Reflecting on medical school and residency

 From the 6/11/2021 newsletter

Perspective

Reflecting on medical school and residency

By Buba Marong, MD

Dr. Marong reflects on his journey of gratitude through MCW as a student and resident.  

It has been quite the journey, these past seven years. As I conclude what I considered to be the most meaningful endeavor of my adult life, I am filled with a range of emotions, but perhaps the sentiment that overshadows them all is GRATITUDE. I am eternally grateful for the opportunity and privilege to realize this childhood goal of mine in this faraway land. A land so far away from where I grew up, yet it never quite feels foreign to me. America always feels like home to me because I consider myself so lucky to have crossed paths with some amazing human beings; human beings whose impact on my growth - both personally and professionally – has been immeasurable. 

“Buba! Very nice to meet you.” That was how Jennifer Haluzak, then the admission coordinator at the Medical College of Wisconsin (MCW), greeted me during our first encounter when interviewing for a position in the Class of 2018. I usually remark that it doesn’t bother me at all when folks butcher my name, and I mean that. But there was something about how perfectly she pronounced my name that made me feel right at home. That sentiment of feeling right home would stay with me throughout medical school. I am painfully cognizant of race relations in America, and I must admit that I mentally prepared myself to tackle both the overt and covert issues in medical school and residency. Fortunately, it was preparation that I never needed, for all my interactions have been filled with genuine and mutual respectful curiosity and admiration. 

It should be no surprise then that residency selection was an easy choice for me. Medical College of Wisconsin Affiliated Hospitals (MCWAH) was my number one and only choice. I knew if I was willing to put in the work and time, I could garner the requisite skillset necessary to become the kind of physician that I knew I wanted to be. I was lucky to be surrounded by colleagues and educators who are just as passionate about their craft as I am. There is something special about the Internal Medicine residency class of 2021. As a function of my family obligations, I didn’t get to interact with folks that much outside of work, but there is an indescribable warmth about this class and an eagerness to be there for each other. I will greatly miss listening to Curren’s quiet wisdom, catching up with Kam in the hallways about family, and Matt giving me a hard time about that one award that he thought I stole from him.

When I look back at my residency, though, perhaps the turning point for me was formative feedback I received from my favorite attending and mentor, Dr. Jayshil Patel. I had solicited feedback at the end of a rotation, and he told me to be “comfortable with being uncomfortable.” He went on to elaborate that true growth only comes about through putting oneself through intellectually uncomfortable situations. I took that to heart and read the entire Annals of Internal Medicine Clinic Series (for example) to shore up my foundational knowledge. I re-read basic biochemistry again (at least the components with pertinent clinical applicability). I was appreciative of that formative feedback. At the time, I didn’t understand it as being “called out” for becoming complacent, and there was a reason for that, which brings me to my final point and a challenge to all my fellow educators. 

Giving trainees formative feedback should be considered a privilege. A privilege that is only earned after establishing with said trainee that you genuinely care for their personal and professional growth. Take some time to get to know your trainees. What drives them to do what they do? What are their biggest fears? What makes them happy and/or sad? Have they lost someone close to them recently or in the past? Is their family doing okay?  I am fervent believer that if the very first time that you have any meaningful non-work-related conversation with a trainee is to give them feedback, the chance that those tips will land on a receptive ear is slim to none. Instead, the sentiment you expressed will merely serve as a fodder for venting to the next willing listener that the trainee can find. 

To the graduating class of 2021, I challenge you all (myself included) to please use your new-found status and privilege in society for the common good.  Start with the simple things: Be the best friend, partner, son, daughter, parent that you can be and let your north star always be DOING THE RIGHT THING! 

Buba Marong, MD is a PGY3 Internal Medicine resident at MCW. He founded the Marong Health Group with the goal of establishing quality and affordable primary health care clinics in Gambia.  He will be practicing hospital medicine in the Milwaukee area.

Reflection on Residency and the ACGME during a Pandemic

 From the 6/11/2021 newsletter

Take 3 with Eric Holmboe, MD

 

 

Reflection on Residency and the ACGME during a Pandemic

 

 

Eric Holmboe, MD, MACP, FRCP-Chief Research, Milestone Development, and Evaluation Officer, Accreditation Council for Graduate Medical Education (ACGME)

 

 

 

Dr. Holmboe, a leader in graduate medical education, describes an important lesson he learned during training, covers what the ACGME has done to adapt to the pandemic, and gives this year’s graduates some sage advice. He was interviewed by Transformational Times editor, Kathlyn Fletcher, MD MA.

 

 

 

Transformational Times: Tell me a story about something that occurred during residency that was influenced the development of your character as a doctor and a person.   

Dr. Holmboe: One moment that stands out is from my chief residency.  The chief of service at the West Haven VA was Asghar Rastegar.  One day he asked me how the year was going.  I told him that it was great but that I always felt as though I didn’t know enough.  He leaned back in his chair and said, “Eric, I hope you never stop feeling that way.”  I realized then that Asghar was the epitome of that kind of doctor.  He role modeled that desire to always be learning and was explicit about how important it was.  He said “I don’t know” when he didn’t know.  He was a co-learner with others, even though he was brilliant.  I realize now that those are the people that I admire the most.  They are humble and quiet and always learning.  

 

Transformational Times: What do you think was the most important role the ACGME played during the past year?  Was that something you (as a group) explicitly decided?

Dr. Holmboe: The ACGME made an explicit decision to be flexible and to respond quickly as the pandemic unfolded.  We wanted to provide programs with relief and give them flexibility to do what they needed to do, but we also wanted to hold firm on things like duty hours.  We created first a tiered pandemic status, then revised the program to an “emergency status” so institutions could have sufficient flexibility to meet the demands of COVID surges in their communities, including moving residents and fellows around to help with the evolving patient care needs. 

A specific intervention that proved to be very helpful was setting up routine national DIO (designated institutional official) calls by our Sponsoring Institution team to provide the DIOs with information and also to get input and feedback from them about what was happening on the ground.   We also quickly put together a supplemental survey for the annual update so that we could better understand what was happening around teaching and the health impacts of the pandemic.  It was good that we did all that work in the spring because the winter surge was so much worse.

We also routinely asked ourselves, “How can we be more helpful?”  We tried to be deliberate and proactive. For example, we moved our faculty development assessment courses from in-person to online and also made the courses free.  In the end, we know that the GME community made many sacrifices, including residents and faculty that got sick, and some that died.  One faculty member from Geisinger contracted COVID19, was on ECMO and ultimately needed a double lung transplant.  His story can be seen in this public service announcement, encouraging people to get vaccinated.  The ACGME recognizes the loss and sacrifice that occurred in our community.  

 

Transformational Times: What words of wisdom would you share with the residents who are graduating this month?

Dr. Holmboe: Remain curious.  Take care of yourself (I didn’t do it as well).  I do try to avoid nostalgialitis imperfecta profunda (the “profoundly imperfect recollection of or yearning for the past”).  I loved my training but would not repeat it. 

Stay involved.  Your generation has already been amazing in this regard.  Continue with your advocacy for yourselves and others. 

Humility is really important.  Medicine suffers from arrogance.  You are a member of a team, an interprofessional team.  You are not the most important person on a team – the patient and family are and remember they are also part of the team. 

Always remain patient- and family-centered.  Think about your community, outside the hospital walls.  Your goal is to positively impact the lives of others through service.

Co-produce your work; co-produce your assessments; co-create learning. 

 

Small moments of human connection make all the difference

 From the 6/11/2021 newsletter

Perspective

 

Small moments of human connection make all the difference

 

By J. Daren Covington, DO

 

Dr. Covington reflects on the moments of empathy and connection that make a difference for patients.

 

As someone who has been on all sides of medicine as a patient, as a father, and as a physician I’ve tried my best to bring all my life experiences to the table when taking care of my patients. Some of the most meaningful and impactful moments during residency have been during my time in labor and delivery (L&D). A vast majority of these patients are young, healthy women presenting for normal labor pain and might be the very first time they are in the hospital for any reason at all. Several patients that I’ve interacted with were very defensive because of either poor past experiences with medical personnel, horror stories from the internet, and/or other physical or mental abuse and trauma. There have been times when I felt the medical staff in general have judged the patient harshly during their care because of something the patient has said or done upon arrival.  I try to put myself in the patient’s shoes and remember that the patients are doing the best that they can under the circumstances while still trusting in us to provide the best medical care possible.

A recent experience illustrated how we can build connections by being present for patients.  There was a young lady who was being “difficult,” but after sitting down, talking calmly, and really taking the extra minute or two to connect with her, she really opened up and allowed me to help alleviate her pain. She told me that she was just feeling “pushed around and not heard.”

Time and time again I’ve had these experiences on L&D, and they have really shaped my interactions with these young, laboring patients. It quickly became apparent that these small connections I was making in the beginning of our conversations were going much further than I realized.  These connections allowed not only Anesthesia to provide care, but also laid the groundwork to improve all aspects of care, from the obstetrician to the nursing staff. It’s adding the human element that really brings this together and makes each and every interaction a purposeful and meaningful experience for me. I hope that I can impart this insight to future medical students, residents, and staff wherever I go to improve obstetrical care and anesthetic care everywhere.

 

 

Dr. Covington is finishing his anesthesiology residency and will be staff at the University of Pittsburgh Medical Center NorthWest Hospital in Seneca, PA upon graduation.

The Experience That Changed My Perspective on Everything

From the 6/11/2021 newsletter

Perspective/Opinion

The Experience That Changed My Perspective on Everything

Kaitlin Kirkpatrick, MD

Dr. Kirkpatrick writes movingly on how experiencing her own illness had a profound influence on how she sees others who suffer...

Four years of medical school, 2.5 years of residency under my belt, I entered spring of my 3rd year of residency as a confident and competent senior resident. I knew how to manage my inpatient team: which tests and procedures we needed to order right away, how to triage pages from nurses, and how much time we could allot to each patient we rounded - the essentials that kept us efficient and on top of our workload. Then one day I got sick, and everything changed.

Catching a variety of illnesses in residency seems to just come as part of the job, especially when you spend time in the pediatric emergency room. I remember when norovirus wiped out my team intern year, and I’ve had so many mild URIs over the years that I’ve lost count. That’s why when I started feeling ill one weekend, I felt guilty calling in the jeopardy resident but figured it would be quick. What I didn’t expect was to be barely conscious in the Moorland Reserve emergency room with blood pressures in the 70s/40s and the ER staff arguing about whether to start pressors now or let the ambulance take me straight to Froedtert’s surgical ICU.

The following days were a blur of overwhelming exhaustion, confusion, and fear, especially for my husband hearing words like “portal venous gas” and “likely sepsis” with little explanation of what it all meant. My memories come more in flashes. I recall crying when they told me they wanted to get an arterial blood gas. I remembered patients complaining of how much they hurt, but that had never stopped me from ordering them in the past. I've ordered so many nasogastric (NG) tubes during residency, that when they warned me that they were placing one on me, I assumed, “Okay, this can’t be that bad.” I was wrong. I was so tangled up in wires from my central line, a separate peripheral IV, telemetry wires, and a Foley. All of that was tolerable. 

The NG tube was not.

I suddenly became the patient that I used to dread. The surgical nurse practitioner came by and told me that we’d probably be able to take the NG tube out that day, but she had to run it past the attending first (a line I’ve used many times with my patients). Waiting for the attending doesn’t feel as easy when you’re the patient. Finally after telling the nurse I’d pull it out myself, she helped me remove it. For the first time that admission, I started to feel like things might be getting better. It was still another couple of days in the ICU consisting of sleep, echocardiograms, CT scans, more sleep, antibiotics/antifungals, the occasional pathetic walk around the unit, and more sleep before I finally got to transfer to the acute care floor. A few days after that I was able to discharge home, but it wasn’t until we picked up my 9-month-old son from his grandparents and made it back to the safety of our own home that I finally cried and began to process everything I endured. 

I still know the tests and procedures to order on my own patients, but now I’ve started to ask a little more often, “How badly do I need this test?” When my patient has something like an NG tube, I am much more conscientious about when it can come out. Will poking this patient for a lab really change what I’m doing or am I just ordering these tests out of routine? If the nurse is paging me, I try to be quicker to respond unless I truly am in the middle of an emergency. I understand now more how much they really are trying to advocate for their patients. Even now, I spend just a little more time at a patient’s bedside talking to them, to their family, trying to make a little bit of their hospitalization better, because I remember what it was like to be on the other side. 

I’m not the same physician I was prior to this experience, but I’d like to think that I am better than I was before. I do more critical thinking about testing and procedures, I try to be a more involved team player with my support staff. And most importantly, I’m more empathetic towards my patients and their families. I also try to make more time to take care of myself. Sometimes the mental healing takes longer than the physical. I’m lucky my husband and my residency program always supported me in finding the psychological support I needed to recover. I can’t say I’m thankful for having gone through it all, but I am grateful for the doctor it helped me become - the doctor I will continue to be as I graduate from residency this year and begin the next phase of my career. 

Kaitlin Kirkpatrick, MD, is a PGY4 Internal Medicine-Pediatrics resident.