The Rossi July 2013 by Mount Sinai Health System

ROSSI

THE

Volume 3 | July 2013

The Student Newsletter of the Icahn School of Medicine at Mount Sinai

A Career in Education: An Interview with Erica Friedman By K. H. Vincent Lau

Since 1994, Erica Friedman, MD, has served in numerous medical education roles at the Icahn School of Medicine at Mount Sinai, most recently as Associate Dean for Education Assessment and Scholarship, and Medical Director of the Morchand Center for Clinical Competence. She is a recipient of many teaching awards and project grants, including research grants from the AAMC, the Medical, Educational and Scientific Foundation of New York, Inc, and the Oregon State Attorney General's Prescriber Education Program. In 2012, she served as the founding faculty mentor and editor-atlarge of The Rossi. K.H. Vincent Lau, former editor-in-chief of the Rossi,

recently spoke with Dr. Friedman about her career, her views on medical education, and her love for the arts. At the time of publication, Dr. Friedman is the Deputy Dean and Medical Professor at Sophie Davis School of Biomedical Education at The City College of New York. Early in your career, did you ever think you would become an associate dean of a medical school? When I was in medical school, I wanted to be a primary care doctor in New England and trade goods, like chickens, for my services. During my internship, I got very excited about immunology, because one of my first patients had an intestinal bypass for morbid obesity and developed a sarSEE FRIEDMAN, PAGE 7

COURTESY OF ERICA FRIEDMAN Erica Friedman was the Associate Dean for Education Assessment and Scholarship.

Successful Match Day Celebrated at Mount Sinai By Dipal Savla, MII

Sinai Seeks Ways to Reduce Stress Among Residents, Students . . . Page 2 Are White Coat Ceremonies Too Elitist? . . . Page 2 Essay Contest Highlights Student Perspectives on Professionalism . . . Page 3 Being an Effective Mentor and Mentee . . . Page 11

Resident Matching Program (NRMP) and find out where they will conSince 1952, on the third Thursday tinue their training. The match procin March, senior medical students ess is a complicated one: in order to nationwide have maxi miz e the celebrated Match number of filled Day, the culminatraining programs, tion of an arduous, the NRMP uses a year-long applicacomputerized tion process to mathematical alresidency progorithm to match grams. As a class, preferences of the these soon-to-be applicants with physicians gather those of the resitogether to open dency program up their envelopes COURTESY OF MOUNTSINAI.COM directors. SEE MATCH, PAGE 4 from the National Sinai students celebrate at Match Day.

Sinai Seeks Ways to Reduce Stress Among Residents, Students By John Rozehnal, MII

COURTESY OF WWW.MOUNTSINAI.ORG Faculty give first-year medical students white coats during the September 2012 ISMMS ceremony.

Are White Coat Ceremonies Too Elitist? By Ann Wang, MII

This article is part of The Rossi’s Critical Assessment of Recent Literature Series, and reviews the following study: Karnieli-Miller O, Frankel RM, Inui TS. Cloak of compassion, or evidence of elitism? An empirical analysis of white coat ceremonies. Med Educ. 2013 Jan. Abstract: White coat ceremonies have become a well-established tradition in most medical schools throughout the United States, but the positives and negatives of the messages they convey and the principles they promote have yet to be systematically analyzed. Detractors caution that these ceremonies do not properly integrate professionalism and humanism, and can transform the white coat itself into a status symbol. In this study, eighteen white coat ceremonies were analyzed. Overall, white coat ceremonies were found to address professionalism only in the context of compassionate patient care, and assigned qualities such as humility and generosity to the white coat.

Description of the study:

The white coat ceremony, a tradition initiated nearly twenty years ago, has become a celebrated rite of passage for new medical students throughout the world. A research article published in the December 2012 issue of Medical Education takes a deeper look at these ceremonies: the history behind them, their purpose and, especially, their problems. The Arthur P. Gold Foundation for Humanism in Medicine — the goal of which, according to the Foundation’s website, is to “nurture and preserve the tradition of the caring physician” — designed the present-day white coat ceremony. The first white coat ceremony was held in 1993 at the Columbia University College of Physicians & Surgeons, and has since spread to over 90 percent of medical schools in the United States, as well as many international schools. Most ceremonies follow a similar pattern. The dean welcomes the gathered friends and family, a physician faculty member gives a keynote speech, the students recite an oath and, finally, faculty members coat the students one-by-one. Detractors of the ceremony express concerns that the ceremony does not strike a coherent balance SEE COAT, PAGE 5

Rates of depression and anxiety disorders among medical students and residents have been estimated to be nearly three times as high as in the general population. Mount Sinai, which has long been at the forefront of the worldwide struggle to identify and address these issues, recently implemented a number of stress-reducing and wellnessboosting initiatives. But as ‘wellness’ becomes the norm (‘wellness’: the new catch-all term suggesting everything from better work hours to free tai chi classes in the student lounge), educators are grappling with the extent to which it should be integrated into medical schools and hospitals. I recently spoke with a number of prominent medical education leaders at Mount Sinai about the impact of stress in medical training, and about the risks and rewards of the steps taken to alleviate it. Celia Divino, MD, residency director of surgery at Mount Sinai, argues that residency work hours are, to some extent, inalterable, because the resident’s role is not only as a trainee but as an employee. “In many ways, SEE STRESS, PAGE 5

COURTESY OF MOUNTSINAI.ORG Residents’ work hours may be hard to alter.

Essay Contest Highlights Student Perspectives on Professionalism Each year in the first-year Art and Science of Medicine (ASM) course, students participate in an essay contest to explore professionalism in medicine. Eric Bortnick, now a second-year medical student, wrote the following 2013 winning essay:

My preceptor showed me to where our patient was sleeping. In my mind, he too was in an open casket. You had to walk through two separate doors to even enter the room he was in, and one window let all the onlookers see his motionless, lifeless body. We walked into the room, and efore I started medical when I saw him up close it only furschool, the sickest patient I thered my belief that he was dead. It ever saw was my grandfadidn’t matter what the monitors on ther. He was recovering the screen were telling me about his from a heart valve replacement, and heart rate and blood pressure and was able to talk, eat, and walk - not respiratory rate. There was a tube very sick at all. So when I arrived at going down his throat and dried the MICU for my blood filled his clinical site visit mouth and spilled over a month ago, I onto his chin. His was not really sure yellow and red spotwhat to expect. I ted body reacted to met my preceptor a firm touch like a and we went to the memory-foam matcomputer to look at tress, taking five the patient’s chart seconds to rise back that we would be to its initial position. seeing for the day. His scrotum was so After going over the swollen that you long list of probcouldn’t see his pelems this patient COURTESY OF ERIC BORTNICK nis hiding behind had, and then havthe sac. I haven’t ing the doctor tell me that they wereeven mentioned the sedatives he was n’t sure what was wrong, I began to given, which presumably bring his realize that this would be an experimind to a place that no living creaence I had never had before. ture will ever experience. By all acI’ve been fortunate to only attend counts, he was much closer to that a couple of funerals in my life. One high school classmate of mine than was for my great-grandmother, a any living person I had ever spent closed casket ceremony as she was time with. Yep, he was dead, and I above 90 years old. The other was for was about to practice my physical a high school classmate who died my exam on yet another lifeless body. senior year, a passenger in the car of “Hello.” a drunk driver that crashed into a It is amazing how one word can pole and sent her unbuckled body change an entire situation. My prethrough the windshield. That service ceptor said that one word, and I was was an open-casket, presumably a immediately brought back to life — choice by her family to let all of us no, my patient was brought back to 18 year olds know the ultimate danlife, and I was brought down to ger of driving under the influence. earth. Before we did anything, my When I saw her, she looked different. preceptor turned towards the seHer face was swollen and her skin a dated patient in front of us and said different tone. Her image is what I hello. She closed the blinds to rehave associated death with ever since. spect his privacy, and she proceeded

to explain to him why I was there in the same way that she did in the outpatient setting of her office a week earlier. It didn’t matter that when — if — this guy regained consciousness he would have no idea that I was ever in his room. This was her patient, a human being, and she was treating him with the respect, care, and compassion that he so rightfully deserved. The entire time I was practicing my exam, she had her hand on his arm or his head, a soft touch of a reminder that someone was there for him, and cared about him. When I was finished and we were ready to go, I said thank you to him. I wasn’t expecting a response, and it didn’t matter that I wasn’t going to get one. He deserved the same gratitude and smile I had given all the other patients I had practiced on. A constant theme throughout this year has been about how important it is to listen to your patients. We have heard it through patient presentations, small group discussions, and constant lectures in ASM. By listening, we will show our patients that we are there to help them, and more often than not paying closer attention will help us solve the problem and treat the case. Listening is our main way of expressing the care, compassion, and humanity that our patients expect from us. On its surface, this is fairly easy to do, and it separates a great physician from a good one. We change our moods based on the mood of the patient, we smile when they smile, we keep eye contact. We ask good questions, not just about the illness, but also about the patient’s family and interests. Listening is not what separates an extraordinary physician from a great physician. An extraordinary physician is one who listens when the patient can’t speak, or doesn’t even know we are in the room.

—Erik Bortnick, MII

Fourth-Year Students Head to Diverse Futures After Match Day MATCH, FROM PAGE 1 Match Day 2013 was the largest match event in NRMP history, with 25,463 applicants successfully matching to first year residency positions. From the Icahn School of Medicine at Mount Sinai, 139 graduating seniors matched to 68 institutions in 22 states. More than half of all students matched to programs in New York, and more than a quarter will remain at Mount Sinai. Demetri Blanas, a fourth year medical student who was accepted into the Institute for Family Health/ Mount Sinai Harlem Residency Program in family medicine, is thrilled. Staying at Mount Sinai, he says, “allows me to continue working with community organizations that I have developed strong ties with during my time here as a medical student.” The most popular specialties chosen by the class of 2013 were Internal Medicine (22%), Anesthesiology (9%), Emergency Medicine (8%), General Surgery (8%), and Pediatrics (6%). Three students matched into child neurology, a field with only 123 spots. Recent graduate, Daniela Sloninsky, matched into Mount Sinai’s integrated “Triple Board Program” in pediatrics, psychiatry, and child psy-

COURTESY OF WWW.MOUNTSINAI.ORG More than a quarter of this year’s graduates will remain at The Mount Sinai Hospital for residency.

chiatry. Only nine such programs exist nationwide. “I chose triple board because I wanted to be able to approach the child as a whole, addressing patients' physical ailments, mental health, and family contexts. I plan to do mainly child psychiatry but am very interested in the interplay between medical and psychiatric illness, especially helping kids and families cope with illness.” Dr. Sloninsky said. In the United States, primary care was more popular than ever before. As compared to 2012, 400 more United States medical students matched into pediatrics, internal medicine, and family medicine programs. Mount Sinai saw the same trend, with 32 percent of graduates matching into these specialties. Rehema Kutua, who matched into the pediatrics program at Children’s National Medical Center in D.C., hopes eventually to work in global health with a focus on community healthcare in subCOURTESY OF WWW.MOUNTSINAI.ORG Saharan Africa, where Internal medicine was by far the most popular specialty chosen. she’s from. Dr. Kutua

says that Mount Sinai was incredibly supportive of her interests from the start of her education. “I found great mentors in the leadership, ” she said. However, not all graduates will be starting residency this July. Tom Flaherty, for instance, the class speaker at this year’s graduation ceremony, will spend the year working as a writer for the Dr. Oz Show. Dr. Flaherty previously worked at a local radio station, created his own entertainment show, and was extensively involved in The Zone, the show put on by Mount Sinai’s Kravis Children’s Hospital. “When I heard about the Dr. Oz Show job, it seemed to be a great way of continuing to do something I enjoy so much,” he says, “as well as gain experience in media in a much larger production than I have been involved in before. It also enables me to use the skills and knowledge that I have gained in the last four years at med school. So it’s the perfect mix.” Dr. Flaherty plans to begin a residency program in family medicine the following year. The Class of 2013 joins a successful and distinguished network of alumni, and the entire community at Mount Sinai is extremely proud. Congratulations!

New Study Empirically Analyzes Traditional White Coat Ceremonies COAT, FROM PAGE 2 between humanistic and professional values. The ceremony, they argue, highlights the privileges and prestige that can be associated with the medical profession rather than focusing on the humanism of the doctorpatient relationship. The white coat itself can be shaped by these ceremonies into a hierarchical symbol that ultimately sets physicians far apart from their patients. The authors aimed to empirically analyze the rituals and vocabulary used in white coat ceremonies. First, they divided the 112 United States medical schools that conduct white coat ceremonies into groups: schools that grant MD vs. DO degrees, and then further into public vs. private institutions. A random selection of schools in each group were contacted and asked to provide videos, programs, and other written materials used during their ceremonies. Data was collected from a total of 25 schools. To analyze the data, the authors used four different approaches. First, the format of each ceremony was qualitatively described. Second, each key word or phrase used by the SEE COAT2, PAGE 6

COURTESY OF ORIT MILLER ET AL. The study grouped words and phrases used in ceremonies into four categories, shown above.

Stress and Burnout Threaten Residents Sinai departments shift focus to wellness of trainees

MD, the director of Mount Sinai’s STRESS, FROM PAGE 2 emergency medicine residency proresidency is not a controllable situagram, “but it’s harder to know where tion,” she suggests, “this is a vocathe sweet spot is when you’re sometion.” where towards the middle.” Nonetheless, in 2003, a number of In other words, reducing the work studies came to the conclusion that week hours from one hundred to patient outcomes were consistently eighty seems reasonable, but what poorer when patients were treated by about eighty to seventy? Will the residents who had been working for quality of training and medical care extended hours and hadn’t had decline? nearly enough “How many sleep. The consecases of appendiquences were citis does an ER impressive: naresident have to tionwide, new see to really get and better hours it?” continues Dr. (work duty Shearer. “If you’ve hours) were imalready seen five plemented, and that week, it’s the maximum frustrating to be workweek was there hours on reduced from one end, late into the hundred to night, to see a eighty hours. Fursixth and seventh. ther adjustments — DAVID MULLER, DEAN Are these cases in 2011 decreased making the maximum OF MEDICAL EDUCATION really you a better doclength of a single tor? We don’t shift to sixteen know. We don’t really know what hours. qualifies as ‘teachable’ moments.” Mount Sinai has gone even furMount Sinai’s Emergency departther to institute additional mechament recently changed their shift nisms to reduce stress and improve durations from twelve hours to nine, overall wellbeing. For instance, Dr. and increased the amount of overlap Divino implemented a wellness probetween shifts. This focus on wellgram as a mandatory part of Mount ness provides a bonus in improved Sinai’s surgery residency. Her procontinuity of care. gram addresses stress, burnout, and But the work is still hard, as many time management issues, and helps argue it should be. “On some level,” residents maintain balance between argues David Muller, MD, Dean of their lives inside and outside the opMedical Education at Icahn School of erating theater. Dr. Divino attributes Medicine, “I want the work-life balthe impressively low dropout rates at ance to be unique for medicine. It’s Sinai’s surgery residency program to gratifying to get a call over Thanksthe support and strong mentorship giving and to have to go take care of offered by this program. someone. That’s part of what’s But the question remains: to what unique about being a doctor. That extent must we all simply take a said, whatever the hours, there has to deep breath and learn to tough it be a way to preserve your sanity and out? “It’s easy to identify the problem your dignity.” in the extreme,” says Peter Shearer,

On some level, I want the work-life balance to be unique for medicine. That said … there has to be a way to preserve your sanity and your dignity.

Humanism and Professionalism Meld in White Coat Ceremonies that tension between professionalism humanism should coexist not only COAT2, FROM PAGE 5 and humanism is, to some extent, during the ceremony, but during a speakers was categorized as addressalways lingering in the customs and physician’s career. ing professionalism, morality, hutraditions of the white coat cere“I see no conflict between profesmanism, or spirituality. Third, all mony. sionalism and humanism,” he said. references to the white coat itself “We talk a lot about the personal “One can be extremely professional were categorized as describing the and intimate side of medicine, and at in the practice of medicine and be coat as either a symbol of humanism the same time equally kind, caring and human.” or a mark of we're putting privilege and obthese cold, sterile Critique of the study: ligation. Finally, coats on our stuThe study provides an imprescommon narradents,” he says of sively thorough empirical analysis of tives and the imthe ceremony. white coat ceremonies throughout pact of the key“We’re forcing the country. However, the authors do note speeches them into this not address how schools might evaluwere studied. weird space beate their own white coat ceremonies, Unsurpristween the two.” and what steps the organizers of such ingly, the authors However, ceremonies can take to ensure that noted many com— M ICHAEL M ARIN , he argues that the the emphasis remains strongly on monalities PROFESSOR AND CHAIR OF struggle to bal- humanism and compassionate paamong ceremonies. For examSURGERY, VASCULAR ance the two is an tient care. The authors also do not go into ple, the majority SUGERY ongoing but important compodetail about the differences that were of both keynote nent of a physifound between public and private speakers and the cian’s career, and both professionalinstitutions, or between those institufaculty that coated the students had ism and humanism are necessary to tions granting MD vs. DO degrees. previously received awards in teachbe a good physician. Further studies might analyze the ing and humanism. The speakers “You can't have professionalism differences among white coat cerehighlighted concepts of gratitude, without humanism,” he said. “You monies that take place in different humility, and empathy, and were can be humanistic, but if medical countries, and, going even further, often open about mistakes and vulprofessionalism isn't part of that huassess the overall balance between nerabilities they’d experienced in manism, you're just another nice perprofessionalism and humanism their own careers. son. The lesson is not to separate the found not only in white coat ceremoAlthough statements related to two. They have to coexist.” nies but in medical school curricuobligation and privilege were comMichael Marin, MD, Professor and lums themselves. How closely, for mon, many were put in the context Chair of Surgery, Vascular Surgery at instance, do the ideals and concepts of physicians’ obligation to help their ISMMS and the keynote speaker at taught throughout the four years of patients, or related to the privilege of ISMMS’s 2012 White Coat Ceremony, medical school adhere to the ideals treating and maintaining the trust of believes that professionalism and conveyed at the white coat ceremony? patients. Based on these results, the authors concluded that white coat ceremonies do not show inherent conflict between professionalism and humanism and do not, as they put it, “celebrate the status of an elite class.” David Muller, MD, Dean for Medical Education at the Icahn School of Medicine at Mount Sinai COURTESY OF WWW.MSSMENROLLMENT.COM (ISMMS), acknowledges Many White Coat Ceremonies invite keynote speakers who have been awarded for teaching and humanism.

One can be extremely professional in the practice of medicine and be equally kind, caring and human.

An Interview with Former Associate Dean Erica Friedman FRIEDMAN, FROM PAGE 1 -coid-like illness. I consumed the literature on sarcoid and became fascinated with immunology, and decided to do a fellowship in Rheumatology. Since I’d been in a five-year BS/ MD program, I’d had no time to do research during college or medical school so, during my fellowship, I became involved in basic science research. After my fellowship, I did research on the complement pathway and its interactions with platelet function, both at NYU and at New York Medical College (NYMC). A little later, I transitioned into clinical research: I studied Lyme disease since Westchester County was a hotbed for symptomatic Lyme disease during the late 1980’s and early 1990s. So, in short, my focus for a little over a decade was on both basic and clinical research. At NYMC, I found myself always interested in teaching and I helped out with a number of rheumatology electives. Eventually, in 1993, I wound up officially involved in medical student teaching and administration for the department of medicine and then, a year later, was recruited by Dr. Larry Smith to come to Mount Sinai for the same role. At the time, Larry was the internal medicine residency program director and was vice-chair for education in the department of medicine. Soon after, I was selected to participate in a medical educator training program called the HarvardMacy Program for Physician Educators. Finally, the light bulb went off, and I had a frame-shift in terms of the focus of my career. I realized that teaching was without question what I wanted to do. What exactly was your role at Mount Sinai? I was lucky in having Larry Smith as my boss. He subsequently became the Dean of Medical Education. As he moved up in the medical school, he

COURTESY OF ERICA FRIEDMAN Dr. Erica Friedman pictured with children Noah and Becky Asch during a recent trip to Ethiopia. brought me with him. He encouraged me to explore my interests in the importance and benefits of student peer-evaluation and selfassessment. I applied to the HarvardMacy Program with a project focused on these things and, through the program, learned a lot about educationrelated research. I took what I’d learned and applied it to Mount Sinai’s internal medicine clerkship. My ideas and programs were later adopted by the pediatric and surgery clerkships, as well. Soon after, and largely because of my Harvard-Macy project, I was asked to be the new Director of Assessment for the medical school. I then became Assistant and then Associate Dean for Assessment, and subsequently took over the Medical Director role for the Morchand Center. Can you tell me more about the Harvard-Macy program? Harvard Medical School was funded by the Josiah Macy Foundation to create this program and to recruit and create a network of physi-

cian educators across the country. I attended during the second year of the program. When the money from Macy ran out, Harvard began to require tuition and significantly expanded the number of participants. The idea was to recruit, one after another, people from the same institutions, so that, eventually, they would create small communities of medical educators within each medical center and across the country. The Institute of Medical Education and many department chairs from many institutions have consistently supported the participation of faculty members in this program. There are many, many faculty members at Mount Sinai who have completed the program. Can you tell me the details about your project on assessment? How did it change the way assessment was conducted in medical school? In the mid to late 1990’s, prior to Dr. Smith’s tenure, there were only a few administrators overseeing the CONTINUED ON NEXT PAGE

CONTINUED FROM PREVIOUS PAGE medical school program and there not a great deal of administrative support, and so the only assessments going on were those at the end of the course or clerkship, right after students took their final exams. Although those evaluations were sent back to the course directors, we had little other evidence to determine how well we were meeting our educational goals. With support from the Dean’s office, I was able to implement the current Compass 1 and I changed a formative standardized patient assessment in year 4 to the current summative Compass 2 assessment. In addition, I implemented programmatic assessments including assessments of our graduates during their residency, a periodic alumni survey, and the graduation and intern’s surveys. I also developed the process of summarizing all course and clerkship evaluations and providing the data to the course and clerkship directors, their Department chairs, key administrators, and our Executive Curriculum Committee to ensure that student feedback was

carefully reviewed. the assessments at a course and I also developed and implemented clerkship level, at a faculty level, and the Curriculum Content Review at a programmatic level. The LCME T a s k f o r c e has specific re(CCRT), to enable quirements that the faculty to rewe document to view every course show we are and clerkship. meeting our This allowed goals, including us to ensure that required assessour curriculum ments of the conwas providing the tent of our curappropriate level riculum and our of depth and destudent performtail to prepare ance. our students for I have also residency and to been involved in — ERICA FRIEDMAN, provide meaningthe Institute of FORMER ASSOCIATE DEAN Medical Educaful feedback to AT ICAHN SCHOOL OF tion, helping with course directors, clerkship direcMEDICINE AT MOUNT SINAI faculty developtors and curricument programs, lum oversight facilitating recogcommittees about the strengths and nition of both faculty and medical weaknesses of the curriculum. student educators and creating a mentorship program for junior facYour most recent title is the Associate ulty. Dean of Education and Scholarship. I also oversee the medical content What kind of work does that entail? areas of the standardized patient proI have been responsible for all of grams at the Morchand Center, which includes the medical school assessments, but also the assessments we do for other medical schools and residency programs and other independent clients.

Art and medicine … both increase our sense of doubt and help us appreciate the strangeness and brilliance of the human experience.

Do you enjoy having so many roles? Yes, it’s wonderful because it’s constantly stimulating. Every day is different in terms of what my tasks are and who I’m interacting with, from students to faculty to course directors.

COURTESY OF ERICA FRIEDMAN Dr. Erica Friedman with her close friend Michelle Abreu at Mission Chinese, a restaurant in NYC.

Do you still get to see patients? Gradually, over the last decade, my commitment to education and administration has increased and my time in patient care has decreased. I have very little patient contact now, and most of it is in volunteer situations like EHHOP [East Harlem Health Outreach Program, the student-run health clinic at Icahn CONTINUED ON NEXT PAGE

CONTINUED FROM PREVIOUS PAGE School of Medicine at Mount Sinai], and Mount Sinai’s human rights clinic that screens asylum seekers. How did your role working with asylum seekers come about? An old colleague of mine was actively involved in human rights. About six years ago, he recruited faculty to help screen asylum seekers. I took a two-day weekend class on how to interview, assess and document asylum seekers for court, and how to obtain independent referrals. As part of the global health program here, Dr. Asgari started a human rights clinic, and I began working with him, teaching students how to interview and write up a testimony for asylum seekers. After he left, the program was re-started by Dr. Holly Atkinson, who is a colleague and close friend of mine. Now I am part of the administrative board that’s expanding the Human Rights Clinic program at Mount Sinai. You’ve received several grants in the past for education research and development, including an AAMC grant and the Mannix Award from the Medical, Educational and Scientific Foundation of New York Inc. Can you tell us about a project you’ve been particularly proud of? The project that has meant the most to me was focused on the implementation of a chronic illness curriculum. The project was an expansion of the Seniors as Mentors (SaM) project that was started by Valerie Parkas and Rosanne Leipzig as part of ASM 1. The program paired students with elderly patients to help students understand the impact of chronic disease. We ultimately decided to expand the program beyond geriatric patients in order to provide students with a broader perspective. With the SaM program as the starting point, we were awarded the grant from the AAMC and went on to implement the current Longitudi-

COURTESY OF WWW.MSSM.EDU One of Dr. Erica Friedman’s roles was serving as the Medical Director of the Morchand Center. nal Clinical Experience (LCE) course, which is now an integral part of the curriculum. To switch gears a bit, can you tell us a little about your life outside of medicine? I grew up in Philadelphia, but I was always a little bit in love with Manhattan. Now that I live here, it is so easy to take advantage of everything the city has to offer. I’m a “foodie” — I love to cook and try new restaurants and food. I’m also an avid solo exerciser — I swim and walk several miles every day. And I love art and music. I’m a member of several museums and visit them frequently. I feel really lucky to have come to Mount Sinai for many reasons, but Mount Sinai was the primary reason that I moved to Harlem. Living where I live it’s easy to have a life outside of medicine, even with only a little bit of free time. That reminds me about the NYC Cultural Consults program that was featured in a previous issue of The Rossi. We had a chance to speak with the student leaders of that program. Can you tell us about how it came to fruition, from your of view? One of the best parts of my job at

Mount Sinai has been to be able to help students implement projects that they have dreamed up themselves - like The Rossi! For the NYC Cultural Consults program, Sar Medoff and Adam Philips approached me through Sar’s Humanities in Medicine mentor, Robert Accordino, to talk about the creation of the program. I was really excited to be part of it. The idea was entirely the students’, but I’m good at logistics and process. It was my role along with Basil Hanss to make sure the project had financial and faculty support. I also contributed by helping select the speakers and provide the wine. But it absolutely could have come about without me! It’s really the brainchild of Sar and Adam. What is the role of culture and art in medicine? I was fortunate to attend a program recently, called “Do the arts and humanities make us human?”. The panelists included Anna Deavere Smith, Richard Armstrong (the director of the Guggenheim), and the Reverend Dr. Jane Shaw. I think the arts enable us to get outside of ourselves and develop “moral imagination,” or the ability to CONTINUED ON NEXT PAGE

In terms of teaching, I believe CONTINUED FROM PREVIOUS PAGE put aside our own issues and get deep that both faculty and students are inside the thoughts and feelings of learners, and that we are constantly others. It’s the difference between learning from each other. We learn sympathy and empathy. Art and both through our teaching and medicine are similar in that they through our interactions with our both increase our sense of doubt and students. help us appreciate the strangeness In terms of administration, I like and brilliance of the human experito think that I’m inclusive and a good ence. team player. I want to challenge and I’ve been an avid reader since I empower faculty to be better and was little. I used to read in bed under more effective educators. I realize I the covers with a flashlight when my need to model what I expect others mother made me go to bed early. to do, whether it’s helping with basic And I would consume a book in two tasks like Xeroxing or making coffee days. So for me it or following was a way to through on comlearn about the mitments. It’s world outside of important to be a my own experitrue team player. ence. That’s also why I love to From an administravel. trator point of I think that’s view, what do you really what art see as the major, allows us to do. It — ERICA FRIEDMAN, current trends in helps us gain a education that FORMER ASSOCIATE DEAN faculty should be different perspecAT ICAHN SCHOOL OF aware of? tive on our lives and the lives of The curricuMEDICINE AT MOUNT SINAI others. I think lum needs to that’s really imevolve so that it is portant for physicians in particular, student-driven, and is also more effiin order to better understand our cient in engaging student learning patients. and in meeting major outcomes. What’s important is to understand You’ve worked with medical students that you can’t have a curriculum that on many successful projects. Do you expects every student to come out have any tips regarding mentorship? the other end the same way. Students I believe the key to good mentormust be allowed the flexibility to ing is to first listen — really listen — focus on their areas of interest and to to the student’s idea, and then to learn at their own pace. challenge the student to define what We can’t presume that everyone they hope to achieve, what the excan learn the same material in the pected outcomes are and what resame time frame. At the same time, sources they’ll need to achieve them. we should constantly be challenging It’s also important to have a strict our students to explore and learn as timeline and, during the process, to much as possible, above and beyond continually question and refine the any expectations we may set. project, keep pushing to make it the best it can be. What advice do you have for students interested in medical teaching or What are some of your philosophies administration? on teaching and teaching administraIt’s a lot easier now than it was tion? several decades ago to choose a ca-

Be confident in yourself, and believe that you are capable of making change — big change.

reer as a medical educator or administrator. The LCME helped facilitate this change by mandating a significantly increased infrastructure of educators at medical schools. Further, most academic medical centers now recognize the importance of educators and administrators and have developed clinician/educator tracks that recognize and promote these individuals. In addition, education research has become a valued endeavor, and while there isn’t a lot of funding for it, certainly there are outstanding venues for publication. Also, many educators are incredible role models for students. I can remember my best teacher from medical school, even though that was thirty-five years ago! I think educators have an incredible impact on students. Student-to-student teaching has also become a big component of medical school and residency curriculums. There are students-as-teachers and residents-asteachers programs throughout the country. If a student was interested in becoming a career educator, it would be important early in medical school to identify a mentor who also has chosen to focus on education. The other important aspect is to appreciate that there is a science to being an educator. Explore best practices, like how to give a good lecture or create a useful survey or assessment tool. What is the single best piece of advice you can give to medical students? Be confident in yourself, and believe that you are capable of making change — big change. I would like you never to lose the belief that, with enough passion, drive, and effort, you can make the changes that you wish to see in your own lives and in the lives of people around you. Thank you very much for the interview, Dr. Friedman.

Being an Effective Mentor and Mentee

Mentorship is crucial to successful medical education By Kamini Doobay, MII Mentorship has been an integral part of education for centuries: Plato learned from Socrates, Thomas McCrae from William Osler, Mark Zuckerberg from Steve Jobs, Britney Spears (among so many others) from Madonna. Although education — particularly medical education — has come to take on a myriad of different forms in recent years, mentorship remains a central component of medical school, not to mention virtually all other undergraduate and graduate programs. Peer-to-peer, alumni-to-peer, and faculty-to-student mentoring are all common within academic settings. Mentors play an integral role in many of our lives. If you’re interested in paying it forward and mentoring others, consider these tips adapted from literature written about faculty-student mentoring programs:  While students can often serve as informal mentors to one another, students interested in mentoring can also participate in formal, intentional, and structured programs. Seek out these programs or create one if it doesn’t exist.  Matching each mentee with an appropriate mentor is key. Thoughtful matching is often critical to the development of successful mentor-mentee relationships, and ought to take into consideration the professional and personal interests of both parties.  Once you have a mentee, set aside protected meeting times for mentoring sessions.  Try to serve as a mentor to one person over a long duration of time so the relationship spans the mentee’s professional and personal milestones.

 Schedule meetings at regular intervals to provide structure, support and predictability while making room for spontaneous meetings when necessary.  Mentoring has the potential to change others’ lives by nurturing professional and personal development. Therefore, make sure to provide mentees with tangible and practical resources (for example, lists of scholarships or volunteer opportunities) as well as moral support.  The mentor-mentee relationship is one of imbalanced power. As a mentor, you should remember your role and respect the mentee’s personal boundaries.  Regular conversation about the mentor-mentee relationship should take place. Some questions that can be used to help evaluate the relationship may include: - Is the mentee getting what he/ she wants out of the relationship? - Is the mentoring relationship contributing to the mentee’s professional development? - Is he/she becoming independent rather than dependent on the mentor?  Seek out formal resources or training programs to help you become a better mentor.  When possible, collect data to evaluate and assess whether you were an effective mentor. References:

Allen, Tammy D. and Lillian T. Eby (eds). "Best Practices for StudentFaculty Mentoring Programs."The Blackwell Handbook of Mentoring. Blackwell Publishing, 2007. Sambunjak, D., Straus, S. E., & Marusic, A. (2006). Mentoring in academic medicine. Journal of the American Medical Association, 296,1103–1115.

EDITOR-IN-CHIEF Alexa M. Mieses

ASSOCIATE EDITOR Alison Thaler

EDITOR-AT-LARGE Daniel Caplivski, MD

LAYOUT EDITOR Ann Wang

WRITERS Kamini Doobay K.H. Vincent Lau John Rozehnal Dipal Savla Ann Wang

The Rossi was founded by students at the Icahn School of Medicine at Mount Sinai in 2012 and is published quarterly at http://icahn.mssm.edu/ education/institute-formedical-education/medicalstudent-quarterly-report . Do you have questions? Comments? Story ideas? Email TheRossiNewsletter@gmail.com. Follow The Rossi on Twitter @SinaiRossi