Thursday, January 19, 2023

Three New Year's Questions for Amy Zosel, MD, MSCS

From the January 20, 2023 New Year’s Resolutions issue of the Transformational Times



Three New Year's Questions for Amy Zosel, MD, MSCS



As part of our January 20, 2023 issue, the newsletter reached out to several facutly, staff, and students and asked them three questions about their hopes and plans for 2023. Here is a resposnse from Emergency Medicine faculty member and recipient of multiple teaching awards, Amy Zosel, MD, MSCS.


Transformational Times: What is one thing that you hope for when you think about 2023? Why? 

Amy Zosel, MD, MSCS: In 2023, I hope for opportunity to reconnect with family and friends. As front-line health care providers, we were asked to ramp up our work, and pour time and energy into solving new problems. There were extra planning meetings and task forces to develop COVID-related clinical pathways and creatively move education to online platforms. While people in other sectors found time to pursue baking sourdough and playing board games, we were busier than normal. Many of us are also trying to figure out how to do online school at home with our kids. As this business dissipates, my hope is to spend more quality time connecting face-to-face with loved ones. I am especially looking forward to travel this year. 


Transformational Times: Do you have a new year's resolution that you can share with us? What inspired you to choose that? How is it going so far? 

Amy Zosel, MD, MSCS: Our Department of Emergency Medicine did an exercise challenge this fall. (Nothing like a little friendly competition to get you on the treadmill). Fitting in a little exercise everyday feels great, so I am aiming to continue that. Thanks, MCW EM Wellness Committee! 


Transformational Times: What do you see as an example of the "new normal" in our world? How do you feel about it? 

Amy Zosel, MD, MSCS: An example of the “new normal” is the opportunity to take meetings via Zoom. While this offers certain flexibility and cuts down on commute time, it can be difficult to engage deeply at home and at work. We need to make sure meetings are meaningful and that we are giving our families the attention they deserve. 


Amy Zosel, MD, MSCS, is an Associate Professor; Interim Division Chief, Medical Toxicology; and Director of Research Operations and Mentorship in the Emergency Medicine Hub for Collaborative Medicine at MCW. She also has been active with the Council for Women’s Advocacy (CWA) -- an advisory committee on issues of professional development of all faculty members.

Monday, January 16, 2023

The Kern Institute Learns to Blow our Shofar!

From the January 13, 2023 issue of the Transformational Times




The Kern Institute Learns to Blow our Shofar!  


By Adina Kalet, MD, MPH


In this week’s Director’s Corner, Dr. Kalet describes what she learned about transformational leadership while drinking coffee on a beach overlooking the Mediterranean Sea …

 

The beginning is the most important part of the work.

-Plato


In December 2018, I traveled to Israel to meet with palliative care physician and medical educator Dr. Dafna Meitar and educational psychologist and philosopher Dr. Daniel Marom. We talked about the Mandel Leadership Institute’s Leadership in Medical Education Program, a sophisticated, unique, year-long, philosophically-framed, intensive training they were creating in Jerusalem. We spent a whole day in a café in the coastal city of Herzliya, looking out over the Mediterranean, drinking coffee, eating pita, hummus, and diced salad, and discussing medical education. Ideas flew back and forth. We shared serious ideas, stories, and jokes. We gesticulated wildly. I got a tan and furiously took notes in multiple colors. 

When there was a lull in the conversation, I asked their advice about the job opportunity I was contemplating in Milwaukee. Daniel asked solemnly, “When you take this job, what will you mean by ‘transforming medical education’?” 

I talked unintelligently for a few minutes, reciting the laundry list of things I intended to do, but the look on their faces made it clear I hadn’t answered his question. “You must develop your shofar!” he said, cutting me off. “You must articulate the why of your work before  you will be ready to decide on the what.” He assumed that I would—although I had not yet decided to—take the job. 

Soon after that conversation, I accepted the offer. 

A shofar is an ancient musical instrument made from a ram’s horn. It was used like a modern bugle to call the community together for important announcements and discussion, to proclaim important calendar events, and to note solemn occasions. In modern times, the shofar is used during the Jewish High Holidays. In my community, the shofar can be—and is—blown by any member of the community with the proper embouchure. It is considered an honor and a source of pride to be able to “blow shofar.” 

I find the sound of the shofar stirring and meaningful. It accompanies those moments during the religious services when, in community, we are contemplating past errors, seeking forgiveness, and feeling humble. In awe, we formulate our resolutions for the future. I knew that by linking my career change to the shofar, Daniel was challenging me to think deeply and then “blast a horn” to get the attention of like-minded others so we could articulate a manifesto that would transform medical education. I had no clue what that would require, but I was reassured that Daniel and Dafna would be there to accompany me.

Once I joined the Kern Institute in fall 2019, I saw that our members were very busy. They had rolled up their sleeves and were solving problems. The KI had launched a robust faculty development program (KINETIC3), a well-being curriculum for students (REACH), and the Transformational Initiatives (TI2) program. However, I sensed that our members, our community within MCW, and the community beyond our walls did not clearly understand why we were doing what we were doing. I searched for ways to dedicate time to rest from all the doing and engage in some deep thinking. 


COVID-19 changed everything, and we wrote (and we wrote...)

As they say, be careful what you wish for! In March 2020, with the pandemic on our heels,  we launched the Transformational Times and have published weekly ever since. Once a collection of quality essays built over the first year-and-a-half, we published them in Character and Caring: A Pandemic Year in Medical Education at the end of 2021. 

Now, as we have continued our work and our writing, we present our new book, Character and Caring: Medical Education Emerge From the Pandemic, which was released on  January 2nd, 2023!  See Dr. Fletcher’s essay in this issue detailing the history of our work. 


Please consider purchasing the two volume Character and Caring  set (at a special price) for your favorite health professional. This is our shofar! It is a good read. Every member of the Kern Institute is expected to write regularly. The Transformational Times and the books call us all together for the deep conversations. In addition, we are publishing contributions from an enlarging group of local and national stakeholders and fellow travelers. 

Many have heard the “blast.” We receive emails from our readers and have regular literal and virtual hallway conversations stimulated by the essays. The responses are mostly expressions of appreciation for the opportunity to hear our why; the newsletter and books allow people to know us and know our work. Readers regularly share their own stories. There has been an occasional friendly debate and rarely a pointed disagreement. We welcome it all.  


Beyond the transactional to the transformational

We have a much more to learn from Drs. Marom and Meitar. Their deep and abiding respect for educators is intoxicating. They believe that educational leaders, through their work, define and design their professional community and, therefore, are responsible for giving expression to the values that comprise what medical sociologist, Eliot Freidson, PhD, called the "soul of their profession." Their approach to leadership development is guided by a clearly articulated framework they call a “typology” made up of five interrelated levels. The typology frames everything they do to facilitate—and provides a language for ensuring—that leaders understand why we are doing what we are doing. This, in turn, greatly enhances the likelihood that these motivated and committed individuals will have an impact that goes well beyond the transactional toward the transformational. 

All the work in the Leadership in Medical Education Program is done in peer groups and supported by coaching. Through discourse, readings, and reflective writing, senior medical educators wrestle first with core philosophical ideas surrounding human health and sickness (Level 1 of the typology) followed by questions surrounding the larger aims of the education of physicians (Level two). Then, and only then, are they allowed to dive into the implications of all this for educational theory (Level 3), implementation of new educational practice (Level 4) and, finally, evaluation of outcomes of that practice to measure success (Level 5). 

For most physicians who are very action-oriented, it takes discipline not to jump into the “doing” (Level 3) too soon. But, with practice and experience, most of Meitar and Marom’s participants internalize the discipline needed to seriously engage with the philosophical questions underpinning medical education before jumping into or designing and/or implementing programs. 

 Over the past few years, as I have worked with the five medical schools in Israel (more on that another time). I have had the honor of meeting many of the nearly fifty medical educators who have completed the Mandel Institute’s Leadership in Medical Education Program. After experiencing a very old-fashioned medical education themselves, most of them light up when discussing the pleasure in having the opportunity to engage with their peers intellectually and personally through this program. They are inspired to lead the change that is needed, even though it will be difficult, even though it will be resisted, and even though resources are very limited. Many of these graduates are now moving into positions of influence in their medical schools. 

Marom and Meitar are having an impact on the future of the whole country. I continue to take notes in multiple colors and have tried to bring these renderings into our work in the Kern Institute.  


Checking in again

After a couple of years in lockdown, I recently returned to a beach café in Israel to meet with Dafna and Daniel, both of whom are now affiliate faculty of the Kern Institute. They read our Transformational Times. They are still working to lift up medical education in their country as we are in ours. We discussed how the Kern Institute’s shofar is going and shared our successes and challenges. It is my hope to bring them to Milwaukee very soon (in the warm season) to teach us a thing or two about medical education leadership. I will take them—and as many of you as can join us—to the South Shore Terrace Kitchen & Beer Garden for a campfire, some s’mores, and a view of Lake Michigan. 

Looking out over the water, we will pick up our conversations from where we left off. 


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.


Thursday, January 12, 2023

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. 


Monday, January 9, 2023

Temperature


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.