Posts (17)

Thu, Sep 7 7:20pm · The civilizing influence of historical continuity

By Andrew M. Harrison

I am not a scholar of history, but I like to pretend I play one on the TV machine.

After writing of the Minnesota cornfield-tundra earlier this year for Meet Mayo Med, The Official Blog of Mayo Clinic School of Medicine, it occurred to me I do not understand the cornfields. After almost a decade near the cornfields, my first summer at Mayo Clinic in 2008, this seemed to me rather embarrassing. Thus, I pursued the only reasonable course of action and moved into the cornfields. After many months watching the cornfields evolve from dirt to [something appearing to approach corn], still I do not yet understand the cornfields. I also do not entirely understand the grain silo next to my apartment. One truck dumps in grain. Another truck dumps out what I presume is the same grain. What purpose does this serve? I suspect Wikipedia possesses information describing this process, but I am not convinced Wikipedia can help me experience or truly understand this process.

People seem to like to reference On the Origin of Species by Charles Darwin, published in 1859 at age 50 years, but I find the story behind this story, the second voyage of HMS Beagle, originally published as The Voyage of the Beagle by Charles Darwin in 1839, at age 30 years, a more insightful read. At least, I was first enamored to learn Charles Darwin set sail on the second voyage of HMS Beagle in 1831 at age 22 years and returned in 1836 at age 27 years. Despite his writings, I still do not understand how Darwin possessed so much knowledge at such a young age. I also do not understand how this child, who effectively flunked out as a parson in training at Christ’s College in Cambridge, after an attempt to become a physician at Edinburgh Medical School, could accomplish these epic feats. The only reasonable course of actions is to ask him, how the corn grows as well, but he passed away in 1882 at age 73 years.

“Aren’t you [physicians] the ones who decided to go to college for 12 years?”

My best attempt above to quote Lace Larrabee from a recent performance at The Punchline Comedy Club in Atlanta, I decided to swing by for a performance by Dave Attell at the same event, where Jarrod Harris referenced the ongoing demise of standup comedy, due in part to the rise of children who possess fancy camera phones, but have lost sight of the past.

Dave Attell does not look much the actor, or so he claims.

“A popular piece of sociology holds that Americans are losing confidence in the future because they are losing sight of the past.” —William Least Heat-Moon, Blue Highways, 1982 (100 years after the death of Darwin)

The words above written a few lines before the title of this post, published the same year The Punchline Comedy Club opened. I no longer follow the US news (aka “the news”). It is filled with stories of death and destruction. At least for me, demise does not generally instill great confidence. However, the corn does not seem to care. The child Darwin (somehow) figured out the natural order, possibly minus humans, but including all other animals, also does not seem to care. Whether humans are unique because we care or mere coincidence I do not know either.

From Blue Highways, I am glad this scholar of history, including a PhD in English, was brave enough to preserve the ugly history, less it become forgotten as well. One day I should ask him, easier to converse with the living, I hope he agrees with me paperback remains the best way to consume knowledge, for I find modern flavors such as tablet too crunchy.

I hear Mayo Clinic is becoming some sort of Destination Medical Center. At least in Rochester, I hope this impending influx of new humans and technology also brings newfound remembrance of the past, as well as deep reflection upon the history of diversity, less confidence become lost. If nothing else, Jarrod Harris will have more places to land his helicopter-house. Perhaps Dave Attell will even visit “the tavern” in Bellechester, assuming his tour bus can navigate the blue highways required to reach this civilization Google Maps still struggles to touch, where I feel some form of continuity between the natural order and a future of hope remains largely intact, at least as long as the corn continues to rise.

Probably I should end with “Medicine is the best of all professions, the most hopeful” (Aphorisms, William J. Mayo, #36). However, I wonder if non-physician patients would agree, and prefer this image, from a time when I heard too many aphorisms of the Mayo Brothers quoted as if some form of scripture, hallow versus hollow words, this one resonated with me, also not so easy to find on Google. My greatest thanks to Hilary Lane and Nicole Babcock of Mayo Clinic’s History of Medicine Library for sourcing this quote, these words were originally published as the opening of “Tolerance and Honesty” by the Mayo Brothers in 1925 for Rochester High School students, reaching high school students at least as far as Tennessee by 1936 via East Tennessee Education Association of Signal Mountain and the radio machine. I am glad real historians remain, plus the ending of this talk: “…a reputation which can be handed down as an example to their children.”

Andrew M. Harrison is one of the co-managers of Mayo Clinic’s Diversity in Education Blog and a student in the Medical Scientist Training Program at Mayo Clinic.

Sep 29, 2016 · Invisible Disability

By Andrew M. Harrison

The time: January 2010. The place: The barren cornfield-tundra (then tundra) of Rochester, Minnesota. The setting: Other applicants and current students enjoying drunkenly sliding along the sheets of black ice, but you are in pain and hiding a back brace under your clothing from a spine surgery two weeks ago. Do you: (A) join along and hope nothing goes wrong, (B) point out you are weak for the aforementioned reasons and risk judgement, (C) act uptight and risk a different form of non-weak judgement, or (D) cry and risk every judgement?

I am not a fan of “fancy” words or terms, but this is known as invisible disability. When I broke my neck a few years later, the subsequent J Collar was not invisible disability. (Iconic survivors of this sort of injury, at least in my mind, include Arnold S. Relman and Dave Brubeck.) However, some disability turns out to be more visible than others.

Kaur-Harrison

Dr. Kaur and Andrew in Kodiak, Alaska (August 2016). Can you tell who holds the record for more lifetime joint dislocations? What about joint replacements?

I recently had the pleasure of breaking my foot. The details are unimportant, except to extend my thanks to Drs. Erik R. Brodt, Judith S. Kaur, and Dave R. Baines for providing me with the experience of a lifetime on the island of Kodiak, AK. In the process, hopefully we made some progress recruiting Indians Into Medicine (I am not a fan of political correctness either) and increasing awareness of the need for colon cancer screening in the Alaskan Native population, but these are stories for another time.

Wheelchair

Andrew (one of my first attempts at “the selfie”). Do “ortho shorts” match with the scrubs top? I discovered the next day leather gloves help to prevent the wheelchair from ripping apart the hands, but do fashionable forearm protectors exist? Note: The impalement injury to my right leg is old. Older (and even less visible) is the neuropathic damage to this “good” leg.

In the relatively rapid transition from walking on a broken foot for 2 weeks (I hate doctors) to “the boot” to crutches to wheelchair to [cast + knee scooter + iWALK], I experienced disability for at least one day. I learned some things this day:

  1. One day is more than enough for me. People with years to decades of experience, feel free to chime in with additional tips and/or thoughts.
  2. I was already aware the average human lacks the spatial IQ to make efficient use of corner/curved mirrors, omnipresent in most buildings, but now I really wish some human-factors engineer would improve upon this design by lowering this spatial IQ burden.
  3. Perhaps I am just incompetent, but it seems to me, in buildings with the luxury of “handicap accessibility”, if automatic swing-door operation is even present (and functioning), the time-delay on many of these doors can stand to be increased slightly.
  4. People like to ignore you. When I am in a suit or scrubs, my research colleagues walk past me. When I am in my hobo clothes, my physician colleagues walk past me. When I cannot walk, almost everyone walks past me. In fact, more stories for other times, I had some of the most interesting conversations in these days with the few people who did not (or could not) easily walk/hobble/crawl past me.
  5. People like to NOT ignore you. Please, thank you, and “you’re welcome” (confirmation of affirmation of words of limited value to begin with) are very common, and even more exhausting. From the East Coast to the Midwest: How or why exactly do you think I need or want your help? My thanks to Ted (custodian of Mayo Clinic’s Mitchell Student Center) for laughing at me, which was what I needed most.
  6. Unsolicited “help” (genuine or otherwise) is often dangerous. The most extreme case: Random people I have never met before (and hope to never meet again) who step in front of me as I am racing down corridors to (seemingly seriously) ask “what’s wrong?” Honestly, I do not know what is wrong with you. However, you are endangering not only my safety, but your own, and everyone else around us.

Baines

Dr. Baines, a one-legged Indian, as he prefers to be addressed, busy teaching his son the importance of not forgetting the fishing poles.

I am a vain man. Out of necessity, I think the most important lesson I quickly learned was to abandon vanity. For pushing me over the train tracks early one morning (do this backwards or the front wheels of the wheelchair like to get caught), I dedicate this post to Charles, survivor of Guillain-Barré Syndrome, as he prefers to be addressed. When he simply could not tolerate my second thanks, his profane words were what I really needed to hear that day. For better or worse, not all disability is easy to hide.

Airport

I am not sure exactly what is happening here. To bastardize the words of former President George W. Bush: I wish to be judged not when I am at my best, but when I am at my worst. I am not fit to pass judgement on others. However, as I struggle in the airport on my peg leg, loading my scooter onto the plane for the beaches of Mayo Clinic Jacksonville, which are not cast friendly, the cruel laughter: How do you wish to be judged, and what disabilities are you trying to hide from me?

Andrew M. Harrison is one of the co-managers of Mayo Clinic’s Diversity in Education Blog and a student in the Medical Scientist Training Program at Mayo Clinic.

Sep 12, 2016 · The Sights and Sounds of Diversity of Mayo Clinic

By Domenic F. Fraboni and Andrew M. Harrison

There I was (DFF). Standing in front of the crowd that had gathered at Mayo Clinic College of Medicine’s Annual Diversity Welcome Reception on Wednesday, September 07, 2016. I may have been one of a handful of people in that room that had never lived outside of Minnesota. A good number of the individuals in the room had even lived or grown up outside the country. I also don’t have what I call great surface diversity. This is what most individuals may think of when they think of diversity: race, ethnicity, and culture (and I would say rightfully so as it is a significant component of diversity). By that standard, I represent the majority here in Rochester and Minnesota. What could I say to help a group of people from out of state (or country) feel more comfortable here in Rochester? I suppose I could simply start with what caused me to gravitate to Mayo Clinic for my graduate education: Mayo Clinic’s Shields (practice, education, and research).

When I was pursuing acceptance into a Physical Therapy program, my journey found me interviewing at Mayo Clinic. It was here that I first learned about the Three Shields. I loved the incredible value Mayo Clinic put into education and research. They sold me on the importance of these two facets, aka the first two shields, in quality patient care. It was when they revealed what the third shield meant that made me mentally start packing my bags to come to Rochester. Patient-centered care. This is what the center and largest shield in the Mayo Clinic logo represents. This showed me that no matter what the research says and regardless of the amount of education a physician and/or clinician has, Mayo Clinic understands that we are in the “business” of the people’s health; not disease. This was the point when, even before I had been accepted into the program, I knew I had to have my physical therapy education here. This is what I told the people that I was fortunate enough to say a few words in front of that evening. I went on to share that since coming to Mayo Clinic, my experiences here have undoubtedly helped me realize the depth that encompasses this thing we call diversity. It is important to realize the amount that we can learn from those who are different than us, and how as a medical center, this intra-diversity education helps us paint a beautiful, comprehensive, and cohesive tapestry that is our Mayo Clinic community. This is what I have to share.

The event as a whole was the perfect opportunity for newbies (new students), veterans (returning students), faculty, and staff alike to mingle, enjoy “heavy hors d’oeuvres” (basically a three course meal complete with dessert and drinks), and talk about great ways to incorporate themselves into a potentially very new community and culture here in central Minnesota. I got to have a discussion in depth with one post-baccalaureate student in particular, Roberto Lopez Cervera. Roberto was born in the Yucatan region of Mexico and moved to Los Angeles with his family when he was six years old. Coming from this background, and moving from a city that is very culturally and ethnically diverse, Roberto said that it was a major culture shock coming to Rochester, smack dab in the middle of rural Minnesota. He also shared with me that he thinks one of the most challenging tasks for some physicians is relating to and understanding those patients who come from different cultures (again pointing at the importance of that patient-centered shield we have).

Sixth year graduate student and PhD candidate, Jennifer Arroyo, also stood up and gave a welcome to all the newbies in the crowd and spoke about her experience coming to Mayo Clinic. She shared a piece of advice that was given to her while she was here for the Initiative for Maximizing Student Diversity program. She was told early on to find herself a mentor, but not just any mentor would do. The trick would be to find a mentor who really understands you as an individual, as a professional, and understands your specific needs to succeed in your chosen field. Yes, there are difficulties for women and individuals from underrepresented populations to find mentors from their exact background in their intended occupation (discussed some in this previous blog post). However, I believe that in our Mayo Clinic community we have plenty of individuals who are able and willing to provide that mentorship to anyone asking. Hopefully, these mentors can help more aspiring graduate students from underrepresented populations reach for and succeed in obtain positions higher and higher in their fields. Only at this point will we have achieved the true strength that diversity can bring to the medical field.

To come full circle, I may not be the most visually diverse person that was at the Diversity Welcome Reception. Nonetheless, it is occasions like these that help me realize that I still am able to add at least one unique paintbrush stroke to an already incredible painted canvas. I think I made the right choice coming here. I hope you feel the same way too. “Within its walls all classes of people, the poor as well as the rich, without regard to color or creed, shall be cared for without discrimination” –Dr. William J. Mayo (October 09, 1912). Wow pretty radical talking there for his time. I guess it makes sense why Mayo Clinic is constantly pioneering countless different avenues in the medical world.

Dr. Vivian Pinn

Earlier this day, Vivian W. Pinn, MD (NIH Senior Scientist Emerita) gave Mayo Clinic’s Annual Elizabeth Blackwell Lecture: “Perspectives on Women’s Health and Women in Biomedical Careers:  The Road Traveled but With Miles to Go!” (Mayo Clinic intranet only). I think she would have enjoyed this event as well. (Photo by AMH)

DFF is someone who has played too many sports, but not taken enough blows to the head (AMH). In the style of Kyle D. Traynor, MD (Mayo Clinic Department of Obstetrics & Gynecology), “fancy doctors” refer to these as concussions. As for Joseph E. Parisi, MD (Departments of Laboratory Medicine & Pathology and Neurology), one of our living legends of Neuropathology, and one of the most empathetic/compassionate clinicians I have ever met (noteworthy because pathologists are not clinicians…), I suspect he might read this and wonder: Where has the music gone? I most enjoyed the performance of Take Five, by Paul Desmond & the Dave Brubeck Quartet (Time Out, 1959), on tenor saxophone by Ryan C. Donohue—PhD student training with Roberto Cattaneo, PhD (Departments of Molecular Medicine and Biochemistry & Molecular Biology)—and Eric Straubmuller on piano (The Ryan Donohue and Eric Straubmuller Duet). Without the passion and diversity of music, where is the fun in life? As host of the greatest Swiss National Day (aka Flag Day) this side of the pond, I was pleased to see Dr. Cattaneo at this event as well, although I am uncertain of his taste in music.

Thanks to Ryan, I was reminded, and thus forced to dig through crates of relic texts that night, to find my 2009 copy of the Charlie Parker Omnibook (1978 reprint). Although I referenced Charlie Parker in the post above as one of the greatest minds who ever lived, in his youth at the time, recently deceased alto saxophonist Phil Woods spoke of how Charlie Parker once asked him, out of concern: “Did you eat today?” As a prolific “consumer” of DFF’s business of healthcare, in all the endless questions of disease, diagnoses, and labels, I will never forget the one and only time a (non-clinician) physician asked me a similar question. Shortly before Parker’s young death, Woods also spoke of “the greatest lesson I ever had” when Parker made “even the [neck] strap sound good” playing Harlem Nocturne. This is music. This is passion. This is diversity. In a time when diversity barely was.

Next year I hope to hear Ryan perform Harlem Nocturne, but only in the style of the original 1939 composition written for the Ray Noble orchestra. This is education. Born before diversity even was, I end with the beautiful voice of the great scholar, educator, and even athlete, Paul Robeson: Shenandoah.

Mayo Clinic Jacksonville Piano

Piano of musical genius Lou Corbin (aka Lou Clayton): Volunteer at Mayo Clinic Jacksonville (FL), retired lawyer, retired trial judge, and blind since childhood accident. (Photo by AMH) I was entertained earlier this year by his bench-side refusal, as well as subsequent Supreme Court-style decision/opinion, to perform Night in Tunisia, even though he sang Saint James Infirmary. Ex post facto law (of sorts), at least the previous appeal was submitted one year prior to my birth.

Domenic F. Fraboni and Andrew M. Harrison are co-managers of Mayo Clinic’s Diversity in Education Blog.

Mar 3, 2016 · The beginning of wisdom

By Andrew M. Harrison

Is racism the result of one of the basic human emotions, social disorder, both, or neither? Is this question even valid? From contemporary American psychologists such as Paul Ekman and Robert Plutchik, I can stretch an argument racism is derived from some basic human emotion and thus a sort of fundamental human right. From the ancient Analects of Confucius, I can argue “the beginning of wisdom is to call things by their proper name” and thus racism is the result of some improperly balanced social construct.

On Wednesday, February 10, 2016, Mayo Clinic’s Office for Diversity (Mayo Clinic College of Medicine) hosted its 5th Diversity Discussion at Mayo Clinic’s Rochester campus in Minnesota: “Social Justice: Roles and Responsibilities in Medicine”. Panelists were Charlie Rose, Michelle Hwang, and Mark Wieland, MD. This event was moderated by Barbara Jordan. Two days later, Camara Jones, MD, PhD, MPH (President of the American Public Health Association) presented the Grand Rounds for Mayo Clinic’s Center for Clinical and Translational Science (CCaTS): “Naming, Measuring and Addressing the Impacts of Racism on Health.” This event was hosted by Joy Balls-Berry, PhD. Both events were held in the context of Black History Month.

Jones

Dr. Jones: The power to speak (Rochester, MN)

Who is qualified to answer my question? I participated in the Office for Diversity’s first Diversity Discussion panel and have written more on this subject, but I am not. Based on the self-introductions of all three recent panelists, neither are they. Is someone qualified? Again I do not know, but someone must speak. It is easy for me to descend into facts and figures, but in these details, I will not truly speak. In this context, I was struck by the fearlessness (perhaps courage) of Dr. Jones to speak. I was struck by her ability to name racism. Still my question is not answered, but in the passion of her words, I felt the call for bravery to collectively face racism by simply calling out its name.

Only two weeks later (February 24 through 26), I attended an annual meeting of Mayo Clinic’s Spirit of EAGLES American Indian/Alaska Native Initiative on Cancer at Mayo Clinic’s Jacksonville campus in Florida: Principal Investigator Judith Kaur, MD. In attendance 1000+ miles away was much of the same audience, including Dr. Balls-Berry and Sumedha Penheiter, PhD. There I was struck by two similarities to the presentations above. First, the pain of racism, prejudice, and discrimination, which I have previously written about and/or solicited many posts for this blog: here, here, here, here, here, and here (Black History Month 2015), with posts on women’s rights omitted only in the sheer interest of space. Second, the seemingly unanimous call for universal health care as a basic human right, which I have also used this blog to ramble about here, here, and here.

Group Ocean Photo

The voice of Spirit of EAGLES (Jacksonville, FL)

I speak, but am not qualified and thus do not know if anyone can (or should) hear. However, how many voices are required to manifest wisdom? What more must be named? Who has yet to speak? In a closing reference to The New Jim Crow: Mass Incarceration in the Age of Colorblindness (Michelle Alexander, 2010) by Dr. Jones in Rochester, as well as a presentation by Christi Patten, PhD in Jacksonville, I am reminded of the enormous challenge of even obtaining funding to research subjects such as racism and health disparities. However, resonance follows when passion and wisdom sing together.

Roubidoux Satter Strickland

Jacksonville, FL (left to right): Marilyn Roubidoux, MD, Delight Satter, MPH, and June Strickland, PhD, RN

Andrew M. Harrison is one of the co-managers of Mayo Clinic’s Diversity in Education Blog and a student in the Medical Scientist Training Program at Mayo Clinic.

Acknowledgement: The continued support from the voices of others I could not fit into this post, such as Shobha Srinivasan, PhD and David Baines, MD.

To attempt to call all people and things by their proper name:

Sherrill (Charlie) J. Rose, Mayo Medical School student

Soyun (Michelle) M. Hwang, Mayo Medical School student

Mark L. Wieland, MD, Assistant Professor of Medicine, Mayo Clinic

Barbara L. Jordan, Administrator, Office for Diversity, Mayo Clinic

Camara P. Jones, MD, PhD, MPH

Senior Fellow at The Satcher Health Leadership Institute, Morehouse School of Medicine

Joyce (Joy) E. Balls-Berry, PhD, Assistant Professor of Epidemiology, Mayo Clinic

Judith S. Kaur, MD, Professor of Oncology, Mayo Clinic

Sumedha G. Penheiter, PhD, Program Manager, Office of Health Disparities Research, Mayo Clinic

Christi A. Patten, PhD, Professor of Psychology, Mayo Clinic

Marilyn A. Roubidoux, MD, Professor of Radiology, University of Michigan

Delight E. Satter, MPH, Senior Advisor for Tribal Research and Program Integration, CDC

C. June Strickland, PhD, RN Professor of Psychosocial & Community Health, University of Washington

Shobha Srinivasan, PhD, Health Disparities Research Coordinator, National Cancer Institute

David R. Baines, MD, My living inspiration: Walk in Beauty

Jul 16, 2015 · Grey Lines - Stepping Over the Interdisciplinary Boundary in Healthcare Education

By Thomas Mork

I was sitting in Phillips Hall in the Siebens Building at Mayo Clinic, immersed in a speech by “Bob”: former patient, cancer survivor, and nationally-renowned speaker. He stood proudly at the podium while his voice reverberated among a crowd of physicians, nurses, and physical therapy students. This self-described “active patient” defied cancer by becoming a dynamic advocate for himself during his medical care. As his story goes, he brought forward multiple treatment options that his physician never considered. They decided to try these treatments when standard care was failing. Over a year later he is still cancer free and advocating to people across the nation to become active members of their healthcare team. The ideas he brought forth saved his life and illustrated that we require contributions from everyone, patient included, within the healthcare system to provide the best care.

Some physicians and therapists might say Bob crossed the line that divides patient from caregiver. They might say that he had no place telling the physician what kind of treatment he should be given. However, this was exactly his point. We can’t possibly know everything about a patient and if a patient is willing to become involved in his or her care to the point of suggesting treatment ideas, this can only help us. The same goes for interdisciplinary teamwork in the healthcare setting. If we are to fight for Bob’s life we need collaboration, cohesiveness, and cooperation among our respective fields, patient included. We need physical therapists notifying physicians they need help managing spasticity. We need speech therapists helping physical therapists include cognitive training during balance exercises. We must remind ourselves that the lines that divide our professions are not black and thin, but grey and wide. The real world of healthcare is fluidly moving over and beyond these lines to enhance our interdisciplinary teamwork. We must complement the strengths and weaknesses of one another to unravel the complexities of the human body with respect to each individual patient. The Mayo School of Health Sciences teaches us just where that grey line is and how to cross it to contribute to the interdisciplinary team.

I remember learning this lesson during a case study session with the Mayo Medical School students. We were each given a practice case and paired up with a medical student. My patient was an older, obese adult who presented with severe abdominal pain and low back pain. Our goal was to brainstorm possible diagnoses and then create a presentation highlighting best care protocols. I blindly took the reins for the assignment and tried my hand at diagnosing what might be going on medically with his abdominal pain. First, my medical student partner in arms let me exhaust the obvious differentials (abdominal aortic aneurysm, appendicitis, belly-ache, etc.) and then she went on to name twenty more diagnoses, only some of which I recognized. When I spewed out some recommendations for medication, she politely pointed out certain side-effects and drug-drug interactions that would make my combinations useless or dangerous. I realized that stepping back to listen to her knowledge in this area would be the quickest path to a solution. Then we came to the treatment session for low back pain. I listened as she listed off pain medications, but jumped in when she said “conservative management”. I taught her the muscles we would be selectively strengthening, those that we would be selectively lengthening, and those that we would reeducate in order to achieve long-term relief. Our teamwork evolved into a comprehensive presentation that left our imaginary patient in a much better place.

Interaction with medical students is just one way that the Mayo School of Health Sciences (MSHS) teaches us to toe the grey line as we learn to communicate with other disciplines. In fact, not a day goes by when I have not had interaction with some other healthcare professional. One day it might be a knee surgeon who recounts a play-by-play of his or her typical cases. Another day it might be a nurse from the ICU who tries to make sense of numerous lines sprouting from a patient’s body. We might be studying in Venables Health Sciences Library in the Siebens Building and overhearing the radiology students talking about MRI proton spin or X-ray magnification. Thus, we are constantly submersed in a diverse healthcare environment – a place in which we are learning from other clinicians, picking experts’ brains for hidden knowledge, and interacting with students of other professions. Our program in the MSHS teaches interdisciplinary teamwork by continuously surrounding us with experts from various fields and students who are experts in areas we barely touch upon. Therefore, when it comes to working in the real world, we already know that we must rely on our partners in the healthcare world to fill the gaps of our knowledge, so together we can provide the best care for our patient. And we want patients like Bob to push our knowledge just a little bit farther.

I began my clinical education in my second year of physical therapy school and instantly found that I was not alone. The occupational therapists in the neighboring gym treated the same patients as me, the nurses reported lab values to our team, and the physicians created their medication cocktails in response to our objective data. I was engulfed once more in a melting pot of different professions in which the goal was to return a patient to their normal life. But this time I was prepared to step across the grey line and fill the void where physical therapy should be. Together we created a plan that we could proudly call “best care”. MSHS prepared us for this moment by surrounding us with the resources and means to communicate with other clinicians in a team learning environment. Its healthcare program entrenches its students in an interdisciplinary educational environment in an effort to expedite the process of working together for the good of the patient. I believe this is the best way to prepare students for a real world – a world in which we must rely on one another to care for others.

Thomas MorkThomas Mork in 2013 at Fort Sumter in Charleston, SC

Thomas Mork was born and raised in North Branch, MN. He graduated from St. Olaf College with a BA in Biology and is currently in the third and final year of the Doctor of Physical Therapy program in the Mayo School of Health Sciences.

Acknowledgement: My sincere appreciation to the Mayo School of Health Sciences for their formal education and in preparing me to be the best clinician I can be.

Editorial comment (Andrew M. Harrison): The entire blog team and the Office for Diversity are grateful for this first-ever post from a MSHS student. We challenge students in the other 40+ MSHS programs, as well as medical residents and fellows in the Mayo School of Graduate Medical Education, to tell your diverse story and why your training program is important for patient care.

May 13, 2015 · Believe it or not...

By Dr. Jim Maher

How can Mayo Clinic best honor the axis of diversity that might be called “faith,” “belief,” “unbelief,” or “religion” and what leadership can be shown within Mayo Clinic’s academic environment (the Mayo Clinic College of Medicine)? These were some of the questions that motivated a fascinating lunch session on May 11, 2015, organized by the College of Medicine Office for Diversity, and featuring a delightful panel representing a sampling of four faith traditions different from the nominal Christianity that typified 78% of Americans in 2010. The premise of the discussion (“Religious Diversity in the Mayo Clinic College of Medicine: Positive Expression, Ongoing Challenges”) was that global faith traditions, including agnosticism and atheism, are richly diverse, and the diversity of faith traditions among members of the Mayo Clinic workforce and Mayo Clinic patients is far greater than the faith diversity of the local communities that host Mayo Clinic campuses. Today’s panel captured the perspectives of Reformed Judaism, Islam, the Sikh faith, and the Church of Jesus Christ of Latter Day Saints. The scope of the conversation allowed panelists to describe the distinctives of their respective faith traditions, common misconceptions, and their experiences as people of faith in the Mayo Clinic environment. There were rich differences in the core articles of faith for the traditions, and in how the different faith communities interact with those outside each faith.

DataData presented by Dr. Dennis C. Mays. Photos by Andrew M. Harrison

How is Mayo Clinic doing with respect to celebrating religious tolerance? The message emerging from the panel was “pretty well.” Panelist Dr. Randal Thomas offered that the Mayo Clinic environment of discussion around personal faith or agnosticism/atheism was, in his experience, neither hostile nor openly conducive, but respectfully indifferent. The other panelists agreed, and Dr. Ravinder Singh suggested that a focus on professionalism has moved discussion of faith or agnosticism to a sphere dictated by personal conversation largely at the instigation of individuals within the institution. Postdoctoral fellow Karim Mustafa affirmed that he had not experienced discrimination or hostility within the Mayo Clinic environment.

IntroductionIntroductions and panel moderation by Barbara L. Jordan

So that all sounded refreshingly upbeat. Where do we need to improve?  Panelist Sarah Lund, a student in Mayo Medical School, helped the audience come to terms with remaining gaps. In response to an audience question highlighting the peculiar historical institutional collaboration between a Roman Catholic (Franciscan) hospital, a Protestant (Methodist) hospital, and the distinctively agnostic character of the Mayo brothers and their family, it was pointed out that the institution, perhaps not surprisingly, sends mixed signals to its employees and patients. Example: multiple manger scenes and Christmas trees appear seasonally in some parts of Mayo campuses, obviously sanctioned by the institution, suggesting to some that those from non-Christian traditions might not be appreciated or well-served as guests. The point was that symbolism is powerful, and Mayo Clinic hasn’t quite figured out if it is a secular and diverse humanitarian institution or an amalgam of various sacred and secular traditions employing a religiously-diverse workforce, while trying to serve an even more diverse patient population. Navigating the diversity of belief, non-belief, symbolism, and inclusion is a challenge for many large organizations, including governments, universities, and academic medical centers.

PanelistsPanelists (left to right) Sarah R. Lund, Karim M. Mustafa, Dr. Ravinder J. Singh, and Dr. Randal J. Thomas

Where do we go from here?  I’ve been thinking about this all afternoon. Two points come to mind. First, if we are truly interested in a search for truth, I suggest that we should deeply respect one another in our choices about faith in a truth beyond us, or even our faith that there is no truth beyond us. However, beyond respect, we should keep searching for truth because it is self-evident that all faiths cannot be equally true (after all, they are inconsistent with one another), so asking and learning and discussing is necessary if we seek to continue toward the ultimate truth. Second, while I would argue that the search for the ultimate truth of faith, belief, or unbelief is the point of life, it is actually not the point of Mayo Clinic. As my colleague Martin Fernandez-Zapico has eloquently pointed out to me, the point of Mayo Clinic is ultimately not truth but service. Here is where I believe we find our best path to tolerance and inclusion of faith traditions: in order to best serve our patients and their families, we must collaborate across lines of faith, belief, and unbelief to meet the needs of patients. Often that means serving the patient in the context of their current understanding of faith, belief, or unbelief. But sometimes, maybe not often enough, this means answering honest questions with honest answers that might lead to a changed heart and a new understanding of truth.

That’s what service looks like.

AudienceThe audience

Interested in more of Jim Maher’s thoughts about science and faith?  Check out this post at his personal blog: http://jim-maher.blogspot.com/2013/02/mantis.html

Care to join in the broader discussion of experiences and views on the roles of faith, belief, and unbelief in the life of the Mayo Clinic as an academic medical center?  Feel free to comment below.

Editorial comment (AMH): I remember Dr. Maher before he became Dean of Mayo Graduate School and was merely a Professor and leader of Mayo Clinic’s Initiative for Maximizing Student Development. I also know he had the courage to publicly reflect on his faith in this blog (in its earlier iteration) as early as 2009. Although possibly beyond human comprehension, the meaning of life is one of the most fundamental and profound unanswered questions for any human being with any intellectual curiosity. As for how this question intersects with education, diversity, tolerance, and patient care, I am reminded of words told to me by Mayo Clinic internist and master medical educator, Dr. John H. Davidson (Master of Arts in Hebrew Letters, Rabbinical Ordination): we are all waiting for the great abyss.

Feb 26, 2015 · The Banality of “That’s Nice”

By Nora E. King

I sat in Mayo Clinic’s St. Marys Hospital cafeteria with my clinical team, in that awkward way medical students know too well: the attending physician (“consultant” at Mayo Clinic) buys you a cup of coffee and then proceeds to gossip with his buddies for the next 15 minutes. It’s never clear whether you should chuckle along with the stories or pretend to not listen, absorbed in your notes on the patient list.

Unusually, the cafeteria was filled with music. “What’s that noise?” someone said. We glanced around and noticed a poster with sepia photos of famous Black Americans. “Oh, it’s Black History Month,” his colleague replied, “that’s nice. Let’s get out of here, the music is too loud.”

Black History Month Poster

A while later, I was using the restroom and happened to glance at the floor, where I saw this drain:

Sioux Chief Drain

How can we have both of these things within a hundred feet of each other? We celebrate diversity when it’s “nice”, but neglect to confront our offenses. Admittedly, it would be hard to tear up a bathroom drain. But, surely someone somewhere at this institution made the conscious decision to purchase drains from an overtly-racist company? Ironic timing, in light of the recent Medical Grand Rounds presentation at Mayo Clinic on February 18th by Dr. Dave Baines, the first American Indian graduate of Mayo Medical School (class of 1982).

Baines and Averill

Dr. David R. Baines with Marcy L. Averill (Mayo Clinic Spirit of EAGLES) after his presentation, titled “Culture, Spirituality & Healing: A Journey of Enlightenment”. Photo by Andrew M. Harrison

I hesitated to write this. As a white, straight, able-bodied woman, is it my place to point out our embarrassments? Are these battles and grudges really worthwhile? Am I missing the point completely, hunting for tangible problems, when there are more important things to address? If, as a person of privilege, I’ve noticed such things, I wonder what ethnic and social minorities must experience.

Over the past several years in Rochester, Minnesota, I’ve collected incidents of racism like ugly mementos. I never know quite what to do with them—speak up, report them, stay quiet—so I’ve stored them away. There was the time a resident referred to ethnic minorities as “colored people”. Another time a nurse anesthetist referred to the Latino McNeilus steel plant workers as the “illegals in Dodge Center”. My first landlord said Rochester was getting more dangerous because of “those people from Chicago”, which I understood to be a reference to the city’s Black community seeking jobs, affordable housing, and peace in other Midwestern towns. A consultant told me he was nearly color-blind because he once dated a Black woman and is half-Asian. I’ve previously written about the awful, benevolent naïveté of how we approach diversity, ignoring an indigenous patient’s identity by marking a Latino checkbox rather than Native American (500 years of colonial oppression aside, a minority is a minority, right?). By no means am I innocent either: I recently embarrassed myself by speaking to an elderly Somali patient as if she must be very provincial and quaint, only to learn she was quadrilingual in Somali, Arabic, Italian, and Swahili. She had also held a prominent communications position in the country’s first democratic government decades ago.

Permit me to explain the (potentially offensive) title. In Arendt’s Eichmann in Jerusalem, she describes a completely normal-seeming man who was found to be the principal architect of the Holocaust—evil incarnate. Adolf Eichmann was not particularly intelligent or ambitious; rather, he just wanted to conform to society and those he admired. From this, Arendt constructs the idea of the banality of evil: assuming charge of, or playing along with, others’ horrific decisions. Doing so essentially transfers moral decision-making to one’s social superiors. I borrow her line of thinking not to compare bathroom drains to the holocaust, but to question myself. When I fail to confront these racist incidents, am I as destructive as the person who said “colored”? Does our institution get to check the “Celebrate Black History Month” box because they put up a poster & played some music?

Here at Mayo Clinic, I believe too many of us take a banal approach to race. Culture is “nice”, something to celebrate with bright colors, posters, and food festivals. At the same time, we neglect to have difficult conversations about privilege, our own offenses, failures, and superficiality.

Nora King

Nora King was born and raised in Saint Paul, Minnesota. She graduated from Boston University and is currently a student at Mayo Medical School. Nora spent the 2013-14 academic year in Guatemala as a U.S. Fulbright Student Scholar, working with indigenous Kaqchikel Maya midwives, and is applying to residencies in Obstetrics and Gynecology.

Dec 18, 2014 · Should dual degree training exist?

By Andrew M. Harrison

No, I will not be writing about the illustrious EdD-JD. However, please note these are both largely regarded as “professional” doctoral degrees in the US. Although still less relevant in the US, you should know the difference, as most of the rest of the world draws a clear distinction between a research doctorate and a “first professional degree”.

As data interferes with effecting social changes (for better or worse), and blogs are by nature not designed to be lengthy, let’s get this part out of the way first and fast. More Commentaries on the subject of MD-PhD training have been published in the academic literature than I care to discuss. The most comprehensive report to date is presumably the 143-page 2014 NIH Physician-Scientist Workforce Working Group Report. Stated to be inspired by the 156-page 2012 NIH Biomedical Research Workforce Working Group Report and amazingly no reference to the fact 2014 also happens to mark the 50th anniversary of the NIH Medical Scientist Training Program. To date, I am aware of no formal, comprehensive NIH history of the MSTP…

To the anecdotes: effectors of social change. My interest in this subject began in the summer of 2010, literally one week after I began MSTP training, with the publication of an economist-centric article in Pacific Standard (then Miller-McCune) magazine, documenting postdoctoral fellows as essentially the most overqualified, underpaid workforce in the US. As an already committed “molecular biologist”—undergraduate honors thesis and multiple summer undergraduate research experiences, including at Mayo Clinic—I was intrigued. However, the real eye-opener came when I was “volunteered” with my classmate, Bennett G. Childs, to co-host the Mayo Clinic MD-PhD Program’s Annual Bench to Bedside Lecture (lecture by Dr. Olaf S. Andersen at this link, on Mayo Clinic intranet only). Buried in the MD-PhD training literature I summarily dismissed above, I discovered Dr. Andersen had co-authored a publication in April 2010 in Academic Medicine, the official journal of the Association of American Medical Colleges, entitled “Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs.” Accurate or not, my interpretation at that time: almost all MD-PhD graduates become physicians, but very few become “scientists”.

Today, my opinions are skewed by many factors: current Year 5 MSTP student*, participant in the National MD-PhD Student Conference, member of the Executive Council of the American Physician Scientists Association (the “other” MD-PhD student conference), and countless interactions with dual degree trainees, graduates, and directors across the US. As for the content of this skewed opinion: I dismiss current, anecdotal arguments that dual degree training, partially funded by the NIH MSTP at many institutions, should be replaced by individual National Research Service Awards, such as the NIH F30. Instead, my own anecdotal argument: the heyday of classic “molecular biology” as the model for dual degree trainees is over. As best as I can divine, with limited formal historical documentation from 1964, MSTP was designed to be “molecular biology, by molecular biologists, for molecular biologists”.

As a failed essayist in the Lasker Foundation’s first-ever 2014 Essay Contest (“innovative ways to build support and ensure funding for medical research”), it would seem the “scientific” community is interested in vagaries such as tax credits for pharmaceutical companies and “innovative” molecular biologists. However, my approach is radically different. In my simple mind, “science” (the hypothesis driven discovery of new knowledge) and “engineering” (the problem-solving driven exploitation of existing knowledge) both fall under the larger umbrella of “research”. This umbrella, which encompasses much more than molecular biology, must be radically expanded to include far more dual degree training in “low level” (math, physics, computer science) and “high level” (sociology, political science, economics) areas of “research”. In my view (lengthy rationale for another time and probably place), progress in these areas of research represents the true rate-limiting factor to improving “medical research” and, more importantly, the health of our society in general. Also for another time and place: dual degree training would make so much more sense if trainees completed the PhD after the MD and medical residency/fellowship training*.

What is ResearchA simple-minded schematic I first created for a presentation for high school students (summer 2013).

I will conclude with two final anecdotes. Both are directly related to diversity. First, I have edited, but not written (here and here), two blog posts on the subject of AI/AN (“Native American”) diversity in education, after attending Annual Meetings of the Association of American Indian Physicians. At both meetings, as well as Spirit of EAGLES 2013, I interacted with many students interested in pursuing dual degree training, but unable to easily do so, largely due to research interest in subjects such as public heath, public policy, and even philosophy. Do these students and their research interests have any place in dual degree training? Second, I refer you to Harvard University’s pioneering dual degree program in Social Sciences-Humanities (“SSH”). Some of the earliest graduates of the “medical anthropology” arm of this program include contemporary leaders in both medicine and global health, such as Dr. Paul Farmer and Dr. Jim Kim. Although dual degree training programs in SSH currently appear to exist at multiple institutions, my understanding is most are underfunded, inactive, or largely defunct…

Andrew M. Harrison is one of the co-managers of Mayo Clinic’s Diversity in Education Blog and a student in the Medical Scientist Training Program at Mayo Clinic.

*Acknowledgement: Although they did not directly contribute to this post, my research doctorate mentors (Drs. Herasevich, Gajic, and Pickering), who I have known since the first year of my professional doctorate training, have expanded my thoughts on this subject in a way I can only hope to experience again.

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