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Check out this piece from the @Kzoo_Gazette about the awesome work being done by Street Medicine Kalamazoo – under…

The Hospice and Palliative Medicine Fellowship at #WMed is a one-year program for skilled candidates who are passio…

WMED SPOTLIGHT

FACULTY SPOTLIGHT
Tyler Gibb, JD, PhD, left, and Michael Redinger, MD There is little debate that over the last two decades an increased amount of attention has been paid to teaching professionalism to medical students and resident physicians. But that trend has only added to the complexities of professionalism – what it is and how best to define it. And, at the same time, there has been little attention focused on the development of practical strategies for remediating unprofessional behavior. Now, in a research article published this week in the New England Journal of Medicine, “Responding to Unprofessional Behavior by Trainees – A ‘Just Culture’ Framework,” two professors from WMed and a professor from Oakland University William Beaumont School of Medicine have put forth what they believe – and hope – could become the “gold standard” for professionalism remediation in undergraduate and graduate medical education. “We believe that lapses in professional behavior can be addressed productively if we view them through the lens of medical error, drawing on ‘just culture’ principles and related procedural approaches,” Tyler Gibb, JD, PhD, and Michael Redinger, MD, co-chiefs of the medical school’s Program in Medical Ethics, Humanities, and Law, said in the piece along with lead author Jason A. Wasserman, PhD, associate professor in the Department of Foundational Medical Studies at Oakland University William Beaumont School of Medicine. “Repurposing these concepts can help medical educators promote a formative learning environment while fairly and rigorously addressing problematic behaviors.” The Just Culture Approach put forth by Drs. Gibb, Redinger, and Wasserman involves the creation of a “culture of psychological safety” that gives way to open dialogue, dissent and transparent reporting with a focus on balancing individual and system accountability. Drawing on those principles, the approach recognizes not only what happened in any particular instance, but the knowledge and intentions of the student, as well as the contributions of the learning environment itself. “We can adapt strategies to address medical errors in a parallel way for lapses in professionalism,” they said. “Our approach to evaluating and remediating lapses in professionalism achieves several goals. It is broadly applicable to situations in which expectations of professional behavior are not met. It is grounded in shared values of medical educators … It distinguishes helpfully among kinds of lapses on the basis of relevant factors, including the trainee’s knowledge of expectations, intentions, and foreseen consequences, and the influence of confounding systemic factors.” At WMed, the undergraduate curriculum is centered around eight domains, one of which is professionalism. Graduate medical education also includes professionalism as one of the six ACGME core competencies. Dr. Hal B. Jenson, the medical school’s founding dean, said professionalism is intentionally “hard-wired” into the curriculum. “How you do things is just as important as what you do. We have high expectations for professionalism for our students and residents from the time they arrive here,” Dr. Jenson said. “Having faculty like Drs. Gibb and Redinger here brings an added dimension to our education that goes beyond the science of medicine to the art of medicine and how we practice medicine.” Dr. Redinger said the research article, which was submitted to the New England Journal of Medicine in late 2019, was the result of a collaboration that began while he and Dr. Gibb, along with Dr. Wasserman, were attending the same ethics conferences. They quickly realized that their philosophies – specifically on how to deal with professionalism lapses by students and residents – were similar and successful. “We would bounce ideas off one another about how we handled specific situations and we found that we had really similar ways of thinking about it and they were ways that weren’t reflected in current best practices in the literature, but we were having some success,” Dr Redinger said. “We realized that the medical error model could be adapted to these situations with students and residents. A lot of times they are in situations that have other systemic factors that are playing a role in how they make a decision or how they decide to do something or not to do something.” Dr. Redinger and Dr. Gibb said they are excited that their work with Dr. Wasserman is now a part of the New England Journal of Medicine, which is the oldest – and among the most prestigious – peer-reviewed medical journals. “For me, so much of what we do is pretty specific and esoteric, and even if it’s high-quality stuff the ability to impact our peers and the profession of medicine is relatively limited,” Dr. Gibb said. “But this article being published in this venue has the opportunity to be read by vastly more people. It’s a different magnitude of impact.” In the piece for the New England Journal of Medicine, Drs. Gibb, Redinger and Wasserman write that “professionalism is not only a matter of individual character or action, but simultaneously a function of systemic factors in the learning environment. It traverses the formal curriculum and spills into our hallways, cafeterias, lounges, and offices.” Given that reality, Dr. Redinger the framework for professionalism remediation he and Drs. Gibb and Wasserman present in the research article is intentional about the importance of early intervention for medical students and residents. That early intervention is meant to stem the risk of serious issues in the future, such as medical license revocation or malpractice lawsuits, that can often be connected back to a physician’s issues with professionalism as a medical student or resident physician. “We’re hoping this becomes the pre-imminent model that’s adopted by other medical schools for dealing with these sorts of issues,” Dr. Redinger said. “The one thing that is really damaging to the medical profession as a whole are professionalism lapses. The bad actions of individuals have ramifications for everyone else in the medical profession. “So, as a result, we have to focus on those individuals that are struggling,” Dr. Redinger added. “If we’re not paying special attention to the medical students and residents struggling at the outset, they may get left behind and that puts them at risk. It puts patients at risk.”
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MEDICAL LIBRARY SPOTLIGHT
Liz Lorbeer In 2013, the WMed library began to take shape under the leadership of Liz Lorbeer, a digital-only resource built completely from scratch. Four years later, the library and the medical school have grown exponentially and Lorbeer says the growth has prompted a growing need for an automated interlibrary loan system for students, residents, faculty and staff at WMed. Now, a $4,642 technology enhancement award from the Greater Midwest Region of the National Network of Libraries of Medicine (NNLM) will help Lorbeer and Digital Strategist Ethan Cutler do just that. “There is a need for a system now,” said Lorbeer, chair of the medical school’s Department of the Medical Library. “It’s the amount of people here now, the growth in our collection. We’re coming out of start-up.” Since its inception, the medical library at WMed has functioned without automated interlibrary loan software with requests from the medical school community being managed manually by four full-time faculty librarians. The library currently supports more than 260 medical students, as well more than 200 residents, more than 300 faculty and staff, and more than 420 community faculty. Borrowing and lending at the WMed medical library more than doubled from 2013 to 2014 and those figures have steadily increased each year since. Borrowing and lending is expected to continue to increase as, by 2020, the number of medical students at WMed will grow to a full enrollment of more than 320. The technology enhancement award from NNLM will fund the implementation of the resource sharing management software ILLiad to improve the medical library’s resource sharing capabilities by automating patron requests and streamlining workflows through a web-based system. The implementation of ILLiad will be done by establishing a satellite of the ILLiad system already in use by Western Michigan University. “As of now, we have the ask.librarian e-mail and if someone has a journal article they can’t get ahold of, they contact us,” Lorbeer said. “This (new) system is not only going to help us and our workflow, it’s going to free up time for library faculty to work alongside clerks, residents, and clinicians to provide evidence-based, prompt searches at journal clubs and morning report. We are part of the healthcare team that answers medical questions at the bedside and do not want to be stuck at our desks filling article requests. It’s going to empower our users to find the information that they need and they can obtain it themselves.” In addition to the implementation of the new ILLiad system, the NNLM award will also fund the training of Cutler and other library faculty on how to use the system. “I’m excited because it’s going to help the WMed library better serve the WMed community,” Cutler said. “ILLiad will empower our users to obtain the information they’re looking for with more efficiency and autonomy. It’s going to help our academic engines run more smoothly and with less maintenance. It’s going to be an improvement for all of us at WMed and the communities we serve.” Lorbeer said the new ILLiad system is expected to be up and running by April 2018. She said she believes the system will help improve healthcare and patient care in the community as information sought by physicians will be more readily accessible. “It’s a huge milestone for us,” she said. “It’s the last big milestone in the start-up and development before (WMed) hits accreditation.”
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RESIDENT SPOTLIGHT
When Matt Kelly, MD, completed his Internal Medicine residency training at WMed, he knew he wanted to stay in Kalamazoo. He is among several resident alumni who decided after their time at the medical school to practice medicine locally and contribute to the communities that make up Southwest Michigan. Matthew Kelly, MD Dr. Kelly, who earned his MD degree at Michigan State University College of Human Medicine, joined Bronson Methodist Hospital as a hospitalist in August. For him, the decision meant the opportunity to work at the hospital where he was born. Dr. Kelly’s wife, Sonya Datta-Sandhu, also a Kalamazoo native, also works at Bronson as a midwife. They are raising their young kids in Kalamazoo. “We know from our experience in Kalamazoo that it’s a great place to raise a family and having our family support here made us want to stay,” Dr. Kelly said. “We’re giving back to the community that helped raise us. Being involved with the people in this area was important to us.” “I really love the variety of things we see as a hospitalist,” he added. “We work as primary doctors for hospitalized adults, so anyone who comes into the hospital and is admitted, we function as their primary doctor. As you can imagine, there is a wide variety of things people are hospitalized for, from stroke and pneumonia to less common things. It’s a variety and not knowing on any given day the responsibilities I’ll have to take care of, it gives me a lot of challenge and reward.” As a hospitalist, Dr. Kelly said he has the opportunity to meet interesting patients and establish a relationship built around trust, usually while the patients are enduring a challenge. Dr. Kelly said he had an advantage as a resident training at Bronson, since it gave him the opportunity to become familiar with the physicians in all the subspecialties before he was hired. “It’s a head start for the people who want to work there,” Dr. Kelly said of his rotations at the hospital. “It’s a friendly and supportive work environment with a strong medical community within the hospital and a strong leadership team that supports all the providers there as well.” Dalal Kassir, MD Dr. Kelly said internal medicine was a good fit for residency as someone who couldn’t quite put a finger on what he wanted to do. “I think it’s a field a lot of people go into because they’re broadly interested in medicine and learning about a lot of different things,” he said. “Just as I had a hard time choosing a career, I had a hard time deciding what area of medicine to go into.” Dr. Kelly said his time as an Internal Medicine resident at WMed trained him well. “There’s a long history and tradition of training internal medicine doctors in the community,” Dr. Kelly said. “My job has a lot of variety and I have to know a lot of different things. Residency helps you with that because we work at medium- to large-size hospitals and at a variety of clinics around town, with the wealthy and poor. Southwest Michigan is a cross section of humanity. We don’t realize how lucky we are to have a strong medical community and all of the resources to be the size we are.” The great working relationship the medical school has with Bronson and Ascension Borgess makes the transition as a staff physician seamless, Dr. Kelly said. “During residency we have all these opportunities to meet the people at different hospitals, rotate among different practices and specialty groups,” he said. “We do that community building during residency. When you want to transition to being an independent health care provider, it’s a really smooth transition. I think it was the perfect preparation for this job, honestly.” Residents who accept jobs at Kalamazoo’s two teaching hospitals elevate the care provided to the local community, become a funnel for good teaching cases, and they become teachers for the residents and students who come after them, said Mark Loehrke, MD, chair of the medical school’s Department of Medicine. “The residents that we graduate are really great physicians and I want people in my community to receive really great care,” Dr. Loehrke said. “When they graduate and stay in our community I can be assured our community members are receiving high quality care.” Local hires from the medical school provide an example of the high quality of physicians that come out of WMed’s primary care residency programs, Dr. Loehrke said. WMed Internal Medicine residents have a 100 percent board pass rate over the last seven years, they have landed competitive subspecialty fellowships, and local practices find positions for them. They are wanted as a part of the local physician community, Dr. Loehrke said. “A quality of our program is that there’s no substitute for clinical excellence,” Dr. Loehrke said. “You cannot cut corners with patient care. They are too vulnerable, too sick, too complicated, and that’s something we emphasize over and over again.” About 20 of Bronson’s current working hospitalists are graduates of WMed, Dr. Loehrke said, and of the 10 graduates each year from the Internal Medicine program, two to three stay to continue their careers in Southwest Michigan. Dr. Loehrke said it is a personal goal of his to see at least two residents per year hired within Southwest Michigan, therefore populating the local area with quality physicians. In the medical school’s Family Medicine residency program, many former residents who go on to jobs at Bronson and Ascension Borgess become community faculty members at the medical school and serve as mentors, role models, and sounding boards for the medical students who come after them, said Lisa Graves, MD, chair of the medical school’s Department of Family and Community Medicine. “When residents stay local, they get to know the community, the medical providers and the social aspects of the community,” Dr. Graves said. “They develop relationships with other physicians and can refer patients to them.” Meanwhile, Dr. Graves said physicians’ spouses and children also become engaged in the local community. “When you recruit professionals to a community, they bring not just their skills, they bring other assets,” Dr. Graves said. “They’re going to hire someone to do the babysitting, the gardening, the childcare. There’s an infusion of good things that happen when you bring a professional into the community.” That is the case with Dalal Kassir, MD, a 2020 graduate of the Family Medicine residency program in Kalamazoo. Dr. Kassir is now at Ascension Borgess and her husband, Mahmood Kassir, MD, plans to join Ascension Borgess later this year after finishing residency. The Kassirs, who are originally from the Metro Detroit area, have decided to raise their son, Ali, in Portage. “It’s a good place to have a family,” said Dr. Kassir, who earned her MD degree from American University of the Caribbean School of Medicine and completed her undergraduate studies at the University of Michigan. “It’s pretty close to home, we’re about an hour and a half to two hours away from where our families live. It’s close enough but far enough. We love the area. We just recently bought a house in Portage. We were just comfortable here.’ Dr. Kassir currently sees patients at Ascension Borgess Woodbridge Hills and she said her time as a Family Medicine resident at WMed prepared her well for what she sees each day as a physician. “I feel like I was trained so well that nothing is a challenge essentially and it’s a nice feeling as a new grad,” she said. “I feel completely comfortable practicing here. I feel like I had such a strong background practicing with our residency clinic. I enjoy taking care of the patients we’re taking care of. We are building really great relationships and I have the opportunity to take care of different members of the same family.”
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SIMULATION CENTER SPOTLIGHT
In 2018, the Simulation Center team hosted a total of 871 events and more than 15,000 learners last year, and more tan 71,000 learner hours were logged. The Simulation Center at the medical school’s W.E. Upjohn M.D. Campus is a hub of activity for medical students, residents and several community agencies, and 2018 was a record year. In all, the Simulation Center team hosted a total of 871 events and more than 15,000 learners last year, and more than 71,000 learner hours were logged. Those figures are part of what has been a period of exponential growth over the last three years. For example, in 2016, the Simulation Center hosted 443 events for more than 9,600 learners with 44,000 learner hours tallied. In 2017, there were 668 events with more than 14,600 learners and more than 62,000 learner hours logged. “WMed faculty are excited about using simulation as a tool for medical education,” said Dr. Richard Lammers, the medical school’s assistant dean for Simulation. “And awareness has also grown in the community from positive feedback.” The number of trainings that were held in the Simulation Center last year included 498 undergraduate medical education events, 279 graduate medical education events and 94 events that involved external agencies, such as local hospitals and EMS providers. Figures from the Simulation Center show that the growth in activity has been fueled by an increase in the breadth of simulation cases and the overall number of events that are being held in the 24,000 square-foot facility. Those events have included advanced procedure labs and PGY-2 and PGY-3 assessments during Emergency Medicine Sim Wednesdays and ultrasound training courses for Medicine-Pediatrics, Family Medicine and Emergency Medicine residents, as well as procedural skills, OSCE and clinical skills stations for pre- and post-clerkship events for third-year medical students. Additionally, the Simulation Center hosted trainings and events for entities outside of the medical school, including Stryker, Bronson Healthcare, West Michigan AirCare and grant-funded programs such as the Michigan Pediatric EMS Error Reduction Study (MI-PEERS) and Cradle Kalamazoo. Dr. Lammers said he is proud of the extensive growth in activity at the Simulation Center and thankful for the work of staff, standardized patients, standardized patient educators and American Heart Association instructors that have made it all possible. He said he also is encouraged by the positive feedback he has received from students and residents who have trained in the Simulation Center and he is confident that the skills they obtain and sharpen in the facility are having a positive impact on patient care. In one instance, Dr. Lammers received a message from an Emergency Medicine resident who credited his training in the Simulation Center during an advanced procedures lab on a Sim Wednesday for preparing him to remove a metal flake that had become embedded in a patient’s eye. “Not only did the sim training allow me to set up the slit lamp correctly, but it also gave me the skills necessary to successfully remove the metal flake using a 21g needle in my non-dominant hand,” Dr. Sean Barkan said. “Without this prior training, I would not have felt comfortable attempting the difficult procedure.” Dr. Lammers said he believes the Simulation Center at the W.E. Upjohn M.D. Campus will soon reach capacity and he anticipates that staff will begin holding more events at the WMed Simulation Center at Ascension Borgess Hospital. “I’ve seen simulation used as a valuable education tool for a long time and I think the residents and students are getting richer experiences as a result of using the Simulation Center,” Dr. Lammers said. “I’ve never had anyone write me a letter because a lecture I gave made them feel more confident about performing a procedure or managing a case. Simulation is more effective in improving learners’ confidence. I think they learn skills faster and the training sticks longer.”
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STUDENT SPOTLIGHT
Third-year student Katie Jones, center, is pictured with BrieLynn Sturm and Sturm's son, Jack. When the contractions began late on the night of July 13 last year, BrieLynn Sturm had a clear birth plan detailing how she and her husband would welcome their first child into the world. She wanted the birth to be a natural process, even entertaining the idea of a home birth; however, a hospital birth was planned to welcome baby Jack and ease the worries of family members. When it came time to give birth, she wanted as few people in the room as possible and she asked that medical students not be allowed to observe. In the end, nothing would go as Sturm had planned. By the morning of July 14, she was admitted to Bronson Methodist Hospital and, after laboring naturally for 25 hours, she agreed to receive Pitocin to help her labor progress. Instead, the medicine brought on intense four-minute contractions that led to Sturm agreeing to receive an epidural. Even with the interventions, Sturm, 34, said her labor stalled. Of even greater concern was that Jack’s heart rate began to drop, prompting Sturm to opt for a C-section. She was in tears, so distressed that she became sick as her care team wheeled her to an operating room. “By then, that was hour 30-something of my labor and I was emotionally a mess,” Sturm said. “Nothing, at all, had gone the way that I wanted … On the way to the operating room I threw up and out of nowhere this little angel heard me and made sure there was something for me to use.” As it turned out, that angel was Katie Jones, a third-year student at WMed, who noticed Sturm was feeling sick and quickly handed a bucket to Sturm’s husband, Rob, as they headed to the operating room. Once they were in the operating room, Sturm said she continued to cry as she waited for her husband and their doula, Kama, to join her the room. Jones was in the operating room too and kept a close eye on Sturm as other members of the medical team focused on prepping her for surgery. Jones said she did her best to stay out of sight, aware of Sturm’s wishes that medical students not be allowed to observe. But Jones said she also wanted to help and didn’t like seeing Sturm so upset. “I just couldn’t stand to see someone so terrified and that was the moment I realized that she clearly needed someone,” Jones said. “So, I took my gloves off and went up to hold her hand.” Katie and Jack, along with Jack's mother, BrieLynn Sturm, got a chance to hang out recently at the W.E. Upjohn M.D. Campus. In the midst of the chaos, Sturm said Jones’ actions were exactly what she needed. She recalled how Jones was wearing a mask at that time but the look in Jones’ eyes was comforting and she could tell Jones was smiling at her beneath the mask. “There was a halo over her and she had this reassuring smile that everything was going to be OK,” Sturm said. “I saw “STUDENT” on her name tag and I didn’t even care. More than any other team member in the room, she put me at ease. “I don’t think I can explain how much her being with me made a difference,” Sturm added, fighting back tears. Even with the comfort and reassurance that Jones’ presence provided Sturm, the ordeal for her and her family was far from over. Shortly after his birth, Jack was taken to the Neonatal Intensive Care Unit at Bronson after his glucose levels fell to dangerously low levels. Sturm’s husband, Rob, accompanied Jack to the NICU and Sturm – still processing everything that had happened with Jack’s birth – found herself alone. And then, just like she had done in the operating room, Sturm said Jones showed up at her door to follow up with her. She came with crackers and ice in hand and, as Sturm remembers it, Jones was “a loving comfort” for her. “We hardly even talked but I felt a loving connection and I didn’t have to prove anything to her or do anything, it was really special,” Sturm said. “She was very in tune with the small things that she could do for me those ended up being huge factors for me not feeling alone and not feeling like a failure.” When she reflects on that day with Sturm, Jones said it was apparent to her that Sturm needed someone with her as she prepared for surgery and Jack’s birth. So, she held Sturm’s hand during the C-section, asking Sturm if she and Rob had a name chosen for their baby, aware that they wouldn’t find out the gender until Jack was born. “At that moment, I was like, ‘She needs someone,’” Jones said. And after Jack’s birth, Jones said she wanted to check on Sturm, recalling how her professors at WMed had told her several times that, as a medical student, she would often have the most time to spend with a patient as opposed to a resident or attending physicians. “Professors tell us we will likely have the most time to spend with patients, to hear more of their stories and get to know them,” Jones said. “I also just wanted to see BrieLynn again and see how she was doing.” When their time together at the hospital came to an end that day in July, Sturm was so warmed and impressed by Jones’ kindness that she sent text messages about the experience to a close family friend – Dr. Mark Loehrke, chair and associate professor in the medical school’s Department of Medicine. The texts from Sturm were detailed but the message they conveyed was simple – “one of your students is really changing the world.” “I was in such a fragile state that I really needed him to know how important his students were, Katie in particular,” Sturm said. Dr. Loehrke said he was thrilled to hear of Jack’s birth and that BrieLynn was recuperating, and he was filled with pride that Jones played such an integral role in helping make what was a traumatic experience better for Sturm. After he received Sturm’s texts, he shared them with Jones, he said. “I think one of the things that is universal for medical students is they don’t always feel a lot of confidence in what they’re doing and they don’t think they can have an impact,” Dr. Loehrke said recently. “And, honestly, nothing could be further from the truth. Their actions are incredibly important to the overall healthcare team and the overall well-being of our patients. “So, when BrieLynn sent me those texts filled with absolute gratitude for what Katie had done and how important she was to BrieLynn getting through this difficult time, I felt like Katie needed to hear that and it’s a real example of how important a medical student’s presence can be to a patient,” Dr. Loehrke added. Jones said the text messages from Dr. Loehrke served as a tangible reminder that her pursuit of a career in medicine is worth it, that she is right where she is supposed to be. “Patient interactions can be rewarding but something like this, it made my day and then when Dr. Loehrke texted me a few days later that I made a huge difference in someone’s life, it was so rewarding,” Jones said, fighting back tears. “It almost felt unreal that I was able to help someone so much. It just made me feel like I’m doing what I’m supposed to be doing.” Even more rewarding is that the experience has forged a connection between Sturm and Jones that extends well beyond that day in July. In October, the new mother and aspiring doctor met for brunch along with Jack and Dr. Loehrke. The time together gave them a chance to share a meal together and relive and retell their perspectives from that day at Bronson. “She’s in our lives forever,” Sturm said of Jones. “I feel very grateful.”
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DONOR SPOTLIGHT
We formally recognize Mr. William D. Johnston and Mrs. Ronda E. Stryker alongside Mr. William U. Parfet and Mrs. Barbara A. Parfet for their leadership in co-chairing the medical school’s tenth anniversary gala WMed Live: A First Decade Celebration. Their leadership played an instrumental role in honoring Dean Emeritus Hal B. Jenson for his decade of leadership as the founding dean of Kalamazoo’s premier medical school and in welcoming our new dean, Dr. Paula Termuhlen. We appreciate their ongoing enthusiasm to celebrate the achievements of the medical school and our future Clinicians, Leaders, Educators, Advocates, and Researchers of tomorrow. Bill and Ronda have been tireless in their advocacy to encourage members of our regional community to support medical education diversity, equity, and inclusion initiatives. Bill and Barbara have shown generous support for the mission of the medical school, the development of the medical school’s physical facilities, and encouraging philanthropy through the WMed Philanthropy Advisory Council, the Dean’s Circle Leadership Giving Society, and the planned giving programs of the medical school. We proudly recognize these two couples for their bold leadership, inspiring vision, and generous financial support to advance the mission of WMed and its place in the field of global medical education.
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