The future of our profession must find their voices

  

From the 9/18/2020 newsletter

The future of our profession must find their voices

Adina Kalet, MD, MPH

Dr. Kalet celebrates the 25^th and first student edited issue of the Transformational Times and argues for the critical importance of strengthening student voices in the transformation of medical education. 

“I write entirely to find out what I'm thinking, what I'm looking at, what I see and what it means. What I want and what I fear.”

- Joan Didion

COVID-19 and the events of the last 6 months has provided us all with a classic disorienting dilemma. According to Mezirow’s transformative learning theory, disorienting dilemmas occur when people have experiences that do not fit their expectations and that they cannot resolve without changing their world views and challenging basic underlying assumptions and beliefs. This perspective transformation is not a common event, but when it does happen, theory has it, profound learning occurs. A strong professional identity is facilitated by these uncomfortable or distressing experiences when coupled with an ability to reflect on what one has learned- usually in writing- and expert support from coaches, mentors, faculty, peers, or others (Kegan & Lahey, 2009).

There is a great deal of evidence that cultivating an ability to write reflectively, expressively and stylistically well is critical to “locking in” learning experiences for the long run- especially if those experiences are emotionally intense. But good reflective writing requires effortful practice. Even for those who do it for a living and find it pleasurable, good writing is never easy. In these very stressful times- given the potential for transformative learning- I believe we should encourage our trainees to cultivate a habit of reflective writing.

These early years of their professional lives in health care will shape them as individuals and as a generation. This current crisis is not over and there are more crises ahead. Hearing from, listening to and engaging with our junior colleagues will be vital to ensure a physician workforce not only ready to serve with expertise, character and passion, but also that as individuals they will be hardy enough to learn from crisis.

Here are my considerations and wonderings for our students in these tumultuous times:

• How will this moment in history imprint on them? What will it mean that they entered our profession during a respiratory virus pandemic, a time of unprecedented political polarization, inescapable consequences of racism, and looming climate disasters?
• What are they learning about the role of physicians in society? How do they imagine their own futures? Are they becoming braver and or more fearful in the face of these challenges? Do they hear and trust their inner voices? Do they perceive their own moral compasses? How do they discern which role models to emulate and which to ignore? 
• How will this moment in history imprint on them? What will it mean that they entered our profession during a respiratory virus pandemic, a time of unprecedented political polarization, inescapable consequences of racism, and looming climate disasters?

In this, our 25th issue of the Transformational Times, hopefully the first of many student-led issues, we highlight stories of profound learning. We now have five students on the editorial board - Olivia Davies, Scott Lamm, Eileen Peterson, Sarah Torres, & Anna Visser - who have worked to bring forth a range of student voices. 

• Kelli Cole & Gopika SenthilKumar describe how their plans for their TI2 and summer projects rapidly evolved -because they courageously and adventurously allowed them to- toward a cutting edge, mentored experience in design for healthcare. 
• Jess Sachs shares her inner struggles and “true north” sources of inspiration as she navigates the extreme discomfort of trying to do right thing as a White woman in the face of racism. 
• Reed Colling describes his experience as an MCW student on the Green Bay campus and Hayden Swartz, from the Central Wisconsin campus shares a beautiful, deceptively simple poem. 
• David Lambert (a Milwaukee M4) describes the uncertainty of being pulled from the wards in March and the exhilaration of returning in June. 
• Olivia Davies ponders the particulars (heels? coffee?) of her upcoming momentous professional transition from medical student to Dermatology resident in a two-dimensional, waist up virtual world. 

With courage, effort and beauty our students share their thinking with us.

Students who view themselves as subjects of oppressive educational structures will not find the joy in the medical profession. In a transformed world of medical education students are active partners in and co-creators of their own education. To do this we must all hone our thinking and ability to communicate. Writing does just this, the act of writing makes things happen, inspires others, clarifies facts and encourages healthy mind-expanding transformational learning.

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.

Ref: Kegan, R., Kegan, L. L. L. R., & Lahey, L. L. (2009). Immunity to change: How to overcome it and unlock potential in yourself and your organization, Harvard Business Press.

Authenticity, Selflessness, Courage, and Team

 From the 9/11/2020 newsletter

Perspective

Authenticity, Selflessness, Courage, and Team

Kathlyn Fletcher, MD MA, Lily Littrell and Luke Littrell

On August 26, the Milwaukee Bucks were scheduled to play the fifth game in their best-of- seven playoff series against the Orlando Magic. But then they didn’t. The team did not take the floor, ready to forfeit an important playoff game. Eventually, we learned that the team had come to the painful decision that they could not play basketball in the wake of another shooting of a black man, this time close to home.

Jacob Blake, a black man from Kenosha, WI, was shot in the back by a police officer seven times on Sunday, August 23, 2020. The circumstances surrounding the shooting are still emerging, but what is clear is that we are once again facing an extreme, violent, life-changing action by law enforcement against a black man. Kenosha, Wisconsin, and the country were reeling. It all felt devastatingly familiar. And then the Bucks stepped in. Or rather, stepped away, firmly, quietly sending the most powerful of messages.

Next, the other NBA teams scheduled to play on that night joined the Bucks in declining to play. Some major league baseball teams, including the Brewers, followed suit as did the WNBA and major league soccer. The message was clear: The status quo is no longer acceptable. The violence and injustice must stop. I wondered, though, how the players would move forward. I asked my 10-year-old son, Luke, what he thought about it. He did not like it that the Bucks had refused to play because he thought that nothing would come as a result. He was glad that the Magic did not accept the forfeit, though. Then the players did something remarkable.

Chris Paul, president of the NBA Players Association and LeBron James reached out to former President Barack Obama for advice. They wanted to make this decision to stop the playoffs matter. Apparently, Obama told them to decide what they wanted, ask for it and then play basketball. The players’ act of resistance resulted in more polling places for the upcomingelection, and the formation of an NBA committee to work on racial injustice issues.

The willingness to forfeit a playoff game to call attention to the moment was a brave act of selflessness on the part of the Bucks. There was a lot at risk. In retrospect, I am not surprised. They have been living this message since the playoffs began. The entire NBA has worn jerseys with racial equity mottos and warm up “Black Lives Matter” shirts for months. Individual players have done more. Several Bucks players led a BLM protest in Milwaukee before reporting to the bubble this summer. And Kyle Korver’s t- shirt selection (often courtesy of the Happy Givers) has created quite the stir, at least in my house. My daughter, Lily, can’t wait to see what the next one will say (see her drawing). The most recent bore the words “When we’re not hungry for justice, it’s usually because we’re too full of privilege.” What has specifically resonated with Lily is that these acts don’t call attention to the individual players, they call attention to the movement. She is drawn to them because they seem authentic and selfless.

This is an important moment, and everyday people might also wonder, as Luke did, what protests will accomplish. While few of us alone have a voice strong enough to demand that our workplace become a polling place, we must find our equivalent of not accepting the status quo any longer. We must do it in an authentic and selfless manner.

Last week, the Bucks taught us about the courage required in taking a stand when it is hard and something is at risk. They also taught us about the power of the team. One player refusing to play would have been a much different statement than the whole team refusing. We also learned that our enemies are sometimes on our side. The Magic had everything to gain in that moment; they could have been down 3-2 instead of 3-1 in the series. But they stood together with the Bucks by declining the forfeit, and the whole league followed. The Bucks have shown us the path forward: Authenticity, selflessness, courage and team.

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Lily Littrell is an up-and-coming artist. Luke Littrell is an aspiring athlete and basketball lover.

On Inclusion, Diversity, and Why Black Lives Matter Too: What our MCW Community BLM Protests Mean to our Colleagues of Color

 From the 9/11/2020 newsletter

Perspective
 
 
On Inclusion, Diversity, and Why Black Lives Matter Too: What our MCW Community BLM Protests Mean to our Colleagues of Color
 
 
Leroy J. Seymour, MD MS - Internal Medicine – PGY1
 
 
Dr. Seymour writes about the recent MCW Black Lives Matter protest and why it is important to create a flourishing, diverse, and inclusive community … 
 
 

On Wednesday, Sept. 2^nd, at 5:11pm, members of the Medical College of Wisconsin community held a Black Lives Matter protest to help shine a light on the frequent propensity for violence against people of color. This latest protest is one of hundreds of protests against police brutality and racial injustice that have been occurring in various cities, states, and countries, most recently triggered by the murder of George Floyd on May 25^th, 2020, in Minneapolis, MN. So many people have demonstrated peacefully and expressed their voices, all vying for the same dream Martin Luther King Jr. expressed to the world. Almost every aspect of the world’s population has provided an overwhelming outpouring of support of the Black Lives Matter movement; taking the baton and relaying the message that “Black Lives Matter too” to widespread media coverage and the political stage.
 
MCW faculty, residents, and medical students alike raised their voices in support of the Black Lives Matter movement. This stance informed the world that MCW and the Froedtert medical community will not tolerate racism, and that racism itself is a pandemic that needs to be eradicated. The Sept. 2^nd protest involved holding 7 minutes of sustained silence, each minute representing every bullet maliciously aimed at the back of Jacob Blake, an unarmed African American man returning to his vehicle, by Rusten Sheskey, a Kenosha WI police officer. Mere seconds after an instinctive proclivity for violence towards nonaggression left a man paralyzed, the world responded with outrage and exhaustion, yet another example of the unfair mistreatment of people of color when interacting with those with a perceived position of authority.
 
Many of us have protested these injustices before. I've protested it before. Our parents protested it before. Our grandparents protested it before. Our ancestors survived and protested it. I’ve stood face to face with the Ku Klux Klan, neo-Nazis, and individuals who have all decided that racial slurs and anger were the best response when asked why they hate people of color or different sexual orientation. Nobody should have to be afraid to walk outside or live in their own homes. People should not be judged by the color of their skin or their sexual orientation, but by the content of their character. People of every ethnicity, background, or creed, should not have to be afraid for their lives when interacting with police. With the many communities, committees, social circles, and groups that I belong to, I can single-handedly attest to the importance of diversity, the inclusive nature of MCW, and why having people of varying backgrounds, experiences, and cultures is so critically important to both the health of a community and a medicine brain trust. 
 
As a new internal medicine resident and as an African American, I have witnessed firsthand the most beautiful sides of humanity, and the darkest corners of vitriol. I have cared for patients who have been incredibly appreciative and receptive of my presence, feeling more at ease with talking about their privileged information because I am a person of color. I have also had patients turn me away for the exact same reason. When I wanted to become a physician, I made a lifelong commitment to improving and protecting my community. I’ve vowed to provide a safe haven for those without a voice, to be a vanguard in the face of hatred, to be the lighthouse in someone else's storm. But when it is you, your family, your friends, or your community who is being harmed, harassed, and violently mistreated, it takes that community to heal the hurt. It is hard to sustain a thriving and supportive community if that same community refuses to break bread with a particular subset of the population, even when everyone shares the same table.
 
I am proud to belong to a program and institution that takes a hard stance against institutionalized racism and is incrementally rolling out educational opportunities for those interested in, and in need of, anti-racism education. It is comforting to know that my colleagues and peers support the Black Lives Matter movement and understand the deeper inclusive meaning behind the statement. However, supporting the movement is only the first step of a marathon many have been running for years. With many cities in various countries now protesting the same cause, only time will tell if our collective voices have resonated, and what changes will result from our collective stance against institutionalized racism and racist ideology. Myself, my colleagues, and my peers at MCW have already decided which path we will walk, and that is hand-in-hand with our flourishing, diverse, and inclusive community.
 
 
 
 
Leroy J. Seymour, MD MS is a first-year internal medicine resident at the Medical College of Wisconsin

Racism is a Public Health Crisis: When Will We Decide It Matters?

From the 9/11/2020 newsletter 

Racial Justice Perspective

 

 

Racism is a Public Health Crisis: When Will We Decide It Matters?

 

 

Kristen Pallok, MD and Shaina Sekhri, MD – PGY2 Internal Medicine Residents

 

 

 

Drs. Pallok and Sekhri, allies as MCW works to become anti-racist, challenge the institution to do better …

 

 

In late June of 2019, we arrived at the Medical College of Wisconsin (MCW) for our internal medicine residency. Two newly minted female physicians arriving at the same institution, struck separately by the same conclusion: a lack of racial diversity. 

 

There is a hallway in MCW that displays a decades-long photographic history of MCW’s medical school classes. As a woman, it’s hard to miss – a long timeline of white, male medical practitioners.  And while some would think we would have long moved beyond this one-sided picture of white, male privilege, it has recently become clear to many individuals that we have not. 

 

Milwaukee is a diverse city with a significant Black population. According to the Milwaukee 2010 Census data, 40% of Milwaukee residents were Black. In comparison, 45% were white. Froedtert and the Medical College of Wisconsin serves this diverse population. Yet, while many of our patients are Black, our practitioners and leadership are not. In fact, the Black:White ratio of our faculty or residency programs is nowhere close to the breakdown of the Milwaukee population. Of the publicly listed members of Froedtert Health’s executive leadership, only 0.25% - 1 in 40 – of the members are Black, while 90% are white. 

 

What does this fact, this lack of racial diversity at MCW and Froedtert Hospital, have in common with our country’s racism and recent acts of police brutality? It is a form of perpetuated structural racism – structural violence designed into our policies, procedures, and our norms that harms our patients and breeds mistrust in our healthcare system. 

 

It’s easy to point at events outside our doors and commiserate about the state of racial equity in our nation. The real difficulty rests on scrutinizing ourselves at MCW and Froedtert to address our own institutional racism.  Our program took its first steps in acknowledging the presence of racism and addressing the Black Lives Matter movement with an hour-long reflection and resident-authored essays. The anonymous responses included an examination of privilege, uncomfortable feelings about the state of our society, fear, anger, and difficult conversations with family and friends. In all honesty, it is disheartening that it took such a large, nationwide movement to realize we must spend time discussing these issues. They have existed long before the events in the media, with thousands of excess Black lives lost each year to healthcare and disparity mortality gaps. Yet, we are hopeful that having finally arrived at a discussion, we can now work to make MCW an equity-driven space that dispels racism from its ranks. 

 

To create an environment that is inclusive and supportive of historically marginalized residents and faculty, we must take steps within our program. We acknowledge that as two non-Black women, we are limited in our perspectives and thus propose creating a racially diverse taskforce willing to identify and address actions such as the following: 

1. Taking an institutional stance against racism and police brutality as a public health issue
2. Asking residency applicants during their interviews how they plan to address healthcare disparities
3. Ending race-based medical practices in an overt manner, including lectures on why certain racist data is no longer used in medical practice
4. Training our residents to become advocates for our patients to receive the equitable care they deserve, which includes implicit bias training, insight into privilege and opportunity, and modules that focus on aiding patients from our communities of historically concentrated disadvantage

 

Yet, most importantly, we believe, for the institution to fully enact such changes, it must change at its roots. It is impossible to fully serve a population which is not reflected in our medical staff. Therefore, we suggest we must racially diversify our residency cohorts. We must focus our efforts on the recruitment of Black residents. We must focus our efforts on the retention and promotion of Black faculty and senior leadership. We must provide examples and mentors for our fellow residents to follow, and we must provide outreach in our Black Milwaukee communities to become members at the table – one which so deeply affects their health and, ultimately, their lives. We cannot fully represent our communities, our patients, if the Black Milwaukee community is not reflected in our medical practitioners and decision-makers.

 

This issue of structural racism is not limited to MCW and our residency program. It spans all of our institutions. And to conquer it, we must take a stance together. In June 2020, thirty-six Chicago hospitals and clinics signed a declarationnaming racism as a public health crisis and made seven commitments to dismantle racism in healthcare. This declaration is now going national through the Healthcare Anchor Network, a group committed to elevating communities and dismantling the effects of racism. In solidarity, we hope we can all sign our names to the list and take a seat at the table.  

 

It is not enough for a program or an institution to say that it is not racist. It must take actionable steps to become anti-racist. This requires us to name anti-racism as an organizational strategy to hold each other accountable, at both the individual and institutional levels. We can do more. If we believe Black lives matter, we cannot be complacent. We are 400 years overdue. We must act now.

 

 

 

Kristen Pallok, MD and Shaina Sekhri, MD are PGY2 Internal Medicine residents at the Medical College of Wisconsin