Eva’s Excerpt September 2021

I am a person who likes my rituals. Every morning I get up (I’m an early riser), make my coffee, feed the pets and then sit in front of my computer and read. Most weekdays, I read my email, whatever documents I need to review for my meetings that day and edit anything that others may have sent me overnight or late in the day. On the weekends, I tend to substitute that email reading with articles of interest or TED talks—something that lets my mind grow. This ritual brings me peace and creates order in what often feels like a chaotic and unpredictable world—especially these days.

This weekend, I was reading this article from Korn Ferry, a leadership blog I enjoy, which has focused frequently on the challenges of leading in this uncertain time. In it, Gary Burnison quotes his son, it’s “all about learning the difference between glass balls and rubber balls.” That is, in this time of so much change, so much to do, so many “balls up in the air,” all we can do is learn to distinguish which will break if we let them drop, and which will bounce, to be dealt with another day. I found this to be a profound metaphor for the life we are all living right now, whether we are talking about school, work, home or the combination of all in any given day.

This week marks the start of orientation for our Phase 1 Gateway M1 students. Our Phase 1 M2s officially graduate to support this new class as they enter, and look forward to (or maybe become anxious about) their core clerkship year starting in January (Phase 2), or transitioning to the lab, in the case of our MSTPs. Our 3rd years are well into their core clerkships and our 4th years are getting ready for interviews, MSPEs soon to be released. Our PT, OT, PACS and DBBS students have started and are already trying to sort the balls they are juggling. Our residents and fellows may be mostly settled in to the hyper focus of this stage of training (lots of glass balls and steep learning curves): 2 months on the job for most of them but no doubt still trying to figure it all out. Faculty and staff are coming back to campus part or full-time, juggling kids in school, other family responsibilities and work in the hybrid world we now live in. All of us—learners, staff, faculty—we are all juggling glass and rubber balls and the trick will be to figure out which are glass and which are rubber.

Many of us will make mistakes as we try to sort out the needs of this new time—whether it is a new place, new curriculum, new work environment or new balancing act. We will drop some glass balls accidentally and hold on too tightly to the rubber ones that would be just fine to let go of and pick up later. It will be okay. We will learn from our mistakes and grow from them. We will call for help when the balls are too many and give help when we have room to take on more. We will, I hope, take pride in our accomplishments, what we have done and what we have overcome in these last few years to get to where we are now. Finally, I hope we will appreciate what we have. For me, I am grateful for this work that sustains me, and for you, whose work and engagement gives me so much joy and pride. I am grateful for my family, whose support gets me through the toughest of days. And, while all of this means more balls up in the air, I am blessed to be surrounded by others, who can catch the balls I will inevitably drop.

Eva’s Excerpt August 2021

This is a very tough time. We caught a glimpse of freedom, of recovery from this pandemic, and now it feels torn from us again. The Delta variant of COVID-19 is a difficult adversary, made more difficult by the political division we are experiencing as a country and as a world. I am disheartened, as I am sure are many of you. I thought I’d use my excerpt this month to talk about what we know about where we are now, what this means for us in the near-term, and where we go from here.

Here’s what we know. Delta is more contagious than previous coronavirus variants. Our vaccines continue to be our absolute best defense against the Delta variant. While we have seen breakthrough cases of COVID in our vaccinated population, COVID is far, far less common in those who are vaccinated and, overwhelmingly, cases that do occur in vaccinated individuals are mild. While we are rapidly moving to a vaccinated campus population, we are not there yet. Moreover, vaccination rates in the larger St Louis region are hovering at about 42% of the total population with 52% of adults fully vaccinated and significant variation by zip code. In addition, a big chunk of our community can’t yet be vaccinated because they are under the age of 12. So, we have a lot of COVID Delta variant spreading in our unvaccinated community, both on and off campus. This has resulted in a rapid rise in cases and a rise in hospitalizations- again, overwhelmingly in those who are unvaccinated.

What can you do? If you are not vaccinated, please, please contact occupational health or make an appointment elsewhere to get vaccinated. Ask your family members and friends to get vaccinated if they aren’t yet. If you want to talk to someone about your concerns about the vaccine, there are a number of people from across the School, medical and non-medical, from a variety of backgrounds, who would be happy to talk to you- pick someone you trust. Wear a mask indoors whenever you are not alone or eating. When you are unmasked indoors, including while eating, try to maintain physical distancing of at least 6 feet from others. Spend time outside when you can and when engaging in social events move them outdoors as much as possible. You don’t need to wear a mask when outdoors, but avoid crowded gatherings if you can or wear a mask if you can’t reliably create distance between you and others who may be unvaccinated. Wash your hands before you eat or put things in your mouth, nose or eyes.

How can you stay emotionally healthy? Exercise, eat right, and get enough sleep- seriously important and easier said than done. If you or the people you love are struggling with anxiety or depression, know you are not alone. Ask for help, please, please don’t suffer in silence. We have wonderful resources available to support you and your family through this difficult time- please access them. If you have school-aged children, there is basically no way you can’t be stressed. There are so many unanswered questions about how schools will function and what this will mean for you as we come back to campus. That uncertainty is so, so difficult. Please know we all know that we will need to be flexible as we come back. Human Resources has and continues to work hard on expanding child care resources including expansion of back up care, increased slots in day care, and the addition of a terrific child and family care facilitator. Finally, take time for you- you cannot take care of others if you do not take care of yourself. It’s just true.

Going into the fall, we will have the ability to be together on campus in classrooms, labs, and in the office. We will still be able to have some events, but they may not look like they used to. This is better, but it’s not what we hoped for. We have demonstrated a remarkable ability to pivot, respond, and keep our Wash U community safe. This is really hard. And we CAN and WILL get through this together.

Supporting a Fair Environment (SAFE) Initiative to address mistreatment and unprofessional behaviors in the learning environment

This past year a taskforce was charged with developing a plan to address concerns that have been raised about the learning climate at Washington University Medical Center. Specifically, we have noted rising rates of reported mistreatment from our medical students, with similar trends among residents and fellows in the clinical environments and graduate students and post-doctoral fellows in the research environments. The taskforce presented recommendations to the executive faculty that were unanimously approved in January. Among these recommendations was the development of the new Supporting a Fair Environment (SAFE) committee, led by Dr. Lisa Moscoso, Associate Dean for Student Affairs and Dr. Jenny Duncan, Director of Wellness for GME. Click here to see Full Report.

The SAFE committee is developing and implementing new processes for reporting and addressing professionalism and mistreatment concerns for all learners at WUSM, including our graduate and professional programs, post-doctoral fellowships and trainees in the WUSM/BJH/SLCH GME Consortium. The committee aims to improve learner confidence in reporting processes, while also ensuring that individuals or system problems identified are appropriately protected from false allegations. The committee has faculty and learner representation from diverse areas of the school of medicine, as well as representatives from the hospitals and will report to the Academic Affairs Committee. Drs. Moscoso and Duncan have spent time meeting with Department Chairs and hospital leaders to ensure strong partnerships in these efforts.

In the coming months, learners, staff and faculty should expect to see many new efforts roll out. Educational modules are being developed by the Academy of Educators that will highlight incidents of mistreatment, especially those that may sometimes go unrecognized. A new confidential reporting system is being refined, with clear and consistent processes for evaluating and acting upon reported incidents. Our goal is for all reports to go into a single system so that reports about the same individual or area are recognized sooner and managed consistently. The reporting system will include the opportunity for anonymous bidirectional communication through the portal and will ensure we can “close the loop” with all reporters so they know that action was taken. A new SAFE initiative website will allow any individual in our medical center community (including those that witness mistreatment of others) quick access to report into the confidential concern portal. There will also be a link to a new accolade form, where we hope to capture positive experiences in our learning environment, so we can learn from these areas and commend individuals for their efforts. The SAFE committee is also working to ensure similar policy language across our different systems, through collaborative efforts with our BJH/SLCH partners.

The new SAFE initiative, combined with many of the efforts from our Office of Diversity, Equity and Inclusion, is another marker of our strong commitment to improve the culture at WUSM.

Eva’s Excerpt July 2021

Those of you who are or have been athletes likely know something about the performance-recovery cycle. Basically, this is the idea that to maximize performance, you need to stress your body intentionally and enough to result in the adaptations it takes to get you to the next level. However, just as important in this cycle is recovery. The stress of the training causes micro-damage that must be recovered from, or that damage continues to accumulate resulting in a degradation in performance or injury. Similarly important are sleep, nutrition and other forms of self-care that support your ability to recover more quickly.

Why am I talking about this? Well, as I look around at each of you (and me), I see a need for recovery. I see it in our faces, body language, and even engagement. We have been training hard for more than a year with few windows of recovery. While we have much still to do to get to our goal outcomes, if we don’t each make time for that recovery, our performance will deteriorate or we will become injured – in the case of work, this manifests as burnout most commonly, or more seriously in people quitting or leaving the industry.

Later this year, we will be hosting the Granger Network back again to talk about performance and recovery at work. While we wait, I thought you might like to read this article by Matt Plummer which talks about performance and the burnout cycle. It describes three kinds of burnout cycles: daily (where you are drained regularly at the end of your workday), weekly (where you do fine day to day but by the end of the week you are spent) and project (where specific kinds of projects or tasks drain you) and offers potential solutions for each.

This idea feels particularly relevant to this COVID transition time where work and life have been transformed and integrated in new ways. We are largely moving to hybrid work in the Office of Education. This means we have both increased flexibility to address our burnout cycles and increased accountability to each other as teammates to communicate it and negotiate it for the benefit of all. This will require a new kind of introspection for us as individuals to understand for ourselves what results in our daily, weekly and project-based burnout, and a new kind of collaboration for us within our work teams. Those of us who are managers and leaders will need to think about this burnout cycle anew and how we prevent it or recognize and address it.

I find this idea both exciting and a little scary. This is our new normal. As we work through it, we must each start by looking at ourselves and then make and execute on plans for recovery. Be well and thank you for all you do to ensure the excellence of our educational mission. I hope you know that I know that included in that is making space for your personal recovery.

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

—————————————————————-

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.