College of
Human
Medicine

Dean's Update

February 21, 2020

Friends,

This week I’m back to visiting clinics as part of my quality and safety rounds. Each time I visit a clinic I am impressed by the dedication of our staff and by how many people make a special effort to help our patients.

Providing high quality and safe care requires robust systems in addition to intelligent, committed, hard-working, and caring people. For the vast majority of safety and quality problems, we are depending on these systems to protect patients when we make mistakes. Obviously, people make mistakes; in fact, we predictably make mistakes. Robust safety systems ensure that patients are safe when people make mistakes. Getting staff involved in the function of quality and safety programs and systems is one of my areas of focus when I visit clinics, and including everyone in quality and safety work is one of the hallmarks of a high quality, robustly safe clinical practice.

This week, Deans Rasch and Amalfitano, of the Colleges of Nursing and Osteopathic Medicine, respectively, and I met with EVP Beauchamp and the leadership of MSU HealthCare to prepare for an MSU leadership retreat that is part of President Stanley’s strategic planning process. Our goal is to develop some common areas of emphasis, for example, improving health and working with communities in the context of scholarship, education, and service to patients. It was a very good meeting, and it is wonderful to have the colleges collaborating so well.

For me last week ended Saturday, or this week began, depending on your tradition, with the Humanism Conference held at Secchia Center. The conference was organized by our stellar student leaders, Albert Tamayo (Lansing), Clementina Asamoah (Flint), and Katie Klammer (Midland), as well as Drs. Julie Phillips and Ajay Khilanani, and the Office of Student Affairs team. (Photo above: Drs. Ajay Khilanani, Hedy Wald, Julie Phillips and me. Photo courtesy of Albert Tamayo, MD Candidate 2020.)

I did not get to attend all the sessions, but I sat in on the prep for bystander training, and it was very thought provoking and well done. I’ve seen several presentations on bystander training at conferences, and I would like us to do the same type of training for everyone in the college. This will not be easy, but we must do it.

Just down the hill from the Secchia Center at the Grand Rapids Research Center, are a set of sculptures including one of Loney Clinton Gordon. You will recall that I am trying to include an enticing bit of history relevant to Black History Month in each of my February updates. This week, I encourage you to read about Loney Clinton Gordon. By 1939, Ms. Gordon, an African-American woman, had completed bachelor’s degrees in home economics and chemistry at Michigan State College. (We became MSU in 1955.) In 1944, she joined the Grand Rapids laboratory of the Michigan Department of Health where she worked to isolate virulent strains of Bordetella pertussis as part of vaccine work at the lab.

Ms. Gordon’s work was key to part of the effort of Drs. Pearl Kendrick and Grace Eldering, who are also honored in the sculptures. The team worked for decades to create and test a useful pertussis vaccine following a whooping cough epidemic in Grand Rapids.

After trying to find work as a dietitian and being stymied by racism, Ms. Gordon was hired by Kendrick and Eldering who valued her talent and ambition. She has been honored by multiple organizations and had a fascinating life in public health. Follow the above links to learn more. Ms. Gordon’s work is part of the legacy of our land-grant university. Education benefited Ms. Gordon, and the people of the state benefited from her intellect, training, talent, and determination.

As we move toward the MSU strategic planning process and the college’s own strategic planning efforts, the legacy of Loney Clinton Gordon demonstrates how the land grant foundation of MSU brings forth discovery to advance health and improve our communities.

Serving the people with you,

Aron

Aron Sousa, MD
Interim Dean

February 14, 2020

Friends,

I have returned to the land of the administrator after a couple of weeks with daily time blocked for rounding. Like most people who have been distracted from one part of their job, I have spent time catching up, replying to emails I had previously not answered (my apologies to many of you), having lunch with some old friends (thanks Dr. Dean and Dr. Kareti), and finishing up charting and billing from my time on service.

One highlight of the week was attending Tuesday’s celebration ceremony honoring Dr. Lipscomb with Michigan State University’s Lifetime Achievement Award for Excellence in Diversity. Dr. Lipscomb has been a national leader in diversity at numerous organizations including the American Association for Medical Colleges and MSU.

She has been federally funded for more than 30 consecutive years and awarded more than $22 million in HRSA grants to support the diversification of the health professions. And, more importantly, her funding and programming has helped thousands of school children, college students, medical students and faculty for more than three decades. She was eloquent in her words and the standing room only crowd was enthusiastic in its standing ovation.

In her comments at the Excellence in Diversity Awards celebration, Dr. Lipscomb recalled how her childhood during the Jim Crow era in Richmond, Virginia (“the capital of the confederacy” – WDL) was good preparation for her move to Michigan. I think people may not realize or they forget, that institutional racism exists in the north as well as the south.

Beyond the great work of Dr. Lipscomb, there is a larger reason for me to talk about awards. As a group, we could do a better job celebrating the greatness of our students and faculty. One area the College Advisory Committee (whoa, I just linked to the minutes!) and Academic Affairs have been working on over the last year, is increasing awards available to faculty. Awards are a brilliant way to recognize the great work of our people and, it turns out, that local awards are a precursor to regional and national awards. The university tracks national awards as a part of staying in the Association of American Universities (AAU). Nominate your colleague for an award and help MSU be in the AAU.

In this second week of Black History Month, I hope my deanly updates will trigger some spark of curiosity about the history and lives of others. Dr. Lipscomb’s comments alluding to northern structural racism brought to mind the history of segregation and redlining in the Lansing-East Lansing area.

First, I want to point you to a 2015 article by Bill Castanier that outlines how hard it was for Blacks to find a place to rent or buy in mid-century East Lansing. Some of the problems were restrictive land deeds and covenants prohibiting renting or selling to Blacks. A more subtle problem, redlining, was exacerbated by government programs that helped lower income Whites buy houses.

Redlining is a process in which banks determine the safety of mortgages based, in part, on the race(s) of people living in the neighborhood. With the creation of the Federal Housing Administration (FHA) in 1934, the US government made redlining the regulated requirement for banks. The FHA housing regulations literally made it impossible for neighborhoods with non-white residents to be a good loan risk.

The FHA was a New Deal effort to help Americans enter home ownership as a way to reduce poverty and expand wealth. As Blacks and other minorities were systematically excluded from this opportunity, Black families were denied the opportunity to benefit from long standing tax benefits of mortgages, to gain wealth as property appreciates, and to use home ownership as collateral for loans supporting business formation and educational investment. This structural racism helped worsen a wealth gap that persists and continues to limit opportunities for people of color.

Back in East Lansing, Black students and faculty could generally get equal access to housing on campus but buying a house in mid-century East Lansing was nearly impossible without intervention from the White community, including MSU President John Hannah. If you read the Castanier article you will find criticism that, while Hannah was a national leader fighting racism, he did not take on the segregation of East Lansing. He did subvert the segregation by surreptitiously helping Black faculty buy houses, but he did not use his national stature to take on local racism. (The Castanier piece also has some really striking information about Malcom X’s childhood in Lansing, including the burning of their house and the probable murder of his father, perhaps by the Black Legion, a racist offshoot of the KKK then active in this part of Michigan.)

In 2018, the City of East Lansing formally apologized for its history of racial discrimination in housing. The city was spurred to action by the activism of an amazing East Lansing High School freshman, Alex Hosey, who wrote an essay explaining to his coach why he chose to sit during the national anthem before sporting events.

Housing discrimination is still our curse.

Serving the people with you,

Aron

Aron Sousa, MD
Interim Dean

 

February 7, 2020

Friends,

Much of my focus this week has been on rounding with the wonderful Green team on the MSU IM service. I’ve learned a lot; it looks like we did a good job for our patients – and we enjoyed our time working together.

My thanks to the tireless and intrepid juniors Nicole Bowden, DO, and Tyler Kemnic, DO, Mackenzie Gendron, our all-over-it Ferris PharmD student, Mzingaye Eustance Siziba, our excellent MCE student, Salma Mohamed, our medical observer who came through with key translations for us, and our fearless leader, Khader Herzallah, MD, who will be going off to his cardiology fellowship at Tufts in July. (Photo above: next to me are Tyler Kemnic, Mzingaye Eustance Siziba, Khador Herzallah, Josh Cole, Mackenzie Gendron, and Salma Mohamed.)

Frankly, between rounding and standing in line at the Secretary of State to get my “REAL ID” driver’s license done, I did not get a lot else finished this week. Here’s a pro tip for you all – with a little planning you can get an appointment at the Secretary of State’s office. Next time.

February is Black History Month, and each update this month I will include a piece meant to challenge you to read a little something more about Black History. To start, I am going to point you to Daniel Hale Williams, the first person to successfully operate on the pericardium – basically the first successful heart surgery. In 1893, a young man who was stabbed in the chest came into Provident Hospital in South Chicago. Dr. Williams tracked the wound back to the heart, stitched up the leaking mammary artery and then, with the heart still beating, sutured closed the stab wound in the pericardium. About 50 days later, the young man walked out of the hospital.

Dr. Williams was a builder of programs. When he found a missed opportunity, he built a program to fill the gap. As an example, to give women of color the chance to become nurses, he founded a nursing school in Provident Hospital that would accept women. (He founded Provident Hospital in 1891 as one of the country’s first racially integrated teaching hospitals.) And, because the American Medical Association would not accept black physicians as members, Dr. Williams and others founded the National Medical Association. Many of you know that the college named one of its learning societies in Dr. William’s honor. He was a great builder, and, a great surgeon.

I also want to comment on a recent photo taken of a shop display on campus that has drawn national attention. Regardless of the intention of the shop staff, the display of historically significant African American leaders hanging by their necks in a way that one could construe as lynching is painful and traumatizing to our students, staff, faculty, alumni, and patients with those historical roots. To be clear, I don’t think that a performing arts center named for the university’s first black president and his wife supports lynching. However, the irony of this display during Black History Month should challenge us all to consider how we can become more aware of how our actions impact others.

I ask that we in the college read something about lynching, which has been used as a method of suppression and terrorism particularly against Black Americans since the aftermath of the civil war. Much of the time, the KKK and white mobs would use trumped up charges to justify lynching Black Americans. While lynching has been used to kill, intimidate and suppress other minorities, extra-judicial killings (the more general term for lynchings) have been a long-term trauma for Black Americans, with stories passed down through families and communities. The current experience of police brutality harkens directly to lynching, complete with parents and community members passing on traumatic stories and warnings to be careful and look out. This is not how it should be. I understand the privilege of not having to worry about my own child in the same way my African American colleagues do.

I do think that these kinds of events are examples of how we hurt people when we fail to think about the lives and history of others in our community. We tend to forget – or do not think about – how others experience the world; we forget how current struggles reach back to heinous origins 70, 150, and 400 years ago. And, that is exactly why Black History Month is important and matters.

Our graduating students have been back in Grand Rapids and East Lansing over the last two weeks – and it has been great to have these pioneering students back with us as, they complete the “Ready for Residency” experience.

The college has been a part of a ten-school pilot of Core Entrustable Professional Activities for Entering Residents (CEPAER). As many of you know, the fourth year of medical school can be “less than rigorous,” which is a problem when the most difficult transition of medical education comes at the end of the fourth year when students become residents. To address this issue, schools have turned to late medical school events that focus on thirteen CEPAER topics including obtaining a focused history and physical, elaborating a differential diagnosis, ordering tests, providing a handover, formulating clinical questions, identifying safety threats and recognizing a decompensating patient, among others.

In our “Ready for Residency” event, students spent half of a day forming and researching patient oriented clinical questions, solving safety problems in a “hospital room of horrors,” and creating fishbone diagrams for root cause analyses. The students spent the other half of the day handling clinical scenarios, including falls, fevers, respiratory failure, delivering bad news, handling dangerous arrhythmias, and calming “angry” patients. Core to this experience was the incredible faculty effort that went into observing the students and giving them feedback. As usual, we owe heartfelt appreciation and thanks to the staff of the simulation centers for running an astonishingly complex day-long event for nearly 190 students. We salute our students for their engagement and effort put into improving their skills at this crossroads to the next phase of their professional journey.

Serving the people with you,

Aron

Aron Sousa, MD
Interim Dean

January 31, 2020

Friends,

This week I am rounding on the internal medicine service. It’s great to see our residents, students, PharmD students from Ferris, nurses and many other health providers working so well together. Each day there is a new challenge and each day the teams find a way to help patients. As an internist, I enjoy rounding, seeing patients, meeting families and working with the team. (And here I get to reference the old doctor joke, how are IM rounds like ascites? They both have shifting dullness!)

Seeing patients and teaching are two parts of faculty life that I have worked to maintain during both of my stints as interim dean. I enjoy them both, which is good for my mood and therefore makes me better at my other jobs. Rounding also helps maintain my perspective. It’s hard to get too wound up by an ugly spreadsheet when you’re taking care of a young person with meningitis.

Speaking of serious diseases, I wanted to let you know that the University Physician’s Office is actively monitoring the developments of the coronavirus and has plans in place for such health situations, “MSU is suspending university-sponsored travel to China for the next eight weeks. The university will continue to monitor the situation with guidance from the CDC and the World Health Organization as it relates to protecting our Spartan community. The university also has been in close contact with MSU travelers.”

Before I started rounding this week, I visited our Flint campus. Wandering around our space in the former Flint Journal Building is inspiring. Just five years ago, the clinical campus was our outpost in Flint. Now, there is a larger clinical campus and the college’s Division of Public Health, including the Master of Public Health degree program and the MSU-Hurley Children’s Hospital Pediatric Public Health Initiative.

There are more than 80 new college employees supported by funding from Hurley Medical Center, Ascension Genesys, McLaren Flint, the university, the college, the Charles Stewart Mott Foundation, and more than $55 million awarded to the unit in federal research grants and awards. In fact, we happen to be highlighting the work of one of our faculty based in Flint, Julia Felton, PhD, who is studying the links between alcohol and depression. 

The work of our people in Flint is about engaging with members of the community to do community-based participatory research. As a result of this community-facing attitude and the great work of our faculty, there are nearly three dozen community member collaborators supported at least in part by their work with our faculty.

A highlight of my visit this week was meeting and talking with the people of the Flint Registry, housed in college space on the mezzanine level of our building. The registry is a congressionally funded effort to find, track, assess, and help people who were exposed to Flint water during the Flint Water Crisis. You can see nearly the whole crew pictured above.

Over 18,950 people have signed up or are in the process of signing up with the registry, and our staff has referred thousands of these people to services and even neurocognitive testing in Flint. Importantly, the registry is about helping and advocating for the people of Flint; to be sure they collect data, but the registry effort is guided by advocacy and helping the people who enroll. I had fun meeting the people of the registry, taking pictures with some of them, hearing their stories about families in Flint, and their prior work in community organizations, AmeriCorps, graduate school – what a great group! The registry team is inspiring and a part of the vibrant Flint community. Our college gets to do this work because of partnerships with our university, our hospitals, our faculty, our students, and our staff – all for the service of the people.

Serving the people with you,

Aron

Aron Sousa, MD, FACP
Interim Dean
Michigan State University
College of Human Medicine

January 24, 2020

Before I get to college news, I want to rant a bit about the failures of the federal government’s Public Service Loan Forgiveness (PSLF) program. For the uninitiated, the PSLF was designed to forgive the remaining federal, direct student loan balances of those who work for a decade in public service after graduation and make ten years of timely, income-based, monthly payments on their loans. When it was created by Congress in 2007, the program looked to become a great benefit to College of Human Medicine graduates, because their residency training could count as public service.

Our graduates would be required to do three to seven years of additional work for an eligible non-profit (like a university or not-for-profit hospital) to reach the required decade of public service, and the remaining balance of their federal direct loans would be forgiven. For many students, this would decrease their debt burden by $100-150 thousand dollars. Instead, the program is broken and technicalities and confusing rules are preventing loan forgiveness. In the most recently available data from September 2019, only 1,561 applications were approved out of 109,932 borrowers submitting applications. This means only about 1% of applying students successfully use the program.

We are not sure how many of our students have been successful with the program, but it cannot be many. The debt of our graduates is too high, and this program was a potential solution for students looking to follow their passion into care for the underserved or in fields traditionally less lucrative. I could head off into another rant about what it means for the government to not come through on an apparent promise, but you really did not sign up for that kind of experience. What I will say is, for CHM, this program’s problems only increase the need for our college to raise scholarship funds. I don’t see how we can count on anyone else to help our students with debt. It is our job now.

Following on the leadership of Dr. Beauchamp, we are working on a new scholarship campaign just for our college. This campaign will be the major focus of the college’s fundraising. For the past decade or so, we have been raising money for the Secchia Center and the Grand Rapids Research Center, but now scholarships are the top priority for fund raisers. Soon the college will launch a major gift campaign focused on scholarship support for our Spartan MD's. This effort will be led by a major gift committee and the CHM Alumni Board.

Quick, small, successful events like “Giving Green Day” back in early December are fun and can be energizing, but, friends, we have only one full-ride scholarship. We will set our sights higher and aim to make a significant difference for our students to help them make a difference in the world.

And while I am all riled up…

For those who saw Dr. Berwick’s talk, or participated in the health colleges’ joint MLK Day event last week, or have been sentient at any level since Truman’s 1945 Fair Deal plan for near universal coverage, you know health care is surrounded by questions of governmental policy. But before we get to the 2020 elections, we have the 2020 census. Census counts are used to distribute federal money, revise state and federal representative districts, and many other public and private purposes. Census counts are particularly important for apportioning federal dollars that address social determinants of health including educational programs, support for city services, and support for health access programs. It is to everyone’s advantage to get ALL individuals in our communities counted. Certainly, make sure you are counted, but also think about how you might help local groups and organizations make sure everyone counts.

Serving the people with you,

Aron

Aron Sousa, MD, FACP
Interim Dean
Michigan State University
College of Human Medicine

January 17, 2020

Friends,

It’s not been a quiet week in CHM, our medical school. Dr. Don Berwick, perhaps the sentinel voice in health care safety and quality visited CHM, the MSU health colleges celebrated the life of Dr. Martin Luther King, Jr., the college and its partners shared progress reports on Parkinson’s research studies funded through the “Gibby vs Parky” funds, and I learned how to use a towing service.

I had another enjoyable and edifying clinic visit this week, and I continue to be impressed by the resilience and dedication of our staff. It is no secret that the Clinical Center is a difficult place to work and a difficult place to be a patient. We are working on this. For example, we are trying to make it clearer for patients to ask for a wheelchair after they arrive in the building. There is new signage, and we will see how well it works.

If your patients are struggling, I would like to hear about those issues, so we can work toward solutions.

One high point this week was hearing about the collaborations of the College of Human Medicine, the Van Andel Institute, and Spectrum Health through the “Gibby and Friends vs Parky” effort, which raised $1.2 million for Parkinson’s Disease research in 2017. These researchers are working on understanding the basic science behind the disease, studying interventions that improve the symptoms and lives of patients and families, and new technologies that could halt or slow the progression of the disease itself. It was exciting to see the progress of these teams.

Speaking of the power of collaboration, Dr. Jose Teixeira and colleagues from VAI and Spectrum Health published a journal study that may lead to fewer hysterectomies in women with uterine fibroid tumors. These promising results have yielded additional RO1 NIH funding for a follow up study.

And, oh yeah, my car broke down in Grand Rapids on a day I needed to get to East Lansing. A lot of people rallied to get me where I needed to be including a very professional and helpful towing service. And in particular, thanks Faith!

Wednesday evening the college collaborated with the colleges of Nursing, Osteopathic Medicine, and Veterinary Medicine to celebrate MLK Day. The university does not hold classes on Monday, MLK Day, and since there are competing events on campus, the health colleges came together this week to have a joint event when students and faculty are around. It was an inspiring event anchored by a panel member from each college talking about how they bring the message and inspiration of Dr. King to their work with people underserved by our health systems. Our college’s panel member was our own alumnus, Dr. Farhan Bhatti (CHM ’12) who runs the Care Free Clinic in Lansing. Farhan (photo above) does great work and did a fantastic job on the panel. It was a wonderful event!

For those of you who were able to meet or watch Don Berwick on Wednesday, you know how energizing and motivating it was to have him visit. My deep thanks to Amy Ward, Randi Stanulis and Claudia Finkelstein for all the work arranging his visit. The accomplishments and words of Dr. Berwick have led me to think more deeply and clearly about the importance of our goals as unifying and guiding efforts that reflect our purpose and mission. Berwick/IHI projects like the 100,000 Lives Campaign and 5 Million Lives Campaign demonstrate how diverse institutions (including some of our existing partners) can come together and join in an effort to provide higher quality care that improves the health of a population. Dr. Berwick’s visit was humbling, inspiring, and sure to make us think more deliberately about our work.

January 10, 2020

I hope you all had time for a bit of a break over the holidays. Certainly, the dean’s update appreciated a couple of weeks off.

We start 2020 with a congratulations to Jennifer Edwards-Johnson, DO, MPH, who has taken on the role of Flint Community Assistant Dean. Dr. Edwards-Johnson is an assistant professor in the Department of Family Medicine and a graduate of MSU College of Osteopathic Medicine.

Now with most people back at work, we see a lot of good progress happening. The Dean’s Student Advisory Committee (DSAC) has been systematically collecting feedback from small student groups in the Early and Middle Clinical Experiences, and they have begun presenting that information to the DSAC, including Drs. Wagner and Lipscomb.

It was gratifying to see the value students have placed on their clinical experiences, the spiral nature of the curriculum, and the value of the small groups. There is obviously work to do. Examples from the feedback include, improving the integration and clinical applicability of some content in the curriculum and streamlining student tasks in the portfolio. My deep thanks to Emily Bush and the rest of DSAC for this important work.

The feedback collected by DSAC also identified student wellness as an area that students would like to see further developed. We are focused on supporting student wellness and are working with DSAC to improve these efforts. The college has psychological support and services available in each of our communities, but those services are not necessarily all that support wellness.

The traditional medical school curriculum is test heavy and punishes sleep. The Shared Discovery Curriculum (SDC) was designed to reduce stress by radically changing examination frequency and trauma through progress testing. We built in peer and faculty support through the CHM Academy, personal-time-off days in each year of the curriculum and reduced the chances of students having to extend their curriculum. While SDC has been successful in these domains, we know that our students acutely feel the burden of clinical training and testing, particularly in years 2 and 3.

The CHM Student Experience survey is given to every student, every year, and includes validated tools for evaluating wellness, student mistreatment, and the college’s response to student stress. National and local data support that all students feel the stress and difficulty of medical school, but our students from underrepresented backgrounds and those who suffer from systemic discrimination and mistreatment carry a larger burden, which challenges their health, well-being, and career.

To help address some of these challenges our students face, we are establishing the College of Human Medicine Office of Diversity, Equity, and Inclusion. Under the leadership of Senior Associate Dean Wanda Lipscomb, the office will have an assistant dean and academic staffing to help with training and curricular programing for the college. This effort has been a long time coming, and I want to thank Drs. Beauchamp, Lipscomb, and Parker for their planning and vision.

I’d also like to make sure you are aware of the great opportunity we have this Wednesday,  Jan. 15, to see the founder of the Institute for Healthcare Improvement and guru of patient safety, Don Berwick, live in East Lansing or streaming in Grand Rapids and Flint. Dr. Berwick is internationally known (and, in fact, is an Honorary Knight Commander of the Most Excellent Order of the British Empire, 2005) in the field of safety and quality, as well as cultural transformation. Please RSVP at this link by noon Monday if you are able to attend.

In the new year I will continue my clinic visits, and I will go on the clinical service for a few weeks this month as well. Our people do excellent work each day taking care of patients, and I appreciate everyone’s dedication and resilience. This is hard work, and we need to remember to be good to each other – even when the work is tiring or frustrating. We are all in this for the long haul and for the good of others. It is good and noble work.

Serving the people with you,
Aron

Aron Sousa, MD, FACP
Interim Dean
Michigan State University
College of Human Medicine