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.

 

 

 

Chest Pain Relieved by Antacids: My Last Night as a Resident

 From the 7/9/2021 newsletter

Director’s Corner

 

 

Chest Pain Relieved by Antacids: My Last Night as a Resident

 

 

Adina Kalet, MD MPH

 

 

 

In this Transformational Times devoted to transitions Dr. Kalet recalls the final night of her residency at Bellevue Hospital in New York City …

 

 

The astute intern standing next to me, noticing the beads of sweat forming on my forehead and my clenched fist rubbing my breastbone, walked to the medicine locker, grabbed a little blue bottle of antacid and handed it to me. “If this works, I won’t have to admit you on your last night on call as a resident!” he said cheerfully.

 

I slugged the chalky, mint flavored substance and almost immediately felt the chest pain—which I hadn’t even fully noticed until then—resolve. “Thanks,” I said, “You’re gonna be a great resident in a few hours!” I glanced at my watch. 4:00 a.m. on June 30. My last day as a house officer.

 

 

“4344 Stat!!” the crackling voice of the Bellevue Hospital operator cried from one of two cigarette box size beepers hanging off the waist band of my white pants.  This dedicated “code beeper” was calling me to the emergency room where, luckily, I already was standing, ready to help my colleagues who were conducting a cardiac resuscitation on the patient in the “slot.”  This was not the cause of my heartburn. I loved this part. I was trained to do this, my movements were smooth and assured, the decision-making was practiced and honed. I felt competent and proud of my colleagues as we surrounded this patient, a man brought in by ambulance from Pennsylvania Station awake and alert, experiencing substernal chest pain and shortness of breath, who now needed us to save his life. And save his life we most likely would. This was quintessential doctoring, one patient at a time. 

 

My heartburn was a result of the other beeper. The “medical consult” beeper was insisting, with the exact same urgency, that I call “bed board” (the office that managed the 400 adult beds in the hospital) and 17 West and 16 East and the Surgical ICU all at the same time. I added the call back numbers to the pink sheet on my clipboard. I made eye contact with the senior resident running the code to signal I was there if he needed me and picked up the wall phone.

 

This part of the job made my stomach acid churn. After a year of med consult call, all of us senior residents had mastered—but did not have a positive attitude about—what we called the “hotel management” or “traffic cop” aspects of the job. We disliked assigning admitted patients to medical teams and working with the hospital administrator (“bed board”) and nursing leadership to assign beds to those patients. It was a hard and thankless three-dimensional chess game. I didn’t feel particularly good at or prepared for these logic puzzles. But I engaged because it was my job on the team that night. 

 

There was also the “consultation” part of the job, which sounds like an opportunity to engage in erudite conversation with residents on other services about how to best care for patients, but that wasn’t how things worked. The attending physicians did that part. Most often, we residents engaged in tense discussions demanding to transfer patients from their service to ours or vice versa. Too often, we debated whose “job” it was to adjust antibiotics or blood pressure medications. I would argue that any physician could handle this simple task with a little advice from us, but they would argue that their job was complete, and the patient now belonged on our team. We would argue where the patient with ominous abdominal pain should be monitored; our team contending that the physicians who could provide definitive surgical therapy would be best positioned to manage the patient, while they argued that until an intervention was needed, the patient should stay with us. On and on. Over and over.

 

Senior residents developed reputations as being a “wall”—staving off patient transfers by playing expert, impenetrable defense, or being a “sieve”—easily persuaded to accept the transfer. I won’t tell you which reputation I had, except to hint that I did accept transfers to our service only when it was obvious that a patient would be best cared for on our team. This was a judgment call, and I trusted both team to do right by the patient.

 

It was also true that I didn’t have the courage or tenacity to insist that other teams handle problems outside of their comfort zones. I have since gotten over that.

 

Physician professional identity formation, in those days, was in a very tribal stage of development. We worked on teams and, as teams, we defended our boundaries. As soon-to-be attending physicians, our main developmental challenge was to balance team loyalty and identity with a much more subtle discernment about “what is best for the patient.” These situations were very complex; a single correct answer was unlikely. Beyond the formidable technical aspects of our disciplines, we attempted to discern what was really, wholistically best for each patient right now and under these circumstances. Without realizing it at the time, we were developing the practical wisdom needed to thrive as a physician for a lifetime.

 

This critical learning process literally gave me chest pain.

 

Eventually the new consult resident, in a fresh scrub shirt and white pants, came by to take over the beepers. She listened carefully to my recitation, jotting down the names, locations, and vital facts about the consults still to be seen and for those who needed follow up. We reviewed the remaining “bed board” issues. I asked her to check on the freshly resuscitated patient; finding him a hospital bed was a priority. The resident had been at our class’s graduation ceremony the week before, so she knew of my plans for a year abroad for medical education research and my ensuing fellowship. She wished me luck.

 

I found myself wistful and sentimental about her very first med consult shift and envious of her freshness and eagerness to do right and good. I hoped she would develop the wisdom needed to navigate the complexities in the best interests of our patients, without spending much time seriously considering being either a wall or a sieve. But we didn’t have any time to discuss this, both beepers were already sounding.

 

I cleared out my locker and packed up the remaining books, toiletries, and other odds and ends. Gathering up fresh beeper batteries and few single dose bottles of antacid I had pilfered from the nurse’s station, I left them on the table in the on-call room. Someone would need them sooner rather than later.

 

 

 

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.

Advice to Interns from Program Directors

 From the 7/9/2021 newsletter

Perspective/Opinion

 

Advice to Interns from Program Directors

 

Compiled by Kathlyn Fletcher, MD MA

 

 

Dr. Fletcher asked several residency program directors from MCWAH to provide their advice to new interns: practical, funny, or both. Here is what they had to say …

 

 

Chad Carlson, MD, FAAN

Professor and Vice Chair – Education

Program Director, Neurology Residency

Program Director, Clinical Neurophysiology & Epilepsy Fellowships

• If you crave a tasty (soft) cookie, check out the Hub.
• It is never too early to start identifying and talking to potential mentors.
• Completing medical notes is not like enjoying a fine wine; notes do not benefit from letting them age or breathe, so complete them in a timely manner.

 

 

 

Yvonne Chiu, MD

Professor of Dermatology and Pediatrics

Program Director, Dermatology Residency

• Use the same password for your work (MCW, Froedtert, VA, and Children’s) accounts and change them all at the same time. Makes it easier to remember what your current password is when you move between sites.
• Bring your lunch when you can. You eat healthier when you are not relying on cafeteria food.
• For those residents who take home call and need to call patients, download the Doximity app. It allows you to call patients using the hospital name and phone number in the caller ID.

 

 

 

Sriram Darisetty, MD, FACP

Assistant Professor of Medicine
Program Director, Transitional Year Residency Program, MCWAH- St Joseph.

• Try not to be under-confident, but absolutely avoid being over-confident. 
• Autonomy is earned, not given.

 

 

 

Stacy L. Fairbanks, MD

Associate Professor of Anesthesiology

Program Director, Core Anesthesiology Residency 

• Prioritize sleep or you won’t get it.  Sleep 7-9 hours per night whenever possible. 
• Study a little bit every day.  Gaining the knowledge you need to pass certifying exams is a marathon, not a sprint.

 

 

 

Kathlyn Fletcher, MD MA

Professor of Internal Medicine

Program Director, Internal Medicine Residency Program

• Always do what is in the best interest of your patient. I actually borrowed this one from a former mentor, Dr. Arthur Rubenstein.
• The quality of your day is directly proportional to how many people you say “hello” to on your way into work.  I have no data to prove this, but I am pretty sure I am right.
• Patients want to believe that you care about them beyond your professional obligation to care.  I do have evidence to back this up and would be happy to provide it to anyone who is interested.

 

 

Camille Garrison, MD

Associate Professor, Medical College of WI, DFCM

Program Director, Ascension Columbia St. Mary’s Family Medicine Residency Program

• Don’t put emojis in a patient’s chart… 😊
• The patients you see are not a means to an end. It is an honor and privilege to care for them.
• Take advantage of every opportunity to grow while in residency, both personally and professionally. What you get out of residency, has a lot to do with what you put in.

 

 

 

 

Matthew Goldblatt, MD

Professor of Surgery

Program Director, General Surgery Residency

• Find good bathrooms

 

 

 

 

Alisa Hayes, MD

Professor of Emergency Medicine

Program Director, Emergency Medicine

• Give yourself enough time to park and arrive on time. Your PD will get a notification if you park illegally.
• The Froedtert finder app can help you navigate the hospital and find rooms / locations as well as notify security when you are leaving the hospital at odd hours.

 

 

 

Heather Toth, MD

Professor of Internal Medicine and Pediatrics

Program Director, Internal Medicine/Pediatrics combined program

• We are all here for you! Please reach out to us as we have all been interns at some point in our lives.
• Remember to stay in touch with family, friends, colleagues, hobbies and things you love.

 

 

 

 

Kathlyn E. Fletcher, MD MA is a Professor and residency program director in the Department of Medicine at MCW. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.