Questions for Four of the 4C Students

From the 5/21/2021 newsletter

 Questions for Four of the 4C Students

Trevor de Sibour, rising M2; Radek Buss, rising M3; Julia Bosco, rising M2; and Ryan Power, rising M3

Medical students Trevor de Sibour, Radek Buss, Julia Bosco and Ryan Power discuss their experiences as students in the Coaching for Character, Caring and Competence (4C) Program …

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 students and coaches have individual student-led meetings, as well as small group meetings to discuss topics such as character, professional identity formation and other topics that will help them through medical school and beyond. 

We wanted to hear from students about why they chose to participate in the 4C program and the impact that this program has had on them. 4 M1s, Trevor de Sibour, Radek Buss, Julia Bosco and Ryan Powers, submitted their responses to us on 4 questions about their experience with the 4C Coaching Program. 

What made you sign up for the 4C program? 

Trevor: I signed up for the 4C program because of the mentorship opportunities it provides. I had attended a large university for college where I struggled to find mentorship, particularly pertaining to character and professional development. Moreover, I was concerned about connecting with faculty and potentially peer mentors due to the ways in which COVID-19 has altered our everyday interactions. As such, when I learned of 4C, I immediately decided to apply. I felt it was well structured and an excellent way to quickly connect with a faculty member, peer mentor, and other students in a casual setting.

Radek: As an international, first-generation college graduate, I was faced with a lot of stressful unknowns when beginning medical school. Therefore, when given the opportunity to apply for the 4C program, I did not hesitate at all. I have always been very fond of the mentors I have had as a student, and I realize that I would not be where I am today without their guidance and support. The 4C program was the perfect opportunity to meet new mentors in medicine and form lasting professional relationships along the way. 

Julia: Following a year of medical school applications, April 30th finally arrived, and I began the matriculation process at MCW. Little did I know that the certifications, requirements, and deadlines would not stop coming once they started. As I navigated this process amidst the COVID pandemic, I felt overwhelmed and isolated. As deadlines grew closer and questions accumulated, these feelings of isolation persisted. As the pandemic dragged on, our matriculation process and education became increasingly virtual. First, our Second Look Day was canceled. Then, my CPR class was delayed, then canceled, then moved online. Coming from a small liberal arts college, I was intimidated by the prospect of what was looking like Zoom School of Medicine. With my higher education being entirely in-person (at my college class attendance was mandatory), I knew, in this virtual world, I needed mentorship ASAP, and on a whim and blindly seeking support, replied to Dr. Pfeifer’s call for participants in the 4C program. 

Ryan: At the beginning of medical school, there are suddenly a lot of questions and a lot of options you didn't have time to consider before. Throughout undergrad and the application process, your only real question is "Can I get in?" Then, suddenly, you start medical school and you have so many extra questions like what you'll do for research, how will you study, what information is truly important, how will you function in a healthcare team, what specialties should you pursue, and the list never ends. When I saw an opportunity for a coach and a mentor, I saw an opportunity to meet with someone who had those questions before, too. Not only that, I knew that anyone who signed up to be a mentor for the program obviously had an interest and a passion in helping me find those answers. 

What has been the most beneficial part of the program? 

Trevor: The most beneficial part of the program is the insight I have gained from each group member. I have an excellent coach whose perspective on medicine I find enlightening, a fantastic peer mentor whose medical school advice has been invaluable, and three incredible peers whose distinct viewpoints have helped shape my understanding of what it means to be a medical student. 

Radek: The 4C program has been source of a very different type of education, more closely resembling the one I was accustomed to as a student at a small liberal arts college. Whether one on one with my coach, or during our group meetings, the discussions are focused on topics such as well-being, emotional agility, or personal strengths. While those may not pertain to pathophysiology or pharmacology, they are undeniably an important aspect of medical education as a whole. We must be able to take care of ourselves in order to properly, and to the best of our ability, treat others. The 4C program has filled this gap in my medical education, for which I am grateful. 

Julia: Structured mentorship. As I discussed above, my entire education was in a small and exclusively in-person environment, which I found critical to finding mentorship. Looking back on my first year of medical school, if not for the 4C program, I would not have had the same opportunity to have such a positive mentorship experience early in my medical education. I have been able to connect with peers, mentors, and develop a feeling of belonging at MCW, despite this virtual age. From day one, I was accountable to other people, and they invested in my development. This structured mentorship has facilitated my growth as a student doctor and professional. I have the privilege of receiving one-on-one mentorship from Dr. Ankur Segon, our group coach, where we spend the entire hour developing strategies to overcome obstacles I am currently facing. Additionally, Miranda Brown, our group’s near-peer mentor, invests in my practical clinical skills. For example, last semester, she generously read and provided feedback on my clinical notes. Their input and feedback have been invaluable. I cannot imagine my first year of medical school without their mentorship and the support of my peers in my 4C group. 

Ryan: Medical school can be a bubble sometimes. You're focused on your next exam, or STEP, or rumors you hear from classmates or social media about what's important and what you need to do to be a good student. Having a mentor who has two feet firmly planted in the practicing world of medicine is a really great way to get the unequivocal truth. How are my grades actually viewed by residency directors? How can I grow in personal and professional ways, rather than just academically? There were plenty of things I never considered that were brought up by my mentor, and they've been invaluable both in class and in personal growth.

How has your coach impacted you? 

Trevor: I greatly appreciate the guidance my coach has provided me in regard to my professional development. During our most recent one-on-one meeting, I went in unsure and somewhat cynical of what I wanted the next steps of my professional development to be. Ultimately, we had a really productive and candid conversation that helped me create goals that I found to be meaningful and personally satisfying. Having a mentor who I can be honest with, without having to worry about any repercussions, is invaluable. 

Radek: My coach has significantly impacted my career as a medical student. From the first day of this program, she has been open to my questions, no matter how trivial, and supported/guided me through my first two years of medical school. The opportunity to meet with her regularly allows me to continually monitor my progress and compels me to stay on track in accomplishing my goals; it’s as though she is there to both support me, but also keep me accountable. 

Julia: Dr. Ankur Segon has been an excellent individual and group mentor. In the group setting, he is engaged, provides individual and generalized feedback, and always asks us directly if we are keeping our minds and bodies healthy. For me, this investment and concern keep me accountable to and help me prioritize my health, which is easy to abandon in the chaos of M1. In the individual setting, Dr. Segon has provided support, helped me navigate professional and personal decisions, and provided his insight on the matter. Additionally, he continually demonstrates what it means to be a good mentor, which is a skill I hope to cultivate in medical school. I look forward to my dedicated 4C meetings. Because of the supportive environment Dr. Segon fosters, I know I can bring any stress or concerns to these meetings, and when I need to, I know that my 4C coach, near peer mentor, and peers are willing to help or to help me get the help I need. 

Ryan: My coach has made MCW an incredibly positive place. I always have someone I can message or email with questions, and she is always willing to celebrate successes with the rest of the group and me. It's invaluable to have a trustworthy resource to dispel any confusion or doubts through such an arduous process.

Why would you recommend the program to incoming students? 

Trevor: There are multiple reasons I would recommend the program to incoming students. For students who find seeking out mentorship daunting, 4C is invaluable, as it pairs you with a faculty member who is clearly committed to providing quality guidance. Moreover, the topics discussed at group meetings are not found elsewhere in medical school curriculum, yet have the potential to make students well rounded future physicians. How much students will benefit from 4C is associated with how much they invest. So for those who are ready to invest in the program, I highly recommend it. And who knows? Perhaps along the way, they too will meet one of their best friends through the program. 

Radek: I would highly recommend the program to incoming students because it connects you with a coach whom you meet with regularly, and therefore are able to develop a professional relationship. As a coach who is often heavily involved in medical education, they provide support, share ideas, and guide you through your time at MCW. Medical school can be quite stressful and hectic, especially the beginning, and having a coach who helps you navigate your student life is priceless. 

Julia: I highly recommend the 4C program to incoming students. I have found this program to be genuine and critical in my growth as a professional. Although similar opportunities for growth and support exist in the M1 curriculum, I think that since this program is elective and outside medical education proper, participants want to invest in and learn from each other, and so, this does not feel like just another obligation taking time away from my studies. To incoming students, I would say: you get out of this program what you put into it. 4C could become like other programs if its participants do not commit, so invest in it. As someone who came to medical school looking for accountability and quality mentorship, I found what I was looking for in the 4C program. 

Ryan: The Big Sib program (which is also hugely helpful) is a really great start to get advice and direction on the academics and requirements of your coursework, but throughout your first two years at MCW you likely won't have regular contact with many mentors who are actively practicing and navigating medicine. This is a great way to get paired up with a faculty member who cares enough about helping and developing students that they've volunteered time out of their incredibly busy schedules to do just that.

Trevor de Sibour is a rising M2 from Grand Rapids, MI, and attended undergrad at University of Michigan. 

Radek Buss is a rising M3 from Prague, Czech Republic, and attended undergrad at St. Norbert College. 

Julia Bosco is a rising M2 from Green Bay, WI, and attended undergrad at Hillsdale College, in Hillsdale, MI. 

Ryan Power is a rising M3 from Racine, WI, and attended undergrad at UW-Whitewater.

Learning Communities at MCW - A Vision for the Future

 From the 5/21/2021 newsletter

Learning Communities at MCW - A Vision for the Future

Kurt Pfeifer, MD, Marty Muntz, MD, and Cassie Ferguson, MD

As the Kern Institute continues its work on implementation of well-being into the medical school curriculum and exploration of the use of learning communities (LCs) in medical education, members of the Kern Institute and key stakeholders have met to discuss the larger vision for what LCs might look like at MCW …

Within the next decade, we envision Learning Communities (LCs) being an integral part of the continuum of medical education, spanning from undergraduate (pre-medical) schooling through graduate medical education (residency & fellowship), and encompassing all healthcare professions (including, for example, nurses, physician assistants, nurse practitioners, pharmacists, physical therapists, and social workers). LCs will target multiple critical objectives, both social and academic, and will greatly improve students’ preparedness for their careers in medicine by providing accessible, essential, and longitudinal relationships in the form of mentorship, coaching, support, and advice with faculty, senior colleagues, and/or peers. Moreover, LCs will provide an essential forum for development of character and caring by serving as a “safer space” for individuals to come together and provide multiple different perspectives as each student forms their professional identity. 

In this essay, we outline what a comprehensive LC program could look like at MCW.

General Structure

Learning Communities would include students from each year of education to provide networks of peer support that span the breadth of the medical school experience (Figure 1). Previous experience from the REACH Curriculum indicates that groups of eight peers provide an optimal group dynamic. 

To enhance the network of support and learning, interprofessional education would be coordinated by having groups of learners from other professions work with medical students within their LCs. Broadening the inclusion further would also allow for resident physicians - perhaps even LC graduates if they stay at MCW for residency - to be part of an “extended family” that can participate sporadically in LC activities and serve as mentors. Lastly, students can participate in supporting the development of future medical students by engaging in mentorship activities with pre-medical/undergraduate students, especially underrepresented in medicine (URM) individuals. 

Each LC would have two faculty facilitators as well as two student facilitators. The faculty facilitators would share responsibilities for leading group activities and would divide the responsibilities for individual student coaching. At least one faculty facilitator would be a clinical faculty and, if both are clinical faculty, the LC would also include a foundational science faculty member or course coordinator to provide their valuable perspective. One M3 and one M4 from within the LC would be nominated to serve as student facilitators. They would join select small group meetings and serve as the student leaders of the LC.

The LC is the basic unit of the LCs program, but higher levels of structure facilitate other aspects of medical education. Given the number of MCW students, six LCs will be collected into a House. The House will provide a format for larger learning activities, including coordination of cohorts in the event of restricted in-person coursework and social events. 

The House structure also incorporates mechanisms for remediation and behavioral health support. We propose that a Continuous Professional Development course directors could be assigned to each house and serve as a resource to faculty and students in their LCs to develop and implement remediation plans and provide additional career planning advice. To encourage students’ willingness to discuss behavioral health and reach out for assistance, we propose having a behavioral health clinician assigned to each House. This individual could come to House and LC meetings and therefore encourage students to get behavioral health assistance by connecting with an individual in their personal network rather than an unknown clinician.

Key: Undergraduates [UG], Nursing [RN], Pharmacy [Pharm], Physician assistant [PA], Resident [Res], Other health professionals [Other], Faculty facilitators [Fac], Student facilitators [Stu],Continuous Professional Development director [CPD], Behavioral Health professional [Ψ], Learning Community directors [LCD]

Activities in LCs

LCs would not have their own curricula but would be a venue utilized to achieve the objectives of key curricular threads – foundational science, clinical science, and personal/professional development. By their nature, they would be most heavily used for achieving objectives of the latter, including well-being, professional identity development, and empathy/character enhancement. These could be achieved through different combinations of LC individuals (Figure 2). However, the LCs could pursue foundational and clinical science objectives by maintaining group continuity for activities such as team-based learning exercises, physical exam education, and medical ethics discussions.

Concluding thoughts

LCs have developed a prominent role in modern medical education for good reason. Groups of students and faculty maintain continuity over the span of education, developing longitudinal faculty and near-peer mentorships and a “safer space,” where a growth mindset can be fostered. Such groups are even more important at large medical schools like MCW. LCs will allow us to place the learner at the center of the educational process around which we weave the comprehensive threads of medical education (Figure 3). 

 Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

 From the 5/21/2021 newsletter

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

Kurt Pfeifer, MD; Marty Muntz, MD; and Cassie Ferguson, MD

The team reviews MCW’s experiences with the REACH Curriculum and the 4C Program, each of which has elements of the proposed Learning Community model …

The challenges of training in medicine have never been greater. Medical students are expected to develop a larger fund of knowledge in hectic clinical environments burdened by great financial, social, and public health pressures. This creates can have numerous consequences, including burnout and increasing rates of psychiatric disease. To better support students and reduce these potential problems, many medical schools have implemented learning communities (LCs).

LCs are comprised of faculty members and students who regularly meet together for community-building, academic and personal support, professional development, and curricular activities. Since the early 2000s, many medical schools have implemented these types of programs, and according to the most recent survey of US medical school have LCs or are developing them . LCs have been shown to improve faculty engagement, student well-being, and professional development.

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In the last few years, MCW has embarked on its own exploration of LCs and has implemented programs which, although limited in scope, are based on the philosophy of LCs.

MCW’s REACH Well-Being Curriculum 

LCs can positively impact student well-being, which has become a major priority for US medical schools. In 2018, with the support of the MCW School of Medicine and the Kern Institute’s Student Pillar, Dr. Cassie Ferguson implemented a well-being curriculum aimed at teaching skills related to well-being and providing opportunities to talk with and learn from peers and faculty members. Utilizing longitudinal groups of faculty, staff, and students, the structure of the REACH (Recognize, Empathize, Allow, Care, Hold Each Other Up) Curriculum incorporates a LC model.

REACH consists of didactic sessions followed by facilitated small-group sessions which focus on the content and objectives covered in the didactic sessions. When first implemented, the program included three sessions in the spring semester of M1 year and three in the fall semester of M2 year. Each small group has eight medical students (ten in the first two years of the program) and two volunteer facilitators. One of the facilitators is a clinical faculty member and the other is a behavioral health clinician or a student support staff member. Using session guides with learning objectives and suggested discussion questions, facilitators conduct two-hour sessions with their students. The objectives of the REACH curriculum are to describe how the well-being is integral to becoming a caring and competent physician and practice skills that will help students thrive in medicine. 

Evaluation of the curriculum was accomplished through a seventeen-question survey made up of Likert scale and open-ended questions. Sixty-two students at MCW-Milwaukee (30%) completed the survey. 85% of respondents believed that what they were asked to learn in REACH was important and 70% would recommend that other medical schools adopt REACH. The REACH small group sessions played a significant role (>70%) in building relationships with peers and faculty. Students commented on the benefits of getting to know their peers, realizing they were “not alone” in how they felt, and feeling faculty were genuine and cared about them.

Following its successful first two years, the REACH program was expanded into the Fall M1 semester starting in August 2020. Now the program uses the same groups of students through the first three semesters of medical school, but in the first semester small groups, volunteer M2 students are utilized as facilitators. Evaluation is ongoing but early subjective feedback has been strongly positive.

MCW’s 4C Program 

The Coaching for Character, Caring, and Competence (4C) Program was launched in August 2019. 4C is structured around the core concept of LCs where groups of students and faculty cultivate professional growth within longitudinal relationships. Within this framework, multiple different components can be implemented to meet specific objectives (Figure). 

Roughly fifty students volunteered for the program during AY2019. Thirteen volunteer faculty were grouped with three to four students each, and these groups meet monthly covering character and professional development topics. In addition, faculty meet individually with each of their students every other month. The program is directed by Kurt Pfeifer, a faculty member in the Student and Curriculum Pillars of the Kern Institute. 

Initial data showed great support for the program as a whole. There was a strong impact on development of mentorship, support for students, and a sense of faculty engagement. Students in the program were less likely to have feelings of isolation and reported strengthening of several character traits, including perspective, self-regulation, perseverance, and social intelligence. 

For AY2020, a new group of volunteer students was sought and the response was overwhelming. Greater than 55% of the incoming class desired to enter the program. Based on available resources, the program was able to enlist fifty-six new students along with fourteen new faculty coaches. The program also added a program of near-peer coaching in AY2020 which paired volunteer M3 near-peer coaches with each group of M1s and M4 near-peer coachs with each group of M2s. Furthermore, MCW-Central Wisconsin and MCW-Green Bay incorporated adaptations of the 4C program for their campuses. 

Evaluation of the 4C program is also ongoing, but subjective feedback from students and coaches alike has been strongly positive. 

Next steps

REACH and 4C both continue to move forward with planning expanded activities and refined content with the coming academic year. These programs have been pivotal for informing MCW’s curricular re-design process, and the hope of their directors and coordinators is that they will form the basis for a comprehensive LCs program at MCW in the future.

For further reading:

Smith S. Acad Med. 2014 Jun;89(6):928-33. 

Eagleton S. Adv Physiol Educ. 2015;39(3):158-66. 

Smith SD et al. Acad Med. 2016;91(9):1263- 9. 

Rosenbaum ME et al. Acad Med. 2007;82(5):508-15. 

Wagner JM et al. Med Teach. 2015;37(5):476-81.

 

Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

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.