David John, M.D. ’77, and some members of his Gold 1 docent unit.
In their docent unit, students find crucial support, friendships and lessons — and then pass them on
It’s not unusual for three conversations to be going on at once in Truman Medical Center’s Gold Clinic, especially when David John, M.D. ’77, and his students in the Gold 1 docent unit are on duty.
“He’s a 66-year-old male experiencing some respiratory distress. He was prescribed Cipro but he hasn’t been taking it because he says he can’t afford it.”
“The blistering could indicate pemphigus vulgaris. How do you treat that?”
“What movie should we see? I haven’t seen a movie in a long time.”
It’s a Thursday morning in January, and John and seven students are packed into an office made for four people. John has a dozen patients to see by noon at the Gold outpatient clinic, one of four at the hospital served by docents and their students. Plus, it’s the first day back in clinic after winter break for some of the students, and there’s catching up to do.
Words ricochet around the office as fourth-year B.A./M.D. student Austin Harris debriefs with John after an initial patient interview. Deven Bhatia, a fifth-year student, is sharing his copious notes on skin diseases with Tony Esswein, a third-year student. A couple of others are figuring out how to fit a movie break into the coming weekend.
It’s all part of staffing the clinic — and of the docent unit experience, a unique feature of the UMKC School of Medicine since its founding in 1971. In each unit, guided by a supervising physician “docent,” a group of third-year through sixth-year students learns by working and studying together in out-patient clinics and on in-patient rounds, and by sharing a study and office area in the School of Medicine.
From observing the Gold 1 students several times in clinic spring semester — half of them work Thursday mornings and the other half work Friday mornings — it was clear they were developing leadership, learning from one another and, perhaps most importantly, building strong personal bonds.
“We’re better when we work together and learn from each other.” – David John
“Medical school is challenging, and your 20s can be a tough time,” said Katie Payne, a fifth-year student who’s in the Thursday group. Friends who understand what you are going through are crucial, and Payne said the students in Gold 1 support one another well.
Besides being under John’s guidance, each third- and fourth-year student has a fifth- or sixth-year “senior partner” for one-on-one help and advice. Esswein and Bhatia are one such pair, which is one reason Bhatia wants to make sure Esswein is ready for the next big pathology test.
“It’s part of my job, but I also want to do it because Suzan did it for me in the past, and she has the most awesome notes,” Bhatia said, smiling toward Suzan Lisenby, who’s on track to graduate in May.
“I do! I want to publish my notes,” said Lisenby, perched on the ledge by the room’s only window, next to a carton of bagels she brought to share with everyone.
On the receiving end of the help is Esswein. “Everyone in our docent unit is always willing to help me understand anything I ask them about, including drugs, diagnoses or terms I have never seen before,” he said. “They are also super-helpful in understanding how to apply for elective rotations and how to prepare for future coursework. As older students, they have done it in the past and relied on their senior partners.”
Connecting one class to the next
“We are a close group,” said Lisenby. “We look out for each other, and you can always find someone to help or just hang out with. We do things together at holidays and birthdays, and do a group outing every few months.”
Besides helping Bhatia in the past, Lisenby now partners with fourth-year student Drew Lecuru, “so we have four generations right here” in Thursday clinic, she said. That draws a smile from Lecuru, as well as from Esswein and Bhatia as Lisenby gets the four of them together for a quick group photo.
It also gets an approving look from John, who has emphasized teamwork since taking over as Gold 1 docent in spring 2017.
“I inherited a great group of students, but we’re better when we work together and learn from each other,” John said.
He pushes the students to develop their competence and confidence, along with their intuition and empathy — to use everything they have. In discussing a patient, whether in clinic or on in-patient docent rotation, John constantly shares his thought process and knowledge gained in more than 30 years of rheumatology practice and teaching. His questioning is incisive but never harsh, designed to add to students’ knowledge and to make them think and apply what they already know to their current patient.
“Medicine is an art and I’m always learning, too,” John said.
He also gives Gold 1 students a living link to the school’s history and tradition as one of its early graduates. During a rare lull in the clinic chatter, he shared some of his memories.
One student mentioned reading that women outnumbered men in U.S. medical school enrollment for the first time in fall 2017. But UMKC was way ahead of that curve, having its first female-majority class in the early 1980s. John offered one possible reason for that.
“Dr. Marjorie Sirridge was someone for women medical students to look to for inspiration,” John said. “She graduated first in her class at KU, back when women didn’t go to medical school. And at UMKC she was one of the original docents; later, she was the dean. The school has always had women in leadership. She was the first.”
John spent most of his career practicing and teaching in Hawaii, but when he heard in 2014 that Dr. Sirridge was in failing health, he came back to Kansas City to see her shortly before she died.
“She made time for me, when she knew she might not have much time left, and I spent a wonderful afternoon visiting with her,” John recalled. “She was an extraordinary presence, a great advocate for including the humanities in medical education, and a big influence in my life.”
John said that visit probably led to his current job, too. “I had been away a long time, but some people remembered me, maybe because I had come back to see Marjorie Sirridge. So, when there was an opening, Steve Waldman saw me at a reunion function and said, ‘Why don’t you come back and be a docent?’ ”
Many ways to bond
The Gold 1 students are glad that John took the offer from Waldman, the school’s associate dean of international programs, chair of the Department of Medical Humanities and Bioethics, senior docent for year-one and year-two students and, like John, a member of the school’s Class of 1977.
Waldman knew John would be a good fit, and Esswein agrees.
“My favorite thing about Dr. John is that he realizes we are all still learning as we go through clinic, so he takes the time to help us understand what he is doing and how to do it ourselves in the future,” Esswein said. “For example, when he is looking at X-rays, it only takes him a couple of seconds to find what he needs. However, he then takes the time to explain to us what he was looking for and how he found it. He talks about the different bones and joints on the screen and explains what common things we should look for.”
Another third-year student, Faith Mueller, added, “I appreciate how clearly Dr. John loves both medicine and his job. This makes his teaching both genuine and engaging.”
The students said John expected a lot from them and let them do more than they had expected in clinic. That pays off in learning more and then having more to share with their peers.
According to senior-partner Payne, “That can be a lot of practical things, such as inputting orders ourselves when a patient needs tests or an X-ray, with Dr. John looking over our shoulder to make sure everything is correct. He shows us things about billing and coding, too, that we don’t need to know for class but will be really helpful after we graduate.”
Maliha Bhatti, a fifth-year student, added, “Dr. John shares a lot of ‘life stuff,’ not just the sciences. He teaches us a lot about appreciating each other and our patients, and he makes it fun.”
Speaking of fun, Bhatti then checked her smartphone and answered a scheduling app’s question about the group’s next outing, which turned out to be an evening at Topgolf, a high-tech driving range.
The students also share their volunteer interests, deepening their ties with each other and with the community.
Deven Bhatia already had his own volunteer project, starting the local chapter of Walk With a Doc. That national organization gives patients a chance to go walking regularly with a physician or medical student.
But Lisenby, who loves to ski and is going into physical and rehabilitation medicine, also got Bhatia involved in her volunteer passion with Midwest Adaptive Sports. That group volunteers regularly at Snow Creek, a ski area north of Kansas City, helping athletes with impaired sight or other disabilities enjoy skiing.
“It’s really great,” Lisenby said, “and now I have Deven doing it.”
Bhatia said it showed how camaraderie between junior-senior partners was a necessity. “And volunteering at Snow Creek allows us to be grateful for what we have, all while helping the disabled skiers gain more confidence in themselves.”
The other half
For all their bonding, though, there is one question that divides the students of Gold 1: Which is better, the Thursday clinic group or the Friday crew?
“Oh, definitely Friday,” fifth-year student Amaka Ofodu said at the beginning of a recent Friday clinic. The other students in the room all smiled and nodded their agreement. And for the next three hours, Ofodu and her colleagues demonstrated the teamwork and inquisitiveness John encourages — complete with continually overlapping conversations.
“I don’t think the rash indicates Lupus. Lupus rashes tend to be in unexposed areas.”
“When did you take Step 1? I think I’ll be ready in a couple of months if I can just finish the work for my undergrad courses soon.”
“Be sure to include that the patient has a family history of the illness. That’s relevant here, and it can help with insurance coverage.”
“This winter has been so dry and my hands get so chapped. What hand cream do you use?”
The Friday group includes one particularly aligned junior-senior partnership, fourth-year student Keaton Altom and sixth-year student Adam Kisling.
“We’re both going the military route,” Altom said. “We commit to a year’s service for each year of medical school the Army pays for.”
Kisling, who will start an internal medicine residency at Tripler Army Medical Center in Honolulu after graduation, said, “The school tries to match junior-senior partners with some things in common, and Keaton and I were a natural.”
Altom agreed. “Adam always knows what will be coming up next for me.”
The Friday group’s teamwork also is evident when its two third-year students, Mueller and Tejal Desai, need help. They both work easily with John and aren’t shy about asking questions of the other students.
On a recent Friday, Desai saw a patient with several health conditions to address, a frequent occurrence at Truman’s clinics, and her senior partner was absent. But Ofodu and then Altom discussed the conditions with her, including back pain and high blood pressure, before she debriefed with John. She and John then revisited the patient and decided on treatments, and Altom helped her get started on her report on that patient.
Mueller also had seen someone with multiple medical conditions, so the patient’s write-up was anything but straightforward. But fourth-year student Elizabeth Onishchenko had seen the same patient before, a few Fridays ago, and she and Mueller worked through the report quickly. They also got some help from Ofodu, who is Mueller’s senior partner.
“I learn best in a team, having a larger pool of experience and knowledge to draw from,” Mueller said. “My senior partner is fantastic, a wonderful combination of challenging and supportive.”
The Friday group blends diverse talents, interests, backgrounds and academic strengths. One week, the seven students present counted nine languages they could speak or read.
“It seems that no matter what your question is, someone here knows the answer,” Onishchenko said.
A Thursday group ending
March 1 was Lisenby’s last scheduled shift in Gold Clinic. Her Thursday colleagues, led by the fifth-years, Bhatia and Payne, made sure Lisenby knew she would be missed.
A big farewell card opened, accordion-style, filled with their well wishes. A multi-layer cake (“Costco is the best,” Bhatia said) provided the sweet in the bittersweet clinic shift. And group photos were taken, well before most of the morning’s patients arrived and everyone had to get down to work.
After graduation, Lisenby will head to Salt Lake City for her residency at the University of Utah Affiliated Hospitals. She will miss her colleagues, she said, but take her Gold 1 lessons, experiences and friendships with her.
Smiling, she lingered over the jokes and messages on her farewell card and then looked up and said, as if it were her diploma, “This is an honor.”
A Friday group beginning
One recent clinic session started with Ofodu reciting “Recuerdo,” an 18-line poem by Edna St. Vincent Milay that John had assigned her. It describes a couple’s lovely night together, riding a ferry back and forth across a channel, and gazing at the moon from a hilltop, and at each other from across a table, until the sun rises “dripping a bucketful of gold.”
John is a product and proponent of the school’s use of art and the humanities to touch the hearts of physicians-to-be in ways the sciences don’t. And whether or not everyone that morning grasped the poem’s meaning, the students all had experienced a piece of art about making memories together.
And then they went about their work — absorbing, assembling and applying medical knowledge, yes, but also creating memories, forging human connections and becoming healing artists.
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Learning to lead
THE UMKC SCHOOL of Medicine is known for developing leaders, and recent research identified the docent system as an important reason for that.
The study originated from Dean Steven L. Kanter’s observation that the school had produced a substantial number of graduates who have ascended to leadership positions in patient care, research, education, the military, organized medicine, industry and government. “I was curious to know why this medical school is graduating so many individuals who achieved so much,” he said.
School of Medicine graduates from 1976 through 1999 in leadership positions were interviewed. The study was led by Louise Arnold, Ph.D., former associate dean for medical education and research, and Paul Cuddy, Pharm.D., vice dean. The graduates, who had received no formal leadership instruction, said the docent system played a critical role in their success. They noted it had contributed to the development of their leadership skills though years of clinical training, combining of third- through sixth-year students, junior-senior partnerships and team experiences.