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A medical student RISEs to our health system’s environmental challenges

“Not in my operating room” he told me, with an air of finality. I had just finished pitching initial plans to address the absence of environmental sustainability at Michigan Medicine, but it wasn’t going well.

Through inefficient energy use and waste production, Michigan Medicine, like many other health systems in the U.S., is straining our planet’s ability to support human life. Daily, we are inundated with news about the climate crisis, so we take care to recycle and turn off the lights when leaving a room, but research shows that to truly create a sustainable society, larger systems, like Michigan Medicine, will have to undergo significant transformation in their daily practices. Even small changes at enormous institutions can have exponential impact–and yet, change is very difficult.

I first observed this problem during my surgery rotation, but in the turmoil of my clerkship year, I was limited to just observing what I considered wasteful and inefficient practices. Now, with the freedom of the Branches I was going to address it, head on. After finishing my clerkship year, I spent months I reviewing the literature, studying hospital trends, surveying employees, and evaluating possible solutions used by other hospitals around the country. Finally, I had an action plan. The first step was unveiling the plan to a surgeon mentor, the mentor; a faculty member well-known to medical students for providing the resources and inspiration to transform medicine. But after listening to my plan his reaction was lukewarm at best.

I was deflated, frustrated, and admittedly maybe even a little unsurprised. It felt as though my hard work researching, observing, and developing solutions had been futile. I started to question if these goals were even aligned with a thriving health system. Maybe if the rest of society made big changes, health systems wouldn’t need to be environmentally sustainable. On that day, I couldn’t yet see what the future would bring but since then, I’ve continued to learn a lot about the challenge of transformation. Here are some of my most important lessons:

  1. Find your allies. I discovered over the next months that many of my fellow medical students were also thinking about the problem of environmental sustainability in the health system. We had been working in silos and had reached the same lack of enthusiasm from the faculty we approached.  A common message we all received was: “I agree personally with your position, but we have other priorities at this time.” We decided that we could achieve much more through collective efforts, so we formed White Coats for Planetary Health (WCPH). After drafting our vision, we invited members of the medical student body to a meeting to gauge interest in this topic and mobilize support and the result was inspiring. More than 10% of the UMMS student body expressed their interest, and many of them showed up physically ready to help us mobilize our efforts.
  2. Take unlikely chances. In the midst of this student support, RISE (which you can check out here) announced a funding opportunity arose to use “educational practices and interventions to address key health issues currently facing society”. We decided WCPH needed to expand its vision. RISE seeks to empower passionate faculty, staff, and students at Michigan Medicine, to pursue ideas which could positively transform human health through medical education. We imagined what might be possible if this grant award and associated support could create formal curriculum in sustainability and climate change for medical students. We could empower an entire cohort of medical trainees to take mitigating and adaptive action in the complex to curb the negative impact of environment on human health. In a few short months, the work of six dedicated medical students had created a group, developed collective goals, found diverse support, and made headway in challenging current systems. I began to understand that the ripple effect of hundreds of trainees engaging sustainability in their future careers could be enormous.
  3. Persistence is a form of leadership. As a medical student, you learn to be comfortable following. Yet medical students will soon transition to residency and eventually the practice of medicine and need to become leaders to create new solutions for the diverse and evolving challenges we will encounter in our daily work. Newly invigorated by my fellow student allies, I met with the surgeon mentor again, determined to sway him with evidence of student support. As it turned out, that deflating conversation several months prior, had been a pivot point for him. After our meeting, he started observing hospital’s practices, reading the literature and engaging with experts abroad. His perspective had taken a radical turn, and now he wanted to know how we could make change faster.
  4. Challenge yourself to develop adaptive expertise. Adaptive expertise, as compared to ‘routine expertise’, is the ability to use trans-disciplinary knowledge to innovate solutions for novel challenges.[1] This expertise is desperately needed in a modern health system where health professionals must adapt to change, generate new knowledge about complex systems, and direct it at improvement of self and work environment. As we move toward change in healthcare, we are often limited by real and (perceived) constraints. RISE is attempting to challenge those constraints in health sciences education in order to transform our current system of science, health, and healthcare delivery.

When a physician with great impact and influence told me “no”, the standard medical student response may have been to take note of an ‘incorrect’ answer. But instead, I persisted in order to address a real problem in our medical school and health system. Along the way, I learned about the importance of allies in confronting the status quo, the unexpected opportunities of taking big chances, and the uncomfortable challenges of leadership and adaptive expertise. Through all of this I’ve realized the power of perseverance–because transformation is rarely linear.

Look forward to a future post about our progress making our health system more environmentally sustainable in the new year!

[1] Bell E, Horton G, Blashki G, Seidel BM. Climate change: could it help develop ‘adaptive expertise’?. Advances in health sciences education. 2012 May 1;17(2):211-24.

My journey to a research year in global health

My journey to a research year in global health

Are you a prospective medical student wondering how you can incorporate global health into your medical school career? Are you a current medical student considering a research year or a dual degree? Or maybe you are one of my family members who wants to better understand why I am living in Uganda for a year? Here is a bit more information about how I decided to take a year away from medical school to pursue global health research.

Global and public health are the passions that brought me into medicine. My mother immigrated to the US from Venezuela, and I grew up hearing stories that compared her life in Venezuela to my life in the US. From a young age, I was acutely aware of my own privilege and of global health disparities. I expected that I would get a Master’s in Public Health (MPH) during medical school, so much so that I applied to several dual degree MD/MPH programs in addition to MD programs.

My mentors came to Kampala and gave a talk on mentorship! Pictured are Dr. Kolars, Dr. Moyer, Catherine and Hilda.

During my clerkship year, I had two important realizations: (1) I absolutely love clinical medicine, and (2) I miss the global and public health roots that brought me into medicine. Armed with the knowledge that I made the right career choice, but also eager to learn about ways to diversify my future career and incorporate global and public health, I consulted multiple mentors. Pivotal insight came from a peer mentor, a fellow medical student, who had applied to multiple research fellowships as well as MPH programs for her gap year. It was invaluable to hear about her thought process, how she approached researching each program, and what she did to be successful in her applications. The University of Michigan Medical School invests in teaching medical students about mentorship and leadership, and my mentors were pivotal in helping me think through my gap year plans and successfully apply to a research fellowship.

In retrospect, I am glad that I did not have to decide about a dual degree during my first year of medical school. The experiences during my clerkships heavily influenced my thinking about the gap year. As I checked in with myself during the clerkships, I realized that I loved working again and learning on the job. I felt so much fulfillment from studying material that directly applied to my patients. I also realized that I struggled to focus during our three-hour lectures on Friday afternoons, and I didn’t feel as much eagerness to return to the classroom just yet. Another important factor for me was, and is, cost. I only explored fully funded programs, including funded research years and MPH scholarships.

At the NIH in Bethesda, Maryland for the Fogarty Orientation!

Ultimately, I learned of the NIH Fogarty International Center global health research fellowship through my mentors. The fellowship is a 12-month global health research training program for post-doctorate and doctoral trainees in the health professions. It is awarded through the University of Michigan, which is part of the Northern Pacific Global Health (NPGH) Fogarty research fellow consortium that includes the Universities of Washington, Hawaii, Indiana and Minnesota. Respective projects range from researching the continuum of care for triple negative breast cancer to diagnostic algorithms for tuberculosis meningitis to community-based death investigation of childhood mortality. What excited me most about the Fogarty program is that it would allow me to genuinely delve into global health research, own my project from start to finish, get on-the-ground experience, and have the space to reflect on what I want my career path to look like going forward. During my research about the Fogarty program, I felt that the fellows and program directors strived to approach global health research in an ethical, collaborative and sustainable manner.

Mentor team meeting in Kampala with Dr. Cheryl Moyer, left, and Dr. Peter Waiswa, center.

In order to apply, I had to find a research mentor based at the University of Michigan as well as a local research mentor based in one of the consortium’s partner countries. Next, I had to develop a project with my mentors, write a research proposal, and outline my previous experience in research and working abroad. I prioritized finding an excellent mentorship team because my prior research experiences taught me that mentorship can not only influence the success of the project, but also can define the extent of my personal growth and learning. Since I was in the midst of my core clerkships, I met potential mentors during the evenings and on my days off. I found that dedicating specific time and energy to networking with and identifying faculty who would be best positioned as well as willing to support me was an invaluable step of the application process. I am fortunate to have found a phenomenal research triad in Dr. Cheryl Moyer, Dr. Peter Waiswa and Dr. Joseph Kolars.

Many people asked me why I did not consider a two-month away rotation with a small research component instead. The short answer is I didn’t feel that would adequately allow me to reach my goals. I preferred to seek an immersive experience where I could fully own a project, learn research skills while directly applying them to my project, and gain an intimate understanding for what it takes to conduct global health research. My journey to the Fogarty fellowship required me to reflect on what I want and how I learn best. I can confidently say I made the right decision. I am incredibly grateful to the University of Michigan Medical School and the Fogarty International Center for the opportunity to pursue my passions.

Stay tuned for another blog next year with updates about my research project!

Snapshot of rooftops in Kampala