Words of gratitude, encouragement and strength from the Senior Associate Dean for Graduate Medical Education

 Freom the 6/11/2021 newsletter

Perspective/Opinion

 

Words of gratitude, encouragement and strength from the Senior Associate Dean for Graduate Medical Education

Kenneth B. Simons, MD

 

Dr. Simons, MCWAH Executive Director & DIO, MCW Senior Associate Dean for Graduate Medical Education and Accreditation, offers this message of congratulations and best wishes to all of the residency and fellowship graduates, reminding them that, while their knowledge and skills are important, it is their humanity, compassion, and caring that their patients and families will remember …

 

The journey of a thousand miles begins with one step.

Lao Tzu

 

The journey of becoming a physician is a difficult one; quite understandable given the importance of what the responsibilities are. Thus, completion of the residency or fellowship training portion of this journey in “normal” times is a remarkable achievement. In extraordinary times such as this, it is a feat of incalculable proportions. You, the 2021 graduates of our 98 ACGME accredited programs along with our non-accredited GME programs have been tested like no other prior graduates. The COVID-19 pandemic was your crucible and pushed you in every possible way. Professionally, while your didactic education became virtual, your responsibilities to be physically present to care for patients never did, other than some telemedicine encounters. You wore your PPE as battle armor and you came to work every day to do what you were born to do; care for the sick who required your expertise and more importantly, use your compassion as you learned and practiced your craft under the supervision of faculty. Some of you in fulfilling your responsibilities to patients actually developed the disease, and we are all very grateful that you survived in contradistinction to the 597,000+ dead in the US and 3,730,000+ worldwide.  And to your great credit and remarkably, more than 95% of you received one of the vaccines, demonstrating to your patients and the world that science is real and that it matters.

 

Beyond having to deal with a viral pandemic, something that hadn’t happened in more than 100 years, you also had to deal with our country’s latest and critical reckoning with health care inequities and systemic racism. America’s shameful legacy of slavery and the institutionalization of racist behavior was placed on international display as a result of the murder of George Floyd which fortunately, was filmed by a brave 17 year old woman, assisted by others who watched and confronted the officers who forsook their oath to protect and serve, something you never have and would never do, given each of you took an oath to care for all who come to you in need of your expertise. Mr. Floyd was not the only black person who was killed or maimed this past year as a result of excessive force by police and racist thugs and it is incumbent upon us to remember all of them. In addition, you witnessed a rise in violence against our Pan-Asian community as a result of the pandemic and the hateful, ignorant rhetoric spewed by some “leaders.” Through it all, you did the right thing for patients, your communities and yourselves. You participated in peaceful demonstrations, you knelt for nearly nine minutes, you wore pins that said Black Lives Matter and others with rainbows, demonstrating to everyone that you cared about your fellow human beings in a committed, real way and that diversity, equity and inclusion aren’t just words in a mission statement, but words to be lived by in a visible, tangible way, each and every day.  As you leave here, it is incumbent on you to continue making society healthier for all, better for all and to eliminate racism in all its forms. 

 

The word doctor comes from the Latin docere and means “to teach.” Throughout your tenure here, you taught medical and other students, your peers, the staff and the faculty that actions do speak louder than words; all while reading about your patients and their conditions to enhance your knowledge for the benefit of your future patients. And as impressive as all of this is, you accomplished this while also caring for your own families and other loved ones, and as such, they clearly share this august accomplishment with you. In your heart you know better than anyone that without them and their support, this accomplishment would not be as sweet, nor would it have been possible. Their assistance, encouragement and unconditional love during this challenging time was critical to your achievement. They, along with your many teachers and mentors throughout the years, coupled with your own efforts, brought you to this moment and they will always be with you, either in spirit or in reality.

 

So, years from now when you look back on your time in training and reflect on what you did during one of the most difficult times in medical history and that of our country, remember that you stood tall and did far more than you probably thought was even possible. Your legacy in MCWAH is secure and represented by the following two stories: Two upper level housestaff volunteered to form a COVID-19 intubation team to “protect our older faculty and younger, less experienced colleagues” and by a mother, a first year resident, who said “while it will be a hardship to leave my young child for a month, it’s nice to go to a place where I will be needed and can make a difference.”

 

You, the graduating housestaff, are inspiring, and you are going to be amazing doctors to whom your patients will look for assistance during what can easily be considered some of the most trying times in their lives: when they are dealing with and overcoming illness. Always remember that while your knowledge and skills are important, it is your humanity, compassion and caring that your patients and their families will remember during those times. It is now time for you to practice independent of supervision and take the next steps on your journey. Godspeed and know that you are ready and we are with you always. Remember, “Your journey never ends. Life has a way of changing things in incredible ways.” Alexander Volkov

 

Best always,

 

 

Kenneth B. Simons, MD

 

Dr. Simons is the Executive Director & DIO, MCWAH, Inc. and the Senior Associate Dean for GME and Accreditation, MCW.  He is also Professor of Ophthalmology and Pathology (tenure) at MCW.

 

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.