Empowering Trainees to be Leaders and Change Agents

On By amroundsIn AM Podcast, AM Podcast Transcript, Annual Call for Trainee-Authored Letters to the Editor, Trainee Perspective

On this episode of the Academic Medicine Podcast, guests Lala Forrest and Joe Geraghty join host Toni Gallo to discuss the journal’s Trainee Letters to the Editor feature. They highlight selected letters submitted in response to last year’s call for submissions about the role of trainees as agents of change and discuss how institutions can empower trainees to be leaders and how trainees can get started leading change efforts. Lala and Joe also introduce this year’s call about transformative moments in a trainee’s professional journey and describe what the editors are looking for in successful submissions.

This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available.

A transcript is below.

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Transcript

Toni Gallo:

Hi everyone. I’m Toni Gallo. I’m a staff editor with Academic Medicine and host of today’s episode. I’ll be talking to Lala Forrest, the Journal’s assistant editor for trainee engagement, and Joe Geraghty, a member of the Journal’s editorial board, about our trainee authored letters to the editor feature, and Lala’s and Joe’s recent commentary entitled “Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow.” That article is published online ahead of print now, and it’s available to read for free on academicmedicine.org. I’ll put the link in the notes for this episode. You might remember Lala from our March 2021 episode about supporting American Indian students pursuing careers in medicine and science. Definitely check out that episode from our archive if you haven’t yet.

Lala Forrest:

Thanks Toni. It’s good to be back. So like Toni said, my name is Lala Forrest. I am the assistant editor for trainee engagement for the Journal Academic Medicine. I’m also in my third year at the Frank H. Netter MD School of Medicine. We go by Netter for short. We’re located in North Haven, Connecticut. So it’s good to be here.

Joe Geraghty:

Thanks Toni. My name is Joe Geraghty. I am on the editorial board for Academic Medicine. I am a current third year medical student at the University of Illinois College of Medicine in Chicago. I’m part of the MSTP program. I recently finished my PhD in neuroscience, and hoping to go into neurology, particularly interested in neurocritical care, epilepsy, and medical education. Happy to be here.

Toni Gallo:

Well, thanks for all your work both of you on the Journal and for joining the podcast today. So I thought we could just start by talking about Academic Medicine’s call for letters to the editor. So every year we issue this call. There’s a specific topic. Last year’s topic, we asked authors to describe their experiences as agents of change in academic medicine and medical students, residents, fellows, trainees in the health professions wrote in on all kinds of experiences that they’ve had.

Toni Gallo:

And in your commentary, “Empowering the Leaders of Tomorrow,” you describe some of the letters that stood out. All of those letters are available online ahead of print now at academicmedicine.org, so listeners can check them out. And they’ll actually appear in the June, July, and August issues later this year. But trainees talk about enacting change at a couple of different levels, so within their institutions, within their local communities, and nationally. And I thought we could start today by just talking about what some of those experiences looked like, what letters stood out to you both, and maybe you can talk also about your own experience with leading change in academic medicine.

Joe Geraghty:

So I can at least get us started here. I think for several years now since these calls for letters to the editor from trainees have been coming out through Academic Medicine, I think it’s been a really great opportunity and I’ve really enjoyed seeing these calls because it puts a spotlight on a lot of the successes, leadership advocacy, and so on that are being led by trainees. And when I say trainees, I mean medical students, I mean residents, fellows, really across the UME to GME spectrum.

Joe Geraghty:

In terms of the way we talked about it in our article, we really focused on four different areas, one being public health, particularly with the COVID-19 pandemic. Another one being really issues of social justice, equity, inclusion, diversity. We talked a little bit about wellness and resilience. And then the USMLE changes that have been announced over the last couple years and some of the larger implications for the undergraduate to graduate medical education spectrum.

Joe Geraghty:

And I think the really nice thing as we were going through these letters to the editors that we’ve been receiving is exactly as you said, there are impacts that trainees are having across the country and really across the world, while some of them are institutional specific. We described several wellness initiatives that were done at individual campuses. The University of Illinois where I attend, we had a wellness committee that we formed led by students. We were able to partner with local companies to bring in more healthy food options. We were able to set up a counseling center dedicated specifically towards medical trainees.

Joe Geraghty:

And so that’s at the institutional level, but then in our local community, we had several letters from places like the University of Chicago. We had a medical student who wrote about how they were developing kind of like easy to digest infographics related to the ever-changing information with the COVID-19 pandemic and how that was able to disseminate this information in real time to the community.

Joe Geraghty:

And then I think if we zoom out even further, in looking at the national level, we had several letters that were talking about really addressing issues related to race-based calculations and how they’ve been kind of improperly used and incorporated into various calculations. The one we talked about and that we had letters were the estimated glomerular filtration rate, or eGFR, and I’m sure Lala can talk more about that. But also the USMLE, we’ve had huge changes with Step 1 becoming pass/fail, Step 2 CS being discontinued, and student voice has been instrumental in calling for those changes and guiding those changes in terms of making sure that us as the end users are really intricately involved with those conversations as they’re happening rather than afterwards.

Lala Forrest:

Thanks, Joe. That’s a really great overview of our commentary and of some of the different topics that we could see across the trainee letters to the editor. I think a couple that have stuck out to me this past year as trainees as agents of change were a couple from… So one of them was from the Cincinnati Children’s Hospital where some pediatric residents put on this fundraising drive called Pledge 43 to highlight the fact that 43% of children living in Cincinnati are living below the federal poverty line. And so they created this fundraiser Pledge 43 where individuals can donate up to 43% of their COVID-19 stimulus check. And it was just incredible to see that they raised over $26,000 to buy kids meals, to buy them masks and stuff like that. So that’s just like one example.

Lala Forrest:

Another example is from the University of Texas Medicine Branch at Galveston where the authors discussed this interprofessional endeavor where there’s medical students, social workers, community health workers, I believe as well, where they established the Congestive Heart Failure Comprehensive Clinic for patients who were low income and couldn’t normally afford their outpatient therapy. They really focused on addressing the social determinants of health, especially in lieu of the COVID-19 pandemic. And I especially liked that they included a quote from one of the patients where the patient stated, “When I first got my heart failure diagnosis, I thought it meant my life was over and this clinic helped me see that it’s not.” So I think these are just a couple examples of, kind of like what Joe was saying like, yeah, trainees can spearhead change at an institutional level, but they can also do it at a larger scale in their communities and also at a national level.

Toni Gallo:

And we’ll put the links to some of these letters that we’re talking about in the notes for this episode. So if anybody who’s listening wants to find them, we’ll make sure you get those links. Some of the examples you both gave were really students pushing their institutions to be more equitable, to be more just, thinking about ways that they could make their institutions better places. And I wonder if you could maybe talk about, from your experience, from some of these letters like, what is the role of trainees in this space of really pushing their institutions around issues that maybe it would take a lot longer for institutions to address if it weren’t for medical students and residents really pushing for these changes and leading those changes and making sure that they’re getting done?

Lala Forrest:

I think, and we talk about this in our commentary as well, trainees are no longer viewed as passive bystanders in medical education, but rather that they’ve become these valuable stakeholders that can hold their faculty and institutional leaders accountable for change and for saying that, yes, we need to push for these resources or these types of initiatives. So, for example, at my own institution, me and a good group of other student leaders, we really wanted to push forward diversity, equity, and inclusion efforts, but we also wanted to do it in a very sustainable way. So what we did was we created the Perspectives on Equity Advancement Research and Learning Symposium called PEARLS for short, PEARLS.

Lala Forrest:

It was a student-led, faculty mentored symposium where we highlighted faculty change makers because I think a lot of the times there’s some really great faculty at our institutions that are doing really great work in the field of DEI but they oftentimes aren’t recognized or as publicized or advertised. So we wanted to make sure that we gave them the opportunity and a platform to come and invite them to speak about the work that they’re doing while simultaneously inviting students who are also interested in pushing forward DEI opportunities to talk about their scholarly efforts and projects, and to kind of give them an opportunity to connect with each other to perhaps foster some mentor-mentee relationships, but most importantly to give a chance of, and by our audience members, to just come and see what kind of great work is being done, to get some direct feedback, and then hopefully get some more people on board to push forward these efforts.

Joe Geraghty:

Yeah, I couldn’t agree more. I think a lot of these initiatives do start at an institutional level. And I think within academic medicine or medical education in general, it’s really easy sometimes to fall into this kind of hierarchy where medical students are kind of viewed as kind of at the bottom of that hierarchy. But what people forget is that we are adults. Many of us have degrees in various diverse backgrounds. Some of us have worked completely different careers before coming to medicine. And so I think the power that a lot of these letters and student initiatives have shown us is that, like Lala said, we can be empowered and we can be instrumental in serving not just as kind of end users or reactive participants, but proactive participants. And we can really collaborate with faculty and have innovative novel ideas.

Joe Geraghty:

And I think incorporating us early on into those decision-making processes really will lead to a better end product because you’re really involving those end users and getting a more comprehensive picture of what the issues are that students are facing. And I think that’s only going to make the delivery of whatever curriculum, whatever services you have in medical education that much stronger. There are so many different examples. One that we did not really talk about in our article but that comes to mind is, when I started medical school back in 2014, a group of my peers were really interested in the biochemistry of sickle cell disease.

Joe Geraghty:

They decided that they wanted to partner with some of our faculty and design an entire team-based learning exercise on sickle cell disease, incorporating the epidemiology, the social determinants of health with the biochemistry. So really tying the basic science to the actual clinical practice and real life of these patients. And from that, that was at an institutional level. They then slowly but surely got more involved with policy. And so they were able to, a year later, go down to Springfield, Illinois, in our capital and actually work with legislators to advocate for changes in reimbursement patterns for patients with sickle cell disease who often have these chronic pain crises, require various medications, repeat hospitalizations.

Joe Geraghty:

And so they were able to take these kind of institutional specific initiatives that they led and transform that to something that was both at the local and state level. And I think allowing students and empowering them to do things like that can be really powerful both for patient care but also for their own development and their professional identity.

Toni Gallo:

So what would you say to either institutions or national organizations that want to do more to empower students to help them be leaders, to bring change to fruition? You touch on some of this in your commentary, but I wonder if you both could share just some advice from the letters, from your own experience, what can organizations do to better support students?

Joe Geraghty:

That’s a great question and I kind of think about this a lot. We touched on a little bit of this in the article, but I actually have kind of five things that come to mind. I know that’s a lot, but number one is involve your trainees in decision making. There are many ways to do that. One, give them a seat at the table. Involve them in the curriculum committees. Involve them in the planning of conferences on the editorial boards of large journals, like Academic Medicine has done. Give them dedicated time to speak up during these meetings. Make sure that they’re not just kind of sitting there and absorbing it, but that there’s a dedicated period of time where you turn to the trainees and you say, “What are your thoughts? What questions do you have? What comments do you have?” And planning that into your meeting agendas.

Joe Geraghty:

Number two is viewing us as partners and collaborators. That we have unique ideas and contributions that can make your product much stronger. Number three is providing time, resources, funding. Those are going to be instrumental to allow us to take our ideas and really transform them into something that is actionable and solution oriented. Number four, a lot of times students don’t realize that they have the ability to make this level of change. And so I would strongly encourage institutions, whether they’re medical schools, residency programs, the AAMC, to identify and empower student champions, to lift them up and let them know that they can have a voice and that voice can be quite powerful.

Joe Geraghty:

And then finally, the fifth part and I think maybe one of the most important is to always close those feedback loops. When you make a change that was in direct response to trainee feedback, let the next generation of students or residents know what those changes were and why they were made. And I think importantly that they were made in direct response to student advocacy and student vision. I think that really starts to develop a culture whereby students feel that they have a say in the system, they have some ownership over their own education and their own career development. And I think that can be really powerful in the end. So those are kind of things that I would encourage every institution, every organization to kind of think about throughout this process.

Lala Forrest:

Yeah. I second everything that Joe said. I think all of those are necessary steps. I think I just want to push faculty members and institutional leaders to kind of ask themselves, do you think your trainees feel like they can share their input or give feedback in their current environment in a nonjudgmental way? So I think that is the first question you should ask yourself is, do you feel like the trainees can make change in their current environments? And if not, why? Identify those barriers. And in addition, do your trainees know off the top of the head who they could go to to accomplish and initiate change in X, Y, and Z? They need to make sure… make known of their resources available and know off the top of their head who they could go to for additional support.

Lala Forrest:

And I also think I want to kind of shift the framework from like engaging trainees, which I feel like could be interpreted in a little passive way. So like engaging could kind of mean just like occupying somebody’s time. It’s kind of easy just to kind of like invite the student to come in and be like, “Oh yeah, come and serve on this committee and stuff.” But like Joe was saying, it’s an additional step to say, “Well, what do you think?” And to always check back in with them and give them a designated time slot on the agenda. That’s a whole other level.

Lala Forrest:

So I think I want to see like the shift of engaging trainees to empowering trainees, and empowering by making them stronger, by making them more confident in their abilities because it’s going to be a win-win situation for everybody. And ways that you can empower students I think starts with that initial conversation with them in the beginning of what do you need from us? How could we support you? Making sure that they’re adequately compensated for their efforts. I know some institutions have started some diversity, equity, and inclusion fellowships for medical students or compensating their peer mentors and basically saying like, “Yeah, we value this type of work and we want to make sure we’re not taking advantage of our students.” And it goes recognized for everything that they do.

Toni Gallo:

Thinking about it from the trainee perspective too, I wonder if you could just start with being a leader is not easy. You’ve both described a lot of barriers and challenges. So maybe professionally like what have you gotten out of leading change at your institutions or in whatever capacity, whether it’s with the Journal. But just sort of like has it been valuable, what have you learned from it, what do you think you’ll take with you to help you down the line in your practice?

Joe Geraghty:

That’s a really good question. I think kind of throughout this journey that I’ve been on, the more I’ve been able to partner with faculty at my own institution, University of Illinois, but then also kind of through that, get exposed to more national conversations through the AAMC, Organization of Student Representatives, through my work working and collaborating with the NBME and USMLE over the past couple years, I think it’s really shown me the power that the trainee voice can have, but I think it’s also really shown me how important it is to incorporate diverse student voices. And in terms of my career development, I started medical school, I never thought that I was going to be interested in or motivated to be part of medical education or academic medicine policy and administration.

Joe Geraghty:

And these opportunities which my mentors have very fortunately given me have actually shown me that this is a really productive and worthwhile career path, and this is something that I can incorporate into my career as a physician. And I think that’s a message that I would love to show other students and other trainees is that we have valuable voices and that these opportunities now are really going to help us set the stage for the future and really empower the leaders of tomorrow like our article says.

Joe Geraghty:

The other thing that I really learned and appreciated is the power of data. Maybe this is the inner nerd in me, but I think whenever I’ve wanted to convince medical school administrators or national organizations, having data to kind of support my claims has really gone a long way. And I think providing trainees with some type of training and understanding of how data is collected, whether it’s quantitative or qualitative data in the realm of academic medicine and medical education, how they can use that data to support their ideas is really powerful. And so I think that’s something that I’ve learned along the way and plan to use throughout my career but really important here in the field of medical education in general.

Lala Forrest:

For me, I think being a leader at my institution has helped me as a future clinician scientist with that being my primary goal. And like Joe, I never thought I would find myself in medical education becoming really very interested in academic medicine, but it’s a really captivating field. And once you kind of get immersed to it, you’re like, “Oh, wow, that’s kind of how this works. Oh, maybe I can do something different.” And I think for me, my interest lies in the fact of, okay, maybe I could just tweak this a little bit and make sure that the future positions of our society are more knowledgeable in this area, are more knowledgeable of certain underserved marginalized communities, populations, and the social determinants of health, structural competency.

Lala Forrest:

All that stuff is very interesting to me because I think it gives you a chance to impact the future of medicine and the future of medical education. So I think that is something that I can really take away with and all the other small lessons of learning how to kind of oversee a team or be a part of a team and really think about long term sustainability and how things are going to turn out. And just being part of a larger process in general is just I think very inspiring at the end of the day because you find yourself amongst peers who are so passionate about the things that you’re passionate about. And I think that in itself feeds forward.

Toni Gallo:

Well, we’ve been very glad for your insight and leadership at Academic Medicine. So I’m glad that this was something you both are interested in doing. So for the other trainees who are out there listening to this, what advice would you have for them, whether it’s overcoming barriers at their institution, just figuring out what they are most passionate about. How would you counsel them as they’re thinking about being leaders and how they can lead at their institutions, in the larger community across academic medicine? Any advice?

Joe Geraghty:

Yeah, for sure. I think that’s a really great question. And something that I would love for people to take away from this podcast is I’m hoping that we’re able to reach trainees and have them hear kind of what we’re talking about here and then kind of hopefully spark or ignite ideas and passion. And I think all of this really starts with, as trainees, we are kind of living medical education in real time. There’s not a day or a week that goes by, as I’m going through my third year rotations or my preclinical courses, where I don’t run into issues or questions or complaints. And students love to vent, that’s true too. But taking those things and translating them into real questions and acting on them and not just venting for the sake of venting, which is healthy in some ways, but you can also translate that into action and advocacy, and making changes even at the local level and those can kind of spring forward.

Joe Geraghty:

For me, the most important thing was finding faculty champions. I was really fortunate to … early on in medical school I wasn’t super involved but started slowly getting more and more involved with kind of medical education initiatives within my own local curricula. And I had our Associate Dean of Curriculum at the time, Dr. Abbas Hyderi, who basically was like, “Hey you, I’d like to talk to you about this. I want to hear your ideas.” And once I started kind of sitting at the table with him and talking, he was kind of like, “Well, how would you do it differently? Here’s our like curricular roadmap, what would you change? What would you add?” And it wasn’t just me. He did that with several other students. That was a really powerful way to show me, oh, wow, I can actually have a role here.

Joe Geraghty:

I think those types of faculty champions are really important in terms of, just as Lala was saying, not just engaging us but empowering us to really play an active role. I think it’s finding meaning in what you do as you go through medicine and medical education in general. I think finding questions that you’re really interested or passionate about or problems that you’ve identified that you would like to change. And then I think going back to what I said earlier, doing that in kind of as much of a data driven or scholarly way as possible will also really help propel your cause forward.

Lala Forrest:

Yeah. That’s all great advice. I think in terms of kind of how can trainees kind of initiate change and stuff at their institutions, it can be very specific when it comes down to it. But in general, I think something one of my good friends from college taught me was he always said never complain about something unless you have a solution for it. I think that has stuck with me throughout the several years just because it has helped me kind of pinpoint, like kind of understand like, yeah, this is pretty complicated if you get down to the basic. It’s kind of easy to superficially look at something as a trainee and be like, why is our school doing this and why not this, and how come they’re not acting now? Well, stuff like that.

Lala Forrest:

But when you get into the weeds of it and you’re like, oh, well, what’s the solution? And then it’s like this. And then it’s like, oh, well, what about this? And it kind of just makes you think of how complicated it can be, but also it helps you identify like what you are kind of passionate about, like what really makes you go and look in depth about how you could change something. And I think that’s my main advice that I would kind of give to people is kind of figure out what really drives you and ask yourself at the end of the day, what do you want to be known for? What do you want to, kind of, as in your future career, what kind of work do you want to be known for? Because I think as trainees, we get torn in so many different directions and there’s so many clubs and responsibilities that on top of being a student that we kind of get thrown at.

Lala Forrest:

But I think it’s also important for you to take the time for you to really reflect and be like, this is what I’m passionate about and this is what drives me and this is kind of what I want to be known for and make a name, the field that I want to make a name in. And I think that will help you kind of harness your energy and your focus and make some really impactful change long term.

Toni Gallo:

That’s great advice. And I think this is a good time to turn to the call that we just issued this year for the next set of trainee letters. The end of March, we released the new topic and we’re asking authors this year to write about a transformative moment in their professional journey. And just kind of some logistics if you’re interested in submitting, we’re looking for letters that are no more than 400 words and that have no more than three authors, and all of the authors should be at some stage of their training in the health professions. It doesn’t have to be medicine, it can be another health profession. But we are looking for only trainee authors.

Toni Gallo:

Like last year, the submission window is just one week. It’s from 9:00 AM on Monday, May 23rd, to 5:00 PM on Friday, May 27th, and those are Eastern time. The full call with all of this information and how to submit and all of that is available on our blog, AM Rounds. That’s academicmedicineblog.org. Again, I’ll put the link for that in the notes for this episode, but that’s kind of an overview of the logistics. But I wonder, Lala and Joe, you were both involved in choosing this topic. Maybe you can tell us a little bit about why this was something you wanted to focus on, and then what are you and the editors looking for in successful submissions? What are you hoping that authors will write in about?

Lala Forrest:

So I think for me what I am especially excited about with this year’s topic is that I think this is basically giving everybody an opportunity to showcase their diversity, their unique perspectives and experiences that they bring as an individual to the field of medicine. I know at my institution, for example, the majority of our students are untraditional in the sense of they don’t come from undergrad straight into med school. They have worked in different fields. They’ve worked several years in the biotech company. They’ve served in the military for a number of years. We have been an opera singer. And then somehow they found their way into medicine.

Lala Forrest:

So I think this is really just giving a chance to give the trainees a chance to talk about their transformative experiences in their life and what has been most meaningful to them because at a large scale, trainees have this kind of extensive list of great skillsets of advocacy and they’re smart, they have great interpersonal skills, they’re very professional, they’re leaders, but we want to know what has been transformative to you, what has been impactful to you. So I think that’s what we’re looking for. I’m really excited. I think this is going to be a great topic for this year and I look forward to reading all of the letters.

Joe Geraghty:

Yeah, me too. I would just echo, as you’re going through medical school, residency, sometimes you just kind of feel like you’re one of the herd and you lose some of that individuality that brought you to medicine in the first place, those individual diverse backgrounds, passions that made you as a much younger version of yourself say, “Hey, I want to go to medical school. I want to pursue medicine. I want to help people.” Everybody has a different reason for that. And I think what brought them to medicine in the first place, and then as you’re going through this journey learning more about yourself and what you can do as part of this career is a really interesting topic.

Joe Geraghty:

And as people are writing these letters, things that we could see, and we discussed a bunch of different letters with the Journal staff and other editors. We picked this one because I think it will really show how unique people’s journey into and through medicine can be. But I think also there’s a lot of common themes. I think as people are describing their own individual descriptions or narratives of experiences, if they can draw on kind of broad themes that they think are applicable or generalizable to other trainees, I think that will help them a lot in terms of really putting together like a high quality or impactful letter.

Joe Geraghty:

On a personal standpoint, as I’ve been in medical school for eight years now, as I moved from medical school preclinical world to my PhD world and then have since moved back into the clinical world of medical school, there are so many different transitions that I’ve gone through and I think back to, oh, now I feel really good in the preclinical world. And then now I’m in a basic science lab and I have no idea what I’m doing. And then I felt really strong at the end of my PhD. And then I’m thrown back into clerkship and I forgot how to do a complete physical exam. There are so many different transitions and transformations that people go through during this journey that I think we’re really excited to kind of hear what drives student, resident, fellow passions and how those have really impacted their careers and their professional identity formation.

Toni Gallo:

So I have one final question to kind of tie this year’s topic to last year’s topic. I wonder if you could each maybe talk about a transformative moment in your own journeys as leaders and what did that look like? I know we’ve kind of circled around this a little bit, but just maybe an experience that was particularly impactful and kind of how it shaped how you see yourself as a leader, the type of leader you want to be going forward, anything like that.

Lala Forrest:

Off the top of my head, something that has been transformative for me: I come from an upbringing where I’ve kind of lived in this rural urban environment going kind of back and forth and seeing kind of how health care is like in both worlds. But something that I was especially interested in at my medical school was pursuing a rural clerkship opportunity up in Fort Kent, Maine. So going through OB GYN, surgery, primary care, psychiatry, all of those rotations in a rural setting. And I think the transformative aspect has been, this is how people live in the rural. That they have a lack of access to specialty care. Sometimes it’s hard for them to get an appointment, and just realizing this is how people live in a rural setting and it impacts not only their individual care but their family’s care, the community care.

Lala Forrest:

For example, it takes 365 days for a person up in Fort Kent, Maine, to go and see a dermatologist. They have to drive three to five hours in an ambulance in order to get transported to get a stent placement for a clogged coronary artery because the weather’s bad, because the helicopter can’t come, just stuff like that. And just realizing that there’s a lot of work that needs to be done in terms of rural health care.

Joe Geraghty:

Yeah. For me, I think the thing that comes to mind is really back at the beginning of the COVID-19 pandemic back in March, April, 2020, I had just been, for about a year or so, elected to this position through the AAMC OSR as the student representative to the NBME. And as the COVID-19 pandemic started rearing its head and we had these intense issues with Prometric cancellations of both Step 1, Step 2, Step 3, as the student representative to this committee and my name must have been on a website somewhere, I started getting all of these emails from students throughout the country about the issues that they were facing, multiple cancellations, issues with communication, misunderstanding in terms of what’s going on.

Joe Geraghty:

I remember sitting at this desk right here and being like, wow, this is a problem and it is widespread and it is really having an impact on not only students as they’re preparing for these exams, which is one of the most stressful periods of medical school, but also potentially downstream in their career because at the time Step 1, for example, was still a three digit score. And there’s this kind of Step 1 mania that’s driving people to increase or strive for high scores. It really brought to light a lot of issues related to this process of undergraduate to graduate medical education transition for trainees as they move from medical school to residency.

Joe Geraghty:

And for me, being able to kind of be thrown into that environment and have to represent hundreds if not thousands of students in conversations with the NBME was incredibly intimidating because like I said, students have diverse opinions, they have diverse backgrounds, diverse goals, and making sure that I was channeling all of those various opinions in a productive way but still meeting with the NBME and discussing with them what the issues students are facing are and identifying potential ways that we can solve them; deployment of alternative testing strategies, working closely with Prometric to identify issues and helping to resolve them.

Joe Geraghty:

For me, that was a both intimidating and humbling experience to be able to represent students at that type of level. And I don’t think I would’ve been able to do that well, and I’m not saying I did it perfectly, but I don’t think I would’ve been able to do that as well if it had not been for some of the earlier experiences that I had in medical school, in medical education, working at my own institution and locally in Chicago on medical curriculum and serving as a leader.

Joe Geraghty:

And so each moment students and trainees experience throughout their careers and throughout their educations are additive. You gain so much from even what might be a small thing of I was interested in advocating for changes to USMLE and working with them and then this pandemic hit, and now I’m learning all about COVID and testing accommodations and how to advocate for my peers. It was a truly transformative moment for me realizing the weight of serving as a leader and having to advocate for my peers. I think there’s a long way to go in terms of that area still. I really look forward to continuing to work with my fellow medical students and residents throughout the country, throughout the world, to hopefully make this system just a little bit better and a little bit more equitable. And I think that’s a huge goal of mine moving forward into my career.

Toni Gallo:

I want to give you each a chance if you have any final thoughts, anything we haven’t touched on yet in our conversation, anything you want to leave listeners with. Lala, would you like to go first and then Joe?

Lala Forrest:

Yes, certainly. I think I want to reiterate some of the stuff that I mentioned earlier with I really think we owe it to ourselves to take some time to reflect and really think about our main purpose and drive because I think that will help us kind of naturally find and surround ourselves with people and mentors, identify mentors who can help us accomplish our goals. And I also kind of just want to make sure trainees out there know like when you kind of look at these letters or these student initiatives from a bird’s eye lens, you see like, wow, these are phenomenal, these are great work, and sometimes you can be intimidated.

Lala Forrest:

But I want to just reassure you, majority of the times, especially for me, everything starts with just having a conversation with somebody. Me being on Zoom lately and just talking to a couple of my other classmates and being like, “You know, this is what’s going on. This issue, what can we do about it?” And just really brainstorming. A lot of the time that’s how stuff gets started. And so I just want to encourage trainees that it’s incremental change that will lead up to this kind of bird’s eye view of a large scale change.

Lala Forrest:

And lastly, I just want to thank all the trainees and the mentors out there who do such a great job of helping us trainees navigate the complicated process of medical education. I feel like we cannot do it without our mentors’ support. I just want to thank the trainees and mentors for taking the time and effort to make a positive difference for cultivating the future leaders of medicine and academia.

Joe Geraghty:

Yeah, I would echo everything Lala just said. I think one last thing to maybe just mention is that these initiatives, these levels of trainee advocacy are happening all the time in medical schools throughout the country, but we don’t often hear about it. A lot of them just go unmentioned. Students are developing lectures, they are transforming curricula, they are changing policy whether it’s at a local, state, or national level. And I think this call for letters to the editor is one way that we can actually make those stories that would otherwise go unheard of heard by fellow trainees, by leaders in academic medicine.

Joe Geraghty:

And I think I would just encourage students to think about some of the things that they are probably already doing on campus or on a larger level and think about, hey, maybe this is something that the rest of the world would also be interested in learning about. 400 words is not too much. So it might be hard to squeeze everything you want into that, but it’s a way to kind of initiate the conversation through these letters and to start something. And I think it all kind of can really ignite a much larger conversation in the field by sharing what many students throughout the country are already doing. I would just encourage people to really think about it that way is what are we already doing that could teach a valuable lesson?

Joe Geraghty:

And then the last thing I would just say is, again, just thanks to you, Toni, to Lala and really to all of the people at Academic Medicine because I think it’s amazing to see how this Journal has kind of embraced the power of student, I want to say engagement but I’ll say empowerment. And it’s something that I think many other journals both within medical education but also within medicine and research more broadly could really do is to incorporate and empower trainees to be involved in the decision making, to be involved in the conversations. And I think if we could just encourage other groups, other journals, other organizations to do that, I think the field would be that much better. So I just want to say thank you all for the opportunity. It was great to chat with you all.

Toni Gallo:

Well, thank you both for being on the podcast today. I want to encourage listeners to look for Lala’s and Joe’s commentary which is out now as well as all of the trainee letters that we discussed today and a bunch more really interesting ones too. If you are a trainee listening to this, check out this year’s call about transformative moments. We’d love to hear what you have to say. We want to hear about your experiences. So check out the call, submit your work to us. For all of the faculty listening, encourage your mentees and anyone else to check out the call too. That’s available on academicmedicineblog.org with all of the information. So thanks a lot and have a good afternoon.

Toni Gallo:

Remember to visit academicmedicine.org to read the latest articles from the Journal as well as those in our archive. You can also access additional content, including free eBooks and article collections. Subscribe to Academic Medicine through the Subscription Services link under the Journal Info tab or visit shop.lww.com and enter Academic Medicine in the search bar. Be sure to follow us and interact with the Journal staff on Twitter at @AcadMedJournal, and subscribe to this podcast anywhere podcasts are available. Be sure to leave us a rating and a review when you do. Let us know how we’re doing. Thanks so much for listening.