Love in the Time of Medical School

From the December 30, 2022 issue of the Transformational Times

Perspective/Opinion

Love in the Time of Medical School

Nicholas Visser – MCW Class of 2023

Once a staple of the American social scene, swing dancing is a vigorous form of dance which requires exquisite rhythm and grace. Alternatively - as for my teenage self - it is a time in which a man can speak to a woman, providing he can keep left foot one and left foot two from colliding for a few minutes. I would like to think that night at a church fundraiser it was my comedic chops that proved myself worthy of a second date, but I have been assured it was how convinced I was that I did not look like a fool dancing the night away. In either case, it would be easy to say that the rest is history; however, there’s more to this story.

Finding one’s spouse in college is a story that has been told a thousand times. The joy of discovering freedom and responsibility. The winter break trips to each hometown, anxiously seeking parental approval. On some occasions, a shared career interest can add to the connection. In my case, a shared goal of medical school tested and formed it.

Surely, it was only a few months into dating that Anna and I become aware that we both intended to become physicians, but this desire did not weigh so heavily on our relationship until Fall 2018. I had graduated and elected to take a gap year, in part for the opportunity to apply in the same cycle. Anna was enjoying a thrilling senior year. We both had worked tirelessly on primary and secondary applications. But as interview invites were released, the dream of having the chance to study together in medical school was evaporating. As fall turned to winter, we had only two shared interviews and no shared acceptances.

The reality of having to choose between starting our lives together and both pursuing this career had become such a real possibility. In those moments – sharing long evenings discussing our values and priorities – I believe that the groundwork for a strong marriage was formed: listening and being open to working through any challenge together. Less than one week after one particularly moving discussion, I bought an engagement ring. Less than one week after that, we shared an acceptance to the Medical College of Wisconsin.

It is hard to say where we would be now had our cards not turned up so serendipitously, but I know that being willing to bet on our relationship and let career aspirations follow has strengthened rather than weakened us as individuals and as students. Focusing first on loving and serving one another has developed a habit of caring and hard work that benefits our patients and colleagues. As medical school gives way to the match, residency, and attending life, I know the rhythm of life may get more complicated, but I am confident I will be able to keep the beat with my till-death-do-us-dance partner by my side.

Nicholas Visser is a medical student at MCW-Milwaukee.

Editor's note: This essay, which originally appeared in the Transformational Time's Valentine's Day issue (2/11/2022), was one of the most popular of the year. 

Temperature

From the January 6, 2023 issue of the Transformational Times

Temperature

By David Nelson, PhD, MS

Temperature
36 degrees Fahrenheit.
AM? PM?
Breathe that stands out.
Feet to stand on – cold.
Concrete to stand on – cold.
It rains, and the feet on the concrete – are cold.
Head, shoulders, arms, waist, legs, wet and cold.
You are out and in need of everything.
Gratitude for those that come along to support.
Holding a sign with shaking hands from the cold.
Breathe or fog – we do not know.
AM? PM?
36 degrees Fahrenheit.







Author’s Notes

This day was memorable for all the wrong reasons. There are days in the city that are just glorious. Bluebird days with blue skies and moderate temperatures and a shining sun. Then, there are days like this one. Gray clouds, frosty-just-short-of-freezing air and rain. I do not remember exactly if the forecast predicted a day of the weather, but having been out on the streets doing outreach for many years, I thought it could be just like this all day long. I snapped a picture with my phone of the digital thermometer in the truck while stopping for a coffee up a coffee and it stood out. Only the temperature showed on the digital thermometer. For some reason I thought it might be the same temperature all day long and it turned out to be so. It was going to be a crap weather day.

A recurrent theme of the streets are shoes. Community members walk a lot. It is not unusual to for someone to walk five or six miles on a given day. On outreach, I look at a person’s feet first. The shoes tell me a lot about the person. I can also know their size and if they have feet issues by seeing how they wear their shoes out. Worn heels signify one issue, toe sticking straight up or to the side another issue and so on. The size comes from changing a lot of shoes over the years – the benefit of working in a shoe store for a season.

David Nelson, PhD MS is an Associate Professor of Family and Community Medicine at MCW. He leads many of MCW’s community engagement efforts, partnering with public and private organizations to enhance learning, research, patient care and the health of the community. Much of this work involves leaving campus and going to the places where the people he wants to help live, work and play. He serves on the board of Friedens Community Ministries, a local network of food pantries working to end hunger in the community.

Finally Flourishing: A Long Journey to Living the Life She Was Meant to Live

From the January 6, 2023 issue of the Transformational Times

 
Finally Flourishing: A Long Journey to Living the Life She Was Meant to Live   

By Adina Kalet, MD, MPH 
 
 

This week Dr. Kalet shares (with permission) what she has learned from witnessing the life journey of a longtime colleague, a physician leader, and a transgender woman ... 
 
 

“Like so many trans people I don’t remember a time that I didn’t feel I was the wrong gender,” Joanne said recently, recalling growing up in the 1950s as a quiet, withdrawn, ‘super-confused’ boy. Until one day in sixth grade,” she continued, “I went to the library and found a few books about transexual people.” The image of a prepubescent boy laying on the concrete library floor reading a book flashed in my “mind’s eye.” I could imagine the deep relief she must have felt to put words to the feelings, learning, for the first time that there were others like her out there.   
 
She described her high school-aged self as a “super-introverted, mute, ashamed,” and very lonely teenager.   
 

Joanne first told me she was a woman in 1990 when she looked very much like the man she had been for the first forty years of her life. She was still the bearded and balding man I had known as my favorite fellowship officemate and partner in a research project on physician-patient risk communication. I was initially shocked by the matter-of-fact admission and graphic description of gender dysphoria. At that point in time, I had no experience talking openly with someone who was transgender. But because of our friendship, I quelled my confused panic and listened carefully. The story, hard to hear, shot through with sadness, depression, loneliness, awkward relationships and periods of self-hatred broke my heart. At the same time, I was struck by the absolute certainty of my friend's femaleness. “I am a woman. I have been all my life.”  
 
Those next few years were a low point. While still living as a man, raising young children, and married for a second time, Joanne and her wife worked hard to hold it together. They both completed their medical training, found meaningful clinical work, and raised their family. However, after being hospitalized for suicidal depression, they knew that moving forward would require Joanne living openly and honestly as a woman.   
 
 
A familiar voice  
 
Almost twenty-five years later, I stared up at the television set in the patient lounge, drawn by the familiar voice I had not heard in a long while.  It was October 24th, 2014, and I watched the all-too-common national news coverage of a mass shooting. The local Chief Medical Officer stood at the podium describing the teenagers in the ICU, who had suffered bullet wounds to the head delivered by a 14-year-old classmate who opened fire in the cafeteria at Marysville Pilchuck High School in a suburb north of Seattle. After describing the gruesome situation as tactfully, clinically, and calmly as possible, Dr. Joanne Roberts said, "Our community is going to mourn this for years." She went on, "I can tell you that we will all go home tonight and cry."  
 
I emailed her immediately. “I saw you. That was you, right?” (I had not seen her for years), “You were so beautiful. What a great communicator, leader, and public physician,” I continued to gush. She politely confirmed this was her and thanked me for the compliments. I realized too late that my comments on her physical beauty and poise could have seemed rather sexist given that she was clearly doing her job expertly as a senior, physician leader. But to be honest, my clumsiness resulted from the powerful relief I felt to see her looking so confident and relaxed in her own personal and professional identity and, truthfully, I was thankful that she was alive.   
 
 
The gift of being “Trans” 
 
Joanne is retired now, living a peaceful life as a single woman surrounded by many close friends. There were hard times after her transition. She and her wife divorced. She remains close with her children who have struggled from time to time with their “dad’s” gender transition but have moved on as she has. 
 
Her three careers, first as a journalist, then a practicing palliative care physician and, finally, her six years as Chief Medical Officer at a hospital in Washington State, have given her many opportunities to consider issues related to gender and work. Reflection, reading, and talking with others have made her wise.  
 
“In my career, it was a gift to be trans, to have been socialized as a boy, and to live as a woman was a gift,” she shared during a recent conversation.  “… after the shooting, for instance… leading as a woman but having the male socialization, allowed me to act with confidence (real or false), …and be strong with the press, families, and law enforcement.” She reflected on how the complex alchemy of her gender as well as her professional journey enabled her to serve the community, helping them face the horrific moment, “…having been a journalist, …. I trust the media; they want to get the news out to the community. It was easy for me to do.”  
 
And finally, she attributes being calm in a crisis, seeing opportunity in bad times, and listening more than talking, to her unique experience of being socialized as a boy and living as a woman. While she readily describes blatant discrimination, she finds ways to empathize with all perspectives and points of view.  
 
Her leadership skills were honed by the many surprises of her gender journey. “One of the biggest shocks of my transition was that my biggest supporters were my conservative friends,” she says, noting the irony. It turned out that the people with whom she had already had a relationship found it much easier to accept her as Joanne. “It is so easy to hate groups and hard to hate individuals,” she notes, “…knowing this has made me a much better leader…you inspire, one conversation at a time.”  
 
 
The depression is cured 
 
Joanne had always wanted to become a physician. In the 1980s, though, despite having finally found a therapist and physician willing to help with the transition using gender-affirming hormone therapy, and even though planning to fully transition surgically and live as a feminine woman, Joanne stopped the transition because many medical schools considered transsexuality a mental illness incompatible with being a physician. This was a fraught, nearly unbearable tradeoff.  
 
Eventually, she was able to transition. “The sadness is gone, it never gets dark, I haven’t had an episode of depression since transition.” The emotionality she gained being able to live as a woman, attributed both to female hormones and the experience of being treated by others as a woman, greatly enhanced her capacity to practice palliative care medicine. Although Joanne is not a highly vocal advocate for the “queer community,” she does supportive work through one-on-one mentoring. “I just want to fit in as a woman doctor. No need for advocacy…” Toward the end of her administrative career, there was no explicit discussion with her bosses about transition. “A lot of people know, and a lot don’t,” she reflected with a verbal shrug. This is what acceptance sounds like.  
 
 
We have work to do…  
 
Less than 1% of physicians and matriculating medical students identify as Transgender or Non-Binary (TGNB). Most practicing physicians have persistent gaps in their knowledge about even the most mundane routine care for TGNB patients despite the increasing number of patients requiring that care.  
 
The public has become more accepting of gender diversity. A GLAAD—the world's largest Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) advocacy organization—survey from 2016 showed that nearly 12% of millennials identified as TGNB. Despite the increase in visibility and acceptance, those who identify as TGNB continue to be marginalized in their communities and vulnerable to high rates of depression, self-harm, homelessness, substance abuse, and sexually transmitted infections. Many healthcare settings continue to perpetuate intolerance by denying TGNB patients access to a clinician knowledgeable about gender-affirming care or treating sexual minorities with disrespect.  
 
As medical schools, we have a role to play in diversifying the physician workforce and ensuring that the workforce meets the needs of the communities we serve. We do this by becoming actively inclusive. We recruit students from gender minority groups, make efforts to feature TGNB students and physicians in public messaging, and encourage our current students, staff, and physicians to see themselves in the curriculum, the work, research, community engagement, and social events. We offer clinical care tailored for the LGBTQ+ community.  
 
While Joanne is delighted and envious that the world has become a much safer place for young people to explore their many identities, she hopes that this will lead to more character and caring. She worries that we are not socializing our young doctors “to have integrity, to develop wisdom.” She challenges us to remain clear about why we do this work. “I found in my leadership career when I was younger, I focused on the doctors, when I got older, I focused on patients again…we come to work to serve them…” That is what matters most.  
 

 
For further reading: 
 
https://www.aamc.org/news-insights/we-need-more-transgender-and-gender-nonbinary-doctors  
 
Westafer LM, Freiermuth CE, Lall MD, Muder SJ, Ragone EL, Jarman AF. Experiences of Transgender and Gender Expansive Physicians. JAMA New Open. 2022;5(6):e2219791. doi:10.1001/jamanetworkopen.2022.19791  
 
https://www.aamc.org/media/9641/download?attachment 
 
https://www.aafp.org/news/practice-professional-issues/20181214transgendercare.html 
 
https://www.glaad.org/publications/accelerating-acceptance-2016 
 
 

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. 
 
 
 
 
 

So, You Want to Publish Your Medical Education Paper in Academic Medicine - The @AcadMedJournal Editors Share Their Tips

So, You Want to Publish Your Medical Education Paper in Academic Medicine - The @AcadMedJournal Editors Share Their Tips

By Bruce H. Campbell, MD FACS

Dr. Campbell, who curates the blog, shares highlights of a recent podcast moderated by Toni Gallo, the Academic Medicine staff editor, with practical tips that will smooth your way into publishing in the journal ...

Happy New Year! Maybe one of your resolutions this year is to publish a MedEd article in a top-tier journal. You can do it!

To make it more likely, the editors of Academic Medicine created an Academic Medicine Podcast (12/19/2022) where the people who help decide what will get into print offer a peak behind the curtain. The episode is entitled “Writing Effectively and Navigating the Publication Process."

First of all, here are links to online medical writing resources: 

• Fostering Scholarship in Medical Education: Resources for Authors and Reviewers
• The Conducting Research in Health Professions Education: From Idea to Publication eBook
• The Writer’s Craft section in the journal Perspectives on Medical Education  
• Review Criteria for Research Manuscripts
• Scholarly Publishing Webinar Series

Below are tips and suggestions that each editor offers. As you prepare your manuscript, remember that folks like these editors will eventually be reading it. 

Colin West, MD, PhD (Deputy Editor, Professor of Medicine, Medical Education, and Biostatistics, Mayo Clinic) 

Three things to think about when preparing a manuscript:

• Be clear on how a practical application of your work bridges the gap from theory to practice without overstating your findings
• Be clear about the paper’s place in the field of study
• Be honest and thoughtful about the paper’s limitations

Jonathan Michael Amiel, MD (Assistant Editor, Professor of Psychiatry and Senior Associate Dean for Innovation in Health Professions Education, Columbia University)

Things he hopes to see when reviewing a submission:

• A clear demonstration of how the work helps make medical education better
• The paper doesn’t overreach; rather it takes a “small bite” and rigorously addresses the problem

Laura E. Hirschfield, PhD (Assistant Editor, Associate Professor of Medical Education and Sociology, University of Illinois-Chicago) 

Things she looks for when reviewing a submission:

• A clear demonstration that the authors have engaged with the foundational papers and authors in relevant fields, even if outside the traditional MedEd disciplines. 
• A well-demonstrated link between the research question or topic and the research design 

Gustavo Patino, MD, PhD (Assistant Editor, Associate Professor of Neuroscience, Oakland University William Beaumont School of Medicine) 

Questions he asks as a reviewer:

• Do the authors clearly articulate the research question?
• Have they described the knowledge gap? 
• What was the genesis of the idea? 
• Why is it important that this question be answered? 
• Are the research methods and study design appropriate to answer the question? 
• In the Discussion, are the claims and takeaway points consistent with the Methods and Results? 

Dan Schumacher, MD, PhD, Med (Assistant Editor, Associate Professor, University of Cincinnati)

His advice to authors:

• Pay attention to Lorelei Lingard’s idea of “It’s a Story, Not a Study.” Tell the reader why it’s important, what you found, and why what you found is important.
• Rely on well-crafted research questions and matching methodologies. 
• Write with clarity.

John H. Coverdale, MD (Associate Editor, Professor of Psychiatry and Behavioral Sciences, Baylor College of Medicine)

His advice to authors:

• For both qualitative and quantitative research, make the Methods section crystal clear.  Explain how the design relates to the research question or hypothesis, including how it is appropriate to the question.

Mary Beth DeVilbiss (Managing editor)

What she likes to see in the visuals:

• Exhibits, tables, figures, charts should have a clear purpose and add value.
• Visuals that enhance and illuminate the text, but never repeat it. 

Teresa Chan, MD, MHPE (Associate editor)

How she describes the Academic Medicine "Innovation Reports": 

• They are a first stab at a new way of doing things that builds on previous literature but then tweaks it in a novel way. Outline the problem, outline the approach, and always provide a reflective component.

Bridget O’Brien, PhD (Deputy editor, Adjunct Professor of Medicine, UCSF)

Things she suggests to authors before they submit a manuscript: 

• Read through the manuscript three times before submitting. 
• Read as an author. Make certain arguments flow and that essential details are covered. 
• Read as a reviewer. Try to apply the manuscript review criteria you use to your own work. 
• Read as a reader. Is it interesting? Do you skip sections? Does it make sense?
• Then ask others to read your manuscript from these perspectives, as well. 

Tony Artino, PhD (Assistant Editor for Last Pages, Professor at the George Washington School of Medicine and Health Sciences)

Reactions he suggests you have if you are asked to “revise and resubmit”:

• A revision request is a win, right? Don’t be discouraged! It is better to get it right before publication than after.
• Revisions always result in a better paper. 
• (Tongue-in-cheek) Editors and reviewers are always right. Realize that arguing only delays getting your manuscript into print. 
• Remember that medical and health professions education is a very small world. Your work might end up in the hands of the same reviewers if you re-submit to another journal. So, be gracious.

That should get you started. Happy writing!

Bruce H. Campbell, MD, FACS, is a Professor in the Department of Otolaryngology and Communication Sciences and in the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the editorial board of the Transformational Times and a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He has published two Innovation Reports in Academic Medicine and still learned some stuff listening to and summarizing this podcast.