‘As it comes to thinking about unconscious bias and structural racism, you need all hands on deck’

There’s no shortage of challenges facing medical schools these days. But the impact of the coronavirus pandemic and finding ways to tackle structural racism and unconscious bias have moved to the forefront for many educators. Modern Healthcare Managing

Dr. Joseph Kerschner,

Editor Matthew Weinstock spoke with dean and executive vice president of the Medical College of Wisconsin, as well as the immediate past chair of the Association of American Medical Colleges’ board of directors, about the state of medical education in the country. The following is an edited transcript.

MH: There’s a lot of focus on stress and burnout now. What are you seeing in terms of the stressors for students and your faculty? Are there specific things you’ve done at MCW to help address that?

Kerschner:

One of the things we specifically emphasized is having listening sessions, having the ability for people to download their emotions, as well as their thoughts, and then providing additional supports from a wellbeing perspective, support from our mental health professionals to provide opportunities for our faculty and staff, to make sure they’re getting the help they may need. And talking about the challenges that are there.

Something else that’s really important is to make sure there’s open communication, open discussion about the difficulties. As a physician, you’re supposed to be this rock and you shouldn’t talk about your own personal challenges as much. Fortunately, I think in medicine that very much is changing. The idea that we have vulnerabilities as physicians, nurses, others, just like every human does, and to be open, transparent, and seek help when you need to is becoming much more of the norm in medicine, but there’s still distance to travel.

Certainly, there have been stories in the media where there are physicians who have said they didn’t feel that they had an ability to reach out and say that they were tired or stressed or burning out.

We’ve tried very hard here at the Medical College of Wisconsin, along with our partners at Froedtert Health, Children’s Wisconsin, and our veteran’s hospital to make sure that we set the tone and set the tenor that reaching out for help is not only OK but expected. With our students, it’s been somewhat variable about what they’ve had to go through. There have been stops and starts in their education. And there was a time as the pandemic started in February, March, April, where we had to suspend clinical teaching opportunities for our students, which was very difficult for them.

The students have had to make different accommodations for their career decisions. Normally, as a medical student and other students in health professions, you’re able to do away-rotations. You’re able to go on interviews as you’re trying to decide which institution to choose for training. As you can imagine with the pandemic, opportunities for traveling and being able to make inperson interviews have been limited or even non-existent.

One really concrete thing that we’ve implemented for our students also around well-being is to really increase the number of opportunities for them to visit with and have appointments with mental health professionals to ensure that they’re checking in, to ensure that they have opportunities to discuss their stressors. And we’ve always had a strong culture of mentorship here at the Medical College of Wisconsin. We’re really fortunate at MCW to have a structure called the Kern Institute. The Kern Institute was … developed after a wonderful gift from the Kern family and Kern Family Foundation, which provides us an opportunity to really look at medical education and the transformation of medical education. And we’ve had many opportunities through our Kern Institute to talk with our students and support them. So those are some of the things that we’re doing for faculty and students, but it’s by no means an exhaustive list.

MH: We also saw heightened awareness last year surrounding structural racism and unconscious bias. Can you talk about where medical education needs to go to get to some of those underlying things that still permeate the industry?

Kerschner: It’s really important. I’ll start with saying that our organization still has a long distance to travel, for sure. I think most organizations, if they’re being honest with their assessment of where they stand, would come to a similar conclusion. Having said that, I’m proud of the initiatives we’ve taken at MCW to address those two issues. And I’ll give you a couple of examples.

We have had a process of examining unconscious bias for a number of years. Every faculty, staff member and learner at the Medical College of Wisconsin goes through a process of examining unconscious bias and really having a personal journey with that.

We tend to think of academic institutions as having this hierarchy. And I think one of the important things in this particular area is to break down some of that hierarchy and to really support people at all levels and realize that as it comes to thinking about unconscious bias and structural racism, you need all hands on deck and you need people that come from all walks of life and you need people from a variety of different experiences.

One specific example: As we’re talking about our learners, it would have been last year or maybe

“We’re having conversations … we probably didn’t have a year ago and it’s uncovering additional things that we need to work on.”

the year before when the medical students came to our leadership and said, “We really love this unconscious bias training that all medical students get to do. Could we move it up in the curriculum and have it really early? Could we have it in the first year of medical school so that it percolates through everything that we do?”

And we were actually able to do that. We moved it earlier in their curriculum and gave them opportunities earlier so that as soon as they entered the organization, they could do that.

One of the other things I’m really happy that we’ve done, during these times of examining where you are as an organization, is that the Medical College of Wisconsin … has committed ourselves on our journey to being an anti-racist organization..

I would encourage all organizations to actually understand what that means, understand where that would be for your own organization to consider that. But I think as an academic institution, as a health science university, it’s important for us to take that stance.

As we’ve examined our organization around those issues, we’ve developed new policies, new conversations, new ways in which we engage each other. Again, there is much distance for the organization to go, but we’re having conversations in a way that we probably, honestly, didn’t have a year ago and it’s uncovering additional things that we need to work on. ●