Understanding Sexual Harassment Reporting at MCW

 From the 12/11/2020 newsletter

 

 

Three Questions for Katie Kassulke – MCW Administrative Director of Faculty Relations/Title IX 

 

 

 

Understanding Sexual Harassment Reporting at MCW

 

 

The term, “Title IX” refers to a specific section of the Education Amendments of 1972 that protects people from discrimination based on sex in educational programs or activities that receive Federal financial assistance. Ms. Kassulke, the Administrative Director of Faculty Relations and Title IX coordinator for MCW, is responsible for coordinating the investigation of   reports and offering supportive resources and services. She was interviewed by Transformational Timeseditor, Bruce Campbell, MD …

 

 

QUESTION 1: How will recent Title IX legislative changes affect institutions like MCW? 

 

The U.S. Department of Education released new regulations governing reports of sexual harassment that went into effect in August 2020.  The regulations include new, narrow definitions of sexual harassment, requiring a significant shift in our grievance procedures, including a requirement that MCW hold live hearings.  In a hearing, both the reporting party and the accused will participate in cross examination of parties and any witnesses involved. 

 

MCW can maintain current investigation processes without live hearings for any report of inappropriate conduct such as unwelcome verbal comments, microaggressions or unprofessionalism that fall outside of the new Title IX definitions.  MCW is not unique in the practice of maintaining dual processes.  My role will be to carefully review all reports to ensure the appropriate procedure is used.  Both processes provide support and equitable treatment to all involved.

 

 

QUESTION 2: How does the office support victims when they come forward? 

 

It takes incredible courage for an individual to come forward and make a report.  I recognize that and seek ways to provide individualized support.  Support might include: 

·      providing resources such as arranging a no-contact order

·      helping arrange counseling

·      making academic accommodations

·      assisting with reporting a crime to law enforcement

Listening can be the best initial response to provide support. Reports may come to me from witnesses, colleagues, and/or the person who is experiencing unwelcome behavior.  I seek to understand how the reporting party  wants to proceed after a  report is provided.  Sometimes, individuals want to proceed with a full grievance process, and at times they prefer alternative resolution options.  Under the new regulations, we can now explore mediation, restorative justice, or other options.  

 

In my role, the regulations require I must avoid any type of judgment and remain neutral. What this means is I reserve making any judgment until fact finding and full grievance processes are completed, and I offer equitable treatment including supportive resources to all parties involved.

 

 

QUESTION 3: How has the #MeToo movement affected how you see your work?

 

The #MeToo Movement began in 2006 when Tarana Burke first coined the phrase and is designed to raise awareness of women subject to abuse.  The Movement has encouraged many individuals across the world to come forward and has shined a spotlight on how power structures have facilitated widespread sexual harassment.  #MeToo not only promotes hearing victims’ voices, it also hopes to force largescale changes. 

 

I am committed to providing a safe space for all involved parties to be heard and to reach appropriate resolution for each incident.   It is my hope all people come forward and make a report of any type of oppression or abuse they are experiencing.  

 

The #MeToo movement has made it clear to me that I can make a difference by addressing inappropriate behavior starting with disrespect and helping everyone know how to be an ally by speaking up when they see any type of unprofessionalism.  I love MCW’s focus on maintaining a culture of professionalism and work hard to support the efforts, and the IWill MCW that engages the MCW community in conversation and action around gender equity.  The annual Respect Training provided by MCW is another area I focus on to promote guidance about our policies, expectations, how to make a report, be an active bystander, and how to seek out resources.

 

 

Resources:

MCW Title IX Webpage

IWill MCW

MCW Policies

·      Professional Conduct Policy

·      Anti-Harassment and Non-Discrimination Policy

·      Prohibiting Sexual Harassment and Abuse in Education Programs

 

Integrating the Basic and Clinical Sciences in the Minds of Learners: Where the Rubber Meets the Road in Transforming Medical Education

From the 12/18/2020 newsletter

 

 

Workshop Review

 

 

Integrating the Basic and Clinical Sciences in the Minds of Learners: Where the Rubber Meets the Road in Transforming Medical Education

 

 

Jacob Prunuske, MD, MSPH and Amy J. Prunuske, PhD - Faculty members at MCW-Central Wisconsin

 

 

Drs. Prunuske describe a recent workshop that illustrates the key concepts to transforming medical education …

 

 

On November 24, 2020, MCW hosted an event co-sponsored by the Office of Academic Affairs and the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education that reflected MCW’s commitment to transforming how we approach medical education. The afternoon event consisted of a plenary and two workshops. 

 

 

Plenary Session: Promoting Cognitive Integration and Student-Centered Learning

 

The plenary was delivered by Amy Wilson-Delfosse, PhD, the Associate Dean for Curriculum at Case Western Reserve University School of Medicine, and Leslie Fall, MD, the Chief Executive Officer of Aquifer, a non-profit dedicated to delivering high-impact, virtual health care education.  The session focused on the key principle that cognitive integration must occur in the learner’s mind and thought processes. Medical educators must, therefore, design educational experiences that foster cognitive integration because that is the essence of what it means to be a doctor. Facts, figures, pictures, and diagrams are all available with quick internet searches, yet the availability of this material does not make someone a doctor. Rather, clinicians must be able to integrate the basic and clinical sciences within the context of patient needs, family dynamics, and community resources, and then develop appropriate differential diagnosis and management plans. Educators must support this cognitive integration and not limit their teaching to a simple transfer of facts and figures. 

 

Basic scientists and clinicians sometime lack a common language to describe key concepts. This disconnect increases the cognitive load for medical students and decreases the likelihood that students will learn to truly integrate basic and clinical concepts. To help alleviate this load, educators should identify the top clinically relevant concepts every medical student must be able to understand and apply in clinical situations to make safe, effective, and high-quality decisions. To meet this goal, medical educators must craft learning objectives that challenge students to justify clinical decisions using core basic science concepts.

 

 

Webshop: Student Centered Teaching and Learning (Dr. Wilson-Delfosse)

 

Following the plenary, Dr. Wilson-Delfosse presented the first webshop. Participants identified the MCW “Ideal Learner” as curious, reflective, humble, self-aware, adaptive, and collaborative. These characteristics align well with the educational philosophy of the Master Adaptive Learner framework. With the support of a robust coaching and support system, medical students must engage in four critical phases to develop the skills of a master adaptive learner: 

 

·      Planning phase: students identify gaps, select opportunities for learning, and search for learning resources. 

·      Learning phase: students critically appraise the resources they use for learning and intentionally practice effective study and learning strategies. 

·      Assessment phase: students assess themselves and receive feedback from others. 

·      Adjusting phase: students demonstrate an ability to transfer learning to both routine and novel clinical situations. 

 

Dr. Wilson-Delfosse highlighted a practical application: the Master Adaptive Learner Checklist. This checklist provides a template for medical educators to assess whether any given educational session fosters master adaptive learning skills development. MCW participants in the webshop were given the opportunity to apply this checklist to instructional vignettes, highlighting the value of the checklist for improving and aligning educational sessions.

 

Finally, Dr. Wison-Delfosse emphasized our role as medical educators in attending to student learning experiences and serving to energize and invigorate student excitement about learning. 

 

 

Webshop: Integration of Basic Sciences into Clinical Reasoning and Decision Making (Dr. Fall) 

 

Dr. Fall presented the second webshop. She described how the use of integrated illness scripts and mechanism of disease mapping supports student learning by integrating basic, clinical, and health systems sciences. This results in improved retention of information. Mapping of mechanisms of disease creates visual representations that foster integration of key scientific concepts and provide frameworks for exploring the art and practice of clinical medicine. 

 

MCW participants then applied these concepts to case-based learning strategies. By comparing and contrasting causal mechanisms of disease and illness scripts, participants provided rationales for laboratory evaluation, imaging, and clinical next steps. 

 

 

We look forward to applying the ideas and concepts presented during this event to our efforts to redesign our MCW curriculum. We encourage you to watch and review these sessions and explore opportunities to promote Cognitive Integration and Student-Centered Learning in your courses and clerkships. 

 

Recordings of the sessions are available here:

 

·      Plenary Session
Webshop 1- Student Centered Teaching and Learning

·      Webshop 2- Integrating Basic Sciences into Clinical Reasoning & Decision Making

 

 

 

 

Jacob Prunuske, MD MSPH is the Assistant Dean for Clinical Learning at MCW- Central Wisconsin.

 

Amy Prunuske, PhD is on the basic science faculty at MCW-Central Wisconsin.

 

 

A great miracle is happening here. Rededication is needed.

 From the 12/18/2020 newsletter

 

 

Director’s Corner

 

 

A great miracle is happening here. Rededication is needed. 

 

 

Adina Kalet, MD MPH

 

 

This week Dr. Kalet reflects on this season of miracles in our medical, societal, and spiritual lives, as we celebrate some remarkable achievements and ready ourselves for the future ...  

 

 

The photographs are spellbinding: first responders, nurses, environmental service workers, transporters, laboratory technologists, physicians in full PPE, sleeves rolled up at the ready to receive the vaccine. The science – messenger RNA presenting small bits of the SARS-CoV-2 spike protein to recruit our immune systems – is a miracle. The rapidity and coordination with which the basic and clinical scientists and government approval processes advanced to save lives is astonishing. The administration and engineering know-how enabling mass production, distribution, and inoculation is wonderous. 

 

Like the generations of physicians who experienced the end of the polio epidemic, the taming of tuberculosis, and the turning of HIV/AIDS into a chronic manageable disease, this generation should be inspired by the awesome power of civil and political society, health care systems, science, and medicine pulling together to address the existential threats to humanity. Many have been overwhelmed from the sacrifice, work, commitment, and persistence it has taken to make the miraculous a reality. Many on the front lines have been infected. Some suffer from late effects of the virus. Some have died. Modern miracles are not magic. 

 

At the same time, the Electoral College met and affirmed that we will have a new president and vice-president this coming New Year. Never in my lifetime have the gears of democracy been so transparent and inspiring. The campaign, the voting during a pandemic, counting and recounting, certifying and recertifying, and vigorously defense of the “voice of the people” were affirmed through the judicial process. We have disagreed and debated, we have exerted ourselves and have made a choice. This process has opened fissures in our civic life. We are in the midst of a major social upheaval, a tipping point, a moment of reckoning. We are exploring new territory. It has been truly miraculous and grueling.  

 

As I write this, it is the sixth night of Chanukah, a word that means “dedication.” On Chanukah, we celebrate a “Great Miracle.” We light candles and eat fried potato pancakes, jelly doughnuts, and chocolate coins. We play games and exchange gifts. We are celebrating, literally, having to clean up and make do after having survived a horrific era of bloody war and civil unrest. Chanukah recalls an historic, not biblical, event that took place during the 3^rd Century BCE.  The metaphorical miracle of Chanukah is that a bit of lamp oil lasted way longer than it should have, keeping the “eternal light” in a nation’s holiest space aflame while a a fresh supply could be procured.  But the miraculous thing we celebrate is that we had the privilege of cleaning up the mess and rededicating our places and spaces to the important work of the body, mind, and spirit. And many of us survived to tell the story. 

 

As 2020 ends, we have now breeched over 300,000 COVID-19 deaths in the US alone. More deaths from a single cause than in any war, although not unusual when compared to other pandemics.  Boxes of vaccine have landed in airports in every state, placed on trucks, delivered to the receiving docks of health care facilities, defrosted, and injected into the arms of our colleagues, friends, and family. 

 

The masked front-line workers in the photographs receiving their immunizations are people who continue to care for us, our health care team, our community, and our most vulnerable. It will likely be many months until we are free to lower our masks, but an end is in sight. 

 

I am looking forward, along with our MCW Kern Institute community to taking stock, cleaning up, and reorganizing in a better way, facing the austerity and dedicating ourselves to the challenging tasks ahead both within the house of medicine and well beyond. Together, we await the miracles yet to come. 

 

 

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.

 

 

We have both a duty-to-care and a responsibility to care: what does that look like?

 From the 12/11/2020 newsletter

Director’s Corner

We have both a duty-to-care and a responsibility to care: what does that look like?

 

Adina Kalet, MD MPH

 

This week Dr. Kalet considers how today’s physicians, facing unacceptable fragmentation of care, need to recommit to an Ethics of Care for, with, and about the individual patient. Our Tripe Aim is Character, Care, and Competence.

 

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A good friend of mine is suffering. She recently underwent what was expected to be a relatively straightforward surgical procedure both she and her physician expected would correct a disabling problem and improve her quality of life. Instead, she developed a rare, perplexing, painful complication that significantly limits her mobility, interferes with getting a night’s sleep, and has not responded well to treatments. And she essentially has been abandoned by the surgeon who performed the procedure.

 When, months later, it became clear that she was not going to recover as expected, the surgeon did not make referrals to a pain specialist, and only referred her to physical therapy on the patient’s request. He does see her in “follow-up,” but focuses only on the immediate post-operative issues, not the new condition. When my friend reaches out to inform him of her progress and asks clarifying questions or for advice, the registered nurse on his team responds to her messages in a curt “just the facts,” perfunctory manner. Although the surgeon’s office has reached out to inquire about her progress through an impersonal “app,” no one has expressed care or concern that her pain continues. In my book, this is abandonment and, therefore, unethical. 

 As physicians, we have both an obligation and responsibility to care for, with, and about our patients. Like other service providers, we have a “duty of care,” which is a legal obligation requiring us to adhere to “standards of reasonable care while performing any acts that could foreseeably harm others.” From this perspective, strictly speaking, my friend’s surgeon did his duty. And given the current fragmentation of health care into sub-specialties, he can argue that by ensuring post-operative wound healing, he is discharging his obligations.  But this is not caring.  

The Ethics of Care, developed by feminist scholars including Carol Gilligan and Joan Tronto among many others, holds that moral action goes beyond meeting standards – being objective and justice orientated – but centers on the relationships and connection with others, especially when they are vulnerable and require expertise. The Ethics of Care emphasizes the importance of attentiveness and responsiveness to the individual and acknowledges the complexity of care taking. Rather than taking a narrow view on the obligation to refer my friend to a competent expert, I believe this physician had a responsibility to do the complex, skilled work of caring for her. He demonstrated no intention to do anything beyond his narrowly focused area of expertise.

When I told my friend’s story to a mentor who is an experienced surgeon, he said, “These are the patients you hold close, you give them your personal cell phone number, you respond and see them often until there is some resolution or even if there isn’t one. You are in this relationship for the long haul.” The wise and ethical physician makes the referrals, ensures the patient understands what needs to be done, has the difficult conversations, and “quarterbacks” the game until there is a resolution.  

By any measure, my friend is a “good” patient. She takes medication as prescribed, engages in physical therapy with enthusiasm and commitment (she is a “weekend warrior,” after all), listens carefully to the recommendations and advice of her physician, engages actively in decision making, and is extremely well informed. Luckily, she has caring pain management specialist and access to friends and relatives who are in health care. I have advised her to move on and consider the surgeon who operated on her as she would any high paid tradesman rather than as her physician. This is terribly disappointing, but common.

To be clear, while this isn’t likely “malpractice” it is, in my view, clinical incompetence. My friend’s current predicament was not likely due to a mistake in judgement or poor surgical technique, but her physician did not take responsibility to relieve her suffering by actively, assertively, compassionately, and competently caring for her. To do this well, he would need a mature, internalized professional identity to help him make morally informed choices in a therapeutic and caring relationship, especially when things got frustrating or went wrong. It would enable him to spend the time and make the effort to communicate with this patient directly, guide her to effective symptom relief, and sincerely empathize with her situation. This is not easy; sophisticated clinical communication skills are required. These include being capable of actively listening, while accurately identifying and appropriately responding to emotions, all while conducting clinical reasoning and creative problem solving. These are learnable skills, but require both a desire and practice to master. This physician is not trying hard enough. 

All physicians need to take responsibility for caring for patients, especially when the going gets tough, vexing, perplexing, and challenging, like when a patient, who should have recovered, does not. In one way or another, managing chronic pain is the responsibility of all physicians. Central to effective pain control from the patient’s point of view is being taken seriously, remaining hopeful and realistic, being listened to, and experiencing authentic empathy from a trustworthy physician or other health care professional. Anyone who has gone through childbirth understands that extreme pain – as long as it is going to be time-limited and will end with the birth of a healthy infant – can be “suffered” without medication, be well-tolerated, and can even be experienced as joyful when surrounded by trustworthy, caring, and competent health professionals. On the flip side, even mild to moderate pain can be unbearable when “suffered” alone or is a sign of loss of bodily integrity, increasing disability, or a terminal diagnosis. A mature and skillful physician has the potential to relieve suffering simply by staying in relationship with a patient. 

Modern medicine takes place within complex institutions and, even with the best intentions, the incentives can be perverse. If care and caring must happen within trustworthy relationships, then health care systems that divide the labor so that everyone works at the “top of their license,” are dividing the patient. I worry that as a side effect of “team care,” health care professionals are being encouraged, incentivized, or forced to destroy therapeutic relationships.  This is why physicians must have a strong character and a moral compass-sense of agency, and masterful communication skills to remain “the patient’s doctor” when there is rough going; staying put when it would be more comfortable to leave or send in someone else.

I have spent much of my career learning, teaching, and studying patient-physician communications. To motivate others to take this very seriously, I often point out that patients are more likely to sue a physician for “abandonment” of the type described here than for actual malpractice. I interpret this to mean that people will forgive mistakes, but not lack of care.

 

 

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.