Fall / Winter 2023
From the Editor
"Get yourself a good mentor."
That's a phrase we've all heard before, but what exactly does it mean? Why is it so important to have good mentors in medicine? Where do you find one? How can you tell if a mentor is right for you?
In the Fall / Winter 2023 edition of the Center for Humanism newsletter, members of the Cooper Medical School of Rowan University community explore these questions about mentorship in medicine. Their answers are funny, moving, and often surprising. You'll be glad you read them.
Read more below.
Not An Exclusive Word
Dr. Mary Kraemer
It has hit me as an exclusive word: "my mentor." Perhaps raised on one too many fairy tales, it either implied that one was worthy enough for another to take them under their wing -- or they needed rescue. I wanted neither.
I see now that mentoring is expansive. Mentors are all around, like all those things you see when you take a good, long look at the clouds. They are for me a mother, though decades gone, who tells me to find my joy and pursue it. A patient who told me that taking the time to sit and explain what is happening helped them more than any medicine. "Don’t ever stop doing that," they said. A friend who says, "Just try it on! I think it will look great on you," and pushes the boundaries of how I view my own possibilities. A partner who honestly tells me the hard truths, making himself vulnerable to my hard reactions. The work colleagues who guided me through the mazes of healthcare and academic medicine and pushed me to start, even if the destination was not completely clear.
They are the best pit crews. My advice: Look around. Stop waiting for a mentor to find or rescue you. Find who is shaping you, values your authentic self, pushes you – and trust them as mentors.
In Touch Over The Decades
Dr. Larry Weisberg
I first met Malcolm Cox when I was a first-year nephrology fellow at the Hospital of the University of Pennsylvania. Malcolm was a member of the faculty of the Renal-Electrolyte Section, as it was known at the time. The section was positively crawling with superb teachers. Malcolm was one of that august crowd.
When it came time for me to decide how to spend my second fellowship year, I chose to work in Malcolm’s lab from among the many productive labs in the section, because it was doing appealing research and he described the project so clearly.
That was one of the first things I learned from Malcolm: clarity of expression. He made complex concepts – like ion transport, short circuit current, and polyacrylamide gel electrophoresis – easily comprehensible. (It didn’t hurt that he had an elegant South African accent that was very pleasing to hear.) Writing was a big part of the work in the lab: grant proposals, research abstracts, manuscript reviews. He used his red pen exuberantly, through which he taught me to write with clarity. (I wrote two grant proposals under his red pen that year, and both were funded.)
Malcolm was a valuable research mentor, not just in the lab itself, but in the politics of research. He invited me to present my work at an international meeting as a second-year fellow, and through him I learned the value of networking in that sort of setting. Once Malcolm discovered I could write, he invited me to co-author quite a number of book chapters, some of which we wrote together many years after I had moved on to a faculty position elsewhere.
Malcolm left Penn and became dean for education at Harvard Medical School, during which time he inaugurated and edited the Medical Education section of the New England Journal of Medicine. Eventually, he became the chief academic affiliations officer for the US Department of Veterans Affairs, overseeing all medical education and training in the entire VA health system. We remained in close touch through the decades and I could always count on him for wise counsel as I navigated my career in academic medicine. Malcolm was a great and constant mentor.
It's Mrs. J. For Me
Dr. Nowai Brapoh
When health care providers think of mentors, we often think about those who have impacted our professional careers. A senior nurse who took us under their wing; a manager who showed us the ropes; a physician who offered sage advice. While I’ve been fortunate to have several mentors throughout my career, it always come back to my high school English teacher, Mrs. J.
There are many definitions and theoretical understandings of a mentor. I choose to defer to good old-fashioned Merriam-Webster: a mentor is a trusted counselor or guide. Reflecting on this definition, Mrs. J. was, by far, the most influential mentor that I’ve had in my life. A mentor not only teaches you the basics of whatever you’re engaged in, but also stretches and challenges you beyond your comfort and current skills. A mentor helps you dig deeper to ultimately climb higher. Mrs. J. was definitely that person for me. I still owe my full undergraduate scholarship award to her guidance in ensuring that I had the most compelling application essay. She sat with me through draft after draft, pushing me to think more with every iteration. I often return to the lessons she taught me and her Socratic questioning that I still employ every day.
She saw something special in me and helped me refine my skills. Even if I met all requirements for a paper and got an A+, she would still call me in after school to discuss my technique and how I could be even better. She encouraged me, she inspired me, and most importantly, she genuinely believed in me. I trusted that whatever she told me was in my best interest and would ultimately be to my benefit. I always gravitate to mentors like Mrs. J. and aim to be the same for those who I mentor. She is the barometer against which I measure mentors, myself included. Every time I pick up a pen (or more than likely, sit in front of a keyboard ), I think “What would Mrs. J. say?”
A true mentor’s presence is felt even more in their absence. Almost 30 years later, it’s still Mrs. J., for me. For that, I am grateful.
My First Presentation
Mitch McDaniels
I gave my first patient presentation to an attending at the age of 15, without any of the nervous rush I might feel now as I present my patient to the team on rounds or the morning after surgery.
My father’s life journey as a Special Agent in the FBI on 9/11 provided the spark that would forever push me towards medicine. I shared this interest with two physicians on my first week volunteering at the AtlantiCare ED in Hammonton.
Days later, I presented to one of them my first patient. From there, many years in advance, he began to gradually prepare me for my dream of one day becoming a medical student. Over the course of several summers together, we’d go room to room discussing the pathophysiology of a patient’s disease, clinical course, and expectations for recovery, together at bedside with the patient. He was a master educator, with enormous compassion for the patient and the future of medicine at heart.
He would encourage me to ask questions of the patient and take the time to explain his thought process in diagnosis. He brought everything down to a level that was challenging, but not unattainable for me. He took special interest in making sure that my role was an active one with every case, even though I was only 15. Even in the busiest of times – there was always an instrument I could grab, something I could print and review, or a topic/patient that I could present to him. If we saw an interesting or rare disease, I could almost guarantee he’d ask me to look it up and share a bit with him the next day.
His commitment to keeping my interest in managing acutely ill patients never wavered over the many summers I was lucky to spend with him. Limping around the ED with his bad hip, now in his mid-sixties, there came a time we saw our last patient together, without me ever knowing it.
I returned to college for the year. Life got busy. In my first semester of medical school, I thought of his mentorship often and the sense of purpose, inspiration, and excitement my time with him gave me. I never got to work the next shift I was hoping to with him, but I still think of him often, especially on my time in the wards throughout this year. I imagine this will hold true for the rest of my time to come as I take care of patients myself and interact with the students of tomorrow. It is my hope to, one day, be able to do the same for someone else in my same shoes. To me, this will always be his legacy. This is my thank you to him.
In memory of Dr. James P. Bagnell, for his tireless dedication to patients, his community, and inspiring others.
Paired With An M2
Samuel Snyder
As an M1 in the Cooper Rowan Clinic, I was paired with just an M2 for the entire year. Usually, first-year students work with both an M2 and an M3, but my situation was special. For the sake of anonymity, I will call my M2 Alex.
This situation led to a very unique clinic experience for me, but even more so for Alex. My role didn’t really change very much, as I was still the one taking the history. But Alex now had to assume the role of an M3 as well, formulating an Assessment and Plan before having completed an entire year of system blocks or having stepped foot in the hospital for clinical rotations as most M3s would have done at this point.
This was a lot to ask of a new M2. But Alex went full steam ahead, and quickly became one of the best peer mentors I have ever had. It was clear he was a bit nervous the first couple sessions, as anyone would be in his situation. But he would prep extensively for each clinic session- notebook pages full of scribbles and highlighter and lab values. He even included teaching points ready for each patient. All this to ensure the best clinic experience for me and the best care for our patients. It was very rare that an attending even knew he was an M2 at the end of his presentations. Alex carried himself with professionalism, compassion, and was an excellent role model for me to strive to emulate.
Each session he sat in the same seat at the computer and led the team, coaching me with the composure of an FMP instructor who had been doing this job for years. As we added an M1 to our team the following year, things continued to go off without a hitch. He had our M1 watching him in awe, just as I had done the previous year. But as the end of the year was starting to approach, the thoughts of self-doubt began creeping into my mind, “How am I supposed to do this next year?”
As the first clinic session of the year came upon us, the weight of Alex’s computer seat loomed large when I opened the door to Room 11. I know everyone goes through imposter syndrome throughout many stages of medical school, and we are reminded time and time again to not compare ourselves to others. But in this moment a wave of uncertainty overtook me without warning, as I wondered, “can I really do this”? Well, I didn’t really have much of a choice. So I took a deep breath, channeled everything I had learned from Alex over the last two years, and sat in his old seat.
At the conclusion of this first session, my M2 looked at me and chuckled to herself. “What’s so funny?” I asked. She grinned and replied, “it’s just so cool watching you up there really taking control and teaching. Reminds me of Alex”.
Finding A Mentor
Dr. Doug Reifler
I went to college hoping to become a doctor, but quickly realized I would not make a proper premed. I was well versed in math and science, but preferred physics and philosophy to biology. I had little desire to out-memorize my peers, and the organic chemistry professor’s exams with medians of 27% gave me acid reflux. If it was dehumanizing to be a premed I thought practicing medicine might be worse. Doctors I had met seemed self-absorbed, and I began to worry that medicine ruined people. My biochemistry major covered the premed requirements and allowed me to spend most of my time elsewhere—on English literature, creative writing, and philosophy.
Fast forward 10 years, and I am a PGY2 resident in primary care internal medicine at Northwestern, having worked for 5 years after college as a medical editor—the majority with Scientific American in New York—and then gone to medical school after all. In medical school, I journaled, co-founded a medical school newspaper, The Murmur, and assembled a senior thesis of stories published in part in JAMA as a “Piece of My Mind.” I was applying for fellowship in the Robert Wood Johnson Clinical Scholars program, and the General Internal Medicine (GIM) division chief wanted me to stay at Northwestern as a GIM fellow.
The chief did not fully understand my unconventional interests, but he knew well enough to suggest that I meet with professor Kathryn Montgomery, then director of the Medical Humanities and Bioethics program at Northwestern. He told her I was interested in the history of medicine or something like that. Her face lit with recognition when I described my actual interests: “Oh, so you want to use reflective writing in medicine,” she said.
With a background in English Literature and an interest in medical epistemology, Professor Montgomery (henceforth, Kathryn) had helped to found the Morehouse School of Medicine in Atlanta and had served on the advisory board for the 1984 GPEP report, which promoted greater attention to values, skills, and behaviors in medical education. She had come to Northwestern most directly from the Department of Health Humanities and Bioethics of the University of Rochester, home of Dr. George Engel and the biopsychosocial model, as well as my uncle Cliff, another creative psychiatrist.
Kathryn and I understood one another immediately. We were both renegades with ideas about how medicine could be more humane. I was a newcomer, but she knew well and had essentially co-founded modern medical humanities as part of a small cohort of luminaries, including Edmund Pellegrino, Howard Brody, Rita Charon, Jack Coulehan, and others. She gave wind to my sails when I proposed to teach a writing selective for first-year medical students to reflect on their experiences in gross anatomy. She pointed me to the Society for Health and Human Values (SHHV) and introduced me to her friends. Her endorsement was contact magic, sparking trust and collaboration. I stayed at Northwestern through fellowship and well beyond, largely to work with her.
Over the years I have regularly sought Kathryn’s counsel. A southerner by birth with academic forbears, she is exceptionally attuned to social graces and diplomacy in academic medicine. I have benefitted repeatedly from her wisdom and owe much of my career success to her. I am proud and deeply grateful to call Kathryn Montgomery my mentor.
Being A Mentor
Dr. Fay Young
She contacted me after hearing my answer to “Why did you become a doctor?” as part of a student-sponsored CMSRU physician panel. In contrast to most of the other panelists, I shared that studying medicine was not my first choice. However, a career in comparative literature or music was highly unlikely to guarantee my own financial independence, or to address the retirement needs of my hardworking emigrant parents who chose to invest everything in their children. I needed to work during college and medical school to guarantee funding from semester to semester, which set me apart from most of my peers in Ivy League institutions. At medical school graduation, the wonder and joy of my parents about what the degree meant for my future amplified my quiet pride at what that same degree meant for their future.
The student was not the only one who stopped by my office, located in a busy corridor of the medical school. But her visits were “irregularly regular,” spanning 5 years -– she found a non-judgmental place to talk about anxiety about money and food, self-doubt, shame over her jealousy of students who took vacations and frequented restaurants, a course remediation, heartbreak, Step 1, Step 2, a year of independent study, shelf exams, how her strong personality shaped interactions and performance reviews, and the weird agony of creating rank lists. The visits were not long or burdensome, but my colleague in a neighboring office (the walls were thin!) smiled sympathetically when he once saw me arrive at the door juggling a few boxes of tissues needed to reinforce supplies.
On Match Day, I left earlier than usual after envelopes were opened, smiling as the future bloomed for so many students. As I walked to my car, I noticed her walking ahead of me. I called her name and she turned to reveal a face streaked with tears. She was angry, and crying, angry that she was crying, and embarrassed that she had matched to a program so low on her rank list. I listened and pulled a small pack of tissues from my bag. Silently, I was happy that she had matched, and I thought that the program in an underserved area was about to meet and train a warrior and patient advocate who I suspected would blossom in a myriad of ways. Those were not thoughts that could be planted that day, but, in the weeks before graduation I saw her settle emotionally and start to plan for a life in a new city with her sibling. On graduation day, she chased after me, hugged me, and once again I saw a tear-streaked face, but for the best of reasons.
A few weeks later, an e-mail popped up with the simple subject line “thank you,” and no message other than an attachment. It was a picture of a place card, marking her spot at a table on the first day of orientation. The card printed her name in a large font that looked bold and confident. She had digitally outlined the “M.D” after her name and included a happy face.
After I opened the attachment and smiled, I looked around my office for necessary supplies, and, of course, there wasn’t a tissue to be found.
Does A Mentor Know They're A Mentor?
Karla Reid
Sometimes a mentor may not know they’re a mentor, or to rephrase, sometimes a mentor may know they’re a mentor in general – but may not know they’re a mentor to you, specifically. I’ll offer as an example here, Dr. Gable, whom is beloved and appreciated by all. I am aware, of course, that some students are worried about the intricate questions he has warned us M1s and M2s he will ask us on clinical rotations. Perhaps pathologically extroverted, I am actually quite excited at the prospect of being bold enough to answer, even -- and perhaps specifically -- incorrectly. The mild embarrassment of not knowing something I thought I knew, publicly, sears the accurate information into my brain with more ferocity and longevity than any study method could hope to sustain.
Dr. Gable gently guided the fraction of my FMP group that was assigned to the same SIM center room, day, and time together last year through the particulars of many physical exam maneuvers. Explaining the reasoning behind a maneuver, the mechanisms behind a reflex, he sealed the whys and therefore the hows into my mind.
I read the end of M1 year evaluation he wrote for me three times; I forwarded it to my grandmother and aunt and mother. (Dr. Gable, if you read this, thank you for the kind words and the advice). This year, upon Dr. Gable’s recommendation, I’ve been trying to think along the lines of diagnostic schema – clinical symptoms first, pathophysiology later.
During Dr. Gable’s lecture titled “Clinical Reasoning: Demystifying the Process,” in August of this M2 year, I realized why this new way of thinking resonated so strongly with me. Dr. Gable mentioned House, and Sherlock Holmes, a pair of cultural curmudgeons whom I cannot in good conscience quite designate as role models due to their sometimes less than sensitive treatment of others, despite my friendships with many curmudgeonly types in real life. I was obsessed with House, in high school, and re-watched seven seasons of the show the summer before I started at CMSRU. I would love to emulate the pristine deductive reasoning, and beyond that, the instinct -– which seems to come from experience and knowledge amassed and synthesized within.
The moment that Dr. Gable mentioned that clinical reasoning, this concept of starting with symptoms and working back toward the cause (medically: the pathogenesis) and thereby reaching the diagnosis – organic chemistry jumped into my mind. Dr. Gable said that backwards thinking was not a thing often taught. He is right – and I am so grateful that I had the opportunity to study under Dr. Karen Phillips during my time at Columbia University. Dr. Phillips, or KP as I am lucky enough to call her, introduced me to retrosynthesis.
In a problem that requires retrosynthetic thinking, you are presented with the molecule (let’s say a symptom, or few) that results from a series of chemical reactions, a select few other pieces of information – like an intermediate molecule or a set of chemical reagents – and you must work back, logically, through what other reagents might have been added, what other molecules may have been formed (let’s say the pathophysiology) to come up with the initial molecule(s)(let’s say the diagnosis).
KP was my mentor at Columbia, and remains one of my mentors and close friends now. During a FaceTime in which we were catching up, sometime after Dr. Gable’s lecture, I actually told her about how my roommate and I had separately noticed we were living in a 212B (so close to 221B) numbered apartment and how Dr. Gable had discussed backwards thinking, in medicine, and how I was so grateful that she had fostered that ability within me. I promised her I would write a piece on the importance of organic chemistry in the premed curriculum when I have time (so, in ten years).
KP, while teaching me retrosynthetic thinking and how to learn through problem solving, also showed me I could bring my authentic self to an academic space by doing so herself in our lecture hall. I trusted her feedback, her way of being, as I wrote my medical school application and secondaries. I decided to be myself, to write about things the internet advised to strictly avoid (I will say, that topic is Dungeons and Dragons, which I now get to play here and with another mentor, Dr. Kocher (also, thank you, Dr. Kocher), which of course was the dream the minute I found out about CMSRU’s club, Med Students and Monsters. I am in the perfect place for me, now. KP is the one who told me CMSRU would be a great fit for me –- and I am so grateful CMSRU thought so too.
I could never have foreseen the Center for Humanism creating the Narrative Medicine concentration at the perfect time for me to partake, or Dr. Mara Gordon (also current and continuing mentor, thank you!) agreeing to advise me through my capstone. For every moment the stress of medical school ensures I’ll have a phone call with my father where he utters the phrase “opportunity for growth,” I have the privilege of interacting with my peers and mentors so soon after – and am reminded that there is no place I would rather be than here.
the Epitome Of A Mentor
Dr. Ed Viner
I have had the good fortune to have four excellent mentors over the course of my medical career. The last, best and most important was Dr. Albert Tama.
In the fall of 1986, I was deciding whether to leave Penn, where I was already a full Professor, to become Chief of Medicine at what was then an inauspicious little community hospital in Camden. On the positive side of making such a momentous personal decision, Cooper Hospital’s President, Mr. Kevin Halpern, had big ideas about the future, and told me I would be able to take the ball and run, which was a very appealing challenge.
It was It also evident that my relationship with the person to whom I would be reporting, Dr. Al Tama, Executive Vice President for Medical Affairs, would be of vital importance to my success.
During the exploratory process, I met with this unassuming guy from upstate Pennsylvania, an obstetrician/gynecologist by trade, a total of five times. I found him to be very patient with my decision-making machinations and endless questions, and to have an ever-positive attitude and wonderful sense of humor. He also warned me, correctly, that any pressure I would feel in my job would come not from above, but from below.
I decided I would like to work for him, and in the end, he was the reason I accepted the position. Fortunately, while it was very tough going at times, I have never felt sorry.
The charge to me by President Halpern, who I also liked and respected a lot, was “to build an academic Department of Medicine, strong enough to make us eligible to become a new four-year, medical school.”
We did do just that, but none of this would have ever happened without the stalwart presence of Dr. Al Tama. Unfortunately, he never got the credit he deserved for his skilled mentoring, not only of myself, but of the entire group of 14 Department chiefs who reported to him. It is, of course, particularly challenging to be a “group mentor," for we were all competing for very sparse fundamental resources, such as space and money.
It was also a period of tremendous turmoil and financial difficulty, as we transitioned from a community facility to a true "University Hospital." Nevertheless, Dr. Tama was able to maintain his equanimity and lead us through all that. But, while he was our leader, he functioned much more as a mentor, i.e., by and large, he let us set our own goals, and then guided us through to achieving them. He didn’t solve our problems for us, but suggested how we could resolve them ourselves, as well as showing us how to get out of any holes we had dug for ourselves. For me personally, he shared my values, trusted my judgment, and supported me when others disagreed with my suggestions.
We knew he was a very good doctor and that helped us respect and trust him. We also felt that he genuinely cared about each of us. He was was very careful to never show any favoritism and was equally supportive of the chiefs of the small departments as he was of the chiefs of the financially larger ones. When he sensed a bit of conflict, he would call for a meeting, tell us to “leave our egos at the door,” and talk it through with us. He was always available when an important decision had to be made. He was steady, consistent and able to be definitive, and, only once in those many years did he ever renege on an agreement or promise made to me, and that time was clearly beyond his control.
In closing, It is important to note that Al Tama was an early and vigorous champion of women in medicine. He constantly urged us to find and hire good women physicians and hounded us to be sure they were being advanced and paid appropriately. Unfortunately, he was unhappy in his retirement and urged me never to do so. (Obviously, I I have worked hard to comply with this final advice.) I feel that I owe this fine man so much, as do all of us at CMSRU. Again, without his superb mentorship of his department chiefs over the 20 years he was our Boss, and during which the foundation for creating the school was being built, it is very likely that CMSRU would not exist today.