The CMSRU center for humanism newsletter: Spring 2020
Reflections from a pandemic
FROM THE EDITOR
What a spring it's been!
The COVID-19 crisis has turned life upside down for many of us at Cooper University Health Care and Cooper Medical School of Rowan University.
But in the face of these challenges, our community remains stronger than ever. In every corner of our health system -- from the emergency department, to primary care clinics, to CMSRU research labs -- our team continues to provide excellent patient care, educate our trainees, and advance new knowledge.
As a member of the Center for Humanism Executive Committee, I've gotten to hear your stories firsthand: stories of hope, resilience, and creativity. This edition of our newsletter is dedicated to those stories.
Inside, you'll find a selection of dispatches from the frontlines of the COVID-19 pandemic, written by members of the the Cooper community. I have been so impressed by these moving stories of what it's like to care for our patients during this global emergency, and I hope you'll continue reading your colleagues' reflections. (It's important to note that each piece represents only the views of the author, and not any organizations with which they're affiliated.)
We've also included some updates from the leadership of Center for Humanism's committees, each of which is working hard to advance the cause of humanism in medicine. In this moment of crisis, that cause is more important than ever.
Warmly,
Mara Gordon, MD
Assistant Professor of Family Medicine
DISPATCHES FROM THE PANDEMIC
"the lady took my branch"
Jenny Melli, MD
Assistant Professor of Medicine
“The lady took my branch!”
One Saturday morning, I set out for a run with my son in the jogging stroller. As we got under way, we noticed a man and woman, both wearing masks, out for a walk. The woman crossed the street towards us, so I stopped and waited to greet her. However, she did not look at us. Instead, she walked up to our fence, picked up a large fallen tree branch and dragged it back across the street. Then she hoisted it up on her shoulders and walked away, all without saying a word. My son pointed at her and yelled, “The lady took my branch!”
These are strange times indeed.
We’ve come up with ways to explain to Henry why he can’t go to the park (the slide is broken and we’re waiting on parts) and why people are wearing masks (they are trying not to get sick) and why he shouldn’t worry about that (Mommy has plenty of band-aids at work). Strangest of all was explaining why a masked woman would come to our house and take a branch from our yard (she wanted beautiful cherry blossoms at her house, too).
These are also challenging times. The emails are endless, the workflows change constantly, and there are times that the fear of the pandemic is palpable. As an introvert, I find WebEx meetings and telehealth encounters exhausting. It’s hard to work from home with two small children. It’s hard to go in to work and feel guilt about the added strain on my husband who stays home.
There is joy, too. It’s still a privilege to take care of patients. These days they seem more concerned about my personal safety than their own health. They show genuine concern for our staff as well as my family.
We have a beautiful cherry blossom tree in our front yard that bloomed last week. When the sky darkened and a storm rolled through, a giant branch fell from the tree. But it didn’t damage our house; instead it brought joy to a new home or wherever that masked woman carried it.
the most precious gift
Lori Feldman-Winter, MD
Professor of Pediatrics
“Breastfeeding is the most precious gift a mother can give to her infant. When there is infection or disease it may be a life-saving gift. When there is poverty it may be the only gift.” Ruth Lawrence, MD, 1992
There is nothing more human than having a baby, and being mammals, the most natural behavior following birth is to use the mammary glands in suckling the young. Breastfeeding has evolved over time and sustained multiple pressures throughout history such as industrialization, women joining the workforce, natural and unnatural disasters, and most recently, a global pandemic. The outbreak of SARS-CoV-2 has led to unprecedented global panic. In response, medical professionals have rallied together by mobilizing health care facilities, determining the best approach to surges, and establishing, refining and updating policies and protocols. Among these policies is the guidance about what to do if a mother presents in labor and either has been tested positive for COVID-19 or is a person under investigation. Leading health organizations have scrambled to react, and in doing so have created policies that are contradictory and have led to unintended consequences that are heartbreaking. The recommendations include a complete disruption in the usual practices that support new mothers to bond with their babies and begin breastfeeding, by immediate separation and quarantine of the new mother as well as her newborn.
This following is one such story:
Ms. G shared her story this past April about her birth experience. She agreed to share her birth story but requested to remain anonymous.
Ms. G approached the final month of her pregnancy with the added stress of entering the COVID-19 pandemic in her last trimester with twins. Despite being pregnant with twins, she had a relatively uncomplicated pregnancy. As the COVID-19 pandemic began, she took all possible precautions and stayed in her home. Her husband did the same, only venturing out of their apartment once per week to shop for food. Ms. G was contacted by her obstetrician’s office to cancel most of her remaining visits, with the exception of a few tests. She was counseled to let her obstetrician know if she had any symptoms of COVID-19, so when she developed fever and a slight cough, she contacted the office. Her doctor arranged for testing, and she reports she was incredibly shocked to learn that the testing was positive for the COVID-19 virus as she entered her 35th week of pregnancy. She had only one night of fever and a mild cough. Her husband had similar symptoms and had a much more difficult time obtaining testing. Eventually he was able to receive the test and also learned that he was positive as well. Both of them felt well with a mild cough.
At 36 weeks, Ms. G’s water broke and she called her doctor. She was told to come to the hospital but with very specific instructions to come alone, and to call before arriving to the floor. She was terrified at the prospect of heading into the hospital alone to give birth. Upon arrival, she was met by a nurse and obstetrician in full personal protective equipment. She was relieved to learn that her husband could come once she was confirmed to be in active labor, but told he could only stay until the babies were born, and then would have to leave.
Ms. G described her labor as “very stressful” and “mental torture as I kept thinking that I might pass this virus to my kids.” She was informed that the babies would need to be separated from her after delivery to minimize the chance of infection. Her labor did not progress, and 24 hours after her arrival she was told she did not dilate and that she would need a Caesarean section. Ms. G states from that point, it was “a quick 10 minutes and everything was done.” After the babies were born, she shared hearing the babies cry, “and all I could think was that I wanted to hold them.” The babies were quickly taken out of the delivery room, and Ms. G did not have an opportunity to see the babies before they were taken away. Her husband saw the babies briefly, and was told he would have to leave as he was also COVID-19 positive and the hospital wanted to reduce the risk of spreading the infection.
Ms. G then describes being wheeled to the COVID-19 ward, where she spent three lonely days. She describes, “So much hurt. . .I wanted to hold them, I wanted to see them.” She was provided a hospital-grade breast pump 24 hours after the babies were born, as she had planned to breastfeed. She appreciated the care from the nurses, especially those who showed her pictures of her babies on their cell phone.” Ms G describes feeling “devastated” as two additional COVID-19 tests on her came back positive despite the fact that her cough had resolved and she felt well. She was encouraged to learn that the babies both tested negative for the virus. As the day of discharge approached, Ms. G stated she was very “confused” as the hospital debated various plans for discharge wanting to avoid her husband coming to the hospital. The family lives in the city, and doesn’t have a car. Finally, the decision was made to send her and the babies each home by a separate ambulance, so there would be a total of 3 ambulances for their family. At this point, she shared, “I was so emotional. . . finally I am going to see my babies. I was really, really happy.”
At home, the family of four was together in their apartment, and Ms. G reports feeling overjoyed to finally see her babies, but was terrified to hold them. Her parents had intended to come to help after the birth, but given the circumstances they were unable to travel and she did not want to expose them to the virus. Ms. G and her husband decided to keep the babies in a separate room, and only entered the room to feed or change the babies while wearing masks and gloves. She attempted to pump every 3 hours to establish her milk supply, but reports feeling so overwhelmed and was in pain recovering from her C-section. Arrangements were made to follow up 2 days later with their pediatric office, where a pediatrician wearing personal protective equipment met the family and evaluated the babies. At this visit, the babies were tested for the COVID-19 virus, which subsequently came back negative. The family was encouraged to hold and feed their babies, and mom was counseled to attempt direct breastfeeding. Ms. G shared that she felt a little confused by the different recommendations, and she was still terrified to pass the virus to the babies. They gradually increased their contact with the babies and when the babies were ten days of age she decided to try direct breastfeeding. She reports that now “we are living like a normal family,” and smiles with relief. Overall, she feels that the hospital took “all the right measures” and appreciates the care that she received from the hospital team.
Interestingly, Ms. G compliments her health care providers, and believes they acted in her and her babies’ best interest. Of course, she does. If families don’t believe in and trust the care they received, they are more likely to have worse outcomes.
The truth is, she never had a choice. Nobody ever gave her the option of skin-to-skin care, rooming-in, even if it was with a 6 ft distance between them, or direct breastfeeding. The truth is, there is no evidence of harm by practicing all of the measures that were stripped away from her without choice. Taking precautions, by wearing a mask and using proper hand hygiene, may be sufficient to protect newborns from becoming ill with COVID-19. Curiously, COVID-19 does not appear to cause severe illness among newborns. Scientists theorize that this may be due to the relative paucity of receptors needed for the virus to enter cells, and/or it may be due to developmental immaturity of the inflammatory response following infection.
Arguments for maintaining maternity care practices that support breastfeeding include a meta-analysis of studies examining the impact of timing of the start of breastfeeding on infant mortality. These results are alarming. There is a 33% greater risk of infant mortality from delaying breastfeeding for 2 hours, (95% CI: 13-56%, I2 = 0%), and a delay of one day has over twice the risk of infant mortality, (95% CI: 1.73-2.77, I2 = 33%). Ms. G was not even shown how to express milk for 24 hours. Presumably her newborns were fed infant formula, but she does not provide these details, as it was not communicated with her. Another situation in which she was given no option.
The CDC and WHO provide the option of shared decision making when it comes to maternity care practices for COVID+ mothers. The practice of evidence-based medicine is a triad, and involves more than simply the evidence. It involves the physician bias and the patient’s wishes. Perhaps we need to introduce a “time out” to ensure patient’s wishes are always a component of care.
This article represents the personal opinions of the author and should not be linked to any professional organization or health care system.
Off The Grid
Mark Thomas, DO
Assistant Professor of Medicine
I recently departed on a planned backpacking “off the grid” sojourn in West Marin, CA just before the anticipated COVID-19 pandemic arrival. In full transparency, I embarked with a salty mix of excited apprehension and calculated opportunism, guesstimating as a Hospitalist, that it may be my last vacation for a while. Honoring my step son’s journey and 21st birthday with one on one “guy time," reflecting on deeper connection with ourselves, with each other, and with the planet beneath our feet was a sweet gamble too hard to forgo. This was not escapism, it was an investment in what matters. Feeling vulnerable with asthma, my life partner and spouse reluctantly agreed to support our journey under the condition that a 14 day self quarantine would be imposed upon my return. Ante up, I loaded my car with additional camping gear and food rations for when I returned, planning to commute to work from a campsite in Belleplain State Forest. With a surgical mask in place, a backpack on my back, and a handful of two ounce hand sanitizers, I boarded an empty plane headed for San Francisco to meet up with my step son.
Beyond the massive redwoods of Muir Woods, majestic Alamere Falls, and just over the San Andreas Fault, we obtained our backcountry camp permits, last minute supplies, and wandered off the North American Plate towards remote hike-in only campsites. We eventually nested on a bluff overlooking the vast Pacific, in perpetual awe amidst migrating whales, fire-roasted fresh oysters, and unfolding sunsets. Little did we know that a growing rustle in the thickets midweek would bring such tectonic shift; a deeper conversation was brewing and its name was Maya. Her mist wafted by our tent whispering, “Get Out”. Lost in translation, another backpacker with more recent 5G access clarified an interesting paradox: “shelter in place” meant evacuate our shelter in this remote socially distanced area, as the National Park Service had closed operations. Now temporarily homeless, a days hike from civilization, we packed out our tent and began on a new adventure.
We re-emerged in “town” with what seemed a Matrix-esque parallel universe. Society had new mandates with California issuing the first “shelter in place” order, police monitoring street-loitering, enforcing social distancing, grocery store priority hours for the aged, and yellow casket shaped boxes taped on aisles as if in anticipation of a mass burial. By the time my flight arrived back in Philly, shelter in place had gone viral, New Jersey campgrounds were now also closed, and I was not really welcome at home. I was officially temporarily homeless, destined to live a week in my car pre-packed with sundries while returning for work. Still, Maya had more in store for us.
Perhaps still intoxicated by the raw natural beauty, timelessness, and connection recently experienced on the NoCal coast, I re-entered the Cooper community in amazement of what had so quickly transpired. Massive mobilization of resources, supported by efficient communication, teamwork, and collaboration despite constant change in anticipation of the tsunami coming with decompressing census, scaling up surge plans, and projected shortfall of supplies and perhaps staff. Wide scale unity in community seemed like the default and had spread across the nation and globe with non-essential business as usual shut down, schools rapidly shifted to on-line learning, even our medical school.
No, my goggles are not fogged, and yes massive disruption and uncertainty loomed like a dense cloud easily palpable by most everyone in some form, including ambulatory care offices, competing government systems, and a rapidly contracting global economy. Perhaps Fear was the bigger plague, the great Tormentor, an insurmountable barrier, and still yet, glimpses of the indomitable human spirit shined through like quantum tunneling; sung off balconies and porches, sewn into masks, displaced workers and students reinvented as volunteers, front line providers flexing scopes of practice to the emerging needs of the moment. Yes, there is a frenetic sympathetic overload in all this “doing” and there is also a more gentle parasympathetic undertone of just “being” that few may notice unless prompted to remain aware. Perhaps we are facing our own existential fear of separateness; or perhaps we are more open and connected to each other and the truth of the moment than ever before.
What symbol does the halo around the coronavirus represent for you?
visitor
John McGeehan, MD
Associate Professor of Medicine
I spent many weeks as a patient in the hospital a few years ago and was encephalopathic during the entire stay. This means that I could speak and interact and at times, especially to those who did not know me, appeared normal. I was told that I would give coherent lectures to the medical students who came to see me on rounds, only to not remember doing so an hour later. I am sure that I was assumed to have capacity and could consent to tests and treatments. The fact was that I still do not remember anything of that time even years since. My wife was at my bedside daily and made every decision during that horrible time and she guided me to wellness. She was more than a visitor.
COVID-19 has taken away visitors from the hospital. Throughout the country people lie in bed, alone, for what is often the singular, most challenging time of their life. Families are forced to stay home – wondering how their parent, spouse, child or friend is doing. The nursing staff and others at the hospital are given the added task of being family to each patient. At a time when they are already burdened by what this terrible virus is doing they now must take on this new role. They are doing it daily and doing it with compassion.
Finally people are seeing how amazing healthcare workers are. In the absence of family at the bedside all are reaching to technology as we are through social distancing every day. They are bringing family into the room through FaceTime, using phones and computer tablets - even showing patients how to Zoom, Google Meet and so many other forums that have risen up to help us fill the social needs we all seek.
What is obvious to those who treat people in the hospital now is that everyone is very ill. COVID-19 has stopped elective surgeries. People do not even come to the emergency room now unless they are seriously ill for fear of exposure. The non-COVID-19 patient is getting little attention in this pandemic by the media. They lie in beds in every hospital fighting to recover without visitors while fearing they will get the virus and bring it to loved ones once discharged.
The COVID-19 patient in the hospital presents yet another challenge. Not only can they not have visitors, but all those they see are stripped of humanity. It is a nightmare. Caregivers are now making badges with their faces on them to wear on their protective clothing so a patient might get some idea of what they look like. Each encounter is a vivid reminder of how serious what they have is. The many tales of how those who treat these patients are going above and beyond are both heartbreaking and enlightening.
So why not open the doors and let those who want to visit come? Isn’t it their right? Shouldn’t it be up to each patient to have a willing visitor come to see them? Autonomy means that the patient has the right to choose as long as they are informed and have the capacity to understand. Autonomy has been the ruling principle in medical ethics for decades. Autonomy now has yielded to Justice – the principle that must guide us in a Pandemic. Our decisions must be focused beyond self and to society. We must look to the good of many as well as the one. Every visitor to a hospital right now must be treated as a possible vector who can carry this horrible virus to and from the hospital. We have no idea yet who is infected, how exactly it is carried, and who it will kill next. These are simple facts. Allowing visitors is likely to continue the spread of COVID-19 and in doing so continue to fill our hospitals with patients who are alone.
These are horrible times. Science fiction is now reality. What about the patient who is dying and in the hospital? What about the child? Rules are created in every hospital and exceptions are part of all rules. People working within hospitals who know the relative risks are making these decisions every day. The reality of the patient who is in the dying stage of COVID-19 is that they are sedated, unable to talk because they are on a ventilator, and they are unaware. The visitor may want to say good bye and know they were there. The patient will not know. The fact that someone wants to visit despite the risk shows the incredible love that they have for this dying person. No doubt that the patient would have felt the same.
Part of love is protecting. The last thing I would want if dying of COVID-19 would be to have those I love risk getting this disease or bringing it to others. The last vision I would want for them is to see me in an ICU on a ventilator. My parents are no longer alive. When I close my eyes I see my father standing tall in his police uniform and I smile. I see my mother baking chocolate chip cookies and I salivate. My wife is resourceful and brilliant and would have found a way to direct my care from home if not allowed at my bedside. She would have gotten me well. We owe it to those we love, as well as to those we do not know, to do our part to control the spread of this heartless virus. Not visiting a hospital right now is an act of love for all.
"I'm just so grateful"
Lawrence Weisberg, MD
Professor of Medicine
I had the great privilege and joy of attending on the nephrology consultation service when the very first patients with COVID-19 were admitted to Cooper’s ICU. There were only four of them at the time, and I was consulted on all of them, because they had the acute kidney injury that turns out to be so common in that disease. “Why great privilege and joy?” you say. Here’s why.
In those very early days – and it’s hard to believe it was only a matter of weeks ago! – we knew desperately little about the disease. There were sketchy published reports out of China and Italy that had been rushed into publication and were of questionable validity, and lots of hastily created podcasts and webinars from “the front lines.” We were all collecting as much information as we could about this new disease and sharing it with each other as quickly as we could. We came to work every day with deep humility and with great respect for our colleagues, who were doing their best to care for these critically ill patients. There was a great sense of excitement, shared purpose and camaraderie.
When I had to start the first Cooper patient with COVID-19 on dialysis for his kidney failure, it was with a grave sense of the moment. He was a relatively young man, but as ill as a person could be, not just with kidney failure but with lung damage that eventually required a pump outside his body to oxygenate his blood (ECMO). I knew from many years of experience that the chance of survival for people who require such intensive life support is extremely slim. But this was a new disease and we really didn’t know what to expect. And of course, we would do everything we could do.
I went off service at the end of the week but followed his progress from a distance. I saw that he was able to come off ECMO, and eventually come off the ventilator. His kidneys still had not recovered by the time I came back onto the consultation service three weeks later. He had been transferred out of the ICU and was on a general medical floor. I saw him when he came to the dialysis unit for a treatment. I said, “I’m sure you don’t remember me, but I’m the one who started you on dialysis for your kidney failure. It’s great to see you looking so well.” I suddenly realized that this was the first time I had spoken to him; he had been completely unresponsive, face down on a ventilator when I first took care of him. His eyes welled with tears and so did mine. We both said at the same time, “I’m just so grateful.”
10 things about me
Dawn Kennedy-Little, DO
Assistant Professor of Medicine
During the first week of the COVID-19 pandemic, I worked as the critical care attending physician in the Viner Intensive Care Unit at Cooper University Hospital caring for the sickest patients. It was the first week of many new procedures and processes. The medical teams were donning and doffing personal protective equipment, social distancing, and restricting visitors. Visitor restrictions for our patients seemed logical to protect them and their families from unnecessary potential COVID-19 exposures.
However, I soon realized that there were unattended consequences of not having our families at the bedside of their loved ones, especially the most vulnerable, those that were unconscious, sedated and on life support. Not only do our families provide much needed medical information to the medical them for incapacitated patients, they also provide support and healing for their loved one. They are an active part of the healthcare team too. During my many years of providing intensive care, I quickly realized how I have taken my bedside families for granted. I missed them. They provide us with stories and details of our patients that reveal who they are and their relationships. They bring that patient to life. Their loved one in the bed on the machine becomes human, a human with feelings, fears, desires, hopes and dreams…just like all of us. Without our families at the bedside of our sickest patients, we had sick patients but we lost the human, we lost the person.
So I added a new routine to the end of each day that week. I called all my families and talked to them every evening for hours. I would update the families on the medical condition and plan of care but I also learned about the person I was caring for every day. I learned what they did for a living, their favorite foods, music, sports team, literary works, etc. I needed to bridge the gap for my patients, my families, and my medical team. I found myself identifying with many of my families as many of my patients were the same age as my husband, my brother, my parents and my colleagues. I could not image not being at the bedside of my loved one if they were critically ill and I empathized with them.
I soon found myself delivering messages from loved ones and sharing news from their homes.These connections and relationships grew quickly. Families wanted the medical teams to get to know their loved ones so they could connect and help them heal. It was at this point that I recalled “10 Things About Me”.
“10 Things About Me” is a quick questionnaire that my children completed in kindergarten so that the kids could get to know each other quickly. I adopted the same format and asked the families of my hospitalized patients to answer 10 questions for their loved ones. We learned what our patients preferred to be called, their family members, pets, favorite foods, colors, music, sports team, favorite memory, etc. I also asked my families to send in photos and we printed them out and shared it at their bedside for the medical teams to enjoy. This connected our patients and families to us, the medical teams. Strong bonds and connections were formed amongst us all. We had names and faces to our patients and families. Our patients were brought to life while fighting for life. It helped us focus on the medical treatments and plans while not forgetting to talk to our patients and hold their hand while caring. Our patients are not just patients, they are people, they are human, they are family, and they are us.
TELEMEDICINE AND MY STETHOSCOPE
Satyajeet Roy, MD
Associate Professor of Medicine
The current pandemic has forced us to follow new avenues of healthcare delivery. In my thirty-five years of medical practice, this is the first time when I have not used my stethoscope for more than two months due to COVID-19 related pandemic and shelter-in-place, yet managed to see patients exclusively via audio-visual telemedicine in my primary care office. Although the virtual proximity with my patients is highly rewarding in terms of maintaining the continuity of patient care and my professional ability, nevertheless the absence of tangible interactions with my patients has created a sense of vacuum in my auscultatory and other clinical examination skills.
The stethoscope has been an extremely powerful tool and an icon for generations. It has inspired many physicians at the early years of their lives to choose this hard path and become physicians, just like it did to me, in order to have the privilege of listening to the core of a fellow human being. Nowadays, my stethoscope sits on my table and keeps looking at me as I continue to provide patient care via telemedicine, feeling ignored, and as if it is gradually getting rusted.
I made this drawing of my stethoscope and colored it with my imagination as to how it would appear as being rusted. I just hope that this visual representation of a metaphorically rusted stethoscope does not become the fate of the bedside and office clinical examination skills.
indulge my paternalism
Edward Viner, MD
Professor of Medicine
I have had a broad spectrum of emotions while self-isolating at home for the past two months. While I had hitherto learned from both my own experience and from my patients, that all of us think more about our own mortality as we age, “this virus” has given us a new whole wrinkle. I now have a heightened and realistic concern about my own safety, because of poor pulmonary function stemming from a four month 1972 hospitalization requiring nearly six weeks on a ventilator. Besides my feelings of vulnerability, I also have vivid memories of what that experience was like, and hate thinking about going through all that again, especially given the current odds concerning the ultimate outcome.
On the positive side, this pestilence has given some of us unexpected time to think and plan for the future. Keeping busy with productive activity is always a good defense against depression. But then I have found myself bothered by a nagging sense of guilt that I am not there, taking my chances with my younger colleagues, fighting this battle on the front line. This, of course, is not realistic,and I would achieve nothing if all that led to was another ICU ventilator case. So, I will continue to work at home and be a cheerleader for the rest of you. Please indulge my paternalism, as it is totally sincere: know that I think and worry about all of you, many of whom I have had the privilege to teach, counsel, hire, and work with during my 33 years at Cooper.
Let us hope that when this crisis is over, we can continue to work together, delivering good care to all who entrust themselves to us, and going on with the successful development of a medical school-hospital (“Across the Continuum”) teaching program that will produce competent, resilient and humanistic physicians. Let us all keep in mind, that while we have seen great changes in the “business of health care”, one-on-one at the bedside, nothing should change.
One of the main goals of our Humanism Center is to ensure that doesn’t change.
AROUND CAMPUS
We are thrilled to announce the publication of the 2020 issue of The Asclepian, the CMSRU Medical Humanities Literary Magazine.
Congratulations to the editorial board and all of our authors, artists, and poets. You can get a physical copy of this year's edition during new student orientation this summer.
With social-distancing and self-quarantine measures in place due to the COVID-19 pandemic, many patients have become significantly isolated. This isolation can manifest as detrimental physical and mental effects on patients including loneliness, heightened anxiety, and depression. Medical students have been working to combat these struggles associated with social isolation by conducting social check-ins for patients of Cooper Family Medicine at the Kroc Center.
Patients identified as possibly benefiting from a social check-in are called by a medical student weekly. During these phone calls, medical students work to develop a relationship with the patient by getting to know who they are as a person – their family, hobbies, childhood – and bonding over shared interests. They also learn about the patient’s worries, concerns, and uncertainties surrounding COVID-19 and address them by providing accurate public health information and updates. While the program’s goal is to provide an avenue for social connection and support for patients, medical students have also benefited. By talking with a patient without time constraints, looming evaluations and grades, or competing thoughts of their lab values or a differential diagnosis, we are able to fully focus on building a human connection. One patient remarked that the phone call “brought joy to her day”, and it turns out, that for medical students, it does the same.
-- Seema Doshi, M4
We should be proud of our robust offerings of the medical humanities at CMSRU! Our school is a leader in the region in the humanities. The depth and breadth of the course content and diversity of offerings rival the top programs in the nation. All of the Philadelphia area programs meet quarterly to discuss and debate the role of the humanities in medical education. It is an incredible gathering of dedicated, innovative, and thoughtful individuals, encompassing physicians as well as content experts in the humanities from the social sciences and bioethics to the fine arts and performance.
Dr. Cerceo and Dr. Gordon regularly represent CMSRU at these spirited and intellectually stimulating quarterly meetings where everyone comes together to share our experiences, best practices, and innovative approaches to how to best deliver content to enrich our students and expand minds and perspectives.
-- Lisa Cerceo, MD
Assistant Professor of Medicine
In March 2020, I attended the Society of Student-Run Free Clinics Conference in Orlando, Florida with fellow M3 Menaka Dhingra and Cooper Rowan Clinic directors Dr. Behjath Jafry and Dr. Anjali Desai. This is an annual conference consisting of workshops, poster presentations, and oral presentations where students get the opportunity to present their clinic models to other student-run free clinics from various institutions. The attendees included students from all aspects of healthcare, including Medicine, Physical Therapy, Nursing, Dentistry, Social Work, and Pharmacy.
Menaka and I gave an oral presentation on the effective use of clinic didactics as an educational model. One thing that distinguishes the Cooper Rowan Clinic from other institutions is that our clinic is a mandatory experience for medical students in their first three years. Therefore, it is imperative that there is a standardized space for students to come together and learn clinic-relevant topics. After presenting our school’s clinic model, we went over different types of didactic sessions. At CMSRU, session formats have included student-led case presentations, skill-building sessions on topics like trauma-informed care, and interprofessional workshops on utilizing point-of-care resources. Dr. Iris Hagans and Director of Community Affairs Sue Liu are the faculty that lead and facilitate didactics. We hoped that this presentation would provide useful information to anyone interested in bringing didactics to their own institutions and demonstrate its utility in reducing knowledge gaps and building confidence in student providers.
During the two-day conference, I had the opportunity to learn about the incredible work done by other clinics. This included UC San Diego student-clinic’s partnership with Feeding San Diego to address food insecurity by providing 2 bags of fresh produce and non-perishable items to qualifying patients every month when they come in for their medical visits. Another particular standout was a mobile clinic van that provides general medical care to patients who are unable to commute to nearby medical centers at HOPES Free Clinic at Eastern Virginia Medical School.
These student-run free clinics can often be an under-discussed component of the medical system. My initial understanding of clinics was at times restricted to my own work as an individual student provider, however upon attending this conference, speaking with students from across the country, and hearing about the diverse, ambitious, and multifaceted ways in which hundreds of medical students across the country are working to better their communities it is clear to me just how great an impact these student-run clinics have on the lives of thousands of individuals.
-- Cecillia Lee, M4
UPDATES FROM THE WARDS:
REPORTS FROM THE CENTER'S COMMITTEES
hidden curriculum
Our committee focused initially on starting to get a sense of the issues surrounding the hidden curriculum at our institution and review literature that specifically identifies ways to address the hidden curriculum in medical education.
After identifying some compelling articles addressing this topic we will now target our efforts on faculty development to foster a humanistic approach to patient care and education. We plan on taking a strength based approach to highlight positive aspects of the culture here at CMSRU while also acknowledging that negative aspects must be addressed.
-- Jenny Melli, MD
humanism and professionalism
The Humanism and Professionalism working group has met with senior leadership of Cooper University Health Care to gauge their interest in joining forces to continue to transform the culture of the organization to one that prioritizes humanism and professionalism. We were gratified to find ourselves in complete accord regarding goals and objectives. A major task at this point is to coordinate the various ongoing efforts at the school and within the health system to maximize effectiveness.
We also are planning a series of presentations by Dr. Salvatore Mangione, to which the entire CMSRU/CUHC community will be invited. Dr. Mangione is renowned for his elegant and inspirational lectures on the interface between medicine and the humanities.
-- Lawrence Weisberg, MD
wellness and burnout prevention
Our working group has met four times over the last six months. We are fortunate that our group includes representation from CMSRU Dept of Student Affairs (including CMSRU Wellness Program), CMSRU Director of Medical Humanities, CMSRU Faculty from the Healer’s Art Course and Foundations of Medical Practice as well as 2 medical students. Our working group also includes practitioners from Cooper Departments of Psychiatry and Behavioral Health, Hospital Medicine, Internal Medicine Residency program, Cooper Nursing Leadership, and Rowan University Dept of Psychology.
Our initial meetings focused on identification of current efforts at the CMSRU and Cooper Hospital communities which promote wellness. Program’s highlighted from Cooper include the Zenith Climb, the Cooper Health and Wellness web resource site (http://wellness.cooperhealth.org/) which includes additional wellness initiatives and educational resources, and GME Wellness activities. At CMSRU, programing includes Random Acts of Kindness, the “Stair Trek” program, and various student wellness activities. One of the challenges identified was how our group stays informed about the breadth of wellness activities going on across the CUH and CMSRU campuses. Currently several of our group members also serve on Cooper’s hospital-based Wellness Committee, which will help keep the lines of communication open. At present there does not seem to be coordination between the CUH and CMSRU Center for Humanism efforts towards Practitioner Wellness. To that end, Drs. Viner and Weisberg have been invited to join the steering committee for the hospital-based Wellness Committee which should aid in development of a coordination plan.
Questions which our group is actively discussing include 1) What options exist to increase content for mindfulness on a longitudinal basis in our medical school curriculum? 2) How have medical schools incorporated resiliency training into their curriculum? 3) How do we identify which factors have the greatest negative impact on wellness or which are the greatest contributors to burnout? 4) Are there differences in these factors between various groups (medical students/residents/attendings/nurses/behavioral health providers/direct care providers)? 5) Focusing on the present, what are easily attainable, highly visible approaches to promote wellness, such as increasing a sense of connection or joy in work in our CMSRU/CUH communities?
Serving as an educational resource is an important role of our working group. Members from our group participated as panel members for the Cooper’s Schwartz Rounds on Wellness on 2/26/20. The session was very well attended and we were encouraged that attendees requested additional resources and follow-up programs to discuss their progress with incorporating practical approaches to improve their sense of wellbeing.
-- Lisa Siegert, MD
communication and compassionate care
Our Committee is tasked with contributing to an environment providing the high quality patient-centered communication skills that embody compassion and confidence, signals professional competence, and promotes resiliency in the learning and practice environment.
To work as physicians, nurses, and allied health professionals brings unique challenges behind every door to a clinic or inpatient room, during every multi-disciplinary meeting, and to every moment we teach students and junior colleagues. Health, function, and sometimes lives are at stake. Emotions are involved. There is an enormous asymmetry of knowledge and understanding. In every setting, every day, communication is the tool we use to connect with patients, colleagues, and the team members involved in establishing an effective therapeutic environment infused with both expertise and compassion. It is not a surprise, therefore, that communication skills affect important patient-centered outcomes, and that a high-order communication with patient and family is a touchstone of compassionate medical care.
An overwhelming body of literature has shown that communication behaviors are teachable, can be effectively modified, and are measurable in medical practitioners. Familiarity with, and the practice of communication techniques in medicine makes a difference. The Committee on Communication and Compassionate Care is focused on providing opportunities for education and access to opportunities enhancing communication skills at every level of our medical school and hospital.
One initiative is to train faculty in the Vital Talk method, an offshoot of an NIH-funded initiative shown to be effective in teaching communication skills to adult learners. Dr. Fay Young, Chair of the Committee, is completing certification in the Vital Talk “train the trainer” program, and will subsequently formalize a program to train CMSRU and Cooper Health System Faculty in this widely used teaching method.
Another active initiative is designing and intercalating short training courses to learn and polish communication skills in a small group format. We all know what it is like to “get stuck” during tough conversations, or to feel unprepared for the intensity of emotions that can emerge during patient or family interactions in our respective fields. These types of interactions are amenable to practice sessions, where learners are in the “hot seat” but in a safe environment, supported by peers and trained facilitators. We will be introducing these sessions in both a focused format and as longitudinal learning opportunities at the medical school, in the Viner ICU, and beyond.
We look forward to expanding and adding projects as opportunities arise to continue this important work.
-- Faith Young, MD
ethics and law
The Ethics and Law working group has been meeting since Fall 2019. Our focus so far has been discussing how to address inequities in care access, particularly in end of life planning for oncology patients who are currently incarcerated. When our normal activities resume, we will be exploring how to begin approaching this problem. A recent exploration has prompted us to also look at ways to incorporate more formalized ethics education in the 3rd and 4th years of the medical school curriculum. This latter effort is quite new and preliminary but represents an exciting avenue of activity.
-- Lars Petersen, MD
FROM THE DIRECTOR OF DEVELOPMENT
Humanism in healthcare matters more urgently now than perhaps ever.This is an uncertain time during COVID-19, and we value the commitment of those on the front lines as well as those studying at CMSRU to be on the front lines.They are dedicated to scientific excellence, compassion, and collaboration, which represent three defining characteristics of humanism in healthcare. This pandemic exemplifies how essential the Center for Humanism at CMSRU is to the future of medicine. Your continuing investment in the Humanism Center creates more opportunities for our medical students and clinicians to have at their disposal a myriad of tools that can be used to create positive wellness levels individually, which can help gather greater strength to express compassion and empathy to patients. Emphasizing these techniques to maximize humanism in the care of patients during this crisis has the potential to bring improvements to patient care well after this pandemic has passed.
Your advocacy and philanthropy are more important now than ever before. To make a contribution to the Center for Humanism at CMSRU today, please click here.
I welcome the opportunity to talk with you in more detail about the Center and to learn more about your thoughts and concerns. Please stay happy, healthy and safe.
Gratefully,
Felicia Gordon-Riehman
Director of Development