‘Take 3’ Question and Answer: Report on a Human-Centered Design Sprint for the MCW Curriculum Re-imagined

 From the 4/16/2021 newsletter

  MCW Curriculum Re-imagined

 

‘Take 3’ Question and Answer:  Report on a Human-Centered Design Sprint for the MCW Curriculum Re-imagined

Dr. Wendy Peltier and second year medical student, Lauren Stippich, share their experience from participating in the first Virtual Design Sprint Workshop on the proposed MCW Curriculum, sharing perspectives through the eyes of a student and senior faculty.

 

The Kern Institute’s Human-Centered Design Lab facilitated a virtual design sprint last week with 77 participants, representing students, faculty, residents and staff from across our MCW community.  Amy Prunuske, PhD, and Travis Webb, MD provided a high-level overview of the key principles of the proposed curriculum, which involves development of learning communities and implementation of longitudinal, case-based and experiential teaching formats for foundational knowledge. The design sprint, led by Karen Marcdante, MD, Chris Decker, MD, and Julia Schmitt, provided an opportunity for participants to work in small groups to provide in-depth feedback on the curriculum proposal. This format ensured that every participant’s feedback was recorded, and all the information  has been qualitatively organized for the Curriculum Steering Committee’s use.   

The curriculum proposal would involve a major shift from our current, ‘2 by 2’ structure of separating basic science course work from clinical rotations. A potential timeline for approval, and detailed summary of background work over the last two years leading up to this proposal was provided. Dr Webb and Pronuske shared, ‘The goal of our curriculum is to produce competent well-rounded physicians who will be excellent clinicians in any specialty and are prepared to practice in the future health care environment’.

They acknowledged the contributions of many in developing this proposal, including Bill Hueston, MD, Jeff Amundson, PhD, and Jennifer Hinrichs.

 

1) What surprised you most about the session?

Lauren:  I was shocked by the high emotion from many of the participants! As students, we only see the ‘end product’ when a curriculum has been implemented, and I did not appreciate all the pre-work and planning that stands behind our course offerings.  It was eye-opening to hear the various worries and hesitations of key faculty for embarking on such a major change in teaching formats.  Frankly, it worried me that some of the comments seemed to go a bit too far, and without recognition for the immense amount of work that went into this workshop and the proposal itself .  This was my first time being part of such a broad group, and I quickly saw how important it will be to have buy-in from all our stakeholders to implement this change.

Wendy:  Must say, I anticipated the high emotions, having been at MCW during  the transition to the Discovery Curriculum, and from my experience with change management.  Hearing the plans for the first time in considerable detail, I was surprised and excited about the spirit behind bringing this new, student-centered approach to adult learning that is explicitly tied to promoting inquiry and innovation in our learners.

 

2) Did you feel your voice was heard?

Lauren:  The small group process really created an authentic, ‘safe space’, to both talk and listen, and we had enough time to review things in detail.  There was a basic science faculty in my group, and I developed an understanding for concerns that previously I did not appreciate even existed.  Some participants complained that the breakouts were too small with only three members each, stating they wanted to hear more opinions, but I understood the rationale behind this.  It is so important to hear all perspectives, and smaller sized groups help to ensure the collected conversations are representative of everyone, not just the most vocal members of a group.  This seems even more important in the virtual setting.  Being part of the workshop planning group, I also saw how the detailed feedback would be gathered, allowing the program leaders to have a full appreciation of all concerns.

Wendy:  My experience echoed Lauren’s.  The more ‘intimate’ breakout sessions created opportunity for in-depth discussion of the guided questions.  It was important to hear both the excitement for a new structure, but also concern and worry over the ‘heavy lift’ involved in implementing such a major change.  A strong theme that came through was need for culture change and to explicitly identify ways to honor educators in our community with protected time and recognition for teaching AND administrative efforts.

 

3) As we reimagine the MCW curriculum, what do you see as important     measures of success?

Lauren:  The new curriculum really excites me, particularly in the thoughtful and deliberate structures that promote student connection and support, as well as the spiral or ‘catch-up’ weeks, where students can take a breath, or refine and review important topics.  As a second year student, I can reflect on what a huge transition it was to enter medical school, and how the 4C Coaching program provided amazing support during this challenging time. I consider my participation in this program the most impactful activity of my M1 year—and I can see how the learning communities and small group activities will help that shine through in the new curriculum.  I would hope that students being more connected, and the environment continuing to be collaborative rather than competitive, despite our large class size, could be key outcomes. After participating in this workshop, I would also hope that all the faculty who contribute to teaching will feel supported, prepared and confident in launching the new changes.

Wendy:  My hope for success would first be a true, institution-wide, commitment to change with resources to manage the transition.  Success will be tied to students and faculty learning together, and for many of us, stepping outside our comfort zone.  The evidence behind the need for change, which is robust, indicates that this will be a much needed and important investment in preparing our graduates for future practice.  This year has certainly been one that highlights the challenges to our profession and current health delivery systems.  To me, training physicians who are prepared to speak up when needed, to care for themselves, and to seek innovation in their daily work, is something to promote and support.

To learn more about the MCW Curriculum Re-imagined and Human-Centered

Design:

1. Discovery Curriculum Exploration Project

2. Human-Centered Design Lab

 

Lauren Stippich is a Wisconsin native currently in her second year of medical school with interest in medical education and the Humanities.  Lauren is a student member of the Human-Centered Design Lab and this was her ‘first dive’ into a curriculum re-design process.  In her free time, Lauren enjoys reading books, time together with friends and a good game of spike-ball.

Wendy Peltier, MD is an Associate Professor of Neurology and Medicine, in the Division of Geriatric and Palliative Medicine at MCW. She is also a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. In her free time, she enjoys yoga, reading books and home-cooked meals by her husband and son.

Opening the Drawer

From the 4/16/2021 newsletter

Medical Humanities reflection

Opening the Drawer

 Amy Domeyer-Klenske, MD

Dr. Domeyer-Klenske write about how engagement in the humanities makes students and residents better doctors, active listeners and more resilient humans …

I have long been interested at the intersection of humanities and medicine and felt challenged in my efforts to braid them together. I recall my enthusiasm to become a Doctor/Writer when I was a medical student and had an opportunity to interact with physician authors at the Examined Life Conference, held annually at University of Iowa. In one of these conversations, I was told I could put my writing interest in a metaphorical drawer during residency. I could allow myself to focus intensively on my training with the plan to re-open the drawer when I’d completed training. I left the conversation feeling a sense of freedom; I didn’t feel guilt or pressure to be too many things at once. Instead of Doctor/Writer I could just be Doctor.

I proceeded throughout my training giving little thought to writing. I’ve since reflected on this advice and my decision to follow it. I’m certain that I write less now than I did as a student. I wonder if something was lost in the drawer, if recovering interests becomes more difficult the longer they are locked away. 

I had the opportunity to share this advice and discuss strategies for remaining active in the humanities with Dr. Zack Schoppen, an OB/gyn resident, and a group of students during the M4 Humanities Elective on March 24, 2021. 

We discussed how the metaphorical drawer can be freeing when we are stressed. Alternatively, we discussed the option of planned engagement and disengagement where we use our time to actively check in on our humanities interests (writing a poem or an essay, reading a novel) but also allow ourselves time to actively “check out” (binge-watch television, nap, spend time with family and friends). The second strategy allows ongoing engagement, but on our own terms. 

This conversation refreshed me. I hope it did the same for our students. Inevitably, becoming a “good doctor” isn’t solely about how many articles you read or how much time you spend in the hospital. Engagement in the humanities can make us better doctors, active listeners and more resilient humans.

Amy Domeyer-Klenske is an Assistant Professor in the Department of Obstetrics and Gynecology at MCW. 

Holding a Virtual Storytelling Event: MCW’s MedMoth

From the 4/16/2021 newsletter

Holding a Virtual Storytelling Event: MCW’s MedMoth

Scott Lamm - MCW-Milwaukee Class of 2022

Mr. Lamm is one of the student leaders of MCW’s MedMoth, a live storytelling event inspired by The Moth and Milwaukee’s Ex Fabula. He reviews the most recent gathering and looks toward the future … 

One year ago, I had no idea how we could make MCW’s MedMoth storytelling event virtual. While yes, storytelling can be accomplished on various platforms, I struggled to grasp how we could take an intimate night of face-to-face interaction and connection and build the same atmosphere from the comfort of one’s home. It was a task, though, that the MedMoth team was prepared to undertake to continue the program.

In the runup to the main event, we held two virtual workshops facilitated by staff at Ex Fabula, a Milwaukee-based storytelling community. Working with other participants, our storytellers developed their narratives and honed their presentation skills. 

What we witnessed on April 8, 2021 was a celebration of stories connecting faculty, residents, staff, and students alike in ways we couldn’t have even imagined. We had eight wonderful storytellers sharing accounts ranging from how they bonded with the supply robots at Children’s to responding to a horrific trauma event as an EMT. Each storyteller brought their own experience and vulnerability on journeys that were both familiar and astonishing. 

About sixty people were in attendance from all aspects of healthcare and all points of the training spectrum. It was absolutely incredible to see a virtual group so engaged in everyone’s stories and, hopefully, they left wanting more. As we believe that there is intrinsic value to these types of narrative opportunities, we gathered data from both the participants and the audience on their experiences. 

As we continue to build the MedMoth program, we hope we can inspire more storytellers and listeners as each of us have a story to tell. It’s just a matter of when will you share it.

Please feel free to follow MCW MedMoth on Instagram (@mcwmedmoth) for updates on future events. We will be back in the Fall with more workshops and storytelling events. If you have any questions or would like to join our team, please feel free to reach out to me (Scott Lamm) at slamm@mcw.edu.

MedMoth is graciously sponsored by the Kern Institute. We would like to thank the entire institute for its continued support.

Scott Lamm is a third-year medical student at MCW-Milwaukee. 

“Ah! Bach!” and other Confessions of a “Humanities in Medical Education” Cynic, Converted

From the 4/16/2021 newsletter

Director’s Corner 

“Ah! Bach!” and other Confessions of a “Humanities in Medical Education” Cynic, Converted

Adina Kalet, MD MPH

In this Director’s Corner, Dr. Kalet admits to her own early arrogance about the introduction of the humanities in medicine and challenges us to find a rich and inspiring way forward using a character and caring framework …

Did you know that M*A*S*H, the comedy-drama television series that ran on CBS from 1972 to 1983 and based on a movie of the same name, is one of the most highly rated US television shows in history? For the few who are unfamiliar, this remarkable ensemble piece told the fictional story of the 4077th Mobile Army Surgical Hospital, in Uijeongbu, South Korea, during the Korean War (1950–53). It ran for eleven seasons, spanning the final years of the Vietnam War and into the Cold War. There were 256 thirty-minute episodes. It was a literal modern War and Peace. As does most great art, M*A*S*H grappled with the most controversial political and humanistic issues of all times. The theme song, “Suicide is Painless,” is an indicator of how deeply philosophical the writing was, and how accessible the insights. In my estimation, it is the best medical drama ever written and performed. To each his/her own, right? 

For me, a child of the 1960s and 1970s, M*A*S*H was formative. I wanted to be “Hawkeye” Pierce. Even though he was a womanizing, sarcastic, sometimes cruel practical trickster, he was also an artfully skilled, lifesaving, courageous, compassionate, and empathic physician and colleague. I was drawn to his deliciously complex character - both in the theatrical and philosophical sense - and strong moral presence. In one of my most memorable episodes, Hawkeye gives seduction advice to Walter “Radar” O’Reilly, the eerily perceptive, dewy-eyed, camp administrative savant, farm boy from Ottumwa, Iowa. Hawkeye coaches him on how to fake his knowledge of classical music to win the affections of a nurse (nurses were all women) in camp by saying “Ah! Bach!” with a dreamy look and expressive hand motions. The superficiality of the gesture has me on the floor laughing even now. Will they stop at nothing to get the girl into bed?

This represented how I felt, as a medical student and resident about the rather clumsy early efforts made by medical educators in the 1980s to seduce medical students into self-awareness through incorporating the “arts and humanities” into medicine. 

Not every humanities experience is meaningful for medical students 

Curricula which required engagement with selected works of art to view or read without much guidance or structure, felt like a manipulative and superficial ploy to get me to feel something I did not (or would not) and do something I could not yet do. I am not proud of this; I know now I was wrong. I was young and insecure. But it is still a common point of view of trainees. 

As Art Derse shares in his history of the humanities in medicine at MCW I, too, have occasionally heard students say, “I didn’t come to medical school to read poetry (insert: write stories, look at art, or watch movies).”  I think that these students are right and, yet, deeply wrong. 

They are right because medical training is hard enough and – given the great variation in how each of us prefers to access our own humanity, empathy and compassion – being required to engage with a particular work of art is too vague. Students who hold this view are deeply wrong because they misunderstand the point of the exercise. 

I personally have great difficulty connecting with poetry. For me, it is hard work and, therefore, not entertaining enough. But, of course, I now know I must do the hard work to reap the most profound lessons the humanities have to offer. And it is almost impossible to do this work on our own. We need facilitators and guides. The work of art is just the “trigger” for reflection, a starting point to get oneself to challenge assumptions, see the wart’s, face the fears. This is both hard work and not guaranteed to lead to the intended learning. 

“If you haven’t read Thomas Mann’s Magic Mountain you should not be allowed to be a physician!” 

I heard this repeatedly from one of the most erudite and revered clinicians in my department in New York City in the 1990s. What he meant to communicate was that physicians should read great literature in order to develop empathy for and access to the deepest, most complex and conflictual aspects of the “illness experience.” But what he said and represented, sounded crude, insensitive and, frankly, terrifying to my modern ears. Would this powerful man really limit access to the profession based on this one book? I believed he would. I tried to talk with him about it many times. He dismissed my concerns and was openly derisive when I insisted that we focus on skills building and personal reflection as a path to ensuring all physicians have the communication skills – including empathy – to elicit the patient’s story and to build a therapeutic rapport. He absolutely despised any mention of Standardized Patients (SPs). He felt – without any direct experience, by the way - that using professional actors trained to portray patients, assess trainees’ communication skills, and provide them feedback was “fake” and manipulative. 

Given his great love of using the arts to instill empathy, this perplexed me. In my experience, SPs are highly disciplined artists willing to engage with our trainees to ensure that all patients have caring and competent physicians.  He also dismissed my choices of “great” literature, which ran more toward Toni Morrison, Alice Walker, Margaret Attwood, Jamaica Kincaid, Alice Munro, Marilynne Robinson, Tillie Olsen, Virginia Woolf, than toward Thomas Mann (as of a month ago, I have yet to get past page 300 of Magic Mountain. I am still struggling, though). And this was the leader of our Humanities in Medicine program. 

Initially, I rebelled. We needed more than simply a trigger for deep thought that was unguided and self-congratulatory.  Over the years, with many pedagogical advances and an openness to a broader range of humanities, my view has softened. My colleague was a man of his times; what other choice did he have? But we must make other choices, expand the canon, and make use of the humanities to open our minds and hearts. Not easy.   

So, where do we begin?

This past Sunday morning, my husband left the New York Times on the table opened to the Op Ed entitled “A Once-in-a-Century Crisis Can Help Educate Doctors.” I “girded my loins,” ready for a diatribe, another “humanist” telling us in medical education what we must add to an already overwhelming experience of medical training. 

But I was relieved. In this piece, Molly Worthen, a historian at UNC-Chapel Hill who writes about higher education, points out that the pandemic has given us an opportunity to transform medical education because it has forced health professionals and medical schools to look beyond the particulars of modern medicine and think more broadly about how we prepare doctors. She says, and I agree, that COVID has provided us “a pilot project to demonstrate that the humanities are an essential part of what a medical education should be — not just a luxury, but foundational.” 

She celebrates the strides we have made away from the early “humanities in medicine” days of museum visits and the “great novels,” as we move toward a true integration of the humanities at many medical centers and in many programs. The humanities force practitioners to be clear eyed even as they evaluate seemingly empirical data. “Humanists take evidence so seriously that they emphasize viewing it from multiple vantage points and recognizing one’s own limited perspective.”  

Worthen finishes, reminding us all of where we began our medical journeys days, years, or even decades ago. She says our students “grasp intuitively that medicine is not a science but an art that uses science as one of many tools.” 

Embracing Ambiguity

There is so much work to do. In this and in the last issue of the Transformational Times, we have highlighted the many ways these efforts are happening at MCW and beyond. Despite this, there is no clear path to integrate the humanities into medicine. Yet, maybe not knowing exactly how, yet embracing, the ambiguity of that task will bring us closer. Maybe that is the point. Ah! Bach!

In his own way, even Hawkeye knew that the humanities were important while working in the M*A*S*H unit. He once told an interviewer that he brought every single book ever written in English with him when he was sent to Korea. How? Well, he responded, “I brought the dictionary. I figure it's got all the other books in it.” Not a very high brow answer for a man named after Benjamin Franklin and nicknamed after a character from James Fenimore Cooper’s The Last of the Mohicans. I can’t say I agree with everything Hawkeye said, but this, at least, was right on target.  

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.