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29
2015

Dozen with ties to medical school played roles at ACP’s Internal Medicine 2015 meeting

The American College of Physicians is the second-largest physician group in the United States. Its annual meeting, also its centennial celebration, was held April 30 – May 2, 2015, in Boston, Mass. From behind the scenes to center stage, a dozen with ties to the medical school played roles at the meeting.

Fisher,John-M69

John F. Fisher, M’69, H’77

John F. Fisher, M’69, H’77, received the Jane F. Desforges Distinguished Teacher Award at the American College of Physicians’ national meeting in Boston, Mass., on April 30, 2015.

A professor emeritus of Georgia Regents University, Fisher’s academic career spans 38 years. The ACP honor is that latest of nearly five dozen teaching awards, including the Clinical Teacher Award from the Infectious Diseases Society of America, the ACP Georgia Chapter’s J. Willis Hurst Teaching Award and two dozen Educator of the Year awards from Georgia Regents University.

During residency training at VCU, he was given the William Harrison Higgins Award. As an infectious disease fellow, he received the Best Fellow Award two years in succession. Following his training, Fisher joined the faculty of the Medical College of Georgia (now Georgia Regents University), where he was professor of medicine and program director for the Infectious Disease Fellowship. He also served as chief of the Division of Infectious Diseases at the VA Medical Center in Augusta, Ga.

Fisher has served on the education committees for both the IDSA and the National Foundation for Infectious Diseases. He has 101 publications including 57 articles in refereed journals and 44 book chapters. At the ACP annual meeting, he was advanced from Fellow of the American College of Physicians to Master of the American College of Physicians.

Wenzel_Richard

Richard “Dick” P. Wenzel, M.D.

Richard “Dick” P. Wenzel, M.D., was the Massachusetts Chapter Lecturer at the ACP meeting. An emeritus professor and former chairman of the Department of Internal Medicine, Wenzel has been long been involved with the ACP and has frequently presented at the annual meeting, keeping physicians up to date with the latest information on topics in internal medicine and infectious disease. His topic at Internal Medicine 2015 was evidence-based physical diagnosis.

In 1988, the Massachusetts Chapter Award Lectureship was established to honor a distinguished Massachusetts internist and to honor an outstanding member of the annual meeting faculty. Today, the recipient of the award is selected by the chair of the Internal Medicine Scientific Program Planning Committee.

Robert Centor

Robert M. Centor, M’75

Robert M. Centor, M’75, concluded his one-year term as chair of the ACP Board of Regents at the annual meeting. The Board of Regents is the main policy-making body of the College.

A member of ACP since 1978, Centor was named a Fellow of ACP in 1985 and became a Master of ACP on October 1, 2014. He has served on the Board of Regents since 2008 and also on many of ACP’s committees, including the Membership Committee, Finance Committee, Strategic Planning Committee and the Health and Public Policy Committee, which he chaired from 2009-2011. Centor was awarded the Laureate Award for outstanding service to medicine and ACP from the Alabama Chapter of ACP in 2009.

He is currently professor of medicine and regional dean of the University of Alabama at Birmingham, Huntsville Regional Medical Campus. He was on the internal medicine faculty on VCU’s Medical College of Virginia Campus until 1993.

Ellis,Lisa-M01-H04

Lisa L. Ellis, M’01, H’04

Lisa L. Ellis, M’01, H’04, chaired the Scientific Program Committee that created a mix of small group sessions, classic lectures and hands-on activities for the annual meeting. Faculty presented new findings in internal medicine and its subspecialties, presented new approaches in practice management and discussed issues related to health care policy as well as lead sessions to hone leadership and teaching skills.

“When I attend each year, I bring back new ideas for managing patients as well as techniques for enhancing my own leadership style,” says Ellis who as the ACP Governor for Virginia represents the state on the ACP’s national Board of Governors. In that role, she helps implement national projects and initiatives at the chapter level and represents member concerns at the national level. Ellis also is on the Board of Governors’ executive committee, which advises the Board of Regents.

Ellis currently is the chief medical officer for the Medical College of Virginia Physicians at VCU and has an appointment as an associate professor in internal medicine and OB-GYN.

A student and young alumnus have taken leadership roles in the organization:

Khan,Ali-M09-Headshot-IAS-1

Ali M. Khan, M’09

Ali M. Khan, M’09, is chair of the ACP’s National Council of Resident/Fellow Members that represents the interests of over 22,000 residents and fellows-in-training. He’s been on the 11-member council since his intern year at Yale and has helped lead ACP’s High Value Care initiative that educates and engages physicians as well as resident and fellow members in how to practice in a value-sensitive, thoughtful manner for resource stewardship and patient engagement.

At the ACP’s annual meeting, he co-hosted the council’s marquee event, a TED talk-style national forum for promising innovations and bright ideas for teaching high-value care. Moderated by author Sandeep Jauhar, M.D., and the New York Times’ Lisa Sanders, M.D., the event showcased winners from the second annual Teaching Value and Choosing Wisely Challenge sponsored by the ABIM Foundation and the national non-profit Costs of Care.

“We’ve read articles, attended lectures and held forums making the case for value-based care delivery,” Khan says. “Now, however, those words are being bolstered by action – on the ground, at institutions all across the country, led by talented health professionals with the creativity and drive to effect the collective change we seek. Award Winning Innovations isn’t about making the theoretical case for value – it’s about sharing the best work being done nationally to make that case a reality.”

Cockburn,Chelsea-MD-PhD-student

MD-PhD student Chelsea Cockburn

MD-PhD student Chelsea Cockburn began her four-year term as a representative on the National Council of Student Members in April 2015. Council members organize programming for medical students at the national ACP conference every year, and Cockburn attended the annual meeting in Boston where she was looking forward to meeting the rest of the council members as well as internal medicine physicians.

As a member of the student council, Cockburn is assigned a region of medical schools in the U.S. and will help advise the internal medicine interest groups at those schools to strengthen activities at the chapter level. She’s also been selected to represent the council on the ACP Education and Publication Committee that provides scientific and professional information to physicians, trainees and patients.

ACP-meeting

ACP attendees with ties to the medical school reunited during the Internal Medicine 2015 meeting. Each year, the Department of Internal Medicine hosts a reception. This year it was held at Boston’s Atlantic Beer Garden overlooking the harbor.

A number of faculty from the Department of Internal Medicine presented at Internal Medicine 2015:

  • Stephanie A. Call, M.D., MSPH, professor in the Division of General Medicine and Primary Care.
  • Alan W. Dow III, M.D., associate professor in the Division of General Medicine and Primary Care.
  • Mary H. Hackney, M.D., associate professor in the Division of Hematology/Oncology.
  • Puneet Puri, M.D., assistant professor in the Division of Gastroenterology.
  • George W. Vetrovec, M.D., professor in the Division of Cardiology.

Others were honored at the meeting:

  • Wendy Klein, M.D., associate professor emerita, was awarded the designation of ACP master and was recognized as the Virginia ACP chapter’s 2015 Laureate winner. Klein was co-founder of the VCU Institute for Women’s Health and was the department’s first program director for an innovative residency in Women’s Health.
  • Curtis N. Sessler M.D., the Orhan Muren Distinguished Professor of Medicine, and professor in the Division of Pulmonary Disease, was named an ACP fellow.
  • John R. Strunk, M.D., assistant professor in the Division of General Medicine, was named an ACP fellow.
  • Darren Witte, M.D., in General Medicine and Pediatrics, was named an ACP fellow.
01
2015

Class of 1980’s Elliot Sternberg inducted into AOA

Elliot Sternberg

Elliot Sternberg, M’80

Elliot Sternberg, M’80, a physician executive who has succeeded in a wide variety of roles, was recently inducted into the Brown Sequard chapter of Alpha Omega Alpha in honor of his accomplishments and dedication to delivering high-quality care to patients.

Sternberg returned to the MCV Campus to participate in the AOA dinner, an annual event that welcomes new members into the prestigious AOA Medical Honor Society. Every year the Brown Sequard chapter of AOA inducts students selected from the top 16 percent of the School of Medicine’s third- and fourth-year classes. The elite society also accepts nominations for deserving faculty, residents and alumni.

As this year’s sole alumni inductee into the society, Sternberg was asked to pass along some of the knowledge he has gained after years working across the continuum of care. In a talk titled “The Joy of Medicine,” he described for the assembled AOA members how physicians can sometimes lose sight of what their true goals are. Sternberg warned that if physicians fail to focus on the meaningfulness of their work, they may stop enjoying their jobs.

“I often hear doctors talking about how the joy of medicine is gone, because of bureaucracy, paperwork, the evils of insurance companies, the stupidity of health systems and declining compensation. But what I think is – these doctors don’t know how to deal with change.”

Sternberg had a remedy on hand for combatting this type of physician burnout. He recalled a mnemonic device that helped him throughout his career: the five “I’s”, which stands for involvement, information, investment, incentives and innovation. By remembering these five principles, Sternberg said, he has remained engaged and happy with his work.

“The beauty of medicine is its flexibility,” he said, “It keeps changing, it’s never boring. There are always new diseases, new presentations of diseases and new treatment options.”

He recommended that physicians pursue ongoing medical education and embrace the challenges of performance benchmarking such as physician report cards. He also urged his audience to seek new innovations that can improve their work and invest themselves in the success of their organizations. By exploring new ways to improve yourself as a student of medicine, a caregiver and a person, he said, one can recapture the joy of medicine.

At the center of all these strategies, Sternberg explained, is the idea that doctors choose their profession because they want to help people. While the five I’s can help deal with the routine challenges of the job, ultimately physicians must remember that the true joy of their work comes from improving the health and quality of life of the patients they serve.

“The essence of medicine, and the joy of medicine,” Sternberg said, “is to know that you made a connection with patients and their families, your colleagues and the community. At the end of the day you can judge your career successful if you made meaningful impacts on these groups.”

By Jack Carmichael

24
2015

MD-PhD student and young alumnus take leadership roles in country’s second-largest physician group

Ali M. Khan

Ali M. Khan, M’09

The Class of 2009’s Ali M. Khan and current M.D.-Ph.D. student Chelsea Cockburn have recently taken on leadership roles with the American College of Physicians, the second-largest physician group in the U.S.

Ali M. Khan, M’09, is chair of the American College of Physicians’ National Council of Resident/Fellow Members. He has served on the national council that represents the interests of over 22,000 residents and fellows-in-training since his intern year at Yale-New Haven Hospital. In his senior year of residency, Khan was elected by the 11-member council to serve as its chair-elect who represents the voices and interests of the resident and fellow members on the ACP’s Board of Governors. Now he has transitioned into the chair’s seat and serves on the Board of Regents, the ACP’s highest governing body.

“Since graduating, the bulk of my health policy and advocacy work has lived in the ACP,” says Khan who has also served on the ACP’s public policy and medical practice committees.

“Over the past five years, my work has focused primarily in two arenas: furthering the college’s role as a hub of leadership training and development for trainees and, accordingly, focusing our role as a council in catalyzing the value proposition and engagement opportunities for trainees.”

He’s helped lead ACP’s High Value Care initiative that educates and engages physicians as well as residents and fellows in how to practice in a value-sensitive, thoughtful manner for resource stewardship and patient engagement. At the ACP’s upcoming annual meeting, he’ll co-host the council’s marquee event, a TED talk-style national forum for promising innovations and bright ideas for teaching high-value care.

When he’s not serving at the ACP, Khan is a clinical innovator and director of physician engagement at Boston-based Iora Health. He practices general internal medicine at Iora’s super-utilizer clinic serving medically complex casino workers in Las Vegas and also serves on Yale’s clinical faculty.

M.D.-Ph.D. student Chelsea Cockburn

M.D.-Ph.D. student Chelsea Cockburn

In April, M.D.-Ph.D. student Chelsea Cockburn began a four-year term on the ACP’s National Council of Student Members, a 13-member group that advises the Board of Regents and Board of Governors on promoting internal medicine as a career and increasing the value of ACP membership to medical students.

She’ll be assigned a region of medical schools in the U.S. and will help advise the internal medicine interest groups at those schools to strengthen activities at the chapter level. She’s also been selected to represent the council on the ACP Education and Publication Committee that provides scientific and professional information to physicians, trainees and patients.

Council members organize programming for medical students at the national ACP conference every year, and Cockburn will attend the annual meeting in Boston later this month. “I’m really excited to get to meet the rest of the council members as well as network with Internal medicine physicians,” she says.

Originally from Harrisonburg, Va., Cockburn entered the M.D.-Ph.D. program in 2013 and in March 2015 began her graduate training in the Department of Microbiology and Immunology. She’s been an admissions tour guide and was a trip leader for HOMBRE, the annual student-led medical relief trip to Honduras. With a strong interest in global health, Cockburn plans on doing a fellowship in infectious disease after a residency in internal medicine.

The ACP is a national organization of internists and is the country’s second-largest medical-physician organization, behind only the American Medical Association. Its membership of 141,000 includes internists and internal medicine subspecialists as well as medical students, residents and fellows. An influential voice in American health care, it’s celebrating 100 years since its founding in 1915.

24
2015

Class of 83’s Wayne Reichman left Baltimore surgery practice to expand access to surgical care in Haiti

Wayne Reichman’s first trip to Haiti in 2013 left him speechless.

“When I got home, I couldn’t talk about the experience for a few days,” he said. “I needed some time to process it all.”

The rubble from the 2010 earthquake still littered the city of Jacmel. Many roads remained unpassable and homeless families continued to struggle.

“Haiti is the poorest country in the Western hemisphere,” said Reichman, M’83. “So many of these people literally have nothing. I simply wanted to do what I was trained to do as a doctor and surgeon – help the less fortunate.”

So Reichman began transitioning out of his vascular surgery practice in Baltimore two years ago to become the medical director of the Jim Wilmot Surgery Center in Jacmel, Haiti. Opened in 2012 and operated by the non-profit Community Coalition for Haiti (CCH), the center provides free surgical care for an impoverished area of 250,000 people and is a sustainable surgical training site for Haitian health care providers. It has three operating rooms, a physical therapy department, pharmacy and primary care clinic.

“The average family earns about $750 a year, so most patients could never afford surgery,” he said. “They are extremely grateful. It can get very emotional.”

Reichman runs the clinic logistics from Baltimore and is on site several a times a year. Other surgeons, nurses and primary care physicians from around the country rotate in monthly, and the clinic typically performs 30 to 40 surgeries a month. Beginning in October, that number will climb to about 75 when more surgeons from all over the U.S. are slated to join the monthly rotation. Each team can comprise student nurses, PT, OT and pharmacy students, med students and residents as well.

Cases include plastic surgical repair of cleft lip and palate, vascular surgery, orthopedics, general surgery, urology and GYN laparoscopic procedures.

“Our clinic is one of the most modern facilities in Haiti,” Reichman said. “We even have air conditioning in the operating rooms and recovery room as well as fluoro and ultrasound capabilities. We don’t have the advanced diagnostic equipment that one would typically expect in the United States. Working in this environment, you become a better diagnostician by relying mainly on your clinical skills,” he said.

“There are no MRIs in Haiti,” Reichman said, “and only one working CT scanner in Port-au Prince that serves a population of about 2.5 million.” The Jim Wilmot facility lacks an ICU ventilator, but he is hopeful two will be donated this year.

Currently eight clinics and hospitals throughout Haiti have partnered under CCH to form a health care alliance to work together to reduce operating costs, but Reichman hopes that number will climb to 12 in the near future. CCH is also planning to build the first pediatric hospital in Haiti to offer oncology, orthopedics, open heart surgery and more.

“It’s pretty amazing what we have accomplished so far,” Reichman said. “There is still so much more to do.”

It’s a good thing, then, that Reichman, 57, has no plans to retire.

“I’ve made a long term commitment to this organization,” he said. “There is a never-ending need.”

Helping the underserved of Baltimore has always been a part of his surgical practice. But completing medical school and his residency, starting a practice and raising a family monopolized his time so traveling to underdeveloped areas was difficult.

“My children are now grown, so it is a good time in my life for this type of service,” he said. “Life is unpredictable and fragile. I often remember the saying that God laughs at those who make plans. I believe that if you want to do something in your life, just go and do it so you have no regrets.”

His wife and two children have also accompanied him on past trips to Haiti teaching in the schools and shooting video for CCH. Vicky, his wife, is a potter and has worked with the schoolchildren teaching them how to make ceramics and their own cereal bowls. The students are ecstatic when their works of art are complete because it means they no longer have to eat off a Frisbee or piece of cardboard.

“This work in Haiti has become a large part of my life,” Reichman said. “It’s a very moving experience to be a part of this. I am more optimistic where this country is headed. I feel like I have re-established my faith in my craft. Being a doctor comes down to helping people.”

By Janet Showalter

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20
2015

Class of 74’s Tom Kerkering shares tragedies and challenges of fighting Ebola

Tom Kerkering, M’74

Tom Kerkering, M’74, returned to campus to talk about his experiences fighting Ebola in West Africa.

Thomas Kerkering, M’74, H’79, points to a picture of the tree that was ground zero for the recent Ebola epidemic. A two-year-old child playing near the tree caught Ebola from bat guano, and from there the virus spread to infect over 20,000 people in Guinea, Liberia and Sierra Leone and claim more than 10,000 lives.

The tree is just the beginning — of the outbreak and of Kerkering’s tale. As the keynote speaker of the VCU Global Health Showcase 2015, he would go on to tell some of the tragic, personal stories of the Ebola outbreak that he experienced during his time fighting the virus in West Africa. He offered an insider’s view on how devastating the outbreak was given the cultural differences and realities of providing health care in West Africa.

Long before the term global health was coined, Kerkering put it into practice. For decades the infectious disease specialist has traveled the world. First from a home base on the MCV Campus, later from East Carolina University and now from Virginia Tech’s Carilion School of Medicine, where the professor of internal medicine is also chief of infectious disease at the Carilion Clinic.

Fighting ebola with protective gear

From Tom Kerkering’s blog: There are no dull moments.

Fighting the Ebola virus was a challenge, said Kerkering, not only because of the lack of infrastructure and supplies in the affected countries, but also because of the nature of the virus itself.

“Ebola is unique, because it stood the Hippocratic Oath on its head,” he said. “We were all trained, and we all took an oath to see that the patient comes first. But with Ebola, the safety of the health care worker is paramount. If health care workers get infected, not only is there one less person to help the sick, but they risk infecting more people in the community.”

Kerkering dedicated his presentation to his “his fellow health care workers in West Africa, many of whom are no longer alive.” He feels a deep connection with the people he met during his time fighting Ebola. There was a 78 percent mortality rate among infected health care workers during his time in Africa – of the 138 workers who fell ill at his treatment center, 108 died. A video shot at the treatment center where Kerkering worked showed his friends and fellow heath care workers, many of whom had since succumbed to the virus.

Photo of a medical tent

From Tom Kerkering’s blog: Carilion physician helping fight the spread of Ebola in Africa.

Kerkering talked about the difficulties of accessing patients in remote locations, the tragedies of families ripped apart by the virus and the few miraculous recoveries that he witnessed. He met a couple who had to leave their three young sons behind and travel hours to the Ebola treatment facility. The father passed away, but the mother recovered and was able to return to her family and her village. “Nothing is absolute with Ebola,” he explained, “we don’t know why the virus kills some people and spares others.”

Kerkering also examined some of the precautions employed by health care workers to protect themselves from infection. When working with patients, health care workers donned protective suits that completely covered their bodies and left no exposed skin. The 20-minute process of taking off this protective gear was the window of highest possibility for infection. It made the most menial tasks complicated and time consuming. Kerkering and his colleagues had to develop special procedures for dealing with an itchy nose, a sneeze or a fly caught under the protective equipment – proof that when dealing with such a highly infectious disease even the mundane can be dangerous.

Informational billboard about Ebola

From Tom Kerkering’s blog: Ebola turns the Hippocratic Oath on its head.

Kerkering urged his audience to consider how response to the Ebola outbreak could have been improved. He said that many academic medical centers in the U.S. lacked a framework for responding to the outbreak of an infectious diseases as virulent and lethal as Ebola, and as a result their reaction was often too little and too late.

At the peak of the outbreak in Africa, a consistent lack of beds, ambulances and medical supplies crippled the health care worker’s ability to slow the disease. In many cases support arrived so late that it was no longer needed – treatment centers sat empty and supplies went unused after the number of cases had declined. He hopes that the lessons learned from Ebola can be applied to better prepare for the next outbreak of an infectious disease, and that the personal tragedies he witnessed in Sierra Leone can be better avoided in the future.

Kerkering wrote three blog entries about his experiences while in Sierra Leone. Follow the links below to learn more about his time fighting the Ebola crisis.

Carilion physician helping fight the spread of Ebola in Africa

There are no dull moments

Ebola turns the Hippocratic Oath on its head

By Jack Carmichael

17
2015

Class of 85’s Joe Sherman on “soul to role”

Joseph P. Sherman, M’85, H’88

Joe Sherman, M’85, H’88

Joseph P. Sherman, M’85, H’88, got an early start on Reunion Weekend, making the cross-country trip from Seattle a day early to talk to the M4 Capstone Course about avoiding burnout and maintaining a passion for the profession.

His launching point was the concept of work/life balance. “It’s a bit of a misnomer,” he said. “It implies work is on one side, life is on the other. But it’s all life. And working as a doctor is a role you play. Not who you are. It’s what you do.”

His own career includes a decade working as a general pediatrician at Children’s National Medical Center and Georgetown as well as two international stints. During the first in Kampala, Uganda, he conducted clinical drug trials in mother-to-child HIV transmission prevention. In the second, he went to Cochabamba, Bolivia, where he worked with the Maryknoll Lay Missioners serving the rural, indigenous population in the Andes.

He says those experiences taught him that the key to not just surviving but thriving is to discover who you are and why you do what you do.

Even during his international postings, he always managed to come back for Reunion every five years. His affection for his classmates is clear. He began his presentation with a series of slides from his own fourth year, a time he remembers as full of joy – joy found in a love of caring for patients and in a love of practicing together with his classmates.

But, at one point, he’d just about lost that joy. He and his family had returned from Bolivia where he’d practiced holistic medicine and loved caring for his patients, not just their health, but many facets of their lives. He couldn’t find a situation in America that would allow him to practice in that same way.

“I was disillusioned,” he says of that time in 2009. “I was ready to quit medicine.”

He’s not alone. He cited a shocking statistic that 40 percent of practicing physicians would quit tomorrow if they could afford it.

At his lowest point, he got a phone call from Richmond. It was a mother he’d met when he was an intern in the NICU. “When my baby was born,” she told him, “I was addicted to heroin. He was premature, sick. I was worried and felt guilty. You told me my baby would be ok.”

She explained how the conversation had changed her life. It motivated her to enroll in recovery. She went back to school, and now worked on the MCV Campus.

And her son? The three-pound baby had grown into a football lineman who was getting ready to graduate from college.

“I got into medicine to sit with people through crises in their lives,” Sherman explained. “I happen to know more science and medicine than they do. But that’s not the important part. I wanted to help people.”

Think of the time you first decided you wanted to become a doctor.

What were the circumstances?

What were your hopes and dreams?

What do you remember about your first day of medical school?

Why were you there?

Why were all those other people there?

Did your hopes and dreams change from when you first thought of being a doctor?

What did you notice happening to you as you progressed through medical school?

How were you influenced by your peers and supervisors?

Did you hopes and dreams change?

How are you different than when you started?

Now you are starting residency.

What do you expect will happen to you?

How will you continue to be molded by the expectations of your peers and supervisors?

How will you maintain your hopes and dreams?

That phone call reminded him he still could. So he stayed in medicine, choosing to work part-time in two pediatric clinics: one a safety net clinic and the second based on a hybrid model that is half Medicare patients, half fee-for-service on a sliding scale. “Blue collar concierge pediatrics” he calls it.

Sherman’s schedule allows him to be the primary parent at home for his two teenage children, and he stays active in international medicine through periodic trips to Latin America.

He also makes a point of sharing what he’s learned. He consults with physicians to improve morale and fight burnout by facilitating reflection groups and retreats on spirituality, meaning in medicine and working with integrity and authenticity in today’s health-care environment.

At the M4 capstone Course, he asked the students to recall when they first wanted to be a doctor. From there, he took them on a mental journey to the first day of medical school, to third-year clinical rotations and up to today, when they are ready to start residency. (see sidebar)

“Have your hopes and dreams changed from when you first thought of being a doctor?” he asked them. “In clinical rotations, you’re rewarded for morphing into what other people want you to be. There’s a danger of forgetting who you are and why you want to be a doctor.”

He warned that there would be a similar risk during residency and suggested that they take note of when there is a match of “soul to role” in their work. “Whether it’s in vascular surgery or on hem-onc rounds, take note when you say to yourself ‘I can’t wait to do that again!’”

To help spot these moments in the busy residency years, he suggested journaling or joining a reflection group.

“As time went on, I realized how much my identity as a doctor confused me,” he said, remembering an era earlier in his career. “It became who I am, not what I do. I want you to hold on to the thread that tells you ‘this is why I practice medicine’.”