1 of 48

I-RESTORE

Intersession Course for the Pre—Clerkship Years

Mika Godzich and Jennifer Karlin (Co-IORs)

2 of 48

SESSION OBJECTIVES

SUMMARIZE WHY THIS COURSE WAS DEVELOPED

EXPLAIN HOW PROFESSIONAL IDENTITY FORMATION HAPPENS IN MEDICINE AND THE WAYS THAT THIS COURSE WILL HELP YOU BE AWARE OF THIS

DESCRIBE WHAT THE STRUCTURE OF THIS COURSE IS, INCLUDING WHEN AND WHERE IT TAKES PLACE, AND HOW TO SUCCESSFULLY COMPLETE IT

3 of 48

THE WHY

A brief course history

4 of 48

I-RESTORE Curriculum

60% of health care costs are a result of environmental, social and behavioral factors

UC Davis Office of Medical Education

Jen:

good evidence that 60% of health care costs result from social, environmental and behavioral factors [3]. Physicians are advised to take social needs into account when providing care, but they are provided neither the tools nor the power to control factors that are customarily considered outside their purview [4-6].

---------

Extra notes/citations:

McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood). 2002;21(2):78-93.

4. Gottlieb LM, Wing H, Adler NE. A Systematic Review of Interventions on Patients' Social and Economic Needs. Am J Prev Med. 2017;53(5):719-729.

5. Pantell MS, De Marchis E, Bueno A, Gottlieb LM. Practice Capacity to Address Patients’ Social Needs and Physician Satisfaction and Perceived Quality of Care. The Annals of Family Medicine. 2019;17(1):42-45.

Alderwick HA, Gottlieb LM, Fichtenberg CM, Adler NE. Social prescribing in the US and England: emerging interventions to address patients’ social needs. American journal of preventive medicine. 2018;54(5):715-718.
Bachrach D PH, Wallis K, Lipson M, Manatt Health Solutions. Addressing patients' social needs: an emerging business case for provider investment. In. The Commonwealth Fund. New York, NY2014

5 of 48

I-RESTORE Curriculum

New LCME and USMLE competencies

60% of health care costs are a result of environmental, social and behavioral factors

UC Davis Office of Medical Education

Jen:

LCME and USMLE have responded to the fact that 60% of our health care costs result from social, environmental and behavioral factors by creating competencies and evaluations to ensure medical students are provided the tools to mange these social factors

This has become even more of an outcry during the covid-19 pandemic by people given the disparities in prevalence and outcomes that we have seen with viral illness and the understanding that it is about social determinants that have led to these disparate outcomes and not necessarily biology. So, This means that medical schools are now charged with providing students with tools to recognize social determinants of health, to interact with diverse populations, and to have tools for understanding the social elements of medical practice, which includes history of medicine in the US context, the soiclogy of institutions and the ways in which we draw upon the social sciences and humanities in our practices of medicine. And, you will be tested on this material eventually on your steps and boards going forward.

6 of 48

I-RESTORE Curriculum

New LCME and USMLE competencies

60% of health care costs are a result of environmental, social and behavioral factors

The culture of medicine

UC Davis Office of Medical Education

Jen:

There is a culture of medicine. That culture of medicine has values. In the past, medical students have had to try to decipher the code themselves.

This has done harm to learners in the past who have thought, “just what is going on here?” And “how am I supposed to act and be while Im getting graded and evaluated?” And, “how much of myself do I need to change to fit in?” “ do I really belong here?” Etc. these are long-standing questions that learners have asked but have not previously had ways of exploring and understanding WHILE they are in the midst of undergoing an intense process of knowledge accumulation.

We are hoping to make this process more apparent, talk about it, give you time to reflect on it, and help serve as cultural brokers for you.

---------

Extra notes:

Found also this outline from Bleakley et al., Medical Education for the Future, Advances in Medical Education 1,�DOI 10.1007/978-90-481-9692-0_17, © Springer Science+Business Media B.V. 2011:

We have argued for a radical future agenda for medical education, including:�• Articulation of the ideological issues that frame choice of theories informing �pedagogical practices.�• Addressing the troubled relationship between the workplace and the academy.�• Managing plural identities in a runaway world of medicine that refuses single �interpretation.�• Mobilizing the power of both a cultural-critical and a literary sensibility in medi-�cal education.�• Addressing the paradoxical refusal of democracy in medical practices and the de-�mocratizing powers of both medical education and medical education research.�• Addressing the unacknowledged imperialism of dominant forms of medical edu-�cation and articulating a number of patterns of interplay between identity, power �and location

7 of 48

I-RESTORE Curriculum

New LCME and USMLE competencies

60% of health care costs are a result of environmental, social and behavioral factors

The culture of medicine

UC Davis Office of Medical Education

8 of 48

I-RESTORE Curriculum

New LCME and USMLE competencies

UC Davis students asked for flexibility and time for decompression

60% of health care costs are a result of environmental, social and behavioral factors

The culture of medicine

UC Davis Office of Medical Education

9 of 48

I-RESTORE Curriculum

Financial aid reorganization

New LCME and USMLE competencies

UC Davis students asked for flexibility and time for decompression

60% of health care costs are a result of environmental, social and behavioral factors

The culture of medicine

UC Davis Office of Medical Education

10 of 48

ANOTHER VIEW OF THE COURSE

Mika

Most of the time in medicine we’re in systole – contracting, pushing out information, sharing our most essential thoughts and understanding out to the rest of our community – of peers, of supervisors, of patients.

But we can’t just contract, pushing out that information, we need to relax, and let ourselves fill up again so that we can bring oxygen to our own muscles and self. Diastole is when the coronary arteries get fed, without diastole, muscles of the heart would die. This course is an intentional effort to bring that moment of giving yourself oxygen into the curriculum

When you don’t have time for diastole within the curriculum you spend a lot of time on your own trying to find downtime and trying to understand the history and structure and culture of medicine – by doing this important work within the curriculum, we’re hoping to free you up for more non medicine time outside of the school of medicine

11 of 48

I-RESTORE:

IDENTITY-FORMATION THROUGH REFLECTION, SOCIAL ANALYSIS, TEAM-ORIENTATION AND ENRICHMENT

12 of 48

I-RESTORE:

IDENTITY-FORMATION THROUGH REFLECTION, SOCIAL ANALYSIS, TEAM ORIENTATION, AND ENRICHMENT

What do these concepts mean to you?

13 of 48

MEDICAL PROFESSIONAL IDENTITY FORMATION

Kalet, A., Buckvar-Keltz, L., Monson, V., Harnik, V., Hubbard, S., Crowe, R., ... & Yingling, S. (2018). Professional identity formation in medical school: one measure reflects changes during pre-clerkship training. MedEdPublish, 7.

Mika:

Kalet’s model of professional identity formation is widely used in SOMs across the country to support growth in UME learners

A framework of Medical Professional Identity Formation based on Bebeau’s adaptation of Kegan’s Stages of Mental Complexity, measured by the Professional Identity Essay (PIE) modified for the Professions .

(M. J. Bebeau & Monson, 2008). Adults spend most of their lives in between the full stages in the transition from external to internal definition. Stage 1 pertains to infancy and childhood. A full Stage 5 exists primarily in theory. Half stages represent transitions between stages and are assigned by individuals trained in the use of coding criteria for professional identity developed by Bebeau and Lewis (M. Bebeau & Lewis, 2003). and guided by the Subject-Object Interview (SOI) .(M. J. Bebeau et al., 1993). Also depicted are descriptive labels proposed for the stages based on key characteristics of each stage and exemplar quotes for each full stage.

14 of 48

COURSE AIMS

Assist students

Move from Stage 2 (Independent Operator) to Stage 3 (Team-Oriented)
Be ready for integration into team-based care on their clerkships

Assist

Recognize the collective culture of medicine and how that might impact our own individual development.

Recognize

Provide students the space to reflect on what they are acquiring in terms of their learning experiences

Provide

Offer students the language, skillset, and opportunity to reflect on being members of a new profession

Offer

Mika

Kalet’s model of professional identity formation is widely used in SOMs across the country to support growth in UME learners

A framework of Medical Professional Identity Formation based on Bebeau’s adaptation of Kegan’s Stages of Mental Complexity, measured by the Professional Identity Essay (PIE) modified for the Professions .

(M. J. Bebeau & Monson, 2008). Adults spend most of their lives in between the full stages in the transition from external to internal definition. Stage 1 pertains to infancy and childhood. A full Stage 5 exists primarily in theory. Half stages represent transitions between stages and are assigned by individuals trained in the use of coding criteria for professional identity developed by Bebeau and Lewis (M. Bebeau & Lewis, 2003). and guided by the Subject-Object Interview (SOI) .(M. J. Bebeau et al., 1993). Also depicted are descriptive labels proposed for the stages based on key characteristics of each stage and exemplar quotes for each full stage.

15 of 48

WHY?

Because we know that achieving these aims is integral to the long- term fulfillment and success of practitioners and for improved quality of care for patients

16 of 48

THE WHAT

Course structure

17 of 48

18 of 48

WEEKLY THEMES

Week 1: Adapting to a new culture and the growth mindset

Week 2: Maintaining wellbeing (of the caregiving relationship)

Week 3: Goal setting, values clarifications, accountability, and self-determination

Week 4: Interprofessional communication

Themes will help move you towards Stage 3 of your Professional Identity

19 of 48

STANDARD WEEK

	Monday	Tuesday	Wednesday	Thursday	Friday
8:00	CHS, independent scholarly work, remediation or unstructured time	Required Curriculum (synchronous & asynchronous)	Required Curriculum (synchronous & asynchronous)	ASC /CHS	CHS, independent scholarly work, remediation exams or unstructured time
9:00

10:00
11:00
12:00
1:00		Required Coach Meeting (individual or small group) OR Learning Passport Work	Required Coach Meeting (individual or small group) OR Learning Passport Work	Required Coach Meeting (individual or small group) OR Learning Passport Work
2:00
3:00
4:00
5:00

20 of 48

ASYNCHRONOUS�CONTENT

Independent readings, videos, modules, and creative time addressing the week’s themes

21 of 48

IN PERSON SESSIONS

LIVE LECTURES

COACHING SESSIONS

LEARNING PASSPORT ACTIVITIES

22 of 48

LEARNING PASSPORT

Students will participate in 4 experiences from one of 6 categories:

Interprofessional Experience (IPE)

time with allied health professionals (i.e., PT/OT/RT/dieticians/nursing staff)

Clinical experiences/procedural workshops (PW)

Workshops offering simulation for learning skills of suturing, IV placement, wound care, vaginal deliveries, etc.

Personal development offerings (PD)

yoga, cooking, finances, fitness

Career exploration (CE)

shadowing, attending professional panels

Lifelong learning (LL)

workshops offering content on study skills, learning how to learn, teaching

Leadership development (LD)

learning your leadership style, acquiring communication skills

Mika:

Selective experiential learning to be done longitudinally over the course of the first 2 years of medical school during intersession weeks and during the summer. As a flexible offering, these activities encourage students to think critically about their own learning needs and assess areas for development, without being prescriptive. Students must choose at least 4 experiences from different categories as follows:

These workshops and experiences (1-6 above) will be varied and will be offered on Mondays, Thursday mornings, and Tuesday/Wednesday/Thursday afternoons during the pre-Clerkship weeks and during the weeks of core selective time in the summer. A balanced portfolio will be offered to students to ensure that they can complete 4 activities over the duration of the course.

23 of 48

24 of 48

SUMMER SESSION

Complement and Critique: Incorporating social sciences, humanities, advocacy, research and community engagement into our practices of medicine

25 of 48

SUMMER SESSION LEARNING OBJECTIVES

Learning Objectives:

1) Be able to explain the ways in which their chosen enrichment activity has furthered their understanding of their identity in the profession of medicine.

2) Explain the impact of power and privilege in an historically informed perspective in the role of the medical professional and how these contribute to health inequities and disparities.

3) Demonstrate an understanding of the complex systems and technologies that surround the patient/physician relationship and the historical context surrounding the development of these systems and the identity of the physician.

4) Describe the different ways in which a physician can engage in advocacy on behalf of team members and patients. 

Jen:

The larger context of medicine. Medicine is not practiced through in a vacuum and physicians have always found ways to connect to the larger context of health and caregiving in various ways. This summer will provide you the opportunity to take a deeper dive into areas in the medial field in which you can enact change in ways that are larger than individual patient-by-patient interactions. You can think of these as levers by which you understand your practice as connecting to a larger societal or humanistic context.

You will have the opportunity to choose one of these selectives in order to take a deeper dive into the content of a specific lever. However, all the selectives will include shared, required content in the following topics: history of race in medicine, basic foundations of advocacy, the sociological concepts of power, privilege, and institutionalization. Each selective will have its own individual objectives; however, all students will achieve the overall objectives listed below after the summer session.

26 of 48

LOGISTICS

27 of 48

SUMMER SESSION��

Common core content

(asynchronously delivered; 6 hours)

Enrichment Option (120 hours)

28 of 48

SUMMER CORE CONTENT�(ALL STUDENTS)

Key concepts in the lived experiences of illness

Environment and Health

Race in Medicine

Advocacy

Ethics and history of biomedical, social, and behavioral research

Humanities and Medicine

29 of 48

SUMMER ENRICHMENT OPTIONS��MINIMUM REQUIREMENT OF 120 HOURS�(4WEEKS)

Community Health Scholars

Alicia Gonzalez-Flores

ACE-PC, TEACH-MS, RURAL-PRIME and REACH

Externship

CES approval

These are external clinical and research opportunities that students find on their own (NIH, etc.)

Health in a global context

Michael Wilkes

Students explore social determinants of health through immersive experiences domestically and abroad

Research

Saul Schaefer

Students have opportunities to work with PIs on research projects

UC Davis Selectives

Multiple faculty leads

Social sciences and humanities offerings

30 of 48

Medicine and the Humanities

Race and Health Institute

Community Health & Student Run Clinics

Qualitative Research and Student Led Exploration

UC Davis Selectives

Multiple faculty leads

Social sciences and humanities offerings

Jen

Selectives Descriptions:

Race and Health Institute: (Jann Murray-Garcia lead). In the United States, health disparities by race and ethnicity cost the nation tens of billions of dollars each year. The total human costs are of course incalculable. Though racial disparities in health status and health care allocation have been well documented for decades, we are not close to eliminating them. This interprofessional course will facilitate the professional and personal developmental trajectory of medical students and other health professions students who think they would like to be leaders in securing population health equity and equitable work environments, wherever they practice in the country. The model for this condensed experience is the popular Summer Institute on Race and Health, taught by the same professor.

Medical humanities (Lead: Dr. Raskin and Dr. Amadi): This course will expose students to four pillars in the medical humanities: literature, art, and performance. Through the exposure to these topics, students will embody other perspectives through study and discussion of character development in literature, to learn about skills and techniques from the humanities as tools to inform healthcare communication and exposure to different perspectives.

Community Medicine and Student Run Clinics: l(ead: Alicia Agnoli). This selective will provide students with the opportunity to explore what it is like to provide care at a student –run clinic. Students will rotate at the clinics and learn the history of their development and functioning. They will be introduced to demographic and epidemiological data about who accesses care at student run clinics. This will be contextualized within a history of safety net (or lack thereof) systems in the United States as well as the ethics of providing care through student run clinics. Students will also be exposed to other models of care that might allow for more robust safety net systems.

Qualitative Research and Student led exploration (Leads: Dr. Ginwala and TBD). This course will teach students the basics in qualitative, ethnographic research including interviews, participant-observation and with an attention to structural competency. Students will be provided content in these qualitative methods and then will be offered the opportunity to do an ethnographic project that will explore a current event related to medicine, or a question in the delivery of care, or an issue in medicine in which students have a curiosity. Students will receive support from faculty to explore this topic from a range of perspectives and will write up an ethnographic vignette. The aims will be to teach ethnographic methods as a way of improving observational skills and skills at interviewing with open-ended question and without pre-determined assumptions, practicing how to approach a question from the ground up and from multiple perspectives.

31 of 48

SUMMER ENRICHMENT OPTIONS��

Community Health Scholars

Alicia Gonzalez-Flores

ACE-PC, TEACH-MS, RURAL-PRIME and REACH

Externship

CES approval

These are external clinical and research opportunities that students find on their own (NIH, etc.)

Health in a global context

Michael Wilkes

Students explore social determinants of health through immersive experiences domestically and abroad

Research

Saul Schaefer

Students have opportunities to work with PIs on research projects

UC Davis Selectives

Multiple faculty leads

Social sciences and humanities offerings

32 of 48

THE HOW

Successful course completion

33 of 48

34 of 48

ASSESSMENT: PASS/FAIL

MEET INDIVIDUALLY WITH COACHES AT LEAST 4 TIMES

MEET WITH GROUP AND COACHES 4 TIMES

COMPLETE A SUMMER ACTIVITY AND RECEIVE A PASS

COMPLETION OF 4 PASSPORT ACTIVITIES

COMPLETE THE MINUTE ESSAY EVERY WEEK

COMPLETION OF 3 REFLECTIONS

35 of 48

THE MINUTE PAPER�AT THE END OF EACH WEEK

36 of 48

COURSE ASSIGNMENTS

Orient to course objectives and structure

Watch, read Asynchronous content

Interview medical professional

Write Reflection 1 about the

interview process

Discuss Reflection 1 with coaching group

Write Reflection 2 about the interview content

Discuss Reflection 2 with coaching group

Write reflection 3 based on your observation of a clinical setting

Discuss Reflection 3 with coaching group

Week 1:

Nov 2021

Week 2:

Feb 2022

Between Week 1 and Week 2

Week 3:

Sept 2022

Week 4:

Oct 2022

Reflection assignments are due at the beginning of the coaching session where they will be discussed

Between Week 3 and Week 4

Jen:

Because we’re losing out on a day for this week, we’re going to ask you to do about 3 hours of work between now and the next week of intersession. Please do

December break: Watch video of medical professional being interviewed about their process acculturating to medicine, optional reading will be included Find providers to interview and schedule interview- ¼ interview different professionals… and record your interview for review. Write up the reflection 1 about the interview process.

Week2 – you’ll discuss what it felt like to interview someone and elicit deeper content in yr coaching group; Goal of interviews is to dig deeper: Elicit narrative about acculturating to medicine. Work on skills of remaining curious, digging deeper, and not closing in on answers

Week3- asynchronous work will include review of taped interview and writing of reflection on content about understanding the culture of medicine and how you relate to that and discuss in coaching groups. What were common stories and drivers

Week 4- you’ll discuss your observation of interprofessional relationships in the practice of medicine in your coaching groups – using prompts from KO’s LCME guide

37 of 48

QUESTIONS?

38 of 48

YOUR WEEK AHEAD

39 of 48

WEEK 1: 11/8-12/21

LEARNING PASSPORT OPTIONS:

Physician Health Thyself: Wellness Tools for Medical School and Beyond (PD); 1-2:30 T and 1:30-3 W

How to make the most of your AMBOSS and Kaplan accounts (LL): 1-2:30 T/W

�

	Monday	Tuesday	Wednesday	Thursday	Friday
8:00	Time for asynchronous work: Growth Mindset	Time for asynchronous work: Communication in Medicine	8:30-9:30 Problem Based Learning focus group (optional zoom session)	Holiday	Unstructured time/remediation exams
9:00

10:00	10:00 AM I-RESTORE Introduction	10:30 AM How to Have Effective Communication	10:00 AM Careers in Medicine: Advising and 4th year panel
11:00
12:00
1:00	1:00 PM ASC Introduction	1:00 PM Coaching Small Groups or Passport Activities �	1:00 PM Coaching Small Groups or Passport Activities
2:00
3:00	Time for asynchronous work: Growth Mindset
4:00
5:00

40 of 48

ASSIGNMENTS THIS WEEK

Orient yourself to course materials and aims

Orient

Engage in all live sessions and complete asynchronous material

Engage

Attend learning passports workshops, if available

Attend

Fill out Qualtrics The Minute Essay on Wednesday at the end of your last session

Turn In

Think about summer options you may be interested in and fill out survey about your interests

Summer prep

Polly Latlow (phlatow@ucdavis.edu ) and Aaron Dang (asdang@ucdavis.edu) about course materials or questions about logistics

IORs Mika Godzich (mgodzich@ucdavis.edu) and Jen Karlin (jkarlin@ucdavis.edu) with any questions about goals of course

Reach out

41 of 48

QUESTIONS?

42 of 48

SUPPLEMENTAL SLIDES

43 of 48

THE HIDDEN CURRICULUM

“One strategy has been to […] not to protect myself from it (difficult emotions), and not just to think: ‘No, this is too difficult and unpleasant, I’ll turn away from that’, but actually do the opposite. […] I think it is about seeing (these situations) several times, talking to patients about how they are feeling. […] I don’t know if it is a habit or if you get detached or if you get used to it, but you… just become more professional.” (Medical student, final year, interview)

“I was on the oncology ward where I felt that the patients’ feelings and mood were being ignored and (they) only dealt with the physical (aspects). Everyone (on the staff) was too busy to see the patients. For me, as an outsider, the whole atmosphere was quite exhausting and affected my state of mind. […] I dealt with the whole situation by talking to my partner and friends. The difficult part was not the patients, but the reluctance among the healthcare professionals to meet the patients’ emotional needs – they didn’t have time or energy to be empathic.” (nursing student, final year)

Weurlander M, Lönn A, Seeberger A, Broberger E, Hult H, Wernerson A. How do medical and nursing students experience emotional challenges during clinical placements?. Int J Med Educ. 2018;9:74-82. Published 2018 Mar 27.

These quotes come from a study that investigated which kinds of situations medical and nursing students found emotionally challenging during their undergraduate education, and how they managed their experiences.

The researchers gathered qualitative data using an open-ended questionnaire distributed to students in the middle and at the end of their education. In total, 49 nursing and 65 medical students participated. Also, five students were interviewed individually to acquire richer data. Data were analysed using narrative thematic analysis.

The quotes above illustrate that the process of getting used to emotionally challenging situations seemed to happen without students knowing precisely how, but students learned what to expect, and this seemed to help them manage the situation and their own emotions.

In addition to talking to other people, students got used to the situations that caused emotional unpleasantness and in time felt more secure in their own ability to deal with these kinds of situations. The students mentioned that “it is much easier now than in the beginning”. Also, feeling more secure seemed to be related to students learning to trust that they had done all they could in these situations.

Weurlander M, Lönn A, Seeberger A, Broberger E, Hult H, Wernerson A. How do medical and nursing students experience emotional challenges during clinical placements?. Int J Med Educ. 2018;9:74-82. Published 2018 Mar 27. doi:10.5116/ijme.5a88.1f80

44 of 48

THE HIDDEN CURRICULUM

“There are many typical situations that are difficult in various ways, for instance during consultations when the supervisor does not treat the patient correctly, but you as a ‘colleague’ are expected to back up or at least not to contradict and thereby undermine the doctor’s message to the patient.”

Weurlander M, Lönn A, Seeberger A, Broberger E, Hult H, Wernerson A. How do medical and nursing students experience emotional challenges during clinical placements?. Int J Med Educ. 2018;9:74-82. Published 2018 Mar 27.

45 of 48

THE HIDDEN CURRICULUM

“[It was] A patient in the haematology department who did not have a promising prognosis. He was not ‘my’ patient, but I was pushed into his room because he had an interesting medical status […]. It felt very awkward and false to go in to see this patient, who was staring blankly at the wall and was clearly depressed, just to broaden my medical experience.”

Weurlander M, Lönn A, Seeberger A, Broberger E, Hult H, Wernerson A. How do medical and nursing students experience emotional challenges during clinical placements?. Int J Med Educ. 2018;9:74-82. Published 2018 Mar 27.

46 of 48

THE HIDDEN CURRICULUM

[Surgeon] Mihir works in a surgical subspeciality that treats unusually sick patients, a significant number of whom will die or receive terminal diagnoses while in his care. Regular contact with dying patients may make Mihir particularly attentive to the nuances of relating to very sick patients, but many other surgeons I spoke with also described their struggles to construct an emotional stance toward patients consistent with professional care. This is one of the most difficult and neglected aspects of the hidden curriculum to embody because it entails learning how to manage one’s own emotions and how to read, sometimes from unarticulated cues, what a patient needs. No textbook or formal program can teach such things. Interacting with patients requires another form of medical judgment, one that depends upon a physician’s ability to sense a patient’s emotions and the physician’s own response.

From Prentice, Rachel. 2013. Bodies in Formation: An Ethnography of Anatomy and Surgery Education. Durham, NC: Duke University Press.

The quote (p. 127) comes from a section called “Emotional surgeons” on how trainees learn to relate emotionally with suffering patients

This is sometimes called the hidden curriculum.

This quote (Prentice, 2013: 110) is from the chapter, “Cultivating the physician’s body,” which examines how much of medical learning involves “adopting values, styles of practice, and techniques that are rarely invoked as explicit curricular objectives” (p. 105).

----------

Extra notes:

Here are other options for potential quotes to put here:

“A 90-year old woman came into the operating room with a ruptured aortic aneurysm. The surgeon and I were the first to arrive, and I got to assist. It was a very bloody surgery, and around 10 bags of blood were used. […] Later during the procedure, she (the patient) suffered a cardiac arrest, and the surgeons needed to conduct a cardiopulmonary resuscitation and managed to start the heart. They covered the operation area […] and could not finish the surgery that day. I did not get any follow-up, and no one asked me how I felt. I don’t know what happened to her, but it all felt macabre, and the surgery was probably unnecessary since she hadn’t a very good chance of surviving. It was a rough atmosphere. […] It would have been good to discuss the ethical aspects of performing this surgery on a 90-year old person who was severely ill.” (43, medical student, final year) cited from this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952306/

Or this quote from Prentice (2013: 103)

“’There is no syllabus,’ complained a first-year surgery resident. After graduating from a Middle Eastern medical school, the resident, who I will call Dr. Amal Nassif, had been on a general surgery rotation for three weeks and had not been in North America for much longer. We were sitting at a nurse’s station outside several surgery suites, waiting for anesthesiologists to finish prepping the next patient. Amal’s first weeks had been disorienting and frustrating, he said. When he was on call, he was on call for four surgery services, handling about forty-five patients. The next resident up the hierarchy from him handled only twenty. He asked how this could possibly make sense, his voice a mix of confusion and anger. Residents surgeons, and nurses told him what to do but rarely explained their reasons. When he asked senior residents and staff physicians whether this disorienting flurry of activity was typical, they told him, “This is the shit I went through. Now you’ve got to go through it.’”

Surgeons often use the phrase “good hands” to describe other surgeons’ abilities. Several surgeons told me the phrase rarely means technical skills when applied to medical students and beginning residents because they have yet to develop technical abilities. Dr. Anna Wilson, a hand surgeon, indicated that, with juniors, the phrase indicates someone who is adept at working within the social and organizational structures of the operating room by reading up on a case beforehand, showing up on time, and knowing when to ask questions and when to challenge the senior surgeon. Juniors who demonstrate that they understand surgery’s unstated social and organizational rules, especially those who earn reputations as “stars,” typically have more opportunities to operate, giving them more possibilities of becoming technically superior.

47 of 48

HUMAN DEVELOPMENTAL STAGES

Kegan, R. (1982) The Evolving Self. Problem and Process in Human Development. Boston, MA: Harvard Business Review Press.

Robert Kegan’s first major academic contribution was his research of human developmental stages. This text will attempt to summarize this work, which drives all his subsequent efforts.

The fundamental idea is that there are different paradigms of consciousness that people go through as they mature. What is vital to understand is that human development does not stop when one turns into an adult.

humans have the capacity to develop significantly after their teenage years. Kegan’s theory of human development is one of the most accessible of these theories that include adult development as well. He himself uses the three stages of his framework for his work in organizations: the socialized, the self-authoring and the self-transforming mind.

The Socialized Mind is able to live in stable relationship with others in a community. Identity and roles are determined by local culture, which also means that one is subject to the opinions of others and wants to please them through telling them what they want to hear. This institutional stage relies on authority to say what beliefs are right, which one will then loyally follower. “I am my relationships, I follow the rules”

The Self-Authoring Mind can take a step back from one’s surroundings and upbringing and regard them critically. One forms one’s owns judgments based on the evidence that is provided. As a result, one is “self-authoring” an identity that is independent of one’s environment. At this inter-individual stage, one can appreciate that others have a different yet equally valid value systems. “I have an identity, I make Choices”

The Self-Transforming Mind is able to look at multiple value-systems simultaneously and evaluate which one is suitable for this occasion. One is wary of any single right ideology, even if it is one’s own that is based on reason. This multi-frame perspective is able to hold the contradictions between competing belief systems and can become comfortable with the dialectic between systems of thought. “I hold many identities, I embrace paradox”

Kegan, R. (2003). In over our heads: the mental demands of modern life. Cambridge, MA: Harvard University Press.

Kegan, R., & Lahey, L. L. (2009). Immunity to change: how to overcome it and unlock potential in yourself and your organization. Boston, MA: Harvard Business Press.

Kegan, R. (2013) The Further Reaches of Adult Development. [Video File] Retrieved in October 2017 from https://www.thersa.org/discover/videos/event-videos/2013/05/thoughts-on-the-self-transforming-mind-.

Kegan, R., Lahey, L. L., & Miller, M. L. (2016). An everyone culture: becoming a deliberately developmental organization. Boston, MA: Harvard Business Review Press.

48 of 48

I-RESTORE Summer Research Opportunities

(all with asynchronous content from ASC provided)

8 weeks

(Summer Research Fellowship)

Application process and selection process (Feb 1 due)

Stipend award provided if selected

Minimum of 240 hours

Required poster presentation in March of MS2 year

Progress report due at end of 8 weeks (evaluated)

4 week (Summer Research Selective)

120 hours

Progress report due at end of 4 weeks signed by mentor

Optional poster day presentation

Research

Saul Schaefer

Students have opportunities to work with PIs on research projects