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.
