Bike vs. Auto

 From the October 21, 2022 issue of the Transformational Times

Guest Director’s Corner 

Bike vs. Auto 

 By Cassie Ferguson, MD 

Dr. Ferguson discusses how empathy can lead to a deeper connection with patients… 

Two weeks ago, I got a call that no parent is truly ever prepared to get, even those of us who spend much of our lives “dress rehearsing tragedy” (Brené Brown, Dare to Lead). I was driving home from a shift in the Children’s emergency department (ED) when an unfamiliar number popped up on my phone. I immediately got a sinking feeling in my gut and answered quickly. It was my oldest son, Ben. 

“Mom, I got hit by a car but I’m okay. I just kind of hurt my leg.” 

Breathless, I paused and tried to find the next right thing to say. 

“Where are you, Benny? Who is with you?” 

“The police are here. Do you want to talk to them?” 

The police?? Suddenly the image I had in my mind of a minor accident was replaced by one that included lights, sirens, and caution tape and I could feel myself getting pulled into the mode I naturally revert to when I’m running a code: gather information quickly, prepare for the worstcase scenario, plan the next steps. I cleared my throat and spoke with the officer who explained what had happened in far more detail than my brain—now fully in flight or fight mode—was ready to hear. 

When I think back to that day, it is that retelling of exactly how my son was hit, how he rolled up onto the hood of the car, and how he was thrown back down to the ground, that still undoes me. It is hearing from Ben that he was riding his bike home from school and decided to turn to get a chocolate chip cookie from the neighborhood bakery just before he was hit that brings me to my knees. 

That night as my son and I sat in my own ED getting films and waiting to hear about the next steps, I thought about all the mothers whose injured children I’d cared for—children far more seriously injured than Ben. Children whose lives were forever changed by their injuries. Children who had died. I thought of all the exquisitely painful details those mothers had to hear and then live with for the days, weeks, and years that followed. And it struck me how little we do to prepare them for what it will feel like to live with those details. How little we prepare them for the searing anger that will suddenly take hold of you when you see your child wince in pain; for the welling up of sadness when you’re reminded of what your child will miss out on because of their injury; for the intense terror that will grab you when you drive by the scene of the accident. 

We have had so many people reach out to us since Ben was hurt, and the love that has surrounded him and our family has been incredible. I’ve observed that in these encounters the two words I hear the most from those intending to comfort and lift up are “at least.” At least he was wearing his helmet. At least he was not more badly injured. At least the driver stopped. At least… And that is all true. I am extraordinarily grateful that Ben is okay, and that his leg will heal. And I say those same words frequently in the ED intending to support my patients’ families after close calls with tragedy. I believe that while it is not necessarily in our nature, our culture prompts us to seek and point out the positive. As caregivers we are taught to be useful and provide hope—as a profession, we value optimism, grit, and resilience and these values are passed onto our patients. 

With some reflection, however, I can see that this approach is also a way to create separation between me and the person for whom I am caring; a way to put a safe distance between myself or my children and a similar, imagined tragedy. And yet empathy requires we get up close. It requires that we connect with something inside of ourselves that knows what it feels like to be them. This is not a knowing that comes from our own experiences or imagining what it would feel like to “walk in their shoes.” This is a deeper knowing that arises from vulnerability; from a willingness to be open to our own suffering, and to know our own darkness such that our care arises not from pity but from a shared sense of what it really is to be human. 

Up close we can just sit and let our presence be a signal that we are there and that we are paying attention. Up close we can use the sacred gift of touch to heal. Up close we can ask questions like, “What does it feel like to experience this as a mother?” If you asked me that question right now, I would tell you that I feel angry and sad and afraid. I would tell you that during the last two weeks I’ve experienced guilt, overwhelm, and anxiety. 

And we might notice, the two of us, that just by asking and answering that question, we can find some kind of relief, some sense of rest in the knowledge that we are not alone. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics (Emergency Medicine) at MCW and the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Mentorship is a Partnership

December 1, 2022

From the December 2, 2022 Global Health Issue of the Transformational Times

Perspective/Opinion 

Mentorship is a Partnership 

By Laura D. Cassidy, MS, PhD  

Dr. Cassidy, the Associate Dean of Global Health, has been a long-term mentor for the Dr. Elaine Kohler Summer Academy of Global Health Research program.   

Being flexible and resilient are important and unexpected skills that medical students develop as they embark upon global health research. Unlike a highly structured medical school experience, students learn to adapt when things do not go according to plans. They pause, engage in the culture, and practice patience and kindness. 

I learned as much from my medical students as they did from me—if not more.  I have enjoyed mentoring many PhD students and, in 2018, I had the wonderful opportunity to mentor my first medical students in the Dr. Elaine Kohler Summer Academy of Global Health Research Program. We traveled to Kigali, Rwanda to meet with my partners and then to Kampala, Uganda where Sarah Benett (M1) and Brittany Fickau (M1) participated in a research project with my colleagues at the Child and Family Youth Foundation. They learned many important and expected research skills, from how to design an international study, to working with clinicians, to administering the Malawi Developmental Assessment Tool (MDAT) in young children, to analyzing data, and to preparing a manuscript. 

I learned about the pressure that medical students impose upon themselves—their perception of needing to work twelve-hour days to being highly productive—and it was difficult for them to slow down and engage at African speed. An important unexpected skill that they developed was to pause and observe the culture.  In this crowded city in a low- to middle-income country (LMIC), being “punctual” takes on a new meaning. Someone can plan to be early for a meeting or clinic but if there is a bad traffic jam, they may sit for hours in traffic. The meeting may happen three hours later or not at all.  

At first, there was stress because of their internal pressure to be productive and, yet, they were dependent on a system and culture that they could not control. They learned to work with women and children in a clinic that served residents of informal settlements.  They did not speak the same language.  They were dependent on clinic staff and interpreters.  They learned to form meaningful relationships and to network.  There were reflections on how to be efficient with very limited resources and the importance of listening…even when you don’t speak the same language. One of the most import skills we all cultivated was flexibility. When things don’t go according to plan- pivot and be resilient. 

All these experiences became even more important in 2020 when the pandemic hit.  The next two M1 mentees, Lauren Tostrud and Hannah Racicot, were planning to do their summer research program in Rwanda. We did the best we could to zoom there frequently, and they worked diligently with our partners on important literature reviews about the effects of the Hutu genocide against the Tutsis. We stayed in our homes and watched movies about sub-Saharan Africa and the culture and discussed them.  Throughout the pandemic, they never complained, they remained excited about their work, and I learned about the ways they implemented the skills they acquired into their medical school training. 

I am honored to serve as a mentor to these bright and dedicated students and this role does not end after a semester or graduation. Together we learn, we support each other, and we thrive. 

Laura D. Cassidy, MS, PhD, is the Associate Dean of Global Health, Professor and Director of the Epidemiology & Social Sciences Division, and Founding Director of the Master of Science Program in Global Health Equity at MCW. 

Gratitude – Who’s Got Time for Gratitude?

November 18, 2022 Thanksgiving Issue

Editor’s Corner 

Gratitude – Who’s Got Time for Gratitude?  

(AND A RECIPE FOR DATE-FILLED SUGAR COOKIES!)  

By Jeff Fritz, PhD 

As we all head into this season of Thanksgiving, Dr. Fritz celebrates the wonderful benefits of being grateful and offers some ideas for developing habits of gratitude ... 

I hate to admit that I suffer from a strong case of what can be termed as negativity bias. Put simply, I tend to overly focus on the negative and use remembering negative information as a protective habit to avoid pain in the future. It’s a cognitive bias and amplifies the power of losses compared to the power of pleasure obtained from gains. Maybe it is why some coaches over time will state that the losses hurt more than the wins, even when the wins are many and the losses few.  

My negativity bias tends to shine when I’m overly busy and plays out in my impatience with interruptions. Yet as an educator, life is all about stepping into and welcoming many interruptions as an opportunity to teach and learn. Someone stating, "I have a question,” can be viewed as either an interruption or an opportunity to engage. 

Thankfully, one of my mentors suggested I try to flip this recording in my brain by focusing on gratitude and developing practices of gratitude. My mentor started the conversation by challenging me with, “What have you got to lose?” 

Looking back on it, that was a smart move! It forced me to use my negativity bias against myself and challenged me to practice gratitude.  

I encourage you to explore the research on the under-appreciated power of gratitude to transform our lives and our health. I explore three habits that could be practiced to develop gratitude:  

• A gratitude journal 
• Three gratitudes daily 
• Random acts of kindness 

A gratitude journal was not a huge success for me, but the practice of sharing with someone three things I was grateful for on a daily basis worked well around the house. Personally, I found random acts of kindness a big help. Little things like holding a door for someone, serving in the moment to fill an easy need, or just saying thanks became a way to add a boost throughout my day.  

Over time, I have begun to view interruptions in a more favorable light. While this may sound strange, I sort of look forward to interruptions as ways to explore new opportunities or deepen friendships. I was reminded by a dear friend to never let a good crisis go to waste. What an amazing way to transform a major interruption into an opportunity to practice gratitude and service! 

Another reminder that recently came my way was that gratitude is a way we can show we care for others. 

My three gratitudes for today:  

• Fire Alarms 
• The trust of the students I’ve been given the opportunity to serve as an instructor 
• The staff support team at MCW-CW – they have repeatedly made me look so much better than I am, and I thank them for their initiative and energy to help us create team wins. 

Grandma’s Date-Filled Sugar Cookies  

Soft and Chewy Date-Filled Sugar Cookies - Oh My! Sugar High  

I was also asked to share a favorite holiday recipe. Another difficult ask as I’m more frequently the recipient of the recipe than the person following the recipe to produce something amazing. I should have mentioned that I’m really grateful for all those amazing people daily transforming ingredients into outstanding meals. Regardless, one of the holiday favorites that took a while to grow on me but I now look forward to each year around this time is Date Filled Sugar Cookies.  It was my grandmother’s signature dessert that she only made during this season. While she refused to share her exact recipe this one comes close:  

For further reading: 

Vaish A, Grossmann T, Woodward A, Not all emotions are created equal: The negativity bias in social-emotional development, Psychol Bull 2008; 134:383-403. https://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.134.3.383  

Hamlin JK, Baron AS, Agency Attribution in Infancy: Evidence for a Negativity Bias, PLoS One 2014; 9(5):e96112  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011708/    

 

Jeff Fritz, PhD, is an Associate Professor in the Department of Cell Biology, Neurobiology and Anatomy and the Department of Regional Campuses, Central Wisconsin Campus. He serves as the Director of the Kern Scholars Program and is a member of the Student Pillar, Curriculum Pillar, Faculty Pillar and the Philosophies of Medical Education Transformation Lab of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Writing is a Deep Conversation

From the 10/29/2021 newsletter

Director’s Corner

 

 

Writing is a Deep Conversation

 

 

Adina Kalet, MD MPH

 

 

In this special “Authorship” issue of the Transformational Times, Dr. Kalet shares her feelings about the value of writing together with others, and why authorship is among the most complex and critical aspects of what we do. She proposes that, if we can do it well, solid writing opens important conversations and can be deeply satisfying …

 

 

If writing seems hard, it is because it is hard. It is one of the hardest things people do.

-William Zinsser, On Writing Well: The Classic Guide to Writing Nonfiction

 

 

As an early-career physician and clinical educator, I felt none of the traditional “publish or perish” academic pressures because, for most of my working life, I had no particular desire to be promoted. So, you may ask, why do I spend so much of my time writing now? The answer to this has evolved. I write to work things out and begin dialogues, much as Joan Didion hinted when she said, “I write entirely to find out what I am thinking.” Once a concept or project has been committed to the page, I am better equipped to engage in conversations about the things that matter to me. 

 

 

I didn’t always love to write

 

Thanks to a few generous mentors, editors, and spell checkers, I now love to write. This was not predictable. Despite a good-enough elementary education, it never occurred to me that writing could be a deeply satisfying communal experience. Like most of us, I learned the rules of grammar, parts of speech, sentence, paragraph, and essay structure, and how to appropriately use quotations and citations to passively draw on the ideas of others. It was all done in a dry, uninteresting, and lonely way. It wasn’t until I discovered, through writing for publication, that one was entering into deep, complex, and important conversations with others, that I became willing and eager to do the hard work. And it is very hard work. But luckily, it is almost never a solo pursuit. 

 

As medical education scholar, Lorelei Lingard, asserts in her stupendous new book Story, Not Study: 30 Brief Lessons to Inspire Health Researchers as Writers (Springer International, 2021): 

 “Medical education moves forward because we share insights, question methods, argue the relevance of emerging ideas and build on one another’s efforts. All of this is possible in large part because of writing, and it explains why writing is such a highly valued currency ….”

Dr. Lingard has taught me through her “writing about writing” to think of the process as a way of entering critical conversations to clarify our thinking. We converse with those who came before us by reading the relevant literature, we converse with those with whom we work by writing together (not easy by any stretch of the imagination, more on that later), we converse or spar with editors and peer reviewers and, finally if we are lucky, we get to converse with our readers. It is a cacophony of conversations. 

Learning the value of writing with others rather than alone

 

One of my most beloved mentors, medical sociologist Jo Anne Earp, ScD, had a framed picture in her office which, literally, is how I really learned to write.  It is a line drawing of a young child on tippy toes, holding a bright red crayon, caught in the act of crossing out and rewriting the statement, “A good mentor accepts ,expects, respects a first draft.” Sitting in her office, struck dumb by the anxiety of having to write about my work, facing that picture, I truly understood for the first time that writing could be a collaborative process. I was paralyzed as I tried to start writing my very first 300-word abstract to submit to a professional meeting. Recognizing my predicament, Jo Anne took her pen and lined yellow pad in hand and asked, “What should we title this?”  I dictated; she wrote. We switched roles.  Sentence by sentence, we polished the words until we were done. It took one hour, an hour in which I learned the key to collaborative writing—what I now call “yoked pair” writing—a process that I use with my colleagues and mentees almost every day. Now, we sit in front of a computer screen and ask each other, “What do we think?” 

 

Writing is hard. No question. Yet now I see that writing can also be a highly valuable, satisfying, and fundamentally communal experience. Since I learned the value of writing collaboratively with others, my writing partners will tell you I am relentless in extoling its virtues. This is because I believe that writing together is the best way to think clearly and develop ideas. 

 

 

Now, I am an enthusiastic writing coach

 

I regularly share my inner writing nerd. On my shelf is a stack of slim books which I both read and give away. My favorites are the latest edition of Strunk and White’s The Elements of Style illustrated by Maira Kalman (I adore the Basset Hound on the cover), Stylish Academic Writing and The Writer’s Diet both by Helen Sword (where I first discovered that I was a “flabby” writer  - yikes!), the hilarious Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation! by Lynne Truss from whom I finally understood commas; How to Write a Sentence and How to Read One by Stanley Fish and, now, Lingard’s Story Not Study, which is an expansion of a series of papers she edited for the journal Perspectives in Medical Education entitled the “Writer’s Craft.” Of course, writers must also be readers and must have very good editors! 

 

 

Ode to Bruce Campbell

 

This is my sixty-seventh Transformational Times Director’s Corner. Before March 2020, all the writing I had done had been as part of a team. I had never published an essay as a single author. When the newsletter was launched and I committed to writing a weekly column, Bruce Campbell became my editor. It requires great talent and generosity to craft someone else’s words. Bruce has done this for me almost every week for the past eighteen months as an act of kindness and compassion despite his surgical and clinic schedules, the publication of a book, and the responsibilities of a professor of otolaryngology at MCW. 

 

I experience his editing as I do an honest conversation with a close colleague.  What he does is the writing equivalent of “active listening.” By reading and rearranging my words, he is saying, “I hear you. Now let me restate that a bit and see if we can make it truer and clearer.”

 

This has been a profound learning experience. At the beginning, my drafts were “messier” and he had to push up his sleeves, often late at night, to find the wheat and eliminate the chaff. By rereading my words with his edits, I have learned how to write in this short essay format.  Originally, he did a heavy edit, rewriting sentences, reorganizing paragraphs and titling sections to hammer the piece into a readable form. Now he takes a lighter touch, refining the words, aligning the tenses, shortening the sentences, and very occasionally rearranging the paragraphs. We have learned to write together, and this has made all the difference.  

 

 

So, let’s get writing!

 

As the Kern Institute moves the mission to transform medical education forward, we must define, refine, and share our ideas. Writing and publishing are critical to this process. Consider writing as a team sport! I hope you enjoy this issue of the Transformational Times as we examine the highs and lows—and the nuts and bolts—of academic publishing. 

 

 

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.