Eva’s Excerpt June 2021

All the great things are simple, and many can be expressed in a single word: freedom; justice; honor; duty; mercy; hope. ~ Winston Churchill

I love this quote from Winston Churchill. Of course, it comes from war times, but, at least to me, it feels a bit like we have been through a war of sorts this last year and half. There is no question it has been hard. People have lost their lives and suffered harm as a result of COVID, racism, and violence. We have had our assumptions, biases and inequities laid bare. We have given tirelessly of ourselves as doctors, researchers, educators, advocates, leaders, parents, children, partners, and siblings. We are tired and maybe still a little scared and a lot wondering about what comes next and how much longer we can tolerate the uncertainty.

But when I look at this last year, I see that we have done amazing and hard things. We not only survived three surges of COVID, but in collaboration with BJC, we kept our community safe, delivered heroic care to suffering patients and families, developed and implemented testing and contact tracing, served as experts and educators on COVID to the region and nation, and supported the effective immunization of our learners, faculty, staff and the broader St Louis community. We demonstrated duty and mercy in our work. We continually advocated for and supported academic freedom and the importance of science in the face of widespread misinformation. Because of this work, we have been able to begin the process of returning to a new normal, slowly and progressively. We began the long and hard process of dismantling racism in medicine and medical education. Our Executive Faculty have strongly supported this work, undergoing extensive training themselves and supporting required training for all in the coming year. We participated in and spurred similar work at the national level through AMA, AAMC, and other national organizations. There is much to do and a long road ahead but we have demonstrated an abiding commitment to justice and honor. And, of course, we supported the education and professional development of our wonderful learners throughout these challenging times, ensuring they have the knowledge, attitudes and skills to go forth and lead the future of medicine.

We close this academic year with much to be proud of. While there is no question that the next few months and years will hold significant change and challenge, I am filled with hope. Hope that together we can do the hard things we must and are called to do. Hope that we can change the world for the better. And finally a firm belief that our perseverance and commitment to academic freedom, justice, honor, duty and mercy will see us through to our goals of advancing human health through the best clinical care, innovative research and the education of tomorrow’s leaders in biomedicine in a culture that supports diversity, inclusion, critical thinking and creativity.

A Message from the Dean Concerning COVID-19 Activity and Masking Guidance

Dear School of Medicine Community:

Today changes were announced to the COVID-19 activity and masking guidance. We recognize that there are likely some lingering questions that relate to this announcement. Below are more detailed instructions about what is and is not allowed. We recognize that this is a major transition and that you may have additional questions. Note that masking should/will still be commonplace in our environment and anyone should feel comfortable wearing a mask at any time.

Sincerely,

Eva Aagaard, MD
Interim Senior Administrator for Occupational Health

David H. Perlmutter, MD
Executive Vice Chancellor for Medical Affairs and Dean

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WUSM Specific Updated Activity Guidance (effective Wednesday May 19, 2021):

Note that this activity guidance is completely consistent with the current all WU announcement but includes some more detail for those who are planning activities within departments and programs.

Background & Principles:

  • Fully vaccinated individuals are at low risk of contracting and reduced risk of spreading COVID-19.
  • Individuals are considered fully vaccinated >=2 weeks after they have received the 2nd dose in a 2-dose series (e.g. Pfizer-BioNTech or Moderna vaccine, or >=2 weeks after they have received the single dose of the Johnson & Johnson/Janssen vaccine.
  • Over 80% of WUSM faculty, staff and trainees are fully vaccinated
  • The vaccination rate in St Louis is well below “herd immunity”
  • There are many in our patient population and work environment who are immune- compromised and cannot achieve a fully protective immune response to the vaccines or who are otherwise at risk of severe COVID-19 infection
  • The following principles reduce risk of COVID-19 transmission when at least 2 of 3 are used:
    • Maintaining ≥6 feet distance
    • Wearing a mask
    • Being outside
  • The CDC and ST Louis City and County have recently updated their guidance for masking and social distancing for those who are fully vaccinated in non-clinical spaces

Updated Guidelines:

Screening: All individuals should continue to screen for COVID-19 symptoms prior to coming to campus.

Spacing:

  • Fully vaccinated individuals do not need to maintain 6 foot physical distancing requirements in Wash U SOM Non-Clinical Spaces. Individuals who are not fully vaccinated should continue to maintain 6 foot physical distancing

Masking:

    • All hospitals and clinical spaces: individuals must continue to mask regardless of vaccination status. This includes any spaces where there are patient or research participant interactions
    • Public indoor spaces (lobbies, open spaces, walkways, classrooms/events/meetings >30 people): you must continue to mask regardless of vaccination status
      • If fully vaccinated, masking is optional
      • If not fully vaccinated, masking is required
      • People may choose to remain masked and distanced regardless of vaccination status for any number of reasons and masking should not be interpreted as being unvaccinatedNon-clinical private or semi-private environments (offices, private meeting spaces, break rooms, labs, classrooms/events/meetings ≤30 people):

Events and Meetings:

  • We strongly recommend utilizing large spaces or meeting outside when possible
  • For outdoor events, masking is optional for fully vaccinated individuals
  • For indoor events with less than 30 people, masking is optional for fully vaccinated individuals and required for individuals who are not fully vaccinated
  •  For indoor events with more than 30 people, masking is required regardless of vaccination status
  • People may choose to remain masked and distanced regardless of vaccination status for any number of reasons and masking should not be interpreted as being unvaccinated
  • All participants should screen for COVID-19 symptoms prior to the event. WUSM personnel should use the daily symptom screening that is required for entering campus. Visitors should use (visitorscreening.wustl.edu/symptom-screener). Evidence of a successfully passed screening should be given to the activity organizer on site. Active temperature monitoring is not necessary.

Food and Drink:

  • Food and drink may be consumed in indoor private/ semi-private environments and outdoor events
  • Food and drink may be consumed in some indoor public environments (e.g. café’s such as Kaldi’s) where seats have been pre-positioned for appropriate physical distancing. Fully vaccinated people may eat together, but must maintain at least 6 ft distancing to other tables or groups
  • Individuals who are not yet fully vaccinated should continue to maintain 6 ft distancing from all others when eating or drinking regardless of setting

Travel:

  • Work related domestic travel can resume
  • Work-related international travel still requires approval and should consider conditions in the country and essentiality of the travel. Approval should occur at the department or unit level after consultation with and approval of the International Travel Oversight Committee (ITOC) as appropriate

Visitors:

  • Visitors may return to campus in non-clinical spaces
  • Visitors may not return to clinical spaces unless they are part of a formal program or there is a pre-existing relationship with a Memorandum of Understanding/ Program Level Agreement

Approval:

  • Approval for events and meetings is not required as long as requests fall within these guidelines
  • Advice regarding events/ visitors, etc. may be sent to Eva Aagaard @ aagaarde@wustl.edu
  • Failure to adhere to guidelines will likely result in changes to guidelines and process. These guidelines rely on the understanding and honor of our community.

Note: These rules may change as disease activity changes and CDC guidelines and science advance including potential return to more restricted guidance based on local conditions.

 

 

Eva’s Excerpt May 2021

“If I have seen further it is by standing on the shoulders of Giants.” Isaac Newton

This month marks the end of an era- the last rendition of the pre-clinical Legacy Curriculum. I want to take a moment to honor this important event and recognize those who have gotten us to this point. While the structure of our curriculum has been relatively constant for the last 25 years, the content and the strategies used have been continually updated and improved to ensure our students are learning what they needed to excel as physicians and academics. No one can deny that we have supported the development of exceptionally gifted doctors, physician-scientists, and leaders in this time. This is a direct result of the work done by our dedicated faculty and staff.

The question regularly comes up- if it is so good, why change? Aren’t you telling me that what we were doing was wrong? The answer to that is simple- we are changing because the world around us has changed and continues to do so at a seemingly ever-increasing pace. This is not failure but an evolution in our approach that incorporates lessons of the past and adapts them to the contextual world around us. Nevertheless, this can feel like a loss- and it is one. It is the end of the way things were.

For those of you who have dedicated a significant part of your careers and your time and energy to the Legacy Curriculum, I want to say thank you. Thank you for the amazing work you have done and the legacy you have left for us as an institution. Without your dedication and skill, our students would not be who they are now and our institution’s faculty would not be of the same caliber. Without your continued partnership through contributions of deep knowledge and experience, lessons learned, and creativity, we would not have evolved to the Gateway Curriculum. For, if we have seen further, it is by standing on your shoulders, our giants. Thank you.

Eva and Kaytlin’s Excerpt April 2021

Trauma – depending on your context, this word may evoke different connotations or have different implications. We want to recognize that the dual pandemic (systemic racism and COVID-19) coupled with escalating violence and national rhetoric laced with racism are tantamount to trauma for many in our community. While the challenges of the last year are apparent to everyone, those who have historically been targeted because of their identities are likely experiencing significant psychological and emotional stress due to the compounding impacts of a national racial reckoning and their own experience of racialized aggressions. In our high stress environment, where we often push down our feelings in order to manage the immediate needs of those we have promised to serve, it is equally important to take the time to recognize these events and the impact they are having on us and on those around us.

First, we would like to acknowledge that the Derek Chauvin (the police officer indicted in George Floyd’s murder) trial is currently happening. We worry deeply about the implications of another sensationalized trial on our students, patients and colleagues. While complete avoidance of this trial is almost impossible, we recommend that we all be cognizant of its impact on our personal well-being and actively manage our engagement with it as needed. We also ask that we all keep a compassionate mind and heart as you interact with those who might be more directly impacted by the daily proceedings and outcomes of this trial. The trial is expected to last four weeks with a high news profile throughout and the impacts will last far longer, regardless of the outcome.

This occurs at the same time as we are experiencing an escalating pattern of anti-Asian racism. Anti-Asian hate crimes have increased by 149 percent in 2020, according to the Center for the Study of Hate and Extremism’s survey of police departments in 16 major U.S. cities. Throughout the pandemic we have also seen an increase in violence against women worldwide. The COVID-19 pandemic has shown us how inextricably connected our local and global community is at every level. It has also clearly elucidated the ways that some in our communities are more susceptible to structural violence and inequity. This is illustrated through the disproportionate burden of both disease and strife borne by people of color, women and gender minorities, those in poverty and particularly those who exist in the intersections of these communities.

As a School, we have taken the following steps to address racism and bias in our own community: (1) in August 2020, WUSM leadership participated in a 10-hour retreat that focused on understanding and dismantling systemic racism; (2) the Gateway Curriculum Build Teams and Curriculum Coaches who led the design and implementation of the Gateway Curriculum are participating in on-going professional development and skill building throughout the year specifically on understanding systemic racism and anti-racism work; (3) the WUSM Understanding Systemic Racism team has developed an anti-racism curriculum and professional development program that is being piloted in various departments/divisions in WUSM; (4) we have established a working committee of students, faculty and staff who are working to actively address issues of relevance to an anti-racism institution from space to policies and everything in between; (5) the Gateway Curriculum explicitly integrates an anti-racism lens and teaches about the impact of racism on health; the Legacy Curriculum students are being offered supplemental curriculum in this area; (6) the Office of Diversity, Equity and Inclusion offers on-going opportunities for learning and professional development; additional information is available on the website (https://diversity.med.wustl.edu) and are collaborating with the Office of Education to build required training on microaggressions, upstander behaviors, mistreatment and bias in assessment and letter writing. There are a number of other initiatives occurring within the departments. We are actively trying to build a culture of trying because change is hard and conflicts will arise. We also commit to continuous learning and remaining open to the changes that are needed. We offer this, not to suggest that we’ve figured it all out for our institution, but rather to be transparent and to offer a framework for which we can be held accountable.

We are a community and it is critically important for us to support each other in these trying times. We are so grateful to you and your commitment to these efforts. Our hearts go out to all who are suffering.

Eva’s Excerpt March 2021

I am going to do something I rarely do—share a personal story. I am writing this while returning from vacation, my first in more than a year and the first real vacation my husband and I have taken alone in over 20 years. Unfortunately, while I was away, my grandmother passed away, likely from complications of COVID-19. She was 102 years old. She died alone in a nursing home, having been unable to receive any visitors for almost a year. My mother cannot make arrangements for the burial until later this week. It is unclear whether we should travel or even go see my relatives since they are as yet not fully vaccinated and at high risk.

I tell you this not to generate sympathy, but only to reflect on the beauty and sadness of life. I suspect many of you have lost someone you love this year, or had people you care deeply about fall sick. You may not have been able to see them or care for them in the way you wished. You may feel guilt. You have all worked hard and put off enjoyment. You may feel exhaustion or burnout. Your family may have made sacrifices to support you so that you could do the work that needed to get done. They may feel anger, frustration or jealousy. We are all hoping for “normalcy” but it remains elusive and likely will for some time still. You may feel irritated and anxious or just plain bone tired.

And yet, there is so much to be thankful for. It may be hard to see right now, but it is there. To find it, you need to take time for yourself. Alison Whelan reminded us of this important fact in a recent communication. Here is the key message: Attention to our own well-being is important for all of us—clinicians and non-clinicians alike. To do so:

  • Take a vacation or a day off
  • Eat healthy, balanced meals
  • Get sufficient sleep
  • Exercise regularly
  • Treat yourself to your favorite dessert, TV show, book, hobby
  • Stay socially connected to friends and family
  • Make time for religion, yoga, meditation, or mindfulness practice

Here are some articles/ resources as well:

On making time for yourself

On self-care

On clinician burnout

Finally, don’t forget to visit the outstanding resources provided by our Human Resources Office.