I wrote this blog in the Seattle and Vancouver airports as I returned home from the annual meeting of the American Association of Medical Colleges (AAMC), Learn Serve Lead 2016. AAMC is the pre-eminent American meeting on medical education and research.
For me, personally, it was a profound week that combined the American election result, Remembrance Day (I still shiver thinking of the sacrifices made by so many Canadians, including an uncle, and of all those cold November 11 mornings I spent as a Boy Scout and Air Cadet!), and the death of Leonard Cohen. It is a good week to remember many of Cohen’s lyrics, but the one that stands out for me now is, “There is a crack in everything; that’s how the light gets in.”
My experience attending American medical education meetings has left me with the impression that many medical educators there lean to the Democratic side. But this meeting was remarkable! Attendees numbering 4,000—and the vast majority were in mourning!! Of course, we were also in a blue state on the left coast, so the newspapers and talk on the street also reflected the mood at the meeting. I said to some friends, “It feels like we are at a wake.” Since I am now acclimatized to Saskatchewan, the daily rain didn’t help!
The meeting began with a plenary by Doris Kearns Goodwin, an author, historian and scholar of American presidents best known for her biography of Lincoln: Team of Rivals. Lincoln was exceptional in many ways but this biography focuses on his leadership, and his strategy to hire his rivals to key cabinet positions. It is an interesting contrast to the current presidential transition underway! And while Goodwin led off with a historian’s confirmation that this election was truly an aberration, her message included many great stories and a reminder all politicians are people with histories, families and a dream of leaving the world a better place. I am sure the conference organizers had no idea their first plenary speaker would be so appropriate for the time!
Dr. Darrell Kirch, the president and CEO of AAMC and an academic leader I have always admired, was somber as he advocated that now more than ever it is important that academic medicine pursue its mission of caring and advocating for the marginalized and the underprivileged. He told an inspiring story of “White Coats for Black Lives,” that described advocacy led by medical students at the University of California, San Francisco. In paraphrasing a politician, he said, “When they go low, academic medicine goes high,” and quoted Lincoln as he called on academic medicine “to be the better angels of our nature.”
Another excellent plenary was delivered by Dr. Atul Gawande, well-known Harvard surgeon, researcher, author and columnist for The New Yorker, and advocate for patient safety. While he led off even more soberly with a definite opinion on the election, he quickly moved on to remind us of the complexity of medicine with 60,000 diagnoses, 6,000 drugs and 4,000 interventions! He described three stages of improvement, with the message that only the third one is proven to work consistently.
1. You should do x (education)
2. You must do x (guidelines, regulation, etc.)
3. Systemize x
Gawande illustrated this point with his work on surgical checklists. One study in Scotland over four years showed a 26 per cent reduction in mortality with 9,000 lives saved – more than had died in motor vehicle accidents. But he brought us back to the present by noting that in the USA, surgical checklists had the lowest uptake in hospitals serving rural, poor and black populations! He described an initiative on a checklist for the prescription of opioids for chronic pain and noted that more people (often marginalized) are dying now from overdoses than from AIDS at that epidemic’s peak! His latest book, Being Mortal, is about end-of-life care, and he noted research shows few people are offered end-of-life discussions by clinicians, with the least likely to receive them being men, those without college educations and marginalized groups.
Overall, his message was that academic medicine can make a difference if we always uphold our values in our clinics, hospitals and medical schools. Read more about his perspective in this week’s short essay in The New Yorker: Health of the Nation.
There were many fantastic seminars and workshops about medical education, concluding with an incredible plenary on advocacy for mental healthcare by psychologist and Johns Hopkins Professor of Psychiatry, Dr. Kay Redfield Jamison. She has been both the co-author on the definitive textbook on bi-polar illness, Manic-Depressive Illness, and sufferer of the same since early adulthood. She has also written extensively for the public, including a memoir, An Unquiet Mind, which describes her experience with mania and depression.
She talked about the stigma of mental illness and described the history that any Johns Hopkins faculty member, staff or learner needing surgical care would seek out a Johns Hopkins surgeon, but those needing mental healthcare would go anywhere but Johns Hopkins due to the stigma of a mental health issue. Dr. Jamison talked about wellness and mental health in particular for clinicians and learners. She talked about how we all had to learn to deal with the paradox that we must all provide care and receive care, and made the link between excellent mental healthcare care for the clinician and patient safety.
Learn Serve Lead 2016 was a great educational meeting, but also a personal experience I will not soon forget. I was struck by three things: the shock and mourning that people were experiencing; the resilience in focusing on what we all can do now to improve healthcare; and the number of shared values with the College of Medicine and our great commitment to social accountability.
And now, I am really glad to be back home.
As always, I have an open door and welcome your feedback, discussion and debate.