December 2024: A Holiday Message

The other day, something unexpected – one might even say shocking – happened. Our colleague and my good friend Khalil Ghanem came into my office, sat down, and said, “I have something to tell you that will shock you.” And shock me he did.

You see, Khalil went to his very first NFL football game at M&T Bank Stadium.

Khalil who doesn’t know anything or care anything about football… or sports.

What’s more shocking… he loved it.

He loved how the game brought people together… hugging, fist bumping and high-fiving. Khalil felt that in a country and in a world so divided, this was a place where people could cast their differences aside and experience solidarity and… well…. love.

Khalil got it.

And I was shocked.

I love this picture. It is a famous photograph of Larry Doby, the first Black player in Major League Baseball’s American League. Doby made his debut in July 1947, less than three months after Jackie Robinson broke MLB’s so-called color barrier. In Game 4 of the 1948 World Series, Larry Doby hit a monstrous home run that gave the Cleveland Indians a 2-1 victory over the Boston Braves. After the game, Doby and the winning pitcher Steve Gromek – that’s Gromek on the left – hugged with the most incredible and adorable ear-to-ear grins on their joyous faces. The picture was printed in newspapers all over the country, and it caused quite a stir.

Almost 50 years later, the NY Times quoted Doby’s comments about the picture, “I would always relate back to that whenever I was insulted or rejected from hotels. I'd always think about that picture. It would take away all the negatives.''

It is the kind of coming together that we see regularly in sports. It’s what we need at work, in life, and in the world. It’s what I wish you all this holiday season. 

November 2024: The 3,000 Hit Club

Pete Rose finished his career with 4,256 hits, more than any player in the history of Major League Baseball. His recent death – on September 30, 2024 – prompted me to review his remarkable career in The 3,000 Hit Club, a baseball book I keep in my office because it highlights an important lesson for teachers and mentors.

 Before I continue, two things to note for those who are not baseball fans.

First, to reach 3,000 hits in a career is an extraordinary feat. Indeed, only 33 players have reached this incredible milestone in baseball history. Second, a batting average – the number of hits divided by the number of at-bats – below .200 is bad, and one above .300 is excellent.

Pete Rose was successful right from the start. In fact, only 14 players had more hits than he did as a 22-year-old first-year player and, not surprisingly, he was named 1963 NL Rookie of the Year.

That’s remarkable, but what’s more remarkable is how unusual early success was for members of this elite club.

Legendary Tris Speaker hit .158 his first year and .220 his second. But no one gave up on him, and he wound up hitting .344 for his career. The great Willie Mays had only 1 hit in his first 26 at-bats and hit a paltry .236 in his second year. But no one quit on him, and he hit .345 his third year. George Brett hit .125 his first year. Lou Brock had only 1 hit in 11 bats his first season, a batting average of .091. Our own Cal Ripken had only 5 hits in 39 at-bats his first season, a batting average of .128.

Each time I pick up the book, I’m reminded how important it is not to give up on anyone who struggles in the beginning. Our students, residents, and fellows deserve – and should expect – teachers who are supportive, understanding, and patient. Many who start out slow will wind up making the Hall of Fame.

October 2024: Please Call Me Roy

The NY Times just reported that monkeys call each other by their names.

Marmosets Call Each Other By Name, Study Finds - The New York Times (nytimes.com)

It turns out that this is true of dolphins and elephants, as well, and likely many other animals.

The implication to me is clear: names are important.

At the beginning of the recent presidential debate, Kamala Harris walked over to Donald Trump, shook his hand, and said, “Kamala Harris.”

Why?

Names are important…  and her name has been deliberately mispronounced as a way to mock and diminish her.

I’m not being political here. I’m talking about the importance of names.

Journalist Mekita Rivas recently noted, “Our names quite literally identify us. In many ways, they legitimize us because they are our primary markers of identity…For immigrants and multiracial individuals in particular, our names—both given and inherited—are often a crucial entry point into our tapestry-like histories…Our name is where our story begins. And it deserves respect and reverence.”

What Trump Is Doing When He Mispronounces “Kamala” | Vogue

Names are important.

Our former Associate Dean for Diversity and Cultural Competence, Brian Gibbs, was once tasked with introducing me before a talk. He approached me beforehand and said, “Roy… I’ve been practicing the pronunciation of your last name all morning.” I told him that I appreciated that, but that it really didn’t matter to me. Brian said, “It matters to me. A person’s name is their identity.”

He gasped audibly as he introduced me as “steen” rather than “stine”.

I want to apologize in advance to anyone whose name I mispronounce. I can assure you it will never be deliberate.

And… if you’re comfortable, please call me Roy.

September 2024: The Future’s So Bright, I Gotta Wear Shades*

I was looking through The Johns Hopkins Hospital Osler Medical Service brochure that I received when I interviewed here for internship on December 16, 1985. Several things stood out to me, and I will note them here without editorializing.

The first is the consistent use of the pronoun “he” when referring to any physician, for example, “Although the intern is the pivotal member of the team, he functions with…” or “Nor does anyone take himself too seriously – to be considered unapproachable, his opinions not to be questioned, his judgments to be regarded as infallible.”

The second is the note that, “Each afternoon the x-rays of the patients on each unit are reviewed with the house staff by senior members of the Department of Radiology.”

The third is the highlighting of Medical Grand Rounds, “Each Saturday of the academic year (9:45 to 11:15 am Labor Day to Memorial Day).”

The fourth is the notation in the section on housing information that “In addition, the House Staff Wives’ Club is a source of useful information for off-campus housing in many areas of the city.”

The fifth is the salary, $19,250 at the time, equivalent to $53,322.73 today (vs. $70,176 for interns beginning this July).

Finally, the note that, “For the sports-minded, Baltimore offers year-round schedules of major professional sports, led by the Orioles, the perennial American League champs.”**

I have many comments about each of these, however some things are better just put out there for summer reading and reflection. And speaking of summer reflection, some will recall that we used to lie on the beach with suntan lotion that did not have any sunscreen. SPF 15 sunscreen really came into widespread use around the same time I began my internship in 1986.

Be safe out there!

*Song by Timbuk 3, released in – you guessed it – 1986

Timbuk 3 - The Future's So Bright (youtube.com)

**This will happen once again!

July 2024: Diversity in Medicine

In my final Reflections of the academic year, I’d like to highlight the amazing Convocation keynote address by Dr. Antonia Coello Novello, the first woman and first Hispanic person to serve as U.S. Surgeon General. In particular, I wanted to highlight the following statement:

“Meet as many people as you can, particularly those who don’t look like you. Realize that unless we make an effort to meet new people and learn new perspectives, our hidden biases and fears will only continue to slowly isolate us.

Recently, I visited another medical school and saw a photograph of their 1964 medical school class. It was striking. The color of every person’s coat in the picture matched their skin color… and I know that such a picture can be found at almost every medical school in the country.

Much has been written about the topic of diversity in medicine, and I will not attempt to summarize that here. Instead, I refer readers to an excellent article on the topic, “Diversity of the National Medical Student Body - Four Decades of Inequities” by Morris, et al. N Engl J Med 2021; 384:1661-1668 (https://doi.org/10.1056/nejmsr2028487).

I have always told medical and graduate students that novel insights into human health don’t result primarily from what goes on in research laboratories or hospital work rooms, but rather from casual conversations in the hallway and cafeteria, where individuals from different backgrounds, and with different lived experiences, talents, knowledge, skills, and perspectives meet and share their work and their stories. I believe it is these interactions that make Johns Hopkins the great place it is. Importantly, as Dr. Novello noted, it is the diversity of perspectives that make these interactions – and all of us – stronger.

June 2024: Sliding Doors

Sliding Doors is one of my favorite movies.

The film shows how the course of a person’s life often hinges on what may seem to be a trivial or even chance occurrence at the time. The movie depicts two dramatically different life courses of the main character depending on whether she catches or misses a subway train.

I have told many people how my own life course was altered by a single chance interaction. When I called Johns Hopkins to cancel my interview for internship, the kind and welcoming words of an administrative assistant in the residency program office led me to visit the program instead. If I had not spoken to her, my whole life course would have been different.

I think about a patient we admitted to the CCU with a heart attack one afternoon in July 1994 who sustained a cardiac arrest at 2 o’clock in the morning. The on-call resident heard the alarms and promptly defibrillated her. Even now, 30 years later, the patient and I often talk about how her entire life course would have been very different had that resident responded even just a minute or two later.

Why do I mention all this in my Reflections?

At a luncheon honoring several prominent SOM alumni a few years ago, each was asked to share an experience that changed the course of their lives, and every one told of a single interaction with a faculty member. It reminded me how our interactions – even ones that may appear inconsequential at the time – may have important effects on our learners’ lives and career trajectories.

May 2024: Invest in Medical Schools!

Several years ago, an article (Clin Orthop Relat Res 2021; 479:2587-2590) proclaimed, “Defund the Medical Schools!” The author, Dr. Joseph Bernstein, proposed “that private medical schools should be legally barred from charging tuition.”

Let me provide my perspective.

It would be great to eliminate medical school tuition… but the truth is that medical education is expensive, with most current estimates greater than $100,000 per student annually, far more than the cost of tuition. Even with philanthropic support, most medical schools must subsidize the cost of medical education through clinical activity. This creates a serious problem because the pressure on clinician-educators to see more patients comes at the expense of time spent teaching and mentoring students.

While “defunding medical schools” would make medical education more accessible, without funding from another source, medical schools would have to cut costs, resulting in a low touch “one size fits all” experience quite different from what today’s medical students need and deserve. A thoughtful, high touch curriculum and student experience tailored to evolving learner needs is also one that includes resources for academic support and student well-being; meaningful interactions with outstanding faculty; and opportunities to participate in research to improve human health. Moreover, faculty need protected time to enhance their skills in teaching; curriculum development; assessment and evaluation; and continuous quality improvement.

“Defund the Medical Schools” may be catchy, but we would do so at our peril.

My perspective may not be as catchy, but it makes far more sense:

Invest in Medical Schools and Medical Educators… and thereby invest in our students and our future.

April 2024: When Something Just Doesn't Make Sense

In medicine and science, we are trained to recognize patterns. Whether it’s interpreting an EKG or identifying patterns in massive datasets, pattern recognition is critical to being an outstanding physician or scientist. But we also have to be able to appreciate the anomaly… when something just doesn’t make sense.

On September 26, 1983 – during one of the most tense periods of the Cold War – 44-year-old Stanislav Petrov was monitoring the early-warning satellite system for the Soviet Air Defense Forces. Suddenly, the alarms went off, and Petrov observed what appeared to be several approaching U.S. nuclear-armed intercontinental ballistic missiles. He had been trained to recognize this pattern and to act immediately to alert his superiors to launch a counterattack.

But something just didn’t make sense.

And Petrov did something that could have cost him his job…or worse. He concluded it was a false alarm.

Petrov later explained, “I had a funny feeling in my gut...” and he was right: the satellite system misinterpreted the reflection of sun off clouds for missiles. Although Petrov is largely unknown, it is thought that his recognition that something just didn’t make sense avoided a large-scale nuclear war and that he “saved the world.”

So how do students, residents, clinical fellows, and postdoctoral research fellows learn to recognize patterns? By spending time in the lab, in the clinics, in the operating rooms, on the wards. And how do they learn to recognize when something just doesn’t make sense? The same way. There’s no other way to do it.

March 2024: Be Kind

At Johns Hopkins, people work hard to make the world a better place… and when people are not kind, the work is that much harder.

I thought about this when I watched the February 3^rd episode of Saturday Night Live. The host that night was Ayo Edebiri – a terrific young actress on The Bear, one of my favorite TV shows – and the musical guest was Jennifer Lopez. Of course, the two shared the stage, not unusual for the host and musical guest.

However, in this case it was… shall we say… interesting.

You see, in a podcast back in 2020, Ayo Edebiri said that J Lo was scamming the public into thinking she’s a good singer, “even though…she’s not singing for most of these songs.”

https://www.tmz.com/2024/02/02/the-bear-ayo-edebiri-trashed-jennifer-lopez-2020-podcast-snl-host/

And now four years later, here they were on SNL… sharing the same stage.

In the SNL episode, Ayo Edebiri played a contestant on a game show called “Why’d You Say It?” In the sketch, the host (played by Kenan Thompson) reads something posted on social media by each contestant and asks, “Why’d you say it?” When it’s Ayo Edebiri’s turn, she answers:

“OK, OK! We get it. It’s wrong to leave mean comments or post comments just for clout — or run your mouth on a podcast and you don’t consider the impact because you’re 24 and stupid… But I think I speak for everyone when I say, from now on, we’re going to be a lot more thoughtful about what we post online.”

The lesson?

Be kind. It helps people know their work is appreciated… and it makes it seem just a little less hard… and it will save you a lot of problems down the road.

February 2024: Soft Skills

There’s a lot of buzz out there about the importance of “soft skills” in STEM careers.

What are soft skills? The term refers to communication, teamwork, creativity, leadership, resilience, critical thinking, professionalism, emotional intelligence, and integrity.

Of note, experts say that soft skills have actually become more important in STEM careers with the advent of AI. In the Top 5 Education Trends in 2023, Forbes noted that soft skills, “are human skills that are unlikely to be replicated by machines anytime soon.” So what about the recent study that found that ChatGPT demonstrated more empathy than physicians (Ayers, et al. JAMA Intern Med 2023; 183:589-596)?

Here’s what I think. Machines may do well head-to-head against doctors because many doctors lack the so-called soft skills.

Let’s consider another recent study (Pollak, et al. JAMA Intern Med 2023; 183:544-553) that randomized cardiologists to either receive a coaching intervention on communication or not. Forget about the main results of the trial for a minute. Here’s the real takeaway: the control group of physicians expressed empathy in only 1 in 4 patient encounters!

I agree that it is unlikely that human skills will be replicated by machines anytime soon; the real question is whether they will be demonstrated by humans!

The bottom line is that the public feels that soft skills are really important in STEM careers. I think we all need to ask ourselves whether we are doing enough to teach and model them for the physicians and scientists we're training today.

 January 2024: Educators Save Lives

You’ll remember that early in the pandemic, people applauded and banged pots and pans for health professionals who were hailed as heroes… deservedly so in my view. It was obvious to all that people who care for patients save lives.

While the connection between education and saving lives may not be as obvious, I want to call your attention to a brief document published recently by the AAMC (https://www.aamc.org/media/33211/download) that shows that what each of us does as an educator does, in fact, save lives.

The document notes that patients do better when cared for at teaching hospitals like ours. While this may be due in part to the greater expertise, highly specialized services, and more advanced technology available at teaching hospitals, the AAMC also notes that, “Teaching hospitals are also the only places where patient care, medical education, and research converge. The intersection of these missions creates an environment that not only advances health care broadly but, as the studies suggest, also benefits individual patients.

So the next time you hear someone talking about the importance of clinical care and biomedical research to our mission, tell them you agree… and then tell them how education contributes. Tell them that the AAMC document notes that as a cardiologist, I have to treat many patients with blood pressure medications and blood thinners to save a single life. However, through your contribution to patient care as medical and biomedical educators, you pack an even greater punch. That’s right… education saves lives.

Happy New Year… hero!

December 2023: A Community of Educators

I’m sure most of us find ourselves reflecting daily on the events of our troubled world, our polarized country, and the challenges we face closer to home. It is difficult times like these that may make people retreat into their own world rather than reaching out to others they work and study with.

That got me thinking of a statement we are asked to respond to on many employee surveys:

“I have a best friend at work.”

Gallup notes that people who strongly agree with this statement are 7 times more engaged than others. They note that, “having a best friend at work has become more important since the start of the pandemic, even considering the dramatic increase in remote and hybrid work.” (Patel and Plowman, “The Increasing Importance of a Best Friend at Work” https://www.gallup.com/workplace/397058/increasing-importance-best-friend-work.aspx).

The concept of a “best friend” seems odd to me and makes me think of elementary school, and so I usually skip this question. However, I do have many close relationships with people who are part of a community of educators. We are brought together because we care about the same thing: the education and experience of students, residents, clinical fellows and postdoctoral research fellows who will improve human health, biomedical science, and the state of the world. I hope you feel that sense of community as well, and join me in feeling that the IEE Educators’ Corner is our community gathering place… a place for best friends… whatever that means.

November 2023: Elmer and Kipekee

Many know the children’s story about Elmer, the elephant who stood out from the drab gray herd because he was a patchwork of many bright colors. Elmer wasn’t happy being different and so he covered himself with elephant-colored berry juice. When he rejoined the herd, he blended in with all the other elephants, and no one was happy… not Elmer or the other elephants in the herd. After the rain washed the berry juice off, Elmer was again a patchwork of colors, and everyone was happy again. I always enjoyed reading this story to my kids when they were young because it helped illustrate the importance of diversity and the value of celebrating uniqueness.

I talk about Brené Brown’s work on the distinction between fitting in and belonging when I remind learners that they were recruited here because of their uniqueness and when I remind educators that our environment must allow learners to be the best version of themselves.

A few weeks ago, I read something that made this all come alive. On July 31, 2023, a giraffe named Kipekee (“unique” in Swahili) was born in a Tennessee zoo and is believed to be one of a kind… it has no spots and instead is a uniform brown color (https://www.theguardian.com/world/2023/aug/21/spotless-giraffe-tennessee-zoo?CMP=oth_b-aplnews_d-1).

So what do Elmer and Kipekee teach us? Diversity is critical both to the group and to personal well-being. As educators, it is our obligation to work every day to create an environment in which learners feel safe and comfortable demonstrating their unique characteristics.

October 2023: Walking the Walk

In 2018, the IEE’s inspirational director, Joe Cofrancesco (and several other authors you know well) published a peer-reviewed paper on the IEE (Teach Learn Med 2018; 30:103-111). Consider that for a moment… a work of educational scholarship about an institute dedicated to educational scholarship. That’s not just talking the talk; it’s walking the walk. Since then, the IEE has developed and implemented additional programs and events, and obtained additional resources to support medical and biomedical educators. I want to express my appreciation for the IEE and my admiration for all the amazing people who have walked the walk by contributing to all that the IEE offers.

Joe and his co-authors noted something important in that 2018 paper. Providing resources to support educators costs money. As they wrote, “It was clear from the beginning that additional, noninstitutional funding would be needed to support educational research and develop successful programming.” The importance of philanthropy to support education is part of our institutional DNA. A letter written by Johns Hopkins University President Daniel Coit Gilman in 1889 highlighted, “an opportunity to establish in Baltimore a school of medicine such as the world does not now possess; but it will take a considerable sum of money…” So even if there is not a Mary Elizabeth Garrett reading this today, I want to express the hope that you support the IEE in whatever way you can… creating educational resources, leading seminars and new programs, or providing funding to support those who do. Walk the walk.