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Michigan Trauma-Informed Medical Education (M-TIME): Using Evidence-Based Practices to Train the Next Generation of Physicians in Trauma-Informed Care

Before medical school, I worked as a crisis counselor at a domestic violence shelter in rural Michigan. I saw the lasting effects of trauma and its manifestations on health, and quickly realized my passion within medicine: trauma-informed care (TIC).

TIC is a framework of medical practice that promotes autonomy, safety, empowerment and healing, and that recognizes individuals are more likely than not to have experienced at least one traumatic event during their lifetime (to be exact, research shows 89% of U.S. adults have been exposed to trauma). TIC is essential for clinicians because trauma has been documented to have deleterious impacts on health; these events can lead to difficulty accessing medical care, remaining engaged in treatment plans, and feeling psychological safety when receiving care. 

At the Duderstadt Center on U-M’s engineering campus advocating for survivors of sexual violence.

Despite this, education on TIC in medical schools across the U.S. is largely absent, and upon starting my M1 year at UMMS, I quickly realized that our first-year clinical skills course did not include any instruction on TIC. However, a special characteristic about UMMS is how receptive the faculty and staff are to curricular improvement, especially regarding strengthening social justice and humanism as key pillars. The clinical skills course leadership immediately responded positively to my advocacy for inclusion of TIC in the curriculum, and asked me to use my prior work and research experience on trauma and TIC to design, implement and evaluate an evidence-based TIC workshop to be completed by all M1s in the fall of 2021. Excited to dive into this medical education project, I enrolled in the Scholarship of Learning and Teaching (SoLT) Path of Excellence program, which allowed me to engage in structured medical education training on a regular basis during my M1 year. 

The culture of mentorship at UMMS is second to none, and I had the pleasure of working on my project with the close mentorship of Dr. Lauren Owens, a faculty member in the Department of Obstetrics and Gynecology. In forming this team, known as Michigan Trauma-Informed Care Education (M-TIME), I also partnered with my incredible classmates Luca Borah, Stephanie Terrell and Elizabeth Erkkinen, each of whom has work experience in trauma-informed care as well. The foundation of our project involved working with LaTeesa James, a health sciences informationist at UMMS’s Taubman Health Sciences Library, to conduct a formal scoping review of the empirical literature on TIC curricula in the health professions. Sifting through more than 1800 articles, we identified the 51 articles meeting review inclusion criteria and quickly got to work synthesizing the strengths of these programs for use in the UMMS TIC workshop.

To support myself financially during the summer between M1 and M2 as I completed this project, I applied for and was awarded the $1,000 M1 Summer Impact Accelerator grant through the medical school. I also knew that part of my project would be designing a retrospective pre-post survey instrument to capture comprehensive data about the workshop’s efficacy and collect narrative feedback from the M1 students about areas for improvement. To maximize survey response rate, I was awarded a $2,000 Capstone for Impact grant through the medical school; this enabled me to provide a $10 gift card to a beloved local coffee shop, Sweetwaters Coffee and Tea, to every single M1 student who completed the survey after the TIC workshop. In implementing a participant survey, I also wrote and submitted an application to the university’s Institutional Review Board (IRB), the first of many IRB applications to come in my career. 

At the Nobel Peace Center in Oslo, Norway after giving a podium presentation at the European Conference on Domestic Violence.

The TIC workshop took place in October 2021 and was a huge success! The workshop components included: (1) a didactics portion emphasizing the link between trauma and health outcomes, best practices for trauma screening within patient encounters, and physician vicarious trauma; (2) a case-based session to practice TIC skills in small groups; and (3) a structured debrief. For statistical analysis of my survey instrument data, I partnered with a statistician at RISE (Research, Innovation, Education, Scholarship), a hub for medical education innovation at Michigan Medicine. I am so happy to share that 129 out of 170 M1 students completed the survey (75.9% response rate) and that our analysis illustrated statistically significant (p < 0.001) increases in students’ knowledge of TIC, intention to integrate TIC into their future clinical practice, and confidence in TIC skills. Moreover, narrative survey responses showed an overwhelming desire for increased curricular time devoted to TIC in the future. 

Now that the workshop has concluded, I have shifted my attention toward disseminating the results of this project and am beginning to conceptualize improvements to the TIC curriculum for next year’s entering class. With mentorship from Dr. Owens, I have written several first-author publications about this work, and have greatly enjoyed connecting with trainees and physicians around the country who also study TIC in medical education.

With my medical school partner in crime, classmate Jacqueline Lewy, who provided the most amazing support and sounding board as I completed my project.

The success of designing, implementing and evaluating an evidence-based curricular intervention for 170 first-year medical students relied upon the unique constellation of resources and support available to UMMS students, including: (1) the SoLT Path of Excellence and steady stream of individualized advice from enthusiastic Path advisors Drs. John Burkhardt, Dan Cronin, and Caren Stalburg; (2) LaTeesa James, a health sciences informationist at the Taubman Health Sciences Library; (3) the $1,000 provided by the M1 Summer Impact Accelerator and $2,000 provided by the Capstone for Impact grant; (4) the statisticians at RISE; (5) the mentorship by faculty member Dr. Owens; (6) the assistance of my classmates Luca Borah, Stephanie Terrell, and Elizabeth Erkkinen; and (7) the enthusiasm of the first-year clinical skills course staff for curricular innovation and improvement. 

All of this is to say that at the University of Michigan Medical School, if you can dream it, you can do it. The faculty and staff here at UMMS enthusiastically champion student projects — my TIC curricular intervention is a true testament to that.

An ASL Elective: Promoting Deaf Health at the University of Michigan

As I walked down the hallway of the University of Michigan hospital, a simple sign caught my eye. Taped to a patient’s door, the sign declared, “Patient uses American Sign Language (ASL)” in bold black letters. I entered the room, smiled and waved to the patient. His eyes met mine and quickly flickered away, as if I were there to speak with his daughter instead. His daughter explained he was deaf and did not communicate in spoken English. I turned to him, introduced myself and asked how he was doing. My hands and facial expressions flowed in synchrony to convey my intended emotions of interest and empathy. 

His eyes lit up in surprise as he recognized ASL. His arms and upper body sprang to life, clearly forming his hands and facial expressions to describe every detail leading up to his hospitalization. Our connection was instantaneous, bound by a language and a mutual appreciation for its community, culture and pride. He taught me that a simple conversation in a patient’s primary language can create a unique bond — a form of healing that extends beyond medical treatment.

My own ASL journey began fortuitously during my sophomore year at the University of Pennsylvania. I enrolled in my first ASL class to fulfill a social science requirement for my bioengineering degree. Little did I know, that first class would inspire me to take four semesters of ASL and pursue a lifelong mission to improve access to healthcare for people with disabilities.

Upon graduating from college, my budding interest in Deaf Health led me straight to Michigan Medicine — home to the Deaf Health Clinic. As a clinical research assistant, I worked closely with Drs. Michael McKee and Philip Zazove, both ASL-fluent physicians in the Family Medicine Department who established the Deaf Health Clinic. Through this work, McKee and Zazove became my mentors and support system as I explored the field of disability health.

With this new exposure to disability in medicine, I sought out disability-friendly institutions when applying to medical school. Fortunately, the University of Michigan Medical School (UMMS) had clearly shown its commitment to disability. From the learning specialist and mental health services to the faculty support from the Center for Disability Health and Wellness, UMMS offered many opportunities to further explore my interests in disability and Deaf health.

As a newly minted medical student, I recognized the need to expand disability inclusion in medical education. Very few medical schools prepare students to partner with Deaf patients, resulting in barriers to communication and adherence. Inspired by the life-changing impact of my ASL classes, I hoped to provide a similar experience for other medical students and increase the number of Deaf-friendly physicians. Thus, in January 2021, I began working with a diverse team of students, faculty and interpreters to establish an ASL elective for medical students.

Kate Panzer (left) and Professor Shields (right) show off their “GO BLUE” shirts at the final ASL class.

To start the process, we needed all hands on deck. Our team began brainstorming ideas, emailing school administrators and searching for funding sources. I sought advice from student leaders of the medical Mandarin and Spanish electives and pitched the course to a Zoom room filled with faculty. By June, the course was officially approved, allowing us to share the instructor job description on various social media platforms. After reviewing several resumes and interviewing applicants, we were fortunate to hire Professor Julia Shields — a Kalamazoo resident, experienced ASL instructor and member of the Deaf community.

The summer break proved to be an ideal time to prepare for the elective. I spent many hours working with Professor Shields on curriculum development and recruitment materials. After first-year medical students settled into the school year, I distributed information about the elective along with an interest form. With such a new elective, I was uncertain about the level of commitment we would receive. Thus, I was moved by the 44 students who completed the form, nearly one quarter of the first-year class! Although that number declined due to other passions and limited time, 22 enthusiastic medical students officially enrolled.

First-year medical students join Kate and Professor Shields for a class picture, posing with the sign for “I LOVE YOU.”

After ten months of planning and countless hours of preparation, the inaugural ASL elective developed into a 10-week course for first-year medical students to learn basic ASL and explore topics of Deaf culture and health inequities. During twice weekly in-person and virtual class sessions, students would leave behind their Anki flashcards and lecture slides to enter a quiet space filled with visual cues and hands-on learning. For many of the students, this class was their first exposure to ASL and Deaf culture and their first meaningful interaction with a Deaf ASL-user as the instructor.

Throughout the course, the students learned hundreds of signs, ranging from numbers and colors to holidays and medical terms. After learning basic ASL fingerspelling, vocabulary and grammar, they eagerly practiced by describing their family trees with neighboring classmates. They soaked in the stories shared by a Deaf Patient Panel and explored effective communication with a certified ASL interpreter. For the final exam, they studied with classmates and flexed their receptive skills on paper. These students took time from their busy schedules to participate in this class, and I am incredibly thankful for their interest and commitment to improving the healthcare experiences of Deaf patients.

Now that the course has come to an end, I’d like to share what I learned along the way. To anyone who hopes to develop a similar elective, here are three factors that are crucial to making it happen: (1) the team, (2) the institutional support and (3) the dedication.

THE TEAM
Our team consisted of six passionate members, including medical students, physicians, ASL interpreters and an instructor who all contributed their unique strengths. Drs. Michael McKee and Philip Zazove from the Deaf Health Clinic provided essential perspectives as ASL-fluent physicians, prominent disability advocates and Deaf individuals. Christa Moran and Leslie Pertz are both medical ASL interpreters with extensive experience bridging the communication gap between patients and providers. Julia Shields, an ASL instructor, brought several years of teaching experience and her lived experiences as a Deaf person. Dr. Alexa Minc, a fourth-year medical student at the time, contributed her institutional knowledge to obtain funding and administrative support. As a first- and second-year medical student, I led the processes of acquiring course approval, interviewing candidates, recruiting students and served as a Teaching Assistant for the elective. Overall, this course would not have been successful without the diversity of perspectives and experiences that each member brought to the team.

THE INSTITUTIONAL SUPPORT
In addition to a strong team, the ASL elective benefited from both financial and administrative support from UMMS. To obtain funding, Dr. Minc applied for a Capstone for Impact Grant. Such grants support capstone projects, which are a graduation requirement for all UMMS students. Once approved, this grant provided funding to compensate an ASL instructor for the 10-week elective. Additionally, I received an M1 Summer Impact Accelerator grant to develop and coordinate the ASL elective. Upon course approval, administrators assisted with setting up a Canvas course site and promoting the elective. This support from UMMS was an essential step in hiring an instructor and ensuring the course ran smoothly.

The classroom was filled with smiles as Professor Shields led a game to practice colors in ASL.

THE DEDICATION
From the early brainstorming sessions in January to the last class session in December, each and every person involved showed unwavering dedication to the elective. UMMS faculty and administrators helped to approve and sustain the technical operations. Team members stepped up to interview potential instructors and organize guest presentations. The ASL instructor developed a new curriculum and spent hours driving from Kalamazoo to Ann Arbor for in-person classes. Several students went above and beyond to request additional learning opportunities and expressed interest in a second ASL elective in the spring. These individuals truly embody the “Michigan Difference” that made this elective so special. 

So, what’s next for the ASL elective? My team is currently gathering student feedback to improve the course for future participants. This feedback will be central to gaining continued support from UMMS and obtaining consistent funding for an ASL instructor. By popular demand, we plan to offer the ASL elective each fall and develop a spring course that builds on students’ foundational knowledge. In the future, we hope to create educational opportunities for all medical students, faculty and staff at Michigan Medicine, and promote the development of similar electives at other institutions through presentations and publications.

The ASL elective has been a large stepping stone in my journey to improving access to health care for people with disabilities. Planning and implementing this course has made me feel challenged, humbled and supported. Various ASL students have told me that this course was a bright spot in their M1 year, which has warmed my heart tremendously. Most of all, I hope this course ultimately helps these students form unique connections with their future Deaf patients — a form of healing that extends beyond medical treatment.

A Med Student Discovers Scrunchie Power

Some days, even a third cup of coffee won’t do. Despite the intrinsic joys of being a member of a team providing life-altering medical care, medicine is hard. It can leave you tired and stuck in a pattern where days run together and routines become bland. Perhaps coupled with a few too few hours of sleep, not even the glorified stimulant caffeine can do much to add an extra pep in your step.

When I began my core clerkship rotations last year, I found myself in this mind numbing pattern after a few weeks of 5:00 am pre-rounding. I truly was loving being involved in patient care and learning ever-growing amounts of information daily, but something was missing. A newness, a joie de vivre, seemed to have been replaced by the early rounds and the frenetic scramble to pre-op between rounds, a quick breakfast, and the first surgical case of the day.

Stuck spinning my tires yet moving nowhere in this monotony, I realized it was time for change.

Enter scrunchies. On a rare day-off trip to Target with my mom, a pack of bright scrunchies stole my attention. The allure drew me in, despite having arrived at Target with intentions to purchase only a few household items (who hasn’t had this happen at Target, though…), and my money was spent before I even had a chance to consider it.

Early the next morning, pre-pre-rounding, I pulled my hair up into a ponytail and looked over my pack of bright, beaming, joyful, exciting, new scrunchies. I chose a hot pink one, looped it twice around my hair and sensed myself grow a few inches taller. I felt just like my scrunchie looked: bright, beaming, joyful, exciting, and new. No longer was today another day of the ordinary; it was hot pink scrunchie day.

Days of the clerkship continued to roll by, each punctuated by a scrunchie. Some days, perhaps days that I was on call and knew would last for many hours or days with feedback from attendings, called for even bolder scrunchies. A friend had sent me cheetah- and zebra-print scrunchies, perfect for when I needed to believe in my own ferocity. A bridesmaid gift from my cousin featured a yellow scrunchie that could be tied into a bow, perfect for when I needed a little more self-confidence. A black scrunchie helped me feel chic and ready to tackle a day in clinic.

Now having completed my core clinical clerkships, I am reflecting back on how my scrunchies have been with me through some of my greatest triumphs, most important lessons, and hardest days of medical school. They’ve been part of relationships with patients and friendships with peers. They’ve added a pep in my step that even a third cup of coffee couldn’t (although perhaps there is some synergy between that third cup and a scrunchie). They’ve helped me re-find my joie de vivre and learn that early morning rounds will never be able to take it away again.

As I approach my upcoming ICU rotation, I look forward to introducing a new pack of scrunchies into the rotation – these ones multicolored and composed of a variety of fabrics, as well as a purple one with a bow – to help mark each new day, accompany me as I learn and grow, support me through the challenging times, and add just a hint more pep with my coffee.

Tag Days – 95 Years of Giving Back while Growing Closer

M1 Cyrus and M2 Kayla tagging together during a shift on Thursday in the hospital

As a medical student here at the University of Michigan there are plenty of ways that we can give back to our community. From Wolverine Street Medicine, a group that provides healthcare to the homeless, to UMAC, a group that advocates for survivors of human rights abuses, to the dedicated students who run our Student-Run Free Clinic – helping others is in our blood. However – I might be a bit biased, but – no other event combines giving back to our community with as much fun, holiday cheer, and wacky tradition as Galens Tag Days.

What is Galens Tag Days, you ask? Tag Days is a large-scale fundraiser for children’s charities and organizations in our local county. Every year, medical students disperse throughout the hospital and the city wearing red ponchos and silly onesies. Looking like this, it’s hard for passersby to ignore our charming requests – and when they learn about our mission and the organizations we support, the donations come rolling in! 

Every year, we raise tens of thousands of dollars in small donations from generous Ann Arbor supporters, and in exchange they receive a fashionable red, green or *maize* tag that they can tie to their coat zipper or dog’s collar! Due to the Covid-19 pandemic, our yearly fundraiser was moved entirely online in 2020, so we were especially excited to be back in person this year!

Can you tell the faculty apart from the students in this picture snapped during Midnight Madness on Friday in downtown Ann Arbor?

In addition to supporting a great cause (For The Kids! is the slogan of Tag Days), there are other compelling reasons for medical students to get involved in this event. Our incredible medical school faculty and staff drive around the town in “Happy Vans” or pull a “Happy Wagon” around the hospital, distributing snacks and beverages to warm our bodies and spirits during our cold shifts outside. It certainly makes our attendings less intimidating on the wards after we’ve played several rounds of chubby bunny with them outside the hospital. 

Some faculty combinations have been going strong for years, and the competition between rival vans is real (I won’t name names, but this year there might have been a legendary van theft in the middle of a shift!) Happy Van Drivers include head of the pulmonary sequence for M1 students, transplant surgeons, and our very own Dean for Student Services, and it’s so special to get to know them in this unique context.

M3 Aaron and M2 Dana raising money For The Kids! on Saturday morning

In addition to creating lasting memories with your med school best friends, Tag Days also allows you another opportunity to get to know students in other classes. As an M1, sharing a tagging experience with an M4 can create a lifelong connection with a future IM physician at Penn or OB/GYN at Northwestern (speaking from experience here!)

So – we have an excuse to break away from UWorld, support a great cause, get to authentically know attendings and build friendships and memories across the medical school – what’s not to love? 

Although Tag Days 2021 is behind us (**online donations still accepted through December, details below), the most exciting part of this tradition is just around the corner! In January and February, we will allocate the funds raised during Tag Days 2020. That means we have the responsibility and privilege of distributing the nearly $80,000 that was raised last year!

Any puppy looks so much cuter with a Galens Tag hanging from their harness!

Organizations we have funded in the past include Girls Group, Children’s Literacy Network, Student Advocacy Center, and the Leslie Science and Nature Center, and some of the projects and events we helped fund can be found on our Instagram page. Stay tuned to see where this year’s donations will go!

**Interested in supporting Tag Days? Donations can be made online at https://www.gofundme.com/f/tagdays2021 or you can Venmo us @GalensTagDays. We’re getting close to our goal and every donation helps!

Advocating for Asylum-Seekers through Connections between the University of Michigan and Physicians for Human Rights

Dr. Hannah Janeway, ED physician and founder of Refugee Health Alliance (https://www.refugeehealthalliance.org/), provides medical care to a patient in the El Chaparral asylum-seeker camp in Tijuana, Mexico. Photo by Lisbeth Chavez (https://www.lisbethchavez.com/).

Thousands of tents lined the crowded streets. The sun was rising slowly on the horizon. At the end of the street stood a large white tent, hovering above the others. A physician and nurse sat in the shade that the tent provided. Quickly, hundreds of people began to line up in front of the tent, waiting to be seen by the health care providers. The doctor handed the coughing children honey, a rare treat that trickled down their lips and stuck to their hands. The children ran around the tent that we had set up, clinging onto my stethoscope and Physicians for Human Rights (PHR) badge. As I worked closely with Dr. Janeway to provide care to those seeking asylum at the border, I felt truly grateful to be a medical student at the University of Michigan.

Tents line the streets at the El Chaparral asylum-seeker camp in Tijuana, Mexico.

As a medical school applicant, I was drawn to the University of Michigan Medical School due to the wide array of opportunities for students to participate in volunteer activities and advocacy efforts. At Michigan, students are given many opportunities to explore advocacy both within the confines of Michigan Medicine and beyond. The school truly understands the importance of training the future generation of physician advocates.

Given my interest in advocating for immigrants, refugees, and asylum-seekers, I dove into advocacy opportunities my first year as a medical student by joining the Physicians for Human Rights student chapter, also known as the University of Michigan Asylum Collaborative. Specifically, I served as the Co-Executive Director of the Asylum Collaborative during my first year of medical school. During my first and second year of medical school, I also collaborated with attendings and other students in providing forensic evaluations for asylum-seekers; such evaluations document the physical and mental health effects of trauma endured by asylum-seekers and are subsequently used as an informative document in their asylum claims. During my first year, I also served a student leader in other student organizations, such as the Co-Community Engagement Director for the Health Equity Scholar’s Program (HESP).

Members of the 2018-2019 University of Michigan Asylum Collaborative (UMAC) Executive Board hosts a forensic evaluation training session for faculty and students at the University of Michigan

During my third year of medical school, I wanted to further explore the role of advocacy at the intersection of clinical care and research. I applied for an internship position with Physicians for Human Rights. As a Medical Student Intern, I helped develop and implement a research project to evaluate the mental health impact of family separation and expulsion among asylum-seekers in Mexico. The experience, particularly interviewing asylum-seekers in Tijuana and Ciudad Juarez, Mexico, granted a holistic picture of how the asylum process intersects with mental health. Our team then used these findings to generate a report for Physicians for Human Rights, titled “Neither Safety Nor Health: How Title 42 Expulsions Harm Health and Violate Rights.” This report was used to guide key advocacy efforts, such as in the creation of a letter to the CDC – signed by 1,383 medical professionals – requesting that the CDC reverse the Title 42 expulsions order at the US-Mexico Border. Our research was also referenced in recent media coverage by organizations such as Amnesty International, Mother Jones, and more. This opportunity was made possible through Michigan Medicine’s unwavering support, ranging from the support of amazing faculty, such as Dr. Michelle Heisler, to funding for the project via the Capstone For Impact Project grant.

PHR representative Cynthia Pompa (right) and I interview a 22-year-old mother from Guatemala who was seeking asylum for herself and her children. Photograph by Lisbeth Chavez (https://www.lisbethchavez.com/).

Now, I am a fourth-year medical student applying to psychiatry residency. In the future, I hope to serve as a psychiatrist who advocates on behalf of immigrants, refugees, and asylum-seekers. Pursuing training at Michigan Medicine fostered my interest in pursuing justice in the field of mental health. The opportunity to pursue such a diverse array of electives during my M3 and M4 year was critical in allowing me to get “on the ground” experience. Furthermore, having incredible mentors who supported my vision for advocacy – such as Dr. Michele Heisler — was critical in my success. I truly believe that pursuing my medical education at the University of Michigan granted me the skills and vision to serve as an effective advocate.

Closing the Premed Experience Gap through Early Clinical Opportunities

When I first considered medical school, I knew nothing about what I was getting myself into. I was a senior in high school ready to go halfway across the country to attend college. I really loved to travel, play volleyball, and play the cello. I also loved biology and somehow, I really don’t remember exactly what did it, I settled on medicine as a future career. I had no idea what was in store. My parents were both teachers, and they encouraged education in its highest form, but I didn’t have any role models in medicine growing up. My uncle is a physician, as are a few of my cousins, but they lived far away and I didn’t know much about what they did on a day-to-day basis. Some of my friends’ parents were doctors, but I didn’t understand or know enough to ask questions about what their lives looked like. All I knew was medicine could be a way to help make people’s lives better. I went off to college assuming I would figure it out at some point.

My roommates and I (center) on our first day of clinical year, trying on our new scrubs.

In college, premedical students were many and opportunities were few. Due to my interest in global health, I joined the International Studies major and was set off on a premedical track for non-STEM majors. I loved my classes, but I was mostly disconnected from other students considering medicine. I read online about how to get into medical school and realized I was woefully behind on experiences, so I tried to shadow or find research opportunities. When I tried to apply for an opportunity to shadow, I was rejected due to my lack of prior experience. When I looked into mentoring, I was greeted with wonderful premedical advisors but a paucity of current medical students and residents to talk to about their experiences. I left college with many more questions, hoping I would find some answers in medical school.

It is no secret that prospective medical students who don’t come from physician families are at a disadvantage. In 2015, the American Medical Association estimated that 1 in 5 medical students has a parent that is a physician. Besides financial advantage, having physicians in the family gives prospective students more opportunity to shadow, find research, and engage with the profession earlier than others. There is a resource to ask questions and create connections, as well as someone to bounce ideas off of when considering medical school. When I thought of medicine, all I had to go on was TV shows like Grey’s Anatomy and House, hyper-realistic portrayals of a profession filled with danger, drama, and intrigue. I knew little of the reality I would find in medical school.

At the University of Michigan Medical School, we are given so many opportunities to find ourselves in the clinical setting, interacting with real patients and providers. The school understands this differential that exists between those with and without doctors in their families, and they strive to close that gap with early programming and clinical experiences. A lot of my early exposure came from individuals that weren’t physicians. For example, as part of the Interprofessional Clinical Experience (now Interprofessional Collaborative Skills – ICS), I shadowed a social worker for a day of family meetings, getting to interact with patients and their loved ones during the hardest moments of their lives. I got to follow a patient advocate as they visited teenagers during chemotherapy, providing companionship, checking in on them, and answering questions about care. As I followed these professionals through the winding, confusing maze of the hospital I could finally see myself in these halls. I could see myself providing care to these patients one day, because now I knew what it might look like.

I also participated in the Clinical Reasoning Elective (CRE) as an M1. This experience allows first-year students to practice their clinical interviewing skills in pairs with support from a faculty mentor. Due to COVID-19, I only ended up completing one shift of the elective, but it was a memorable one. It was my first time in an emergency department, and it was a very busy day, full of trauma patients and beds lined up in the hallways. I was caught in the middle of a storm, overwhelmed by all the activity around me and unsure how to find my place in it all. In a valiant attempt to make me feel useful, my preceptor convinced me it was crucial to go into a patient’s room to listen to a heart murmur and ask about their medical history. I stood outside the door in the hallway for 15 minutes working up the courage to go inside, and once I made it in I spent 20 minutes stumbling over my words and embarrassing myself. Later, debriefing with my preceptor, I realized I had done a patient interview for the first time on a real patient. I was finally learning what life might be like as a physician.

My track on the last day of clinical year (Track G!)

Now, I am an M3 and have just finished my M2 clinical year, a whirlwind of patient care in hospitals and clinics around Ann Arbor. I have assisted with 8-hour long surgeries, delivered babies, diagnosed illness, counseled patients on lifestyle or dietary changes, and participated in so many lifechanging moments. This morning I walked into my first clinical day as an M3 and felt confident – I knew how to use our electronic medical record, I knew how to navigate the halls of the hospital, and I walked right in a patient’s room, after knocking of course. I am well on my way to becoming a physician that the high school version of myself would have not thought possible.

As a prospective student, it is okay to be overwhelmed and have a million unanswered questions. Here at Michigan, you will find the answers through early patient interaction, experience in the hospital, and clinical role models everywhere you turn. You will be part of a supportive, diverse community looking to lift each other up and full of career-changers, non-STEM majors, and those who had never known a single person in the health care field. You will find success through programs like the ICS and CRE, and you will one day find yourself as a mentor to premedical students that were in your shoes not too long ago.