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Christy Porucznik: We're sitting here at the AAMC conference in Nashville in 2022. My name is Christy Porucznik. I'm the Vice Dean for Faculty at the Spencer Fox Eccles School of Medicine. Happened to run into one of our family medicine graduates who's here attending the conference. Introduce yourself.

Jake Prunuske: Hey. Thanks, Christy. I'm Jake Prunuske. I'm an academic family doc currently serving as the Assistant Dean for Clinical Learning at the Medical College of Wisconsin's, Central Wisconsin campus.

Christy: Great. I'm so glad to see you here. So one of our themes that we're talking about at the conference today is what are you building? What are you doing that's new? So what I want to ask you is what are you looking forward to doing to build something new in academic medicine?

Jake: Yeah. We have a lot that we've been doing. We're a relatively new campus, now about seven years old, and we have a regional mission to make doctors who want to serve central and northern Wisconsin and parts around. The need right now is greatest in family medicine, to a lesser degree internal medicine and peds, and, of course, psychiatry.

One of the things we're looking forward to that's new is our Pathways Programs, trying to help people get into medicine. Right now, less than 5% of applicants to medical schools are from rural areas, even though 20% of the U.S. population lives in rural places. And so we have this mismatch between the physicians we're creating and the physicians our communities need.

It's really hard to take someone who grew up in a big city and is used to a certain lifestyle and have them practice in a rural or remote area. So we're really trying to build our pathways for students who grew up in rural areas to become physicians.

The other thing we're looking forward to that's new is really working on equity and diversity and inclusion. Some of that is a rural-urban disparity.

Christy: For sure.

Jake: But we're also looking at other aspects of diversity, really intentionally trying to meet a local need. So about 15% of our community is Hmong, and we're trying to build a pathway program that's actually starting in middle school to help our Hmong students become physicians as well.

Christy: That's really, really interesting. And you might think that it's strange that . . . In some ways, Utah and Wisconsin are so far apart, but we have really similar issues. We have a lot of rural areas where people have lack of access to health care in part because it's hard to get people to be there. And one of our missions with . . . We have rural outreach as well. So it's fun, and it's nice to think about what ideas we can share to be better together.

Mitch: The Scope is here at the AAMC Learn Serve Lead 2022 conference, and we are having conversations about how we can build from the ground up when it comes to medicine, medical care, and academics when it comes to health.

And so, in the effort to continue these types of conversations that we are loving having here at the floor, we're joined by Dr. Jose Rodriguez. He's the Associate Vice President for Equity, Diversity, and Inclusion for University of Utah Health, and a tenured professor for the Department of Family and Preventative Medicine.

As well as a second-year medical student from U of U Health, Moroni Lopez, who is one of two student representatives here at AAMC.

So when it comes to medical education, like how we're training our future doctors, we have a student here. You're in your second year. You're going to be deciding residency sooner than you'll realize, right?

Moroni: Yep.

Mitch: What are some of the ways that we can start to approach this differently, that we can start to change the way we do things?

Dr. Rodriguez: When we think about change, we've got to think a little bit about where we've been. And Moroni here is part of one of the most diverse classes in the history of University of Utah School of Medicine.

Mitch: Wow.

Dr. Rodriguez: And the class that's behind him is actually more diverse than the class that he's in.

Mitch: Oh, wow.

Dr. Rodriguez: And we're making strides in this area in a way that hasn't been seen before. Now, as a diversity officer, I would say that the strides are wonderful, but that we cannot rest on our laurels. Moroni, why don't you tell us a little bit about how you see the diversity of your class and how you see it helping your education.

Moroni: Yeah, I think as the curriculum's been moving along, a lot of the education that is designed for us in our preclinical years is meant to be a lot of team-based learning, a lot of problem-based learning, a lot of collaborating. And I think being able to make sure that within each one of these teams we have diverse thought, we have diverse viewpoints, it' crucial.

I think even when we go through and talk about a patient case, there are some things that I might pick up on, whether the patient is mentioned as being an immigrant, things that have to do with their social determinants of health that I might pick up on because of my experiences, or that my other classmates might have picked up on because of their diverse experiences, that the other members of the team just might not have thought of.

And I think being able to do that and integrate that into every part of our core curriculum as we move forward in our medical education is important so that every one of these future doctors can not just think, "Okay, there's a case. This is what the presentation of a disease looks like," but they can expand it to a more comprehensive and holistic view of a patient and how to best help them.

Dr. Rodriguez: You're talking about how people see each other, right? And I think that's an important part, and I think that's really what makes the diversity of medical school classes important.

Because as you get through this . . . I don't want to call it a traumatic experience, but it certainly is difficult. And for a lot of people, it's the hardest thing that you've ever done in your lives. As you go through this, you bond to your classmates in a different way than you would've bonded to your classmates in, say, undergrad or in high school.

And the way you see your classmates is how you'll end up seeing your patients. And so the more diversity that there is that's visible in your class, the better it's going to be for all of the participants.

We're here at AAMC, and yesterday we heard from Professor Cornel West, who I thought was magnificent in his delivery of the messages. And one of the things that he said that'll always stick with me is he said, "I've got to learn how to love your crooked self with my crooked heart." And I think that's a beautiful quote, because what it recognizes is that in all of our difference, we have some things that make us exactly the same.

And another AAMC lesson that I've learned recently is . . . Last year they had the author of the book "The Sum of Us." That's professor McGhee. And that book talks about how anti-black racism is bad for everybody, including those of us who do not identify as black.

I read that book after she came, and I have to tell you that it struck me how they talked about some of the betrayals that have happened in places that are considered to be very religious.

And one of the things that happened many, many years ago that nobody has the blame for is that we have dismissed a biblical teaching. Now, I know this isn’t a religious space, but I want to say this because it's so important.

Lots of Christian churches were complicit in things like racism, slavery, the Holocaust, Jim Crow laws, all of these things, and the reason was because of a fundamental disconnect. And the disconnect was that they took what is a fundamental and founding principle of their religion and ignored it, and that is the image of God, that all of us as humans are in the image of God.

I think, "My goodness, that seems so religious." But what it says to me in a non-religious sense is that we are all part of the same family, and until we can figure out how to live together as a family, we're not going to get better at eliminating health disparities. We're not going to get better at making education accessible to all.

And so I think about my career and I think about what you're going to do. Why don't you share with us, Moroni, some of the things that you're planning on doing with your career?

Moroni: Yeah. So right now what I'm planning on is I want to become a family medicine doctor, and I want to work in a clinic that predominantly has a lot of underrepresented populations within it.

I grew up myself as an immigrant here in Salt Lake Valley, and my family didn't have access to health care for the longest time just because we couldn't afford it. And so I think for me to be able to turn around and provide a lot of this access to a lot of the families that are where my family was many years ago is very crucial to my personal mission and to a lot of what I stand for when I think of moving forward as a physician.

Dr. Rodriguez: That, my friend, is music to my ears. As a family physician, that makes me so happy. And that is actually one of the things that I've found most fulfilling in my job, is that I still can see patients at Redwood Health Center where I'm an Associate Medical Director, but I also work with a lot of new American populations.

So, as you can imagine, the largest population that I see is the Latino population, and I don't really have to speak English ever at work because my MAs, my front desk, the other providers I work with are all bilingual in Spanish. So it creates community, and it creates a space where our patients feel welcome. And I think we need to figure out how we can get you to be at Redwood for your longitudinal integrated curriculum.

Moroni: That's the key.

Mitch: Well, I had a question, I guess. When I hear you two talking about this idea of community, of seeing one another as human beings, etc., how does representation play into that? Why is it so important that we have those different types of ideas when it comes to providing better care, when it comes to providing better education? How does representation get involved into the community of medicine as a larger goal?

Moroni: For me, I think bringing it back to this conference, our leadership speaker for today, he was talking to us about you can only be what you can see. And for me, that's been playing very true.

I don't know where I got the idea . . . well, I do . . . of becoming a doctor because nobody in my family is a physician. But I knew that I wanted to serve my community and I wanted to really do things that would change the future of my community. And I was very passionate about health care and I couldn't see Latino physicians in my community, right?

And I think to that point of the representation, I remember when I got accepted to the University of Utah, seeing Dr. Rodriguez for the first time on a Zoom call, because it was COVID still. I saw Rodriguez and I thought, "There is a Latino physician in my health system? This is amazing." And I've been trying to catch up with him ever since because I now see what I can be.

And I'm not saying he's the one that's telling me to become a family medicine physician, but it definitely helps to see someone who's taken those exact steps, who understands a lot of my background because he's been where I've been, but also he can show me how I can be a really good version of what I want to be.

Dr. Rodriguez: Well, thank you, Moroni. That's a nice thing to say.

I will tell you that you're absolutely right about you have to see it to be it. My parents are both Puerto Rican. They emigrated from the island just a few months, really, before I was born, and we went to this place in Upstate New York. But my mother and my father were adamant about making sure that we saw Latino physicians. So we didn't see one in our community. We had to drive a half an hour, 45 minutes to the only Cuban doctor around. So it was never a question of if I could do it because my providers were Latino.

And this is an important point because I think that's why even in administrative work and even in academic medicine, those of us who identify as underrepresented or as historically excluded, we feel obligated to be in the community, to be those beacons so that people can come. So thank you for sharing that.

The other reason why diversity matters is when I think about what skill set you need to graduate from medicine in, you need to have the skill set to be able to see lots and lots of different patients.

Mitch: Oh, sure. Yeah.

Dr. Rodriguez: And I have to tell you that we understood that the population was changing before Moroni was born. All right? We knew this.

Moroni: You anticipated me.

Mitch: Yeah, you're quite young.

Dr. Rodriguez: For a long, long time. And the way we were going to do it is we were just going to teach the existing physicians to be culturally competent. But unfortunately, cultural competence has made us nicer doctors, but it has not done anything to address deficiencies, disparities, and inequities in health care.

But what does work and what there's evidence for is racial concordance, guys. When your physician, your provider looks like you, you are more likely to do what the provider says and to get the preventative services that you need. And that's huge, right?

So this is about making things fair. And so, as we move on, we're going to see lots of changes in the Supreme Court decisions. We're going to see lots of decisions on race and ethnicity and including it in admissions. The bottom line is that the value of having a diverse class doesn't change because of a Supreme Court decision, and we have an obligation as physicians and as leaders to work towards the elimination of inequities.

Moroni: Yeah. I think one more point, and it goes back to the Redwood Clinic, right? The physician is the leader of this health team, but when you have every single member of that health team also being able to identify and to connect with all your patients, you can actually streamline a lot of that as well, right? Because it's not the physician that's working with that patient 100% of the time. You're dealing with the entire health team.

And I think for me, it's . . . I mean, also seeing my mother who at 50 years old went back, got her nursing degree, and now she's working in that setting, right? In all of the layers of that health team, to be able to know that there are bilingual and multicultural people, and diverse thoughts within an entire health team helps both provide that security, I think, for the patients, for those families, and it provides that extra foresight sometimes as to how to really help and work with a patient that might be culturally different from what we're used to, from what we're taught maybe in the books of medicine, and things like that.

Dr. Rodriguez: I couldn't agree with you more. I'm very much excited about what the future can bring for us. Utah is changing and it's changing quickly, and the University of Utah has seen it and we're changing as well. And I think what we'll see in the future is we'll see more diversity of our physician providers, but we will also see it in other specialties.

As you know, in our School of Medicine, we have the number two public program for physician assistants in the country. What you might not know is that it is by far the most diverse class of physician assistants outside of a historically black school.

Mitch: Oh, wow.

Dr. Rodriguez: And so you've got to think about that out loud. We're in Utah, we're not known for our diversity, yet this is what's happening. And at a time when physician assistant education is becoming actually less diverse as far as students, our program is changing, and that's in the School of Medicine. And because they work so closely with our MD program, that's changing as well. So it's an exciting time to be here. And being here with students like Moroni makes me happy.

Mitch: I couldn't agree more, having had these amazing conversations with the people who've come.

Moroni, I'm so excited to hear the kinds of things that you're saying and to hear how . . . I'm looking forward to seeing how you can help change medicine.

Moroni, Dr. Rodriguez, thank you so much for joining us here.

Again, this is The Scope at the AAMC 2022 Learn Serve Lead conference, and we are having discussions about how to improve medicine from the ground up. If you would like to hear more of our conversations, you can visit the website, uofuhealth.org/aamc22, or visit thescoperadio.com. Thank you guys.

Dr. Rodriguez: Thank you.

Moroni: Thank you.

Mitch: We are The Scope here at the AAMC Learn Serve Lead 2022 Conference, and we are having conversations about the future of medicine as a whole, how we educate, how we heal, how we treat, and the conversations are from the ground up. What are we doing to kind of completely change some of our approaches, our values? What it means to care and to be a part of medicine.

Today, we are joined by Dr. Adina Kalet. She is the Director of the Robert D. and Patricia E. Kern Institute for Transformation of Medical Education at the Medical College of Wisconsin. And Dr. Tom Hurtado, fellow podcaster from the University of Utah. He runs a great show called "The RealMD." Why don't you tell us a little bit about "The RealMD"?

Dr. Hurtado: "The RealMD" program is a professional identity formation program at Spencer Fox Eccles School of Medicine at the University of Utah. We focus on developing meaning, community, and purpose with our medical students. And we do that through sessions that we have with physicians, a workbook, and we also have a robust coaching program.

Mitch: So, I think what we kind of wanted to just talk about today is what are some of the ways that we can get into the actual core values of medical education and how that in turn changes medicine as a whole, the kind of doctors we can expect, etc.

Dr. Kalet, how are you guys kind of approaching that and trying to solve that?

Dr. Kalet: So, one of the wonderful things about being in the profession of medicine is that we have a foundation in character and caring that's ancient. It goes back to Aristotle, Hippocrates. So, it's not controversial to center character and caring in the training of physicians, but we have drifted . . .

Dr. Hurtado: Oh, I like that word, drifted.

Dr. Kalet: . . . away from that, I think, as the profession became more science-based, more technology-enhanced. And so, now it's a matter of returning to our core values, our core principles while we prepare young people to serve the public's health as physicians.

It's not controversial. It's just challenging. It's hard to do. There's a lot to do. It takes many, many years to make a good physician, to become a physician.

I would love to talk to you about professional identity formation. It's a developmental process. It starts very young and continues through to the end of your career, and it's always evolving and changing.

Dr. Hurtado: This idea of drifting, I guess I'm very intrigued by what you're saying. And it makes perfect sense that these aren't things . . . These fundamental things we're talking about that need to happen in medicine are not new, but we have drifted, we've forgotten. And the word that comes to my mind is, "What are we doing to reawaken these things?" These things we know to be a part of who we are as humans and also as, I think, care providers.

I mean, there are things underneath all of that. People have been caring for people forever, right? So, I guess my question that comes to my mind is, "What are you doing to reawaken people?"

Dr. Kalet: I think part of it is working with medical students very early on, even before they become medical students. People come to us with pure motivations, commitment, and potentially an understanding of what that requires, even as very young people. They just don't have any life experience.

And our goal, I think, is to vaccinate them, to protect them from the loss of their ideals, and what motivates them initially to enter a very, very challenging educational training process that takes a decade at the least. And so, to make that kind of commitment to be the kind of young person who wants to be a physician is a remarkable thing.

You work with medical students. Medical students are among our top 1% of American students.

Dr. Hurtado: Right.

Dr. Kalet: They're academically superstars. They're capable of great things. We just want to keep them connected with the why. 

Dr. Hurtado: Yes. I love this conversation so much. The thing in the literature that I've . . . In my work arriving at the point of starting medical school with more feelings of autonomy and then immediately starting to lose those feelings of autonomy, or engaging or not engaging in help-seeking, so becoming help-avoidant, to not want to appear vulnerable in the system, I look at, "Oh, those are just recipes for . . ."

Dr. Kalet: For the loss of ideals.

Dr. Hurtado: For the loss of ideals.

Dr. Kalet: The loss of values. Right.

Dr. Hurtado: Yeah.

Dr. Kalet: And because it's so competitive to get into medical school, we often select them based on their individual ability to perform.

Dr. Hurtado: Yes.

Dr. Kalet: What I say to medical students during orientation to medical school is, "That's what got you here, being a remarkable individual performer, but it's not what we need you to aspire to as a physician. You need to aspire to care for others, to do things in service of others." And that's not an abhorrent thing. We're just changing the rules, and we have to align medical school structure with that.

Dr. Hurtado: Exactly. That's what we talk about in orientation too. We say, "Look, obviously there's a knowledge and skill delivery that needs to happen here. And the body of knowledge that you're expected to remember and regurgitate on demand continues to grow and evolve and change."

Dr. Kalet: Right. And you have to figure out how to do that.

Dr. Hurtado: And you have to figure out how to do that. I get that. But the part where it really connects with me around professional identity development is this idea of keeping your meaning and purpose, and having a learning environment that supports meaning and purpose. And that is, to me, the other half.

I mean, maybe it's too bold to say that, but the other half of that education experience, whatever is happening, the touchstone that you must always come back to is "Why are you here, and who are you? Who are you becoming? And as you start to think, act, and feel like a physician, are you driven and connected to that higher purpose? And are you exploring that?"

I know that's nascent for a lot of them, that's a lot to ask, but it's creating a conversation that you hope as . . . Professional identity formation is this iterative process over time. If you can commit yourself to a process of meaning-making . . . 

Dr. Kalet: Right. Well, you just quoted the Cruesses, right?

Dr. Hurtado: I did. I should cite Cruess and Cruess.

Dr. Kalet: Anything by Cruess and Cruess. So, we've worked on a measure of professional identity formation, which is based on essays called "The Professional Identity Essay," where we ask students to answer nine prompts. We do it during orientation in medical school.

And those essays are analyzed for the structure of the language they use to explain to us why they want to be a physician. Basically, what we want them to be able to do is move from a place in their identity formation where they're looking outside of themselves.

Dr. Hurtado: External sources.

Dr. Kalet: Right. For rules and regulations about what it means to be a doctor to the point where they internalize that, and it becomes who they are, and they look inside themselves.

We can measure that. We know by the time they come to us very many of our medical students already have internalized . . . Many of them, not all of them. But over time during medical school, more and more and more of them become more mature. They're more internalized.

So, anything we can do to enhance that process by talking with them, by giving them opportunities to reflect, by giving them opportunities to talk to each other, to challenge each other about the why, the meaning, the reason they're spending so many hours a week learning molecular biology, and why that matters.

And we want them to meet the patients whose lives they're going to impact early in their career so that they understand the context why they're doing what they're doing, the purpose of it, the meaning of it, and to meet role models that embrace the best.

Dr. Hurtado: Positive role models.

Dr. Kalet: The best of what our profession has to offer. To also meet people who have stumbled and fallen. The idea of productive failure is something we talk about a lot, which is if you want to be an expert, which we have no choice as physicians but to strive to be experts, then you're going to have to push yourself until you fail. And you're going to have to learn how to learn from that.

Dr. Hurtado: And that goes against all of their training.

Dr. Kalet: Up until that point.

Dr. Hurtado: Up until that point.

Dr. Kalet: Right.

Dr. Hurtado: And yet in this moment you're saying, "Not only are we going to academically challenge you maybe more than you ever have been in a sustained way, but we're also going to ask you to find productive ways to fail or learn from your failures."

Dr. Kalet: And learn from every moment of that failure. And to do it together in teams with more senior, more junior people so that we're, as a profession, supporting each other. That's a model that is not in the traditional curriculum.

Dr. Hurtado: No, it's not.

Dr. Kalet: But it increasingly is in new versions of what we're doing. And at the AAMC-related medical schools, there are many great examples.

Mitch: And to be as kind of this outsider lay person, we have a show called "Bundle of Hers," and it's all about diverse women in medical school and their experience. One of the most responded to, listened to, the most emails we've ever got was an episode where we interviewed someone who failed out of medical school. And it was just transformative for these people. They were so fascinated to hear, "Oh, failure is okay. Failure is a part of learning."

Dr. Kalet: You survive.

Mitch: And so, just hearing how much people resonate with that idea and the fact that that's one of the key values that you're bringing in, that is going to mean so much to so many people.

Dr. Kalet: And the ancient philosophers had lots to say about that. This is not news, right? I can't quote it, unfortunately, but in the Kern Institute, we have a philosophies lab. We have a Philosophies of Medical Education Transformation lab because we want people thinking deeply about the ancient wisdoms, about the new psychology and cognitive psychology that suggests that in order to do this kind of work, which is so emotionally challenging and so intellectually challenging, to do it at your best possible level for your entire career. I mean, there's no room for error in what we do, and yet errors occur. And so, you have to manage all of that.

So, to prepare young adults for that takes attention to them as individuals. And I agree, I think the failure and survival stories are the most important ones.

Dr. Hurtado: Yeah. In "The RealMD" program, it's an acronym, and the E in "Real" is for excellence. And I think on the surface, people think, "Well, the traditional definition of excellence is obviously just perfection."

Dr. Kalet: Perfection in performance, but it's not.

Mitch:  Success, success, success.

Dr. Hurtado: We redefine it. And one of the most popular episodes of "The RealMD Podcast" was from one of our students who was a fantastic student, but tried to match into ophthalmology and didn't the first time.

And what happened in that process after not matching and regrouping and doing a research year, doing a research fellowship, and then coming back to it, in this case was able to succeed, but it took a lot longer. Not the way that was intended.

I think, "What is excellence? Is excellence an outcome or is it a mindset to continue to try . . ."

Dr. Kalet: Of a process. Yeah.

Dr. Hurtado: And commit yourself to a process even when an unexpected failure happens, or multiple failures, or the road . . . Which is never linear. It's expected to be linear.

Mitch: For anyone. Not just medical students, right?

Dr. Kalet: Exactly.

Dr. Hurtado: The road is not linear.

Dr. Kalet: The problem with medical students is they're so special that they . . . Many of them make it to their mid-20s never having faced failure.

Dr. Hurtado: Exactly. And that makes them fragile.

Dr. Hurtado:It does.

Dr. Kalet: And in fact, my favorite medical students are the ones who have faced some very significant challenges and have recovered. They're often much, much more mature.

Dr. Hurtado: Right. The resilience is developed.

Dr. Kalet: It's definitely developed. But if you don't let students stumble with support, then they won't learn that resilience, I don't think. And then the worst thing happens, which is in real patient care situations where things are complicated and chaotic, they don't have all the tools they need.

Dr. Hurtado: So, what sorts of interventions are you doing to awaken this?

Dr. Kalet: So, we're reforming our curriculum at the Medical College of Wisconsin to move from almost an entirely lecture-based, or largely lecture-based, curriculum to one where students have to discuss cases with their peers and faculty as the major educational activity.

They have to learn on their own, they have to identify their own learning needs, and they have to meet their own learning needs. They get assessed frequently, but not at high stakes so that they get to monitor and be accountable for what they're learning and what they know.

They have to demonstrate that they can perform the skills of doctoring early, so in standardized patient exams, in all kinds of simulations. It's not only about knowing, but it's also about being able to do and implement.

We ask them to write a lot more than I ever did as a medical student. To write stories, write about themselves, to reflect with specificity on their own strengths and weaknesses.

Those are the sort of fundamentals. That's a difficult curriculum to design well, to implement well. It requires a lot of faculty support, faculty development. But fundamentally, we want to put the responsibility for learning in the hands of the learners.

Dr. Hurtado: Yeah. Self-directed.

Dr. Kalet: Right. And not infantilize them by lecturing at them and then testing them, which I think we did for way too long, and we need to stop doing.

Dr. Hurtado: Yeah. How did this awaken in you? I mean, we know how training was. We're still struggling to break free from. When did this happen for you? What was your aha moment for professional identity formation being something you were going to dedicate yourself to?

Dr. Kalet: How far back can I go?

Dr. Hurtado: Well, you're going to have to go back a little bit if I'm asking this kind of a question.

Dr. Kalet: So, I can tell you this. I grew up in a family of refugees and immigrants, who lived through some really hard things and they had illnesses as a consequence. And so, I was surrounded by people who really needed the kind of health care that they deserved, the kind of health care I hope my students and residents deliver, but they didn't get it.

And so, I was motivated early to try to understand what it means to be a physician in that situation. I had traditional education, but I had a handful of mentors along the way who didn't let me off the hook.

Dr. Hurtado: Yeah, and a positive role model challenges you too. It's not just someone that's bright and rosy all the time. It's someone who is invested in you.

Dr. Kalet: Right. Invested in you and understands it's about who you are as a person.

Dr. Hurtado: And has a growth mindset about you, about where you're going, and wants to challenge you to get there.

Dr. Kalet: Right. And so, I had motivation, and I had a handful of teachers who believed in me.

Dr. Hurtado: That's awesome.

Dr. Kalet: A small handful, but . . .

Dr. Hurtado: That's all it takes.

Dr. Kalet: Yeah. That was early on. And then my medical education, I had some innovative educators in there. Not most of them, but some. And then I wanted to make sure the future was better than what I had experienced in medical school. Can I tell you a story about remediation?

Dr. Hurtado: Please. Yes.

Dr. Kalet: So, I'm also a quant. I have a Master's in Public Health, and I studied epidemiology and biostats, so I like to count and measure things. And we did a standardized patient exam in our medical school that I worked in before. It was a top-tiered medical school.

And once you start measuring what students can do in terms of communication skills . . . That was my area of interest. I thought communication skills is our primary method for doctoring, and so I thought we should be assessing it rigorously and measuring it. When you assess and measure those things rigorously, it's not like woe begone. Not everybody is above average.

Dr. Hurtado: That's right.

Dr. Kalet: And you identify some students who disappoint you.

Once you get into medical school, it's very hard to not graduate. We tend to graduate everybody who we let in. And so, we started to realize it was our moral obligation to remediate the lower end of that curve, the groups of students who just weren't up to par yet.

And in that work of working with individual students who just weren't getting it yet, we learned a ton of information about what's remediable.

How to work with people who aren't there yet, how to work with people who don't have skills? That's easy. Just teach them the skills.

They don't know stuff? That's easy. You just teach them the stuff.

Don't want to, don't believe, might have attitudes that are not consistent with being a good doctor? That's more challenging, but still remediable in the sense that by challenging their ideas and their beliefs and engaging with them, you can bring them on board.

So, we ended up writing a book on remediation because it was a complicated topic. And the professional identity formation was in that last group, right? Everybody else was motivated and meant well, were good people, and they just needed to learn something. But the ones that weren't quite bought in of what this doctoring thing was . . . Why should people be altruistic? Is that real? I had medical students challenge me, "Can you really be altruistic?" I said, "Well, that's the expectation."

Dr. Hurtado: Yeah. The expectation is a higher purpose.

Dr. Kalet: Yeah. I mean, there are easier ways to make a living. 

Dr. Hurtado: Patients first. Yeah, that kind of thing.

Dr. Kalet: And those were those students I loved to talk to. And that's where the professional identity formation piece came in, which is they realized they hadn't yet internalized what it meant to be a physician. They were looking outside of themselves for someone else to tell them what to do and how to be. And that doesn't get you through too far.

Dr. Hurtado: Right. And then you look at what are the, let's say, career fulfillment outcomes for that person? And what are the patient care outcomes for the person who's treated by a person who's unfulfilled and burned out and experiencing mental illness maybe related to the struggle of becoming a physician?

Dr. Kalet: Right. If you don't really want it and you're not internally driven to do it, it's very hard to do it well.

Dr. Hurtado: Yeah. Where do you hope this is headed?

Dr. Kalet: Our mission at the Kern Institute is to transform medical education so that everybody is . . . so that the character and caring and confidence are obvious to everybody. Our vision is that all Americans will have physicians who care and have a character in a system that cares. Those are not the same, but they're related.

So I think, because of what we said at the beginning, this is fundamental to the profession. If you train good physicians, this should not be controversial. And we just have to figure out how to align the ideal with what is possible. 

Mitch: Dr. Kalet, Tom, thank you guys so much for coming and having that kind of discussion. I think all the things that I at least have been hearing from the AAMC at the AAMC floor is just how important it is for us to really go back to care, go back to what it means to be a human, go back to what it means to be healthy, right? It's really quite interesting that we've somehow gotten away from it. And as we're rebuilding from the ground up, what can we do to kind of incorporate these very real values? So, thank you so much for having a conversation about that here.

Again, if you enjoyed the conversation today and would like to hear more, the episodes from the AAMC floor can be found at uofuhealth.org/aamc22.

And if you just like health content, podcasts, etc., we've got "The RealMD." You can check that out, as well as thescoperadio.com where we have tons of short-form health information, a big library of content. If you have any questions, we have our best doctors there. As well as a bunch of podcasts, long-form shows, talk shows, narratives, etc. that might just tickle your fancy.

So, again, from the AAMC floor at the Learn Serve Lead 2022 Conference, this is The Scope.

Listen to our other AAMC conversations:
• Rethinking Population Health Care and Education
• Reducing the Distance Between Patient and Provider
• Doing the Work: EDI as a Shared Responsibility
• The Power of Diversity in Medicine
• Grappling with Post-Pandemic Burnout and Trauma

Mitch: We're here at the AAMC Learn Serve Lead Conference having conversations about how different organizations within academic medicine are rising up to meet the challenges of the modern world, and what's happening to improve equity, diversity, and inclusion within our organizations.

Today, we are joined by Nafisa Masud. She is a content specialist with University of Utah Health. We're also joined by Natasha Ovuoba. She's from Huntsman Cancer Institute and she is the Associate Director of Equity, Diversity, and Inclusion. As well as Abdulkhaliq Barbaar, who is the Director of Equity, Diversity, and Inclusion at the University of Utah Health.

So one of the things that we wanted to talk about here today is what is life like in our space dealing with burnout after COVID? The novel coronavirus came. It changed everything. We had the Black Lives Matter protests. We had marches and movements. We had press releases. Nafisa, you and I working on those press releases, trying to educate the public about things. It's now been years after that and we're . . . I don't know. For me, at least, it still feels like I'm dealing with burnout. My team is dealing with burnout.

What are you guys seeing in your own organizations? And what are you guys trying to do to acknowledge that experience, move forward? Yeah, let's just have a conversation about that.

Natasha: Yeah, you are not the only person dealing with burnout. An analogy that I like to think of is if you've ever been someone who is trying to zero-scape your yard, so to make it more eco-friendly, use less water, oftentimes you sort of change that grass, some of those flowers to rocks, or to concrete. And oftentimes, it might seem easy to just scrape up the grass and to just lay down some rocks and say, "Okay, I'm done." But then in a few months, especially as the weather warms up, you start seeing that grass, those weeds grow right back up through those rocks.

That, I think, is the moment where we are right now with our burnout. Because we've said, "Okay, we're through COVID. Vaccines are out. Boosters are out. We've got masks available. We're out of the crisis." But we've never laid down the tarp that is supposed to act as that block barrier for weeds to stop growing altogether.

So really, what we're experiencing right now with the trauma of COVID, with the trauma of the racial reckoning, we are experiencing this place of, "We're done. We did it. We hired the EDI teams and directors, and we don't have to worry about COVID." And our clinical staff, our operation staff is all going, "I never laid down that tarp. I never put in the barrier of protection to stop the pain and the hurt from creeping back up through my rocks."

Mitch: Sure. So we're still experiencing burnout. We're still having trauma responses. We're still dealing with those very real raw emotions. How about you, Nafisa? How are you feeling, I guess, after COVID?

Nafisa: Yeah, that's a big question. I think I find myself swinging on a pendulum where it feels like no time at all since COVID first hit, and at the same time, it feels like we've been doing this for years longer than we have.

And I think something that in a strange, twisted way has made me grateful is that COVID has forced me to reevaluate a lot of the practices that I had in place in my workplace. And also, just personally, I think realizing that in some ways the way that we were working, the way that we were communicating, the topics that we were focused on are just not sustainable, or it's not correct, or it's not accurate, or it's not inclusive.

And so that was an interesting awakening for me to realize that I have limitations. I have boundaries. And historically, that's been an issue for me to verbalize and to really put in place.

And then I think as far as the EDI sphere, it really has been an awakening in a lot of ways, not only to the issues that I think as a person of color you're aware of, but that you also now feel a responsibility to make others aware of and to devote more of your time and your communications to covering those topics.

So there definitely felt a greater sense of urgency and meaning to covering those topics. And I think in some ways it's great that we've had that momentum, but it was also a long time coming, and that's the difficult part.

Mitch: You and I both are working on the EDI group within our marketing and communication field, so I've seen some of the stuff that we've been trying to do and some of the great steps we've taken in one way or another.

One of the things I wonder just for you specifically as a content creator and promoter and so forth is what is the biggest shift pre- and post-COVID for you? I mean, we went in assuming one thing about what's going to happen in a pandemic, what's going to happen after a pandemic, and now we're spit out the other side. How has your strategy and your team's strategy changed?

Nafisa: Yeah, that's a good question. I think the biggest takeaway for me really is that our communications are not one-size-fits-all, and our decisions as a healthcare system are also not one-size-fits-all.

I think in the past, when we were rolling out a policy change or a program, it felt very one-dimensional. And in some ways now, I feel like we're more aware of the fact that health issues like COVID are affecting communities in vastly different ways. And it's also highlighting ways that they struggle to access care or be treated equitably when accessing care.

And so I think it's caused me to realize that when I'm creating any form of content, I cannot have just one goal and I cannot have one audience in mind, because it is so complex and so multi-dimensional. And I owe it to those audiences to really tailor our content and center them in a way that they haven't always been.

Mitch: Absolutely. I mean, one of the things that I find interesting is that we're part of a university, right? We're part of the public education arm, and now we're starting to really think and really, really devote time and energy and resources to making sure that everyone can understand us? I think that's a silver lining of everything that happened.

And how about you, Abdulkhaliq? What are some of the things that you've seen pre/post/after COVID? What's going on right now burnout-wise, and what is your group doing to recover?

Abdulkhaliq: Thank you so much, Mitch. And thank you, Nafisa and Natasha, for great points. I think working in the EDI space, burnout is a topic that we should always and constantly discuss with our teams. Because working in the EDI space trying to change policies, procedures, and practices, we are always swimming against the current.

Therefore, checking in with our team, how are they doing, how is the week going, before we even get into work, right? Just checking in, self-care. How are you taking care of yourself? How are you doing? It's critical to surviving in this type of space.

And what we have seen in the community . . . Because we are the bridge, right? I call myself a convener. We are the bridge between the community and the University of Utah Health. And we always constantly hear about how the leadership or the dominant group is advancing academically in health, all of that, compared to the minoritized groups. We hear that and we take that personally, right? So that checking with each other and asking each other how are we doing is critical.

Mitch: Sure. So when you say checking in, making sure they're not getting burned out, are you talking about just with day-to-day life, or with dealing with equity, diversity, and inclusion issues every day for your job?

Abdulkhaliq: Day-to-day life, right? What we do in the community and at home will affect how we perform at work. So we constantly have to check in about, "How is your weekend going?" Then after that, talk about work, right? Sometimes we forget about our other life, right? So that's what I'm talking about.

Mitch: Got you. So one of the things I want to ask the three of you is from your backgrounds, your personal experience, what are some of the good things that you think have happened since after we've come out of this situation and as we are trying to build from the ground up? Rebuild, right? That's kind of the take-home message that we're trying to do with some of these conversations. But what can we look forward to? What efforts are being made now? What are the good things that happened?

Abdulkhaliq: I was at a session today and they talked about how Congress has an act, Health, Equity, and Accountability Act of 2022. That happened because of COVID, I think. Now we recognize the . . . Actually, the silver lining of about COVID is we recognize the disparities in health, disparities in economics, disparities in communities, right? And now, we are hiring more health equity leaders within our universities and community to address those.

We have a long way to go, but now we see the disparities clearly and we are working to address it. We're not there yet, but we are working to address it.

Natasha: I was actually going to speak to a point that Abdulkhaliq said a little bit earlier, which is about finding these moments of significance with those who you're surrounded by.

And something that I have noticed outside of COVID . . . especially because we are still in this hybrid world. But before, we were only on Zoom, we were only on phone calls, and not able to make a lot of those face-to-face connections. Now, whenever I have the chance to be in an in-person meeting and there is that time to just grab a cup of coffee and sort of chat with people and say hi and ask how they're doing, it's given me the opportunity to really break up the mundane, maybe, of our everyday work and sort of just the coming in, clocking in, clocking out, and to be able to see my fellow co-workers as people.

And I think especially for equity, diversity, and inclusion work, especially that inclusion part, that belonging part, there's no way that you feel that sense of belonging if people don't see all aspects of you.

And so being able to connect with people in person now to ask them how they are, how their families are, what color they just painted their nails, whatever it might be, it's just that chance to maybe even move beyond the nurse title, or the researcher title, or the assistant title, and to just be able to connect and find common ground with my people, with my community.

Mitch: I like that a lot. I think that's something that I've experienced myself. It seems like beforehand, I was a content specialist, editor of podcasts, whatever. But we were all kind of forced into extraordinary circumstances, right? And all of a sudden, I care about what your hobbies are, co-worker of mine, because we're both human beings. I think that's really an interesting new foundation that we're building from, and it's very heartening to hear that other people are experiencing that too.

How about you, Nafisa?

Nafisa: I think related to what Natasha and Abdulkhaliq said, we are more . . . I think in our workplaces, we're being seen as more than the work that we do. And obviously, the source of that was not a positive way to learn that, but I think there was this overall focus on resilience and wellness.

The idea that your value does not just lie in the work that you do, and the content you create, and what you produce, but who you are and how you're feeling and how you can contribute to social space and not just a productive one. And so I thought that pivot has been really beautiful to see.

The idea that we see each other as not just colleagues and co-workers, but as friends and as neighbors, as cheesy as that sounds. We're not just productive, but it matters that you're well and that resources and programs are being put in place to ensure that employees and groups are well.

And then I think the other benefit is flexibility and adaptability, the transition to remote work, and allowing for more flexibility for different situations. And I can speak personally. I relocated less than six months ago and moved cross-country. The fact that I was able to do that, it's not something I ever considered . . .

I still have very strong connections with my co-workers, and we've found ways virtually . . . Even though it is so nice to be able to meet in person like this, we found ways to stay connected, to continue to strengthen those bonds and those partnerships without necessarily losing anything over the distance.

Natasha: If I can add in there, I am so glad that you said that because I don't want to sound like that person who sort of says, "Oh, yes, everybody should come back to work, because that's the most engaging way." You know what I mean? We need to do things that are healthy for each of us, because I think that's the way that we are able to show up the best each day in our work.

I think what is really, really important to understand is that even when we talk about right now, in this moment, this is health. I think sometimes we can think, "Oh, healthcare is just at the hospital, seeing the doctor, having the surgery." No. Health is our social health. Health is our educational health. Health is our financial health.

And so to hear moments, like you touching on that remote work and the benefit of remote and hybrid work, that is something that has been helpful. We've heard this across so many voices, across social media, you name it. So many people who have said, "It has been so much healthier for me to be able to work from home. It helps my anxiety. It helps me spend more time with my children because I don't have to spend an hour in the beginning of the day getting ready to leave to sit on the freeway for another hour. It helps me with my disability because, honestly, the building I was in was not quite that accessible anyway. And so now I can just start my day at home, and now I have all of the tools I need to do my job successfully."

I think it really is important to understand that all of our health is so individualized. And so when we talk here about our health and creating healthy outcomes and having health equity in our communities, we need to remember that it's not just who we see as patients crossing the threshold of our buildings. It's what we offer as employers, as professors, as members of our community, supporting other members of our community for their health goals.

Abdulkhaliq: And your children sometimes now will jump into the screen, right? And now we don't feel guilty. We don't feel guilty. Everyone will say hi to the children, right? So that's amazing. And that is another self-care. Feeling guilty eats up on you, but now we don't have to feel guilty about that. It's just liberating.

Mitch: Say someone is out there listening right now who's maybe at the AAMC or just any . . . If you're listening right now, one of the questions that I was wondering is if they're in an organization that is still struggling, if they're in an organization that is still having trouble with burnout and the aftermath of everything that's happened over the last few years, what would be one piece of advice that you would give them that has worked within your own teams, within your own lives, etc., to make sure they can meet that challenge of burnout?

Abdulkhaliq: Michael Good, our leader, last week said, "Organizations don't make change. People do." It's not the building, it's not the organization, it's not the system. People make changes. And we need to value our people. They are more than just workers, right? We need to value of who they are, what they do, the context they live in. We have to look at their supporting structures.

And also, there are two systems that people live in: their nurturing system, and sustaining system. The nurturing system is our family. If we don't have that, we struggle. And the sustaining system is the hospitals, our work, our schools, right? If those two do not support each other, we will struggle. Therefore, we have to look at people from that perspective and support them for who they are.

Natasha: Yes to all of that. I'll add this. And this comes from actually a session that I attended today at the AAMC conference, which was really around being a leader who can help solve problems. And I think to do that, you have to look beyond the obvious and practice a growth mindset. What does that look like looking beyond the obvious?

Sometimes we talk about in the EDI space, we don't have enough people of color, people of the LGBTQ+ community, people with disabilities. They aren't applying for school with us, they aren't applying for our jobs, whatever it might be, right? We talk about not having an adequate number of representation. Look beyond that, right?

If you have a candidate who applies for a job, you have a chance to talk to them, to see them, and you say, "They aren't quite there yet." Instead of just, "Well, we're going to hire the person with the most experience," can you go back to this candidate say, "Okay, you didn't get it this time. Let me help you"?

Or as a leader, if you have a team member who applies for another job, can you say, "Okay, you applied for this job that's a little bit different than what I thought"?

If Nafisa is applying for a job, which I'm not saying she is, but if Nafisa is applying for a job, it's not, "Oh my goodness, she wants to quit." It's, "Okay, I'm seeing a goal that she's showing me that she wants to accomplish." And then that growth mindset. How can I help her get there? Instead of, "Oh my gosh, we're losing a member of our team," it's, "How can I help her grow and get there?"

Or with the jobs when someone is trying to grow, how can I help someone develop the skills they need to get to be a vice president, a COO, a dean? What do I need to do to help them get there? Instead of the, "We can't do it," change that mindset to, "How can we do this? How can we work together for this?"

Nafisa: That's a great point. I think the advice that I would give to an organization that may be struggling with burnout is to focus less on resiliency and more on restoration.

And what I mean by that is many of the resources we got at the beginning of the pandemic, and those resources have changed over the years, focused on "What do you do when you're already past the point of burnout? How do you create wellness for yourself? How do you relieve stress? How do you process?"

That worked in the moment that we were in, but long-term I think we need to focus on the root of the problem and say, "Which of our policies are restoring our employees? How do we prevent the fact that they feel drained and burned down in the first place?"

So rather than fostering resiliency at the end of that process where they're already burnt out, what policies and programs do we have in place that are nourishing and nurturing our employees so that they never reach that point moving forward?

And obviously, speaking now, we have a lot of burnout and a lot of stress and trauma that we're still processing. But long-term looking to the future, how can we avoid that self-care revolution that I think was really necessary and make sure that if we were to enter into a situation like this, or as post-COVID continues, how are we nurturing our employees so that they're not reaching the state of burnout or the levels of burnout that they're currently at?  

Mitch: That is some great advice for I think any organization at any time really. When we're looking at building back after this particular event, we're looking at the end of COVID and what's next.

Abdulkhaliq, Natasha, and Nafisa, thank you so much for joining us. And if you're listening, there are plenty of other discussions here at the AAMC floor from University of Utah Health and The Scope at uofuhealth.org/aamc22. And if you're interested in any other health-related podcasts, talk shows, basic information, you can also hear more of me at thescoperadio.com.

Listen to our other AAMC conversations:
• Rethinking Population Health Care and Education
• Reducing the Distance Between Patient and Provider
• Doing the Work: EDI as a Shared Responsibility
• Personal Identity and the Philosophy of Caring
• The Power of Diversity in Medicine

Mitch:The Scope is here at the AAMC Learn Serve Lead conference. And we're trying to have these conversations about how we can build from the ground up when it comes to medicine, academic medicine, how we teach, the care we give, etc.

And today, carrying on these types of conversations, we are joined by Paloma Cariello. She is the Associate Dean of Equity Diversity Inclusion for the Spencer Fox Eccles School of Medicine. As well as April Mohanty. She is the Vice Chair of Equity, Diversity, and Inclusion for the Department of Internal Medicine. And Q, who is the Vice Chair for Justice, Equity, Diversity, and Inclusion for the Department of Pediatrics.

So, when it comes to how we promote these ideals of diversity, of equity, inclusion, and justice, whose responsibility is it? Is it the medical school? Is it the instructors'? It just seems like it's such a multifaceted, huge idea and it's important. But I guess one of the things that I would really love to hear from you three is . . . Paloma, whose responsibility is it?

Dr. Cariello:Thank you so much, Mitch. EDI work is shared responsibility. Everybody needs to own it, and it's at all different levels across the institution.

Almost two years ago now, I contacted all department chairs looking for a person to be the point of the contact and that we could work within each department. That partnership with the different departments led to the creation of the School of Medicine EDI Leadership Group, so we could unify the work across the school, share best practices, complement each other's efforts, and have greater harmony and alignment across the institution.

I deeply appreciate the thoughtful process that our two largest departments of Internal Medicine and Pediatrics have put into creating positions dedicated to the work, leading to the Vice Chair positions with support from the department. And now we have our outstanding colleagues here today that are leading those efforts in those departments.

So, I would love to hear from our vice chairs. They have been in the role now for a few months. How about barriers? What kind of personal barriers have you encountered/overcome with your EDI work? How has this type of work changed your perspective, and any lessons that you'd like to pass on to others?

Q:One of the hardest things for me to have faced is just recognizing how the systems of systemic racism and bias have affected my own identity and where I feel empowered and disempowered.

As a fully-grown adult, I don't like to think that I'm a victim of the systems around me. And so, recognizing that, despite that sort of fight against that characterization, it does still happen. And then to kind of the mental and the emotional work to process through that, I think that personally has been a hard challenge.

And I've been lucky enough to be surrounded by wonderful mentors and colleagues who have really helped to kind of lift me out of that space and encourage my voice. And as I've used my voice, I'm learning that that's a voice that's very much needed at the table, and it brings insight that otherwise would not exist. So I appreciate that.

One of the hardest things about EDI work is that it can end up being triggering. Because of the history of trauma to different populations, the conversation can end up isolating people from one another, when what are our effort is, is to build community and to build civil discourse.

The AAMC conference today is about conversations and discourse across different viewpoints. And I really appreciate the focus we need because I think as a country, there are ways in which we've been thrown apart, but we don't have to be. And figuring out how to lean into that space so that we can have healthy, productive learning conversations is one of the biggest challenges going forward. And how we build that language and that appreciation for one another's perspectives is one of the first steps.

Dr. Mohanty:For me, even though I feel like I've been steeped in this work as a health equity researcher and in my service work, I know I have my own implicit biases and my limitations and my understanding and knowledge and time are all rate-limiting steps that I struggle with. Further issues and understanding of those issues and resources are advancing at a pace that is challenging to keep pace with.

I've noted this as I've been working to establish our reproductive health task force. There's such excitement and energy to do everything quickly, but I also am working to be intentional and to pace myself.

"Cannot be what you cannot see," that's quoting Dr. Calhoun earlier today. We need a vision and a plan that is intentional about representing all who work here, all who we want to work here, and all who we serve. I want to make sure to work collaboratively. And with the size of our department, I don't want to proceed so quickly that I inadvertently miss out on the ideas, perspectives, and needs of those I'm working with to serve, including our inpatient and ambulatory care providers, trainees, staff, faculty, clinicians, and researchers alike.

I'm aiming to establish more lines of communications, including safe zones and engagement, to draw upon our collective voices, and experiences, and values. This is one of our main short-term goals for the reproductive health task force, in that often there isn't a need to reinvent the wheel. Instead, there's a need to build the infrastructure to support communication and collaboration.

Dr. Cariello:Thank you so much, April. How about you, Q? Any barriers or challenges that you're most focused on right now in your role as vice chair?

Q:I am blessed to be in a really big department with wonderful people who really believe in and support health equity. One of our biggest challenges is to figure out how to bring the people who are most interested in this work together.

Academic silos are not a foreign or new concept, and the work that is actually ahead is building that infrastructure to facilitate collaboration. The other work is figuring out how to encourage folks to look at the same data, but now through a different lens. A lens that can be very painful to look at, but still very much needed, because it speaks to a truth that we've been hiding for a long time.

And so, both of those are . . . I've mentioned culture before, but a cultural shift to kind of lean into this space and . . . I don't want to say enjoy, but recognize the uncomfortableness of it, but normalize it, so that we can move forward from this space together.

The effort from the School of Medicine and the infrastructure that's been built, including the leadership circle with all of the different departments and how we get together monthly, has been really wonderful and impactful for me, because it's helped me learn from other models and be able to use that leverage to share with my own community within my department ideas and steps forward, some steps small, some steps big that we can start taking.

Dr. Cariello:Thank you. And that leadership group has been one of my goals for a while, and it's here. It's live. So let's talk about positives. What are some projects or initiatives that are you most proud of or excited for in your work?

Dr. Mohanty:I'm really excited to advance our new and established leadership and mentoring programs that are mechanisms to prepare women and my colleagues from historically underrepresented groups for leadership and their careers in academic medicine, and to help build a community of belonging and support.

We have a Leadership Immersion program that will be launched this year to include representatives from each of our divisions, our 12 divisions. And also, the University Health Equity Leadership and Mentoring program now has the fifth cohort, among other opportunities like this.

Q:I'm actually just getting to know about all the different efforts and I'm hoping to build a platform so that the members of my own divisions and department can get together. So we're putting together a landscape of the different efforts from our members and our faculty, and with that, opportunities for collaboration and growth. So those are the next couple of steps for us.

Dr. Cariello:And looking for the future, what's your vision for the department, the school, the institution, and what kinds of changes would you like to see?

Q:Before my career at the University of Utah, I had a very pivotal moment. I was the chief at a freestanding health clinic, and we had both family medicine as well as internal medicine and pediatrics in that building with all layers of staff, MAs, RNs.

We'd been given some money to do a remodel, so we were excited about this. And my administrative chief and I sat together and spent hours working out a new floor plan.

And then we presented it to our community. And this involved a meeting that had all of our MAs, all of our RNs, all of our APCs, and our MDS, and MDOs. Within 45 minutes, the floor plan that we had put together and spent hours, they tore it apart. And at the end of 45 minutes working together, the product they came up with was infinitely better than any product I could have come up with alone.

And the learning point for me from that moment is you hire good people, you trust them to know their job, and you give them the opportunity to speak and improve upon it. As a leader and as a learner, you listen. And the product that comes out of that is better than anything you can do no matter what your IQ is, or whatever your siloed experience is.

I take that metaphor with me every day in my work with justice, equity, diversity, and inclusion, because there is absolutely no way I can protect myself against every single bias I have. I rely on my humility, and my ability to listen, and my ability to pull together a diverse team. And that team working together mitigates bias, innovates, and teaches forward.

So we just have to take that and move that forward, is the way I envision my leadership, but also the way I want us to think about diversity. Diversity isn't a "you should do it." Diversity actually improves your evolutionary potential. It also builds better healthcare products, and serves our community, and our faculty, and our students better. So, just as a principle of evolution and progress, that's what we need to be leaning into and be comfortable with.

Dr. Cariello:How about you, April? What is on the horizon at a department-level? Institution? What would you like to see happen?

Dr. Mohanty:I'm just excited to see us become an environment in which Equity, Diversity, and Inclusion is really embedded into our culture. And the Department of Internal Medicine really shares and is leading in EDI across our university.

I think inclusiveness is an area that we could really work to improve in our short-term and to ensure that all values feel that they can thrive and meaningfully contribute to team science and healthcare.

And I think that we really can work to cultivate inclusion for retention in parallel with working to diversify our workforce. It'd be irresponsible for us to bring those from underrepresented groups into our environment if it's not set for them to thrive in. And bringing them here can also help bring about those changes to our culture.

Dr. Cariello: When you wake up every day, every morning, what's most fulfilling about your work that makes you get out of bed and be excited about doing the work? And on the flip side, what is most frustrating that makes you lose motivation?

Dr. Mohanty:I think, for me, what's most fulfilling, again, is that internal drive to pay it forward. And also, it's incredibly fulfilling to work and serve my friends and colleagues in the Department of Internal Medicine and those in the EDI space within the University of Utah.

I think broadly we share similar values and I feel supported by my colleagues and their expertise, knowledge, resources, and passion in this space. And I'm confident that by partnering with them, we will be able to successfully advance our EDI initiatives.

Q:I'm excited to learn. Over the last two years what I've started to do is lean into the spaces that make me uncomfortable, and I use that as a guide.

When you look at Maslow's Hierarchy, you have at the bottom things like housing and food. And at the top of the triangle is that legacy you want to leave behind. Knowing and feeling that the work I'm doing is giving to others in an intangible, but really important abstract way, makes me feel really good because that's not something that is easily given or achieved. And so, to be a part of that bigger effort is very important.

But personally, every day, I wake up now and I think about what I don't know, and I lean into that. That for myself is a personal celebration of what we try to teach in medicine, which is lifelong learning and being comfortable in that space.

Dr. Cariello:Thank you both so much for talking to us today. It is great to see you succeed in your role. Progress has been slow, but things are moving. We are working on supporting more of the people that we have here at our institution so they can be successful and have a true feeling that they belong here and they belong at The U. The work is endless. Let's not lose momentum, and keep running the marathon. Thank you so much.

Mitch:April, Paloma, Q, thank you so much for joining us here at AAMC to talk to us a little bit about the future of medicine as a whole. I think some of the things that you guys shared is really an inspirational step for what we all can be doing to kind of take that shared responsibility when it comes to justice, equity, diversity, and inclusion. Thank you so much for joining us.

If you are listening and appreciating these conversations and want to hear more, you can visit uofuhealth.org/aamc22, or go ahead and visit us at thescoperadio.com, where not only do we have these very conversations but some great health information and some podcast series that just might catch your fancy. Again, thank you so much, guys. Thanks for being here.

Listen to our other AAMC conversations:
• Rethinking Population Health Care and Education
• Reducing the Distance Between Patient and Provider
• The Power of Diversity in Medicine
• Personal Identity and the Philosophy of Caring
• Grappling with Post-Pandemic Burnout and Trauma

My personal passion is: How do we figure out a way to value and measure the variety of indispensable contributions that our faculty make to schools of medicine? I'm working on how do we revise our retention, promotion, and tenure guidelines to reflect the diversity of things that faculty do that make medical schools fantastic.

My problem is: How do you capture excellence? How do you measure that your faculty member is excellent?

I think part of the barrier is we have a model, that everyone is comfortable in, that doesn't really work, which says there's only one way to demonstrate excellence and that is having NIH grants and publishing and discovery science.

I think the big challenge is to change the culture so that not that we say, "Educational scholarship isn't as good," rather that we say, "Wow, there are faculty doing amazing things that aren't related to NIH and discovery science." They're doing other kinds of scholarships, and we've known for 20 years that we should be counting those other kind of scholarship, and now we're going to change our culture so people say, "That's a really valuable activity."

What I see is that we now encourage people to follow their passion, which then transforms how patients get their care, which then transforms how healthy our population is. I think it's an opportunity to really take us back home and change fundamentally how we deliver health care, because I think everyone would agree it's not yet perfect.

For our leadership to be looking for members of our faculty who may not have leadership positions but who have innovative ideas and will be people who can change how we view our institution is really important.

As we really face this changing future, it's time for us to look deep inside and ask ourselves some fundamental questions about how we carry out our work. We have to hold close to our heart the core values and core purposes that are the essence of what we do in academic medicine, training the next generation of caregivers, carrying out the important biomedical and population research, caring for populations and individuals.

But how we do it can all change, and I think we have to start asking ourselves, how do we recognize and reward our researchers? Are we recognizing and rewarding the right things? We've had a tendency to focus on the RO1 or the independent scientist at the expense really of team science, or we acknowledge certain kinds of discovery as being more important than the science of integration or application.

In the education community, there are a number of questions. We use a four year time period to finish medical school. What are the skills that you need? Time should be a dependent variable, not the independent variable that determines how long medical school is.

We need to ask ourselves about cross training and residencies and across all the health professions. And then we have a lot of questions about how we deliver health care. We have traditions and structures. We tend to focus on inpatient care, but not as much on the continuum outpatient, skilled nursing, mental health, rehab. We really need to think more broadly about it.

So it's a time of reflection, of asking ourselves, why do we do things the way we do them, and if we did them differently could we do it better and as society is telling us, do it a lot cheaper? The challenge is, of course, that making change is difficult, it's painful. People often feel a sense of loss because they liked the way things are, but I think leaders have to step up and do it. Otherwise, somebody once said, "Lead, follow, or get out of the parade," and this is the time for leaders to step up and really be leaders.

Some of the most innovative things that we're thinking about right now are something referred to as milestones. So in the residency world, we're being able to now identify exactly where people are along a spectrum of skills in six different areas and with the idea and vision that as people meet those skills we can move them along the pathway and again get rid of the rigid timelines that we're currently married to.

For those of us who have been doing medical education for a long time, we know some people learn faster than others, and other people learn slower. The fact that we're facing a deficit of 90,000 physicians coming up here very soon in the next decade, we really need to be thinking about: How can we turn people out more quickly? How can we ensure that we get people in the pipeline, keep them in the pipeline, and then turn them out at the end?

The thought that keeps me up at night is probably that we're not using people's time effectively. Not just individual people, but thinking about the synergy that gets created when we bring the right people together.

Our universities without the people, the faculty, the staff, the students are really just a collection of buildings and equipment and material supplies. The people who are there are the ones who make all of this work. The faculty are incredibly dedicated people. They've made a commitment beyond just being practitioners within their own field. They've decided to come back and share that knowledge with learners.

I think we've got extraordinary potential, and the thought that we might be wasting any of that really does break my heart.

When you work in an environment like academic medicine, we have so many capable individuals, and you think about what they could do if you could get the right folks at the table at the right time to look at the kinds of problems we're facing. I think the solutions are out there. But we have to talk to each other. We have to build that shared knowledge based. We have to have that ability to catalyze one another's thinking to actually get these problems solved.

There's a saying in the medical school community that when you look at one medical school, you're looking at one school because they're all very unique. I believe that we are all very unique. But I also think that among us we have such common purpose that we really should be thinking about the things where we are catalysts for something together.

It's up to us to think about how to push the frontier about healthcare for people in the United States. So that's not about us just being unique. That's about us using our uniqueness to forge something better and stronger, and I think we've certainly got the capacity to do that.

Most people tend to think about diversity limiting it to race and ethnicity. So at Morehouse School of Medicine we intentionally recruit what we describe as academically diverse students. That means students who don't have the highest GPA or the highest MCAT. We know that if we can get those students who have had different life experiences, and if we can get them to perform just as well as students who have MCAT scores of 31 when they come in, we know that we are now creating a platform for greater success for those students, and for the patients they're going to be caring for.

This is something that I think that all academic health centers should be doing. We all have the responsibility for training the health care professionals that the nations needs. The upside of academically diverse students is that you're giving a broad opportunity for people to participate in the care of patients, the demographics of the nation are changing, and so if we're not responsive to that it's great to have great innovation, and technology, but if it's not useful to the people, then what's the benefit of it.