Questions for Three of the 4C Coaches

From the 5/21/2021 newsletter

Questions for Three of the 4C Coaches

Edmund Duthie, MD; Amy Farkas, MD, MS; and David Marks, MD, MBA

Drs. Edmund Duthie, Amy Farkas, and David Marks, who serve as coaches in the 4C Program, discuss their experiences and encourage other faculty members to volunteer in the future …

In August 2019, the Kern Institute launched the Coaching for Character, Caring and Competence (4C) Program. This optional four-year longitudinal program pairs students with faculty coaches who will help to foster the student’s professional growth. The faculty who serve as coaches volunteer their time to the program. The students and coaches have individual student-led meetings, and small group meetings to discuss topics such as character, professional identity formation and other topics that will help them through medical school and beyond. To help prepare the coaches for these discussions, monthly faculty development sessions are hosted where a content expert on each topic gives an hour session. Group meeting facilitation guides are provided for the coaches, as well. 

We wanted to hear from the faculty about why they chose to participate in the 4C Program and the impact that this program has had on them. Three coaches, Drs. Edmund Duthie, Amy Farkas, and David Marks, submitted their responses to us on four questions about their experiences with the 4C Coaching Program.

What made you sign up for the 4C program?

Dr. Duthie: I signed up for 4C program to better connect with our students. A longitudinal approach was appealing. 

Dr. Farkas: Joining the 4C program as a faculty coach seemed like a great way to pay it forward. I was part of a similar program as a first-year medical student at the University of Pittsburgh and I still mentor with my assigned faculty mentor thirteen years later. To offer that to the next generation of students was important to me.

Dr. Marks: The Kern Institute’s recruitment for new 4C coaches occurred at an opportune time. As a physician administrator, I was heavily involved in COVID care as a leader in both the Incident and Recovery Command teams; I recognized the resumption of operations needed to include better care for our patients, caregivers, staff and learners as a whole. In my personal life, my daughter’s medical school graduation was canceled, and though she was hooded “online,” I recognized that this current medical school class would face unique challenges as a result of the pandemic’s impact on education and socialization. I felt called to offer my services as a 4C Coach to pass on my experience and resilience having served many years as a clinician, and as a leader in both medicine and healthcare administration.

What has been the best part of the program?

Dr. Duthie: Getting to know a small group of M1s better and connecting me with the students, their challenges, and the curriculum. 

Dr. Farkas: Getting to know the students and to watch the group dynamic. My students are great supports for each other, particularly in the time of COVID when so many normal social supports are removed. Knowing that they have connected outside of our 4C group is wonderful. 

Dr. Marks: Our 4C group is composed of unique, talented individuals who are progressing remarkably through the challenges of M1 (and M3). Their personal and professional growth is tremendous. Coming alongside them and encouraging/coaching has been terrifically refreshing for me and I look forward to their ongoing formation as good physicians.

How has being a coach impacted you?

Dr. Duthie: I have achieved my goal of connecting with students. Unexpected benefits: getting to work with the near-peer coach has been great. Further, the faculty development has helped me to grow as a thoughtful educator. 

Dr. Farkas: In the rest of my job, I am pretty removed from the first year of medical school. It’s nice to have a reminder of what that time is like, as it provides me insights into where my MS3 and MS4 students are coming from so that I can better support them. It’s also just a lot of fun. 

Dr. Marks: The coaches’ development sessions and curriculum turned my attention to the resources we have in the Kern Institute; exposure to these individuals and resources allowed me to seek new opportunities of study and growth for myself. I was particularly drawn to discussions of character which prompted thoughts on how clinical operations, artificial intelligence (AI), and patient care are at risk by new technology. Adoption of artificial intelligence can pose challenges for safe, compassionate, and ethical health care. I wanted to explore if appropriate implementation and use of these tools could be addressed with character education and wisdom. This path ultimately led me to apply to become a Kern Scholar and pursue additional training in character education. 

Why would you recommend other faculty join the program as a coach?

Dr. Duthie: Definitely would recommend. It is a commitment, but grounds us in why we are a medical school and why we became physicians. 

Dr. Farkas: Absolutely! Seeing the students’ excitement and watching them develop over the last year has been very fulfilling. I look forward to helping them on their journey over the next few years. 

Dr. Marks: I highly recommend the mentor position in the 4C program as a means to give back to learners and to stimulate one’s own understanding of the current challenges faced by our caregivers. The program has proved to be rewarding not only as I provide counsel and guidance, but also as I gain insight and wisdom from my colleagues. Additionally, the tools that the Kern Institute provide are important and relevant to our broader medical and administrative community.

Edmund Duthie, MD, is a geriatrician and Professor in the Department of Medicine at MCW. 

Amy Farkas, MD, MS, is a general internist and Assistant Professor in the Department of Medicine at MCW. 

David Marks, MD, MBA, is an interventional radiologist and Professor in the Department of Radiology at MCW. 

Read this Issue. Your or Your Colleague’s Life May Depend on It.

From the 5/14/2021 newsletter

Director’s Corner

Read this Issue. Your or Your Colleague’s Life May Depend on It. 

Adina Kalet, MD MPH

This week, we focus on suicide and its prevention. Dr. Kalet urges you to read what is likely our most compelling issue ever of the Transformational Times, curated by Dr. Jeffery Fritz and the Kern Student Leadership group. You will learn a few things, be moved, and be better prepared to save a life …

The MCW-Milwaukee medical school graduating class of 2021 has suffered the loss of two of its cohort to suicide. This has been devastating for the families and close friends of these individuals. Their grief, profound and deeply personal it must be, and has been, treated with tenderness and respect for desired privacy. 

As new physicians, this class joins a profession where suicide is all too common. An estimated 300 US physicians take their own lives each year and the rates may be rising. It is likely that each of us have been, or will be, touched by suicide amongst our colleagues and friends. 

For many people who are contemplating suicide, prevention is possible. As colleagues, it requires each of us to be proactive, skillful, and brave in facing our own acculturated barriers to reaching out to others in times of despair. On a personal level, we must all learn to identify and skillfully intervene with friends and colleagues at risk, and vow to accompany those family members and friends who are left to deal with the grief and guilt that suicide leaves in its wake. It is good news that more than 90% of people who survive an attempted suicide never go on to die by suicide. Intervention and treatment save lives.

We also know that, in some cases, there is little that we can do. Some people are committed to ending their lives without intervention and offer no detectable warning or cry for help. With these deaths, we must care for the survivors, enact the self-compassion to digest and deal with our own thoughts and feelings, and develop meaningful ways to acknowledge the loss.  

What we know about suicide

Suicide is among the most common causes of death in those under 55 years of age. The rate of suicide has increased from 17 to 22 per 100,000 over the past twenty years, rising particularly among white and Native American men. Other Americans with higher-than-average rates of suicide are military veterans, people who live in rural areas, and workers in mining and construction. Lesbian, gay, bisexual, or transgendered young people have higher rates of suicidal ideation and behavior compared to their straight peers. There is a rising concern for adolescents who have been socially isolated during COVID-19. Those with mental health diagnoses, such as major depression and bipolar disorder, and those who struggle with alcohol or other substance abuse disorders are at increased risk. Because of their access to lethal weapons, people who live in homes with firearms are at higher risk. About 60% of firearms deaths each year in the US are suicides.

Systemic approaches to preventing suicide include cultural and institutional efforts that eliminate professional burnout and enhance wellbeing. This requires, as Dr. Cipriano points out in this issue, viewing suicide through a public health lens. Meaningful prevention of suicide on a population basis will require comprehensive approaches that strengthen financial safety nets and coping skills, promote connectedness, and enhance access to excellent mental health care. 

What to do when the person in front of you is suffering

Preventing suicide while in the presence of an individual who concerns you requires your active intervention. Learn to ask about suicidality. Be willing to remain present and keep the individual safe. Help the person stay connected to others and follow up. In this issue, our students describe their efforts to disseminate these basic principles. 

The experience of relatives and friends 

I find hearing that someone has killed themselves is always disorienting and unfathomable. While not ubiquitous, it is common for families to close ranks and feel both stigmatized and ashamed for a time. Traditionally, many cultures and religions have created a stigma around suicide although, as a result of work to raise awareness around these issues, most groups have faced down their stigmatizing actions. As one of this week’s authors, Toni Gray, points out, things have changed for the better through research, public awareness campaigns, and the compassion of mental health caregiving.  The key is to try, follow the lead of those who are grieving, and remember that they will be dealing with the loss for their lifetimes. 

Suicide in medical settings gets uncomfortably close

Suicide has touched my personal social circle a few times over the last years, including a teenager and more than one adult with loving families and seemingly rich lives. 

When I was just starting out in medical practice, it was a commonly held (and incorrect) belief that asking someone, especially someone who was desperately fragile emotionally, if they were considering killing themselves might “plant the idea in their head.” This approach likely cost lives. Now we know better. Many people who attempt suicide have seen a physician, usually not a mental health expert, in the weeks prior to the attempt. Physicians and healthcare workers in every specialty must understand their obligation to recognize and intervene.

In medical settings, I have noticed that suicides tend to happen in waves. A few years ago, a medical student, well known and loved by his peers and teachers and who had no known personal or academic troubles, jumped from the roof of a building in New York City. Soon thereafter, two other young physicians in our community died by suicide. Four senior physicians at a hospital where I have worked took their own lives over the course of a year; this was attributed to workloads of over 100 hours a week. 

MCW has been similarly touched. These are profound shocks for any educational institution and, despite having policies, protocols, confidential counselling, and employee assistance offices, deaths still occur. Each suicide is devastating. With each occurrence, we look for answers. We redouble our commitment to reach out if we are concerned about colleagues, friends or patients. We educate ourselves. We plan to simply ask, “Are you thinking about killing yourself?” and then commit to sitting and listening.  Each loss leaves the community diminished.

We hear the voices of people who have struggled

Like our anonymous student essayist, survivors of profound depression and grief often become so focused on their own suffocating isolation that they can see no other option. Shakespeare reminds us that, "Everyone can master a grief but he that has it." It falls to those of us nearby to accompany the person suffering, offering safety, connection, and help. As the student tells us, “As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction.” We might be the one to save a life.

We are deeply grateful to those who contributed pieces in this issue. Students, staff, and faculty members who have struggled personally or vicariously through close relatives and friends, share their stories. We hear from Brett Linzer, a physician who, having experienced the loss of a number of colleagues and friends to suicide, as he faces his own burnout with the help of his loved ones. Although reluctant at first, he seeks the coaching that strengthens him with skills and support, enhances the joy he experiences in his work, and compels him to use his experience to work toward systems change for all of us. We get to know Kerri Corcoran, Student Behavioral Health and Resource Navigator in the MCW office of Student Services, who is committed to providing direct support for our students. MCW-Central Wisconsin students write about their work at self-organizing, with great creativity, to do suicide prevention work. 

This is a difficult, ongoing, and devastating problem that disproportionately touches us as physicians. We desperately want to do this right and welcome your experiences and efforts. 

I urge you to read this issue. You never know when it will be your turn to save someone’s life. 

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.

Many Hands, Many Voices: Suicide Prevention Work at MCW

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 Many Hands, Many Voices: Suicide Prevention Work at MCW

 

 David J. Cipriano, Ph.D. - Director of Student and Resident Behavioral Health and Co-Chair, MCW Suicide Prevention Council

 

 Dr. Cipriano, Co-chair of MCW’s Suicide Prevention Council, describes how the council is approaching this critical topic through the development of peer support, beginning at MCW-CW …

 

 Many hands, many voices – a common call for community collaboration – describes the progress of our Suicide Prevention Council (SPC).  I reported a few months ago on our identification of two risk factors for suicide that we chose to focus on this year:  isolation and stigma.  And, I promised to report back on our progress. 

Last time, I spoke about the culture change needed to reduce these risk factors.  We began to plan for a public health model to promote such culture change.  There are three categories of prevention: Primary prevention focuses on various determinants in the whole population. Secondary prevention comprises early detection and intervention. Tertiary prevention targets for advanced recovery and reduction of relapse risk. Our model utilizes trained peer supporters as the main change agents in the secondary prevention component. 

 We looked to Drs. Alicia Pilarski and Timothy Klatt’s Supporting Our Staff (SOS) program to address “second victim” - or vicarious trauma - amongst clinicians, and our program is closely modelled on theirs. The primary prevention component seeks to raise awareness, educate, and begin the conversation through events, media, and other means.  These are the seeds of the culture change needed beginning with stigma which keeps mental health in the shadows and isolation, perpetuated by shame and pride which keep us from reaching out to peers and colleagues.  Tertiary prevention involves removing barriers to access to care for those who need it.  We have made good progress on this over the past few years, but there is more we can do.

 

A student-led suicide prevention initiative at MCW-CW

So, whose hands and whose voices?  Dr. Jon Lehrmann, Chair of Psychiatry and Behavioral Medicine and co-founder of our Suicide Prevention Council, kept directing us back to the Pilarski/Klatt SOS program.  He saw the benefits of the public health approach and of the peer support component. MCW-Central Wisconsin medical student, Margaret (Meg) Lieb, pointed out the difference between peer support programs that encourage the active outreach of peer supporters, versus passive models where it is the responsibility of those in distress to reach out.  Then, our terrific community member of SPC, Dr. Barbara Moser, jumped in with her wealth of knowledge of training tools and experiences needed to prepare these peer supporters.  

So, what’s coming next?  Meg Lieb has assembled a group of fellow students with a passion for the mental health and wellbeing at MCW-CW.  They will launch a pilot program next month. You will be hearing from several of them in this issue of Transformational Times.  Meg and her team have been putting together the training materials, recruiting peer supporters and have even secured funding through Dr. Lisa Dodson, Dean of MCW-Central Wisconsin from a grant she received.  All this, while Meg is preparing for the Step 1 exam! 

I’ll stop here and let these amazing students tell their story.  I will make another promise here – while they are running their pilot, we on the SPC will continue to make plans for extending this program to our MCW-Milwaukee and MCW-Green Bay, as well.

 

 

David J. Cipriano, Ph.D. is an Associate Professor in the Department of Psychiatry and Behavioral Health at MCW and Director of Student and Resident Behavioral Health. He is a member of the Community Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

What is it like to be suicidal?

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 

What is it like to be suicidal?  

 

 

By an anonymous medical student

 

 

A medical student shares their personal journey with suicidal thoughts …

 

 

To me, being suicidal is a physical place in my mind. I’ve boarded the wrong train, or maybe it’s the right train going in the wrong direction. It’s a vast transit system: all the stops are underground so I can’t see where the train is going, and the doors are locked so I can’t get off. In addition, my vision is too blurry to read the map posted on the door.  

 

As I ride to The Wrong Place, I only know that’s the destination if I pay close attention to myself. There are telltale signs: my hobbies become boring or arduous, my favorite foods taste like saliva, and I avoid eye contact with the mirror. 

 

As another stop goes by, my arms and ankles become heavy—too heavy to lift. Taking a shower sounds like a luxury that I simply do not deserve. I do not have the energy to hurt myself at this point... until the train reaches its next stop. 

 

This next stop is at the most dangerous neighborhood I can imagine. Here, I have the will to get out of bed, say my goodbyes, and seek out my demise. At this point, one of two things will happen. I either tell a friend my plans (you know, so they aren’t surprised; it’s common courtesy really), or I call my mom. Every single time so far, someone, somehow, has listened to my spiel about why I should leave this world. The person I am speaking to invariably disagrees with me, and I can feel the train slowing down. Slowly, I can sense how absurd the idea sounds as I hear my own voice speak this strange manifesto. 

As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction. The train finally stops, the doors unlock, and my vision clears. I choose to walk onto the platform and take the stairs back up to ground level, where the rest of my life is waiting. I am existentially exhausted, having both won and lost an argument that put my life at stake. 

 

Personally, I find the feelings of suicidality are always temporary. They fade away, and I am left to live with myself, knowing that some part of me tried to delete all parts of me. But I am not afraid for the next time I head to The Wrong Place. At this point, I know all the stops and the symptoms that accompany them. I can usually get off the train before I end up at the I-don’t-deserve-to-shower part of the journey. I can’t exactly put that on my resume but, hey, I can still be proud of myself.  

 

It's a skill in self-awareness to know when you’re in trouble and when to get help. When I am faced with an internal struggle, seeking out a third party gives me a perspective I can’t generate on my own. There are wonderfully compassionate people—counselors, therapists—who have dedicated their careers to helping people get un-stuck when they feel stuck. They have given me tools that I can always carry with me; their expertise has been distilled to a few tips and tricks that work for me to navigate stressful situations and life changes. I encourage you to seek inside yourself the will to live, the love of those around you, and most daringly, the point at which to be vulnerable and seek help; for me, it was the most difficult and most rewarding thing I have ever learned. 

 

 

 

Author’s note: After much deliberation, and due to the current climate of resident medical education, this piece will be published anonymously. Special thanks to my campus colleagues for being such an open and supportive community.