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“My hope for the future is to see a health care workforce that matches the diversity of the communities it serves. As we continue to push for health equity, we also continue to evaluate and reassess our student programs to provide tailored support and help them reach their full potential. I also hope that other medical institutions begin to use social determinants of learning to individualize their education methods so that more Black, Hispanic, and other students of color can achieve their dreams of becoming doctors.”

Heidi Chumley is dean, Ross University School of Medicine.

She shares her story and discusses her KevinMD article, “Who gets to graduate from medical school?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today we welcome back to the show Heidi Chumley. She’s a family physician, and she’s the dean at Ross University School of Medicine. Her KevinMD article is titled “Who gets to graduate from medical school?” Heidi, welcome back to the show.

Heidi Chumley: Thank you, Kevin. It is great to be back. I really appreciate you having me again.

Kevin Pho: We’ll get into your article in a little bit, but for those who didn’t get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.

Heidi Chumley: Yeah, absolutely. As you mentioned, I’m a family physician. I trained at the University of Texas Health Science Center San Antonio. I did a residency there and a fellowship in academic medicine there, then went on to be on the senior leadership team at the University of Kansas School of Medicine and spent several years there. Then, about 10 years ago, I was recruited to lead an international medical school out in the Caribbean, which was American University of the Caribbean School of Medicine. About a year ago, I moved from that school to our sister school, same parent company, Ross University School of Medicine, on the lovely island of Barbados.

Kevin Pho: All right. So you’ve contributed a series of articles on KevinMD. The first is “Who gets to go to medical school?” and today’s article is “Who gets to graduate from medical school?” So let’s jump into your second article. How did this one come together?

Heidi Chumley: Yeah. Well, like you said, Kevin, this is part of a series, and actually the series will be five to six articles, I believe, by the time that we’re through. They’re really focused on who we are losing on this medical education journey. As you mentioned, the first one, “Who gets to go to medical school?” talks about who we’re losing in the admissions process and some things around the admissions process that may be contributing to those factors.

So this one is the next step of the journey. After you admit students to medical school, particularly if you admit students who have a different level of preparation or wider variation in their life experiences, then it is important, and critical, that you understand that those differences, those variations, may contribute to different levels of success in medical school. So “Who gets to graduate” is about what the things are that challenge students while they’re in medical school, how we can really think about that, and what we can put in place to meet our students where they are, help them bridge any gaps in preparation, and be successful in medical school.

Kevin Pho: So tell us, what are some of the common obstacles that prevent students from graduating medical school?

Heidi Chumley: Yeah. Almost all the time, it’s their academic performance. But if you ask any medical educator, they will tell you, “Well, it’s the academic performance, but it’s never about academics.” It’s never about how smart people are. It’s never about their ability to do skills. It’s not those things. It’s always something else in life. It is other things in life that come into play and that really affect people’s ability to perform at the level of academic performance you’ve got to do to be successful in medical school.

So for your physician and health care provider audience, we know this in health care, right? We talk about social determinants of health. We understand how individual situations can really impact somebody’s ability to be healthy. Well, the same thing is true about learning. Just because someone is admitted to medical school does not mean whatever social determinants were around them earlier in life have now changed. In fact, they haven’t, and in many cases some of them have gotten even more strained. If economic instability was a challenge for you, then going to medical school, not being able to have a job, and increasing debt can certainly become a major factor.

So it is those types of things. It’s physical health, it’s psychological health, sense of belonging, and sense of confidence. Those are the types of things that we see and can really help work on with students, to let them get to their peak level of performance.

Kevin Pho: So can you walk us through a typical case study of how some of these social determinants can affect a medical student’s performance? Walk us through a typical case study that you would see.

Heidi Chumley: Absolutely. Unfortunately, a lot of times the case starts with a bad grade, right? Let’s say you get to your first exam, and students do poorly on the exam. What we do with students who do poorly on the exams is begin to engage with them and ask them their stories. So I’ll share a couple of stories with you that I think will illustrate the point.

The group, if you will, that gathers stories is people who have already formed a relationship with the students, and it can include advisors and peers. We have student peers, we have faculty advisors, and we have wellness counselors, so it’s a large group of people who really begin to engage with a student and try to figure out the things that are going on.

Generally, we find things that have interfered with the student’s time. Something happened back home. A parent is now ill. There’s been a change in the family’s finances that they need to intervene in or work with. We find that they’re spending a good amount of time on things other than medical school, because life has come up and gotten in the way, and unfortunately, you can’t make life go away, right? So the things that we work on with people are: How do you really manage those? How do you engage your network? Who is your network? Let’s figure out how you expand your network of people who can help you, so that you begin to really be able to focus back. So that is one common thing that we see.

Another common thing that we see is simply that the skills and study habits somebody used were absolutely fine to get them through college but are really not going to work at the next level. Those, in some cases, are really a little bit easier to work with. People come with a sense of, “It’s always worked for me before.” You’ve really got to help people unpack how this is different and what they need to do differently. But that one sometimes is a little bit easier to deal with. In other situations, people.

Kevin Pho: What would be an example of that? Because you assume that people who do get into medical school, right, have passed the MCAT. They presumably got a very high score on that, a high GPA, a high science GPA. So it’s already pretty rigorous just to get into medical school. But you talk about the next level, where previous study habits may not have worked. So what would be an example?

Heidi Chumley: Yeah. You can be an absolutely fabulous memorizer and get to the level of getting into medical school. Once you get there, the information that you need to be able to manage and work with is now more than you can really memorize, right? So you’ve got to unlearn the way that you learned, which was, “I know what every single PowerPoint says, I know which line, and I can call that up,” and move to a deeper learning and a deeper understanding of what actually is going on, so that you can answer questions that you haven’t seen before.

Kevin Pho: All right. So in terms of some of the remedial or support help that you would give, in general, what would be some success stories? How successful would students be once they engage the support?

Heidi Chumley: Yeah. One of the ways that we follow success is once students have to repeat a course. I mean, it’s a very challenging thing to have to repeat a course, but we look at our outcomes after students successfully complete the course when they’re repeating it, and then if they’re able to continue in their medical studies and complete those.

The way we work with students while they’re remediating a course, I think, is really, really important. We’ve got educational specialists, and we’ve got wellness specialists. One of the most important things I think they do, and I just learned this from my team not too long ago, is that they spend a good amount of time normalizing the experience of needing to repeat coursework. As you mentioned before, these are people who have been successful, hitting an academic block that they may not have experienced before. Hitting that at that point in your life, you have to really understand it, deal with it, and reinvent yourself and your understanding of what that means, so that you can use it as a productive experience. So it’s normalizing that experience, it is improving your ability to self-assess, to find out where you’re doing well and where you’re not doing well, and it’s building your confidence to go on and be successful.

Kevin Pho: So we mentioned social determinants, and we mentioned study habits that may have worked in undergraduate studies but may not work in medical school. Any other obstacles that prevent students from succeeding in medical school?

Heidi Chumley: Confidence and belonging. I think those are really important concepts. This certainly isn’t my work. This is work that people did 10 or 15 years ago, I think in the University of Texas system, with college students, when they talked about who gets to graduate from college. The themes they found there were that confidence and belonging are really important, and difficult to measure. It’s hard to build a regression model that shows this is a factor in what you’re doing.

But we do see that. There are people whose lives, up to a certain point, have been about success. So when they fail, they pick themselves up and they’re ready to go, because everyone has always told them they’ll be successful, and “Oh, something happened. I’ll fix it. That’s fine.” There are other people who’ve been told, or had messages, that this isn’t for them, that they’re not going to make it. So failing for them is a reinforcing message. It’s not the cognitive dissonance zone of “Oh, I don’t know what happened.” It’s this reinforcing message of the messages that they’ve heard.

So that’s where I think the ideas of confidence in yourself and your own performance, and the sense that you can belong to the profession of medicine, sort of regardless of what messages you’ve been told, are just really important. They are very difficult concepts to get at, to piece apart, and to really study, but just so important.

Kevin Pho: So on my podcast, we talk a lot about physician burnout, but I’ve talked to a lot of medical students as well, and medical students are increasingly burning out as well. So comment on that. What kind of support systems do you have when it comes to medical students who may be burning out or dealing with behavioral health issues, and are you finding an increasing frequency of those types of cases?

Heidi Chumley: Yeah. During the pandemic, I think that was prevalent everywhere. Again, life just got harder for a lot of people, and it made medical school even harder. We spend a lot of time talking about wellness, putting wellness practices into place, celebrating that, building community, and helping people, or encouraging people, to find what wellness is to them. I mean, it often doesn’t work to say, “Oh, here are the required wellness activities you could squeeze into your life now.”

But again, it’s trying to normalize the idea that healthy people go to wellness counselors. Programs that are opt-out, I think, are great, where everybody should meet with a wellness counselor, and you can make a case to opt out if you don’t want to, but the normal thing is to do that and to engage in how things are working in your life and how that may be affecting your performance.

One other thing I can tell you really excites me. Medical school, particularly in the first couple of years, can get really hard. You can easily forget why it is you went to medical school if you’ve got your head down. It’s not books anymore, but you’ve got your head down on your electronic podcast or whatever your lectures are that you’re listening to, and you can forget.

We have really leaned into getting people out in the community, in service, and getting them into early clinical experiences and very meaningful roles as part of the health care team. That just breathes life back into people, just seeing young physicians in training with their short white coats on, out in the community, enjoying being part of what they had come to do. I think that is certainly a really helpful thing for the early medical students.

Kevin Pho: We’re talking to Heidi Chumley. She’s a family physician, and she’s the dean at Ross University School of Medicine. We’re talking about her KevinMD article titled “Who gets to graduate from medical school?” Heidi, from your perspective as dean, what kind of advice can you share with medical students to help them complete their training?

Heidi Chumley: Yeah. You got into medical school. You are capable. That is the first message that I would give. Find your network and social supports. Nobody makes it through medical school alone. People have whoever they consider to be their family and their peer group.

It is normal to struggle in medical school. It’s normal to feel like perhaps you’re the impostor, or you’re not supposed to be there. I don’t know of anybody who hasn’t felt that way at some point along the journey. Those are normal feelings. You can’t keep living there. You’ve got to understand how to get out of that and change that mindset, but those are really normal things to happen.

So I would say believe in yourself. If whatever you’re doing is not working, change it. Do it differently. Build your support group and do it together. Get through medical school together.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Heidi Chumley: For your audience, really the biggest takeaway I want to share is that if we really want to be about equitable opportunities in education, like we want to be about equitable outcomes in health care, it’s just really giving some thought to all of the different things that can impact somebody’s learning, and just paying attention to those.

Many physicians, many health care providers, have learners in their practices with them. Take a broader view and understand what’s going on. In between your busy patient encounters, I get it, but try to understand a little bit more about what’s going on with your learners, and offer your life advice. That’s going to be really helpful to people.

Kevin Pho: Heidi, thank you so much for sharing your time and insight. Thanks again for coming back on the show.

Heidi Chumley: You’re welcome. Thanks for having me.