Part 3: You Can Have it All

From the May 19, 2023 issue of the Transformational Times

Part 3: You Can Have it All

Bryan Johnston, MD

In this essay, Dr. Johnston draws on a clinical encounter to show why he was drawn to his career in Family Medicine. He hopes graduating medical students will also find meaning and connections as they help other people throughout their careers ... 

 

 

“Not doing too good, Doc. I buried my cousin last week,” he said, slouching in his chair.

“What happened?” I asked grimly.

“It was sudden, I don’t really know what happened.” 

  

I murmured my regrets and a pause drifted over us. He and I had been meeting monthly for over a year and these moments had become part of our rhythm. He was still recovering from the loss of his son a few months ago, of an aunt last year. His tibia was still healing after a recent assault, his left orbit finally felt better after a pistol-whipping last year. His assailants had been after the most valuable thing he owned—the buprenorphine that felt like a firewall against the cycle of withdrawal and use he had clawed his way out of. 

  

Trauma within trauma, grief upon grief  

  

These moments matter to me because it is in them that I feel I can be of real use. To be of use, to me, is a concept marrying intrinsic and extrinsic needs along a trajectory of development. It is a way of seeking to understand and respond to needs you see that you feel called to and capable of meeting. It is a way to acknowledge what fulfills you, to build skills and experiences toward sharpening the impact you can make in doing those things. It can be a framework allowing you to infuse yourself into your work and also into humanity. 

 

Family Medicine and its proximity to meaningful relationships, behavioral health, and wellness, to community, and to health equity drew me in like whatever attracts songbirds to fly north in springtime. Over time, I gained skills in addiction medicine, trauma-informed care, social determinants of health screening and intervention, and system-level advocacy, always with a growing sense of being of use.

My patient had required all these skills and more, a high level of need but also a high level of mutual fulfillment in meeting that need. After I had found a pharmacist willing to dispense an early refill of buprenorphine after his last assault, he humbly thanked me and told me that he had never trusted a doctor before. 

  

 “How’s your family doing?” I asked.

“They’re ok, I talked to my father this morning and he’s taking it ok.”

“And how are you holding up?”

He laughed then shook his head. “It’s a lot, Doc. It feels like I’m surrounded by death.”  

 

We reviewed his support system, how he was coping with his suffering, checked his mood and screened for suicidality, then turned to the devastating impact of stacking grief and trauma. After months of coaxing, he had agreed to make a therapy appointment but had to miss it due to the funeral. He agreed to reschedule it.

“I know you’re a private person. But nobody can hold all that in. This is not a normal time you’re going through; this may be the hardest time in your life.” The buprenorphine was helping him, and he had not used. There were some positive things amidst the difficult parts, and we spent a few minutes focusing on that. “Be gentle with yourself right now,” I told him as we stood up.

“Ok,Doc,” he said, then shuffled off.  

  

I left the room feeling not sorrow, but deep well-wishes and gratitude for our relationship, for the intimacy we had shared, for the trust enabling support in this critical time. Above all, I felt that I was right where I needed to be -- at the intersection of skill, experience, and need; in short, that I had been of use. 

  

Medical learners often talk about what they want to do in the future

These conversations can take a short or long time, but most often avoid the core bits which underlie who we are, what we have come to understand about ourselves, and the connection we hope to have with others, with the world. In medicine we speak in symbols, we ourselves are symbols for who we are. I say I am a Family & Addiction Physician committed to health equity, and you can imagine several things about me. You might say you are going into Orthopedic Surgery, or Psychiatry, and others may intuit things about you.  

  

What I want to say is that you are a dynamic person, and it’s possible for the most important parts of you to come together in a future in which you are generating meaning for yourself and others by being of use in a way that is yours alone.  

  

Thank you for who you are and all the good you do now and in the future. And— enjoy the ride. 

 

 

(Patient details changed to protect identity) 

Bryan Johnston, MD, is a Family & Addiction Medicine Physician, and an Assistant Professor in the Department of Family & Community Medicine at MCW.  

 

 

2023 Commencement Speaker Dr. Julie Freischlag Returns to MCW to Share What She has Learned

 From the May 19, 2023 issue of the Transformational Times

Newly-minted physicians Bruce Campbell
and Julie Freischlag
May 1980 - Auditorium Theater - Chicago, IL  

“Midwest Nice” and a Force of Nature: 2023 Commencement Speaker Dr. Julie Freischlag Returns to MCW to Share What She has Learned

Bruce Campbell, MD FACS

Dr. Campbell, one of the Transformational Times editors, provides some reflections on why his medical school classmate and friend, Dr. Julie Freischlag, is an exceptional role model. He also offers a sneak peek at her May 19, 2023 Commencement Speech...

MCW-Milwaukee’s 2023 Commencement Speaker, Julie A. Freischlag, MD, FACS, FRCSEd(Hon), DFSVS, has had a remarkable, glass-ceiling and barrier-breaking career. 

Happily, a portion of her world-class calling was spent on the MCW faculty in the 1990s. At MCW, we are delighted that she has returned to inspire our 2023 graduates and send them out into the world. 

I met Dr. Freischlag in August 1976 when we were incoming medical students at Rush University. There was an immediate kinship; both of us had grown up in Illinois and gone directly from large public high schools to the Big 10 (she went to Illinois, I went to Purdue), and were among the youngest members of our medical school class of 104. Whereas I was pretty intimidated, she was energetic, engaging, fearless, and an immediate favorite of the students and faculty. Throughout our four years as students, she was a quick learner, eager participant, friend-to-everyone, and generous listener. When given the opportunity to do something, she always said, “Yes.” She had no problem expressing her well-formed opinions. She was the embodiment of a friendly, accomplished, “what you see is what you get” individual.

A servant leader from the beginning

Over the course of her remarkable career, each institution to which she moved became better because of her presence. After graduating from Rush in 1980, she did her surgery residency and vascular fellowship at UCLA. After two years at UC San Diego and three more back at UCLA, I was delighted when she chose to move to MCW in 1992, although I wondered whether she would thrive in such a male-dominated department of surgery. Before long, though, she was chief of surgery at the VA where she was principal investigator for a national VA aneurysm study. She won teaching awards as an MCW medical student and resident favorite. She was a dynamic, sought-after clinician, a trusted colleague, and an accomplished clinical researcher. 

Her national presence took her back to UCLA to be chief of vascular surgery in 1998 and, from there, she was recruited to be the William Stewart Halsted chair of the surgery department and surgeon-in-chief at Johns Hopkins in 2003. Her tenure at Hopkins was marked by a rapid expansion of the department’s commitment to equity and inclusion, and she enthusiastically mentored residents and students. After Hopkins, she became vice chancellor for human health sciences and dean of the UC Davis School of Medicine in 2014. She has been in North Carolina since 2017, and is currently chief academic officer and executive vice president of Advocate Health, chief executive officer of Atrium Health Wake Forest Baptist, and executive vice president for health affairs of Wake Forest University. She also is the immediate past dean of Wake Forest University School of Medicine.

Despite her critical and demanding administrative roles, she has continued to be a “cutting surgeon,” and has an international reputation for the surgical management of thoracic outlet syndrome. 

Some of her “firsts”

Everywhere she has worked, Dr. Freischlag has challenged the “old boy” status quo and reshaped culture with her positive energy and indomitable presence. 

She was the youngest woman in the Rush University Class of 1980 and then the sixth woman to finish the general surgery program at UCLA. She was the first female UCLA surgery faculty member and, later, the first female chief of UCLA’s vascular surgery division. She was the first woman surgeon at MCW to be promoted to full professor. She was the first woman to serve as surgical chair, and the only woman chair, during her time at Johns Hopkins. She was the first woman to be president of the Society for Vascular Surgery, the first to be president of the Association of VA Surgeons, the first to be president of the Society of Surgical Chairs, and the fifth woman to be president of the American College of Surgeons where, among many other accomplishments, she created and hosted a series on Surgeons Sowing Hope. Her groundbreaking career has been a string of “firsts.”

She has frequently been honored and celebrated. She is a member of the National Academy of Medicine and is an honorary fellow of the Royal College of Surgeons. She was inducted into Alpha Omega Alpha while on the MCW faculty. Among many other responsibilities, she serves on the board of directors of the Association for American Medical Colleges (AAMC), the NIH Clinical Center Research Hospital board, and the Aga Khan University board of trustees.

Her primary interest is people

Titles are important, but Dr. Freischlag’s preeminent commitment is to people who need a leg up. She has driven research, co-authored studies, and advanced policies that have increased the proportion of women and underserved groups in surgical fields and in medicine. She generously offers her experience and voice to individuals and groups. She takes on national roles, knowing that her larger stage benefits future leaders and physicians. She is the embodiment of the servant leader. 

The Commencement Talk: “Be the Spark!”

I had the opportunity to review Dr. Freischlag’s wonderful graduation speech for the MCW-Milwaukee Class of 2023. As I noted a few years ago, attendees and graduates might be a bit preoccupied during the ceremony and possibly not remember all of her words. So, here are a couple of themes for which to listen: 

• You are the one who shapes your story as a doctor. 
• Each of us has the potential to do the hard work and—with courage, compassion, and imagination—be the spark that makes a difference for individuals and entire populations. 
• When entrusted to be part of a team, listen to and learn from your teammates. Take time to know and understand what is important to each of them. Support, elevate, and promote those whose voices are not often heard. 
• As physicians, resilience and “toughness” are important and misunderstood traits. Dr. Freischlag might mention this book. 
• Practice self-care even when it is hard. And treat your patients exactly the way you or your family members would want to be treated.

A couple of quick stories; Ask me for more details ;-)

Life, of course, is not perfect, even for a superstar. As a medical student, she made extra money working as a waitress at a suburban Chicago restaurant. One evening, when I was there as a customer, it is entirely possible that she spilled a full glass of red wine on me. 

On Match Day 1980, the envelope with her name was apparently dropped on the floor. When the dean had apparently emptied the box with the match results and announced, “That’s all of them! Congratulations!” she sent me to the podium to find out what had happened to her envelope. Happily, her match results were quickly located and the rest, as they say, is history. 

While on the MCW faculty in 1995, she was pregnant with her son, Taylor. My wife, Kathi, and I attended a shower for her. One of the greeting cards read, “I would rather be 40 than pregnant!” She erupted in laughter because, at the time, Dr. Freischlag was both. 

Finally, if you have the opportunity to talk to Dr. Freischlag during her visit, ask her about her husband, Phil, her wonderful children, and her amazing grandchildren. 

Thanks, Dr. Freischlag!

On behalf of those of us who work with the Robert D. and Patricia E. Kern Institute for the Transformation of Medicine, we are grateful to Dr. Freischlag for returning to Milwaukee to give this commencement speech, sharing her hard-earned wisdom, and being a role model for the next generation of servant leaders. 

We are grateful for you and for what you have accomplished to make the world a better place. 

Bruce H. Campbell, MD, FACS, is Professor of Otolaryngology and Communication Sciences and the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the editorial board of the Transformational Times.  

Reflections on Mother’s Day: You Become

 From the May 12, 2023 issue of the Transformational Times - Mother's Day

Reflections on Mother’s Day: You Become

Adrienne Klement, MD

You can’t have it all........ all at once.
-Ruth Bader Ginsburg

It was a hot July in Durham, North Carolina. I had just finished fellowship and was starting my new role as an Attending in a large academic hospital when I had my first daughter. I planned for six weeks of maternity leave, thinking this would be “enough,” while my husband was on his Trauma rotation as a chief resident in Orthopedic Surgery. I went into labor on a Saturday night, and we decided that he would finish his call shift and work through the night, while I “slept” after my epidural was in place. Emma patiently waited for him to finish his 28-hour call shift. She even gave him a few hours of rest—on the bench by the window—before her arrival. (Ask any resident—we could sleep anywhere). The first few days of parenting were joyous and blissful. Then my husband went back to work, often leaving before 5:00 AM and getting home well after 8:00 PM. Naively, I decided because I would be home with Emma, that he would plan his busiest rotations for July and August. Why would I need any help?

It turned out, the weeks that followed were the lowest, loneliest, and most exhausting I would experience in my life.

I remember asking myself daily: what am I doing wrong to not feel the joy of being a new mother? I quickly minimized my worries and normalized the challenges new parenting entailed. Then two years later, our second daughter was born. You think I would have learned from my experience with Emma to insist on more support...that more support would be paramount to my well-being, and even more so, to the well-being of my first-born child.

Hailey was born in May on a Wednesday in downtown Philadelphia, where my husband was doing his fellowship and I was working as a Hospice Medical Director at the University of Pennsylvania. The day was significant because not only did my husband get two weekdays off, but also that whole following weekend, too. Now, it seems problematic to say, that this felt undeserved, but it did at the time. 

Just before Hailey arrived, we had bought a house in Wisconsin to be closer to his family and our best career opportunities. After delivery, in the context of many sleepless nights and the blurs of nail-biting pain from a bleeding nipple, we decided that I should move there first with the girls while he stayed back to finish his fellowship through July. If I could do it myself the first time, why not the second? And wouldn’t a house be better than a small apartment in downtown Philadelphia? Nonetheless, once in Wisconsin, while my mother-in-law was able to help at times, I felt more alone and inadequate than ever.

Then I recalled a text my aunt had sent to me a while back after Emma was born. She wrote, “this too, shall pass.”

My feelings of overwhelming exhaustion and defeat, of being unqualified and inadequate were validated.

In Medicine, we learn from communication training that without validating emotions, there is often little progress in moving a conversation forward. Recalling that simple message was a turning point for me. From that moment on, a weight was lifted, a burden unloaded. I had a total paradigm shift in how I perceived myself as a mother. The conversation in my head changed from “I can’t do this,” to “I can’t do this alone” to “I am really good at this.” 

Sadly, we live in a society of contractual relationships, in which asking for help without the ability to reciprocate often feels shameful. Asking for help often requires humility, the ability to receive grace, and some level of trust. While I still wish my own mother could have helped me in those postpartum periods, she died when I was a teenager. I can now look back to those times with gratitude and regard for the much-needed growth I experienced without her. I can now fully appreciate, and am so profoundly grateful for how she sacrificed for me, and for the fierce woman she was. I have become this woman, too.

While some miss the extra time with their newborns—I know I finally did after our third daughter Lucy was born—I felt more energized than ever to return to work. I learned to really invest in relationships both inside and outside the workplace. I have met some girlfriends who are truly exemplary in their parenting, and whom I would never hesitate to ask for help. I have found that reading in bed every night with my girls creates a special space for some deep questions about the universe. My favorite questions so far from my now four-year-old Hailey: “Why did your mom get sick and die, and why couldn’t you help her get better?” and “Can I be a ballerina without doing ballet?” and “If that clock was painted on that house, why did its arms move on the next page?” She noted recently in a school activity that “snuggling with mom” is her favorite activity. This gave me yet another shift in mindset. We learn that sleep is essential for the best cognitive performance. 

After almost seven years now, all three of my girls are finally sleeping through the night. At first, getting up to help them fall back asleep was a major stressful event for me. How was I going to do my best thinking and advising while listening to student and resident presentations early the next morning? But the “snuggling with mom” answer, for which I am so grateful for her 4K teacher, allowed me to truly embrace the fatigue and change my perspective. These nighttime interruptions have become a source of rich solitude and joy and serve as a reminder to take care of myself, too, and ask for help.

In my journey as a working mother, I have learned that “work-life balance” is just a loaded and vague buzz phrase.

There are many ways to interpret “work-life balance.” To me, this term puts too much pressure on achieving perfect “balance” with equal emphasis on “work” and “non-work” or “life” experiences. It all cannot happen in a single day. I realize that some days will have different challenges, or unexpected stressors, in which damage control becomes the theme, while others will be filled with deeply meaningful experiences in which I thrive. Hiding in the pantry eating Oreos is just as acceptable of a day in the home, as being celebrated as employee of the year at work.

Now, with three young girls, and as after-school activities abound, a new tactic I have learned is to time-block my schedule in order to bring my most authentic self to work. As the reader knows, Medicine can command our attention, even when not physically present at the bedside or in the clinical exam room. Recently, I was asked as a consultant to assist with a family meeting that was outside of my usual hours when I am physically present in the hospital. I knew the family and residents well, so I decided to call in from home to help. As I was offering my advice on the care plan over speaker phone, a little voice shouted from the bathroom, “Mom can you help me wipe my butt please?!” The patient, his family, and the care team had a good laugh, and care was able to be moved forward in a most goal-concordant and efficient way. I felt honored to be part of that important aspect of care whilst helping my daughter with proper hygiene.

I have come to understand that each part of my life, work and family, provides me with both energy for and respite from the other, and each gives me a sense of real purpose.

In time-blocking my schedule, I find scheduling early morning chart reviews is as important as blocking time for exercise, reading, and moments with my family and friends. And, it is perfectly acceptable to give myself permission that these time investments are not always in perfect “balance.”

Inspired by a Grand Rounds by one of my great mentors who referenced the book, The Velveteen Rabbit, By Margery Williams Bianco, I bought this book and read it to my girls. The story really struck me, especially her words:

“'Real isn’t how you are made,’ said the Skin Horse. ‘It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real.’

‘Does it hurt?’ asked the Rabbit.

‘Sometimes,’ said the Skin Horse, for he was always truthful. ‘When you are Real you don’t mind being hurt.’

‘Does it happen all at once, like being wound up,’ he asked, ‘or bit by bit?’

‘It doesn’t happen all at once,’ said the Skin Horse. ‘You become. It takes a long time. That’s why it doesn’t happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.'”

 

On this Mother’s Day, the advice I would have given to my younger self is this: “This too, shall pass” and “You don’t need to have it all, all at once.” Respect the process and allow yourself to enjoy the journey alongside others. Unconditionally, and with a deep understanding of the journey, I hope to become a source of help for others, and most of all, for my girls one day.

Adrienne Klement is an Assistant Professor in the Division of Geriatric and Palliative Medicine. She works at the Milwaukee VAMC for both Medicine and Palliative Care teams and was awarded ‘Employee of the Year’ in 2021. Dr. Klement is a graduate of the Kern Institute Kinetic 3 Teaching Academy and exceptionally dedicated to teaching communication skills to residents in training.

What Does a Medical Student Look Like? Social Determinants of Medical Education

From the May 5, 2023 issue of the Transformational Times

What Does a Medical Student Look Like? Social Determinants of Medical Education

Adina Kalet, MD, MPH

In this week’s Director’s Corner, Dr. Kalet muses on what it means that not all, but most, medical students come from high-income households and how this may be the cause of unnecessary struggle and suffering ...

*While this is a true story as I experienced it, I have changed my friend’s name and some of the details to respect her privacy.

It was late on a wintery night when the car’s brakes failed. As we rolled down the steep Upper Manhattan hill the driver, my classmate, Laura, pumped the hand break until we came to a stop by gently bumping the rear of the vintage Mercedes Benz paused at the traffic light. “Shit,” she muttered.

Following Laura’s lead, I got out of the car and gingerly approached the older tuxedoed man who had emerged from the driver’s seat and was now carefully inspecting the rear bumper. No harm done. A moment later, a woman emerging from the passenger seat, wrapping her fur coat tightly around her shoulders as she strode over. She looked us up and down, no doubt taking in our matching server uniforms, poorly fitting black skirts, and polyester white button downs, bow ties askew. She then eyed the rusted 10-year-old baby blue Buick from which we had emerged and screeched, “How can you have this piece of junk on the road? You could have killed us...and my husband is a surgeon!?”

It was chilling. To his credit, the man looked chagrined. Using my best communication skills, intending to diffuse the tension, I said softly, “Ma’am, we are sorry for frightening you. We hope no one is hurt. We are medical students on our way home from a catering job.”

The woman’s tirade revved up. She accused me of lying about being medical students and us of being dangerous menaces, among other things. She was rattled and had cell phones been available in the 1980s, no doubt, she would have called the police. The man coaxed his wife back to the car and waved us on.

Luckily, no one asked for Laura’s insurance information because she didn’t have any.

Clearly, we did not fit this wife-of-a-surgeon’s image of medical students. She could not imagine medical students driving run-down jalopies or being employed in the “service industry.” I was perplexed, aggravated, and embarrassed. But Laura was nonplussed. She was used to this sort of dismissive treatment. After all, she was regular catering waitstaff at NYC gala fundraisers. She was used to being invisible to people like this couple.

Laura’s story

In retrospect, I realize Laura grew up poor. Compared to most of us who had taken loans to pay our tuition and were otherwise fully supported by our parents (I lived with my family in a two- bedroom apartment and commuted to school by subway), she needed the car to get to school and her service jobs from her working-class neighborhood on Staten Island. Public transportation was not an affordable nor easily available option. Both Laura and her mom, who had a serious chronic disease, needed to work to pay the family’s basic expenses. Her car was a mess, clearly in need of repairs, and probably dangerous, but it was all she could afford. While a handful of us occasionally joined her on a catering job to make some extra cash, she had no choice but to work nearly full time. To be clear, medical school is a more than full time endeavor and most medical students do not need to hold down jobs.

Laura’s family likely went hungry or were marginally-housed during the time we were in school together. Maybe they were on public assistance. She might have told me if I had asked. But I didn’t. I hope she asked for—and received—help from the office of financial aid. But I am not certain, knowing her, that she would have.

Even in our highly competitive city university program, dedicated to recruiting a diverse class of local students able and committed to becoming inner city primary care physicians, Laura’s level of financial need was rare. Laura had a few friends and was an excellent school project partner, but she rarely showed up for social outings or joined us when we went out for meals. She couldn’t afford the time or money. I never quite figured out when she studied, but she survived academically, repeating a year of school along the way.

I lost touch with her after we graduated. I know she trained as a surgeon, worked in the community from which she came, and had a child. A few years ago, I learned that Laura died young of cancer.

When we all went off to traditional medical schools to finish our training I was, for the first time in my life, introduced to the fact that most medical students came from relatively wealthy families. Naive as it sounds, I was stunned when a new medical school classmate picked me up in his vintage Aston Martin to drive out to his family’s suburban home, replete with private

swimming pool and tennis court for a weekend barbeque, bringing his laundry along to be done by the maid. I felt like Dorothy in Oz, “Toto, we are not in Kansas anymore.”

The COVID-19 pandemic reveals the Social Determinants of Education

Much has already been written about how the pandemic revealed the stark health and economic disparities in our society. It should not surprise anyone that medical schools were also challenged to recognize and be responsive to the needs of students with fewer resources. It became crystal clear that like Social Determinants of Health that create negative consequences for patients, Social Determinants of Education (SDOE) create disparities among learners. There is a myriad of ways that some student’s lives have been shaped by factors such as socioeconomic stress; bias and oppression; food and housing insecurity; poor access to health care; and unsafe neighborhoods. These challenges put otherwise highly motivated ambitious, capable students at a significant educational disadvantage compared with their peers in terms of access to and success in the health professions.

Because society desperately needs a robustly diverse and excellently prepared pool of future health professionals, the 2022 Josiah Macy Jr. Foundation Consensus Conference on COVID-19 and the Impact on Medical and Nursing Education recommended (among many other things) that, “Health Professions Education (HPE) leaders, educators, and learners—together—must examine and eliminate the detrimental effects of the SDOEs on HPE learners and build equitable learning environments for everyone.” But this is often difficult to do because it is traditionally a hidden problem.

Medical students disproportionately come from high-income households

In 2022, data from an AAMC-Medical Student Questionnaire revealed that 50.5% of all Allopathic medical students come from the top quintile of household income, with 24.0% from the top 5% and less than 6% come from the bottom quintile. This overrepresentation of higher income and underrepresentation of low-income groups—consistent across race and ethnicity— is a manifestation of the fact that access to the profession has been persistently out of reach for those from the lowest socioeconomic strata. This is being addressed in many ways. Long-term upstream targeted investments in the student pipeline through community partnerships can get more students like Laura to feel prepared to apply to health professions programs. Medical schools can, and do, assess socioeconomic disadvantage during the admissions process using essays and the parental education and occupation indicator. And grade point average and Medical College Admission Test scores, can be adjusted for socioeconomic disadvantage.

But more needs to be done. To reduce the unequitable circumstances while in medical school, students from low-income households could be monitored for the accumulation of unexpected expenses and provided with what they need to thrive (e.g., food, clothing, computers and internet access, emergency housing) given that they do not have nearly the same level of family support as most of their peers.

The pandemic worsened every social determinant of education and negatively impacted current and future students. Students from poorer families are much more likely than their peers to have experienced the devastating impact of the pandemic, the death of family members and loss of livelihoods, the serious economic deprivation while having fewer resources to recover from these challenges. In addition to providing concrete support and wellness and financial counseling, schools should monitor policies that inadvertently disadvantage some students like required travel and housing for training and fees not included in financial aid packages (aka “hidden tuition”). Medical schools like ours have restructured large classes into smaller learning communities to build better communal resilience both academically and socially and to enhance our opportunity to look out for each other.

For those of us working for transformation of a medical education that is built around a core of character and caring, the pandemic has “catalyzed a strategic inflection point” (Lucey, 2022) where we now have an opportunity to better address the health care needs of both our patients and students. While Laura’s “journey traveled” from poor kid to surgeon is inspiring, her almost invisible struggles to persevere in the face of hardship makes me wish we had been more compassionate and kinder. We could have done better.

For more reading:

Lucey CR, Davis JA, Green MM. We have no choice but to transform: The future of medical education after the COVID-19 pandemic. Acad Med. 2022(suppl 3);97:S71–S81.

Muller D, Hurtado A, Cunningham T, Soriano RP, Palermo AS, Hess L, Willis MS, Linkowski L, Forsyth B, Parkas V. Social Determinants, Risk Factors, and Needs: A New Paradigm for Medical Education. Acad Med. 2022 Mar 1;97(3S):S12-S18. doi: 10.1097/ACM.0000000000004539. PMID: 34817406; PMCID: PMC8855756

Shahriar AA, Puram VV, Miller JM, et al. Socioeconomic Diversity of the Matriculating US Medical Student Body by Race, Ethnicity, and Sex, 2017-2019. JAMA Netw Open. 2022;5(3):e222621. doi:10.1001/jamanetworkopen.2022.2621

Josiah Macy Jr. Foundation Conference on COVID-19 and the Impact on Medical and Nursing Education: Conference Recommendations Report. Acad Med. 2022 Mar 1;97(3S):S3-S11. doi: 10.1097/ACM.0000000000004506. PMID: 34736279.

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.