the curriculum creates opportunities for both transformation and scholarship. 

But, let’s get real 

Finding time for reflection, creativity, and long-range personal planning is difficult and, frankly, of low priority for busy students, residents, and faculty. Institutions can readily measure clinic slots, RVUs, grant funding, and fiscal margins, but we don’t (yet) have metrics that measure sustained empathy, strengthened character, prevented suicides, and successful prevention of burnout. If we cannot demonstrate that these habits can be nurtured, or if they aren’t seen as valuable, our interventions will have little impact and won’t be sustained. 

Yet, raise your hand if you think that a graduate who is unprepared to thrive in practice will suffer needlessly over the coming decades. 

  

Retirement isn’t for sissies

Over the years I have been at MCW, dozens of colleagues have retired. The end of a career rarely goes exactly as planned. Some have retired amid accolades for lives and careers well-spent while others have left baffled and reluctant, having no idea what they would be doing a week later. Some, after long and productive careers, were forced out after bitter disputes. Some packed up and left in disgrace. Some became ill or died before they had the opportunity to retire. Some, unfortunately, held on too long. Some left huge holes in the institution when they retired. Others barely caused a ripple. 

 Guiding our students and trainees toward rewarding careers and eventual retirements carries responsibility. We must do more than suggest they be financially responsible and keep track of their retirement account outlook. We have equally important responsibilities to help them develop well-rounded professional identities, “seize the day” mentalities, and careers as reflective, empathic, and mindful physicians. If they enter practice self-aware and focusing on character, caring, and practical wisdom, they should have a better chance of emerging into retirement possessing the same values. 

 

Living each day

The act of living intentionally came to mind when I read a story in an interview with Duke University’s director of medical humanities, theologian, and pediatric oncologist, Raymond Barfield, MD: 

 “Think of each day as a gold coin that you are required to trade for something. You’ll never get that coin back, so whatever you trade it for had better be worth it. You also don’t know how many coins you have left to trade, and you don’t know what will happen when your bag is empty.”

My career shot past me like a rocket since I completed my fellowship and joined the MCW faculty 12,945 days ago. I now wish I had learned early on to treat each day like a gold coin. 

As I look back on my clinical practice, there were too many “hamster on a wheel” days. Still, I am grateful for the moments when a colleague or mentor, some of whom have died, encouraged me to take advantage of the self-care and reflective skills I acquired along the way. It helped. A lot.

Here is hoping we all learn to pay it forward. Your retirement will be here before you know.

 

Bruce H Campbell, MD, FACS, is a Professor in the Department of Otolaryngology and Communication Sciences and in the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the Faculty Pillar of The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He serves on the editorial board of the Transformational Times. 

 

Pulse Announces a Writing Contest - "On Being Different" - Deadline 3/31/2023

Pulse Announces a Writing Contest

The online medical writing journal, Pulse, is looking for your essays. Through the generosity of a grant from the Josiah Macy Jr. Foundation, Pulse is sponsoring a writing contest. To further our mutual goal of fostering diversity and inclusion in healthcare delivery, education and work environments, the theme of this contest is: On Being Different. The contest is open to everyone--to health and mental health professionals, to patients and caregivers and to students and trainees. The contest will be judged by Pulse's editors, with a first prize of $1,000 and awards totaling $2,000 to runner-up entries. Top entries will be offered the opportunity to be published in Pulse. The submission deadline is March 31. What does "being different" mean? It could mean: being a member of an underrepresented group; or having an illness that sets one apart; or working on a team where one's credentials or role sets one apart. Your story should reflect your experience of feeling different--and how that has impacted your physical or mental health, your medical care, your education or training, or your work as a health professional alone or as part of a team. Submissions must be true stories--your own experience or that of someone close to you--with a word limit of 1200 words. No fiction, please, and no poetry. Please see the Call for Entries for more details and to learn how to make a submission. Feel free to share this announcement with friends, family, colleagues and students. Please contact Pulse if you have questions. We look forward to reading your submissions!

A Story About Maryam

 From the January 27, 2023 issue of the Transformational Times

Associate Director's Column

A Story About Maryam 

By Cassie C. Ferguson, MD 

 Dr. Ferguson, who is a reknowned mentor and educator at MCW, tells the story of one student who came to her when on the edge of academic despair ...

The most rewarding mentoring relationship I’ve had with a medical student began the day she came to see me in my office to tell me about her experiences on academic leave. Maryam* had heard that I started a task force to learn about our school’s remediation process and wanted to share her story with me. I now know her to be a fierce, determined daughter of immigrants, but that day in my office she sat hesitantly on the very edge of her chair, backpack on, and glanced frequently at the door, as if she hadn’t yet decided to stay. Her voice was flat, and she rarely made eye contact when she spoke. She told me that after failing a course by less than a percentage point, she was asked to take an academic leave of absence before her first year ended. She might be able to come back, she was told, in the fall and repeat her entire first year. What she was not told was that when she drove to school the day after her leave began, her student ID would not work, and she would not be let into the school’s parking lot.  

“They just threw me away,” she said.   

Maryam’s story—her whole story—would take me years to learn. How she was diagnosed with multiple sclerosis during her first year of medical school after months of attributing her symptoms to stress. How she learned that she was dyslexic in her second year of medical school. How intense test-taking anxiety finally drove her to seek help from a psychologist. That information would be given to me in pieces as she grew to trust me, and I have slowly and carefully put those pieces together. Even now, four years after we met for the first time and three years of meeting with her every other week, I know that Maryam has not revealed all the pain she felt during that time, or during the struggles she has had since. I believe that this is in part because of her reluctance to seem as if she is making excuses, in part because of the intense shame that accompanies failing in medical school, and in part out of deference for the archaic medical hierarchy that still hangs over our profession, and the accompanying perception that my time is somehow more valuable than hers.  

That hurt we embrace becomes joy. / Call it to your arms where it can change.

-Rumi 

Medical school is not for the faint of heart. As a result, supporting medical students—particularly those who are struggling—requires love, grit, and fierce compassion. I have learned both through my own experience with failure and from working with students like Maryam that if we are to live up to the titles of teacher, mentor, and advisor we must walk with our students; we must show up even when showing up is uncomfortable. It is precisely when things get hard that we need to lean in and wade through the uncertainty and pain with our students. This requires that we recognize that we have something to offer because of our own life experiences, but I believe the bigger imperative is that we acknowledge that the boundaries of our experiences limit our ability to know what our students are going through. The only way to begin to truly understand is to get very quiet and listen to their stories.  

When we listen to a story, research using fMRI demonstrates that our brain activity begins to synchronize with that of the storyteller; the greater our comprehension, the more closely our brain wave patterns mirror theirs. The areas of our brain involved in the processing of emotions arising from sounds are activated, particularly during the more emotional parts of the story. Even more amazingly, when we read a story, the networks of our brain involved in deciphering another person’s motives—in imagining what drives them—prompts us to take on another person’s perspective and even shift our core beliefs about the world. 

It is impossible to engage properly with a place or a person without engaging with all of the stories of that place or person.

-Chimamanda Ngozi Adichie 

These findings should not come as a surprise to those of us whose work includes caring for patients. As an emergency medicine physician, I have heard thousands of stories. Whether they are snapshots relayed through EMS of how a 14-year-old child was shot in the head at two in the morning on Milwaukee’s north side, an exquisitely detailed account of a 3-year-old’s fever and runny nose from her mother, or a reluctantly provided history of pain and despair that led a 12-year-old to try and kill himself, each of these stories should transform us. They should move us to want and do better for our patients, for our communities, and for our world.  

At the same time, it is essential that as physicians and educators we also recognize what Nigerian author Chimamanda Ngozi Adichie describes as the “danger of the single story.” As an emergency medicine physician, I only hear stories of peoples’ suffering; I am listening to them when they at their most vulnerable, on what may be the worst day of their life. I only hear of the tragedies that have befallen a neighborhood we serve. As an educator who mentors students who are struggling, I often miss out on their stories that are not about failure or crisis. Adichie warns that when we only listen for the single story, there is “no possibility of feelings more complex than pity, no possibility of a connection as human equals.”  

So then our charge as physicians, as educators, and as human beings is to make room for more than just a single story—to remember that all of us are much more than our worst moments, and that compassion and connection arise authentically when we recognize the full spectrum of humanity in one another.  

*Names have been changed.  

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

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

From the January 27, 2023 issue of the Transformational Times

Perspective/Opinion

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

By Michael Stout, Ed.D. – Master of Science in Anesthesia Program Director

The importance of diversity and equity in our organization is demonstrated by our values. But how we invest our time is where real change is cultivated… 

Diversity, Equity, and Inclusion goals are often easier to design than they are to achieve. We value their importance, yet gaps persist. These issues were seldom mentioned when I first entered graduate school. More recently, I would be hard-pressed to find a college leader who does not support DEI initiatives. It appears we renewed interest and enthusiasm for addressing gaps and inequality wherever they exist, including our college campuses. Creating a thriving community built on principles of respect and inclusion remains an institutional priority, but how can we make it imperative? The benefits of participation in DEI initiatives can extend beyond individual growth and development and promote positive change beyond our role. 

Admittedly, I have struggled to find time to participate in development programs. There are countless instances when I have received an email and thought, “That sounds interesting. I would really like to attend that event” only to be pulled immediately back into the consuming list of my daily tasks. Inevitably, the date passes without consequence. While missing an opportunity is usually disappointing, the explanation that other activities were more pressing suffices to allay my concern. However, the impact my non-participation has on my team, and the larger organization, is often missed. A person’s priorities can be discerned by where they spend their most precious resource, their time. How could my faculty, staff, and students understand my support of DEI initiatives, if they do not see me participate? 

These programs are designed to help move our organization

The resources dedicated to them aim to transform our campus community and achieve outcomes that align with our values. As an academic leader, I wish for everyone in my unit to attend these events. I welcome the transformational ideas they bring back to our team. But if I choose not to participate, why would I expect that anyone else will? Therefore, my decisions have expanding ripple effects. These decisions not only impact my own development, but can also impact my team, and the larger organizational culture. 

There is growing evidence that improving diversity yields benefits in both private and public institutions. To this end, I pledge to attend an IWILL event to broaden my views on gender. These programs present opportunities to demonstrate our commitment to improving organizational culture. I am grateful for all the hard work, generously provided, by those who organize and attend them. 

While the demands upon our time are likely to remain unchanged, investing in these initiatives can help close the gap between the aspiration for change and its achievement. 

Michael Stout, EdD, is an Assistant Professor in the Department of Anesthesiology at MCW, a Certified Anesthesiologist Assistant, and Program Director for the Master of Science in Anesthesia Program at MCW.

Bearing Witness to Pain

 From the January 27, 2023 issue of the Transformational Times

MedMoth Story

 

Bearing Witness to Pain 

 

 

By Meghan Schilthuis 

 

 

Meghan Schilthuis, a third-year medical student at MCW-Milwaukee, shares an impactful patient encounter from her first clinical rotation. This story was shared as part of the 2022 MCW MedMoth storytelling evening…  

 

I began my M3 year this past June on my pediatrics rotation, excited to convert knowledge gained from many hours spent studying for the USMLE Step 1 into “the real world” of patient care. I spent my first two weeks in outpatient clinics and had a lot of fun interacting with relatively healthy kids. I wasn’t sure what to expect as I moved to the inpatient portion of the rotation and began a week of night float at the Children’s Hospital of Wisconsin.  

 On my second or third night, my intern and I got a call about an adolescent boy who would be coming up to our team. I began looking through his chart and learned that this boy, who I’ll call Zack, was being admitted with concern for infection in the context of extensive burns suffered a few months prior. My heart fell when I read that these burns were the result of an attempt to end his own life. What sort of situation would we be walking in to?  

When Zack arrived on the floor, my resident and I went to go see him together. We found him lying in bed, heavily bandaged, and clearly in a lot of pain. After we gathered some history and did as much of a physical assessment as possible, Zack’s mom looked at my resident and asked, “Could we speak out in the hall for a couple of minutes?” I wasn’t sure if I was supposed to follow my resident out into the hall, but felt like I should stay behind with Zack. 

 As my resident and Zack’s mom walked out, I had a brief moment of panic; what could I do or say that could possibly help him feel any better? I had no medication to offer him. His skin was so painful to the touch that I couldn’t offer a hand of comfort. I settled for asking him about the stuffed frog he had. He suddenly stopped writhing, locked eyes with me, and exclaimed, “I wouldn’t have done it if I knew it would be this much pain!” Even though we hadn’t talked about how he got his burns, we both knew exactly what “it” he was referring to.  

I fought back any chance for my eyes to well up with tears. “I’m sorry you’re in so much pain. We’re going to do everything we can to help you feel better.” Even though I knew I probably shouldn’t, I couldn’t help but think of my little brother who is the same age as Zack; my little brother who loves to play football and baseball, concoct interesting culinary combinations, and learn new songs on his bass guitar. How could a middle schooler like Zack be saddled with so much pain at such a young age? 

After a few minutes, Zack’s mom came back with my resident and said to me, “I’m sorry, Zack can be a little dramatic.”

“Oh, no, don’t worry,” I told her as I waved goodbye. My resident and I left to staff the case with the attending before our next admission. 

The busyness of the rest of the shift kept me occupied, but I found myself thinking about Zack as I drove home and got ready for bed. When I called my mom to catch up the next day, I shared some of the story with her. She could tell that I was still feeling badly about Zack. She encouraged me to stop worrying about him, which sounded a little harsh to me at first, but she was correct in pointing out that my concern would not change things for Zack. 

Even still, I left our conversation wondering how physicians can best bear witness to their patients’ suffering without allowing it to consume their thoughts. 

In my interaction with Zack, I felt a tension between my strong desire to alleviate his pain and an uncertainty about how to do that. Even though I felt like there was little I could do for him at the time, looking back, I hope that our brief connection helped him feel less alone in that moment. 

I never saw Zack again after that night and don’t know what happened. Wherever he is today, I hope he’s healing and doing well.  

 

Meghan Schilthuis is a third-year medical student at MCW-Milwaukee. She is one of the student leaders of MCW’s MedMoth storytelling event.  

 

There is No Success Alone

From the 1/20/2023 issue of the Transformational Times

There is No Success Alone 

By Cassie Ferguson, MD – Associate Director of the Kern Institute 

 

 

"Talent wins games, but teamwork and intelligence win championships." 

-Michael Jordan 

The depth and breadth of our collective success in the Section of Pediatric Emergency Medicine is staggering. And the pride and reverence with which each of us holds these successes, regardless of the role we played in them, is a testament to the love we have for our patients and for one another.  

It also is a testament to our leader, Dr. David Brousseau.  

Our section begins 2023 with a goodbye to our chief of eleven years, whom we affectionately call D-bro. Dr. Brousseau is leaving for Delaware after 23 years of service to MCW, and I couldn't let him leave without trying my best to explain how much he has meant to me and to all of us – to our team. 

The Section of Pediatric Emergency Medicine is working to address food insecurity among our patient's families, improve patient health literacy and numeracy, strengthen the coordination between the Emergency Department (ED) and our EMS colleagues, decrease sexually transmitted infections in our adolescent patients, share our experience in pediatric sedation medicine with colleagues in under-resourced countries, sharpen our section’s bedside ultrasound skills, ensure all patients have access to life-saving flu vaccines, and give kids who have been victims of interpersonal violence a chance to go to summer camp. Among other things. 

Our team is committed to this challenging work. We also like to win. We are especially proud of wins that showcase our team’s ability to work together creativity – even when it has nothing to do with emergency medicine, and everything to do with teamwork. Even if it’s just for fun. 

For six of the seven years that the Children’s Specialty Group has held a Halloween costume contest at Children’s Wisconsin, the Section of Pediatric Emergency Medicine has either won first place or been in the top three (we don't count the year we were allegedly disqualified). This success is not by accident. Every year, months in advance, we vote on a theme and then each of us—faculty and staff—works on putting together our individual costume such that it fits into the theme. As an often overlooked and perhaps maligned department of the hospital (hey— we don’t like to call you to consult at 0300 either), winning this contest has become a source of pride, primarily because we do it together.  

All hail the Section of Pediatric Emergency Medicine’s Halloween Costume Dynasty. 

“How lucky I am to have something that makes saying goodbye so hard.” 

-A.A. Milne 

I admit this Associate Director's Corner is less an article than a love letter to my pediatric emergency medicine colleagues and to Dr. Brousseau. 

Twelve years ago, I was a new attending physician and had just moved back to Milwaukee with my husband, our three-year old son, and a newborn. I felt so lost. I remember wanting desperately to contribute and to feel useful, yet not knowing how. Within three years, I was co-directing the Quality Improvement and Patient Safety Scholarly Pathway for the medical school, was selected to participate in MCW’s Docere II teaching course and had begun an advanced improvement methods course at Cincinnati Children’s Hospital.  

I acknowledge this required a certain amount of work on my part, but I also know that none of it would have happened without Dr. Brousseau and those foundational opportunities that were key to me building what has become an incredibly fulfilling career. 

Even more meaningfully, for the past 12 years Dr. Brousseau has consistently reminded me what I am capable of and what I contribute, empowering me to take risks and to step into roles I thought were too big for me. 

As I look around at my section colleagues, and at what they have achieved, Dr. Brousseau’s legacy becomes very clear: His leadership has enabled us all to thrive. We are purpose-driven and optimistic; we are continuously learning and pushing for change; we know how we can contribute to the greater good of the section and our community at large and we are given the space to do so. Even in our section's darkest hours, instead of fear and uncertainty and anger tearing us apart, we rose together, becoming closer and more determined to navigate the darkness together. 

"The good leader is he who the people revere. The great leader is he who the people say, we did it ourselves."

-Lao Tzu 

In this country, we like to think of good leadership as big, bold and brash. Crashing through obstacles, pushing past limits. Loudly declaring itself. All-knowing. Strength of conviction is often more apparent than strength of character in the leaders we choose and in those chosen for us. 

Dr. Brousseau, however, has shown me leadership that enables thriving is quiet. It takes mindful, careful steps as if feeling the earth beneath its feet as it walks. This kind of leadership is inclusive. It widens our field of attention and helps us be aware of when we are being called to be more loving, more compassionate, more open hearted. It engenders trust -- not through convincing, but through presence. And it doesn’t get frustrated when it must explain how to calculate positive predictive value for the 1000th time during journal club. 

“Goodbye always makes my throat hurt.” 

-Charlie Brown 

Whenever I sat down with Dr. Brousseau in his office for my annual faculty review, he always began our conversation by asking, "What is your favorite part of your job?"  

If I had that question to answer one more time, knowing that it would be our final faculty review and the last time I would have the chance to share my answer with him, I would say this: 

There are too many favorite parts to name them all. I love showing up to the ED and getting a hug from the person I’m getting sign-out from. I love that when I want to switch a shift so that I can see my kid’s baseball game, someone will instantly volunteer to help. I love that our section meetings never end on time because we are all so excited to see and talk to each other.

Perhaps most of all, I love that I have the freedom to do what I love to do with people I love, and the support and encouragement to keep doing it better.  

Thank you, Dr. Brousseau, for pushing us, for fighting for us, for holding us all together. For helping us to thrive.  

Cassie Ferguson is an Associate Professor in the Department of Pediatrics, Section of Emergency Medicine at MCW. She is the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.  

Three New Year's Questions for Amy Zosel, MD, MSCS

From the January 20, 2023 New Year’s Resolutions issue of the Transformational Times

Three New Year's Questions for Amy Zosel, MD, MSCS

As part of our January 20, 2023 issue, the newsletter reached out to several facutly, staff, and students and asked them three questions about their hopes and plans for 2023. Here is a resposnse from Emergency Medicine faculty member and recipient of multiple teaching awards, Amy Zosel, MD, MSCS.

Transformational Times: What is one thing that you hope for when you think about 2023? Why? 

Amy Zosel, MD, MSCS: In 2023, I hope for opportunity to reconnect with family and friends. As front-line health care providers, we were asked to ramp up our work, and pour time and energy into solving new problems. There were extra planning meetings and task forces to develop COVID-related clinical pathways and creatively move education to online platforms. While people in other sectors found time to pursue baking sourdough and playing board games, we were busier than normal. Many of us are also trying to figure out how to do online school at home with our kids. As this business dissipates, my hope is to spend more quality time connecting face-to-face with loved ones. I am especially looking forward to travel this year. 

Transformational Times: Do you have a new year's resolution that you can share with us? What inspired you to choose that? How is it going so far? 

Amy Zosel, MD, MSCS: Our Department of Emergency Medicine did an exercise challenge this fall. (Nothing like a little friendly competition to get you on the treadmill). Fitting in a little exercise everyday feels great, so I am aiming to continue that. Thanks, MCW EM Wellness Committee! 

Transformational Times: What do you see as an example of the "new normal" in our world? How do you feel about it? 

Amy Zosel, MD, MSCS: An example of the “new normal” is the opportunity to take meetings via Zoom. While this offers certain flexibility and cuts down on commute time, it can be difficult to engage deeply at home and at work. We need to make sure meetings are meaningful and that we are giving our families the attention they deserve. 

Amy Zosel, MD, MSCS, is an Associate Professor; Interim Division Chief, Medical Toxicology; and Director of Research Operations and Mentorship in the Emergency Medicine Hub for Collaborative Medicine at MCW. She also has been active with the Council for Women’s Advocacy (CWA) -- an advisory committee on issues of professional development of all faculty members.