- [Narrator] Funding for this edition of Think Tank with Steve Adubato has been provided by Horizon Blue Cross Blue Shield of New Jersey.

Robert Wood Johnson Foundation.

Working for a more a healthier, more equitable New Jersey.

Johnson & Johnson.

The Turrell Fund, a foundation serving children.

Valley Bank.

New Jersey Sharing Network.

The New Jersey Education Association.

NJM Insurance Group.

Serving New Jersey’s drivers, homeowners and business owners for more than 100 years.

And by New Brunswick Development Corporation.

Promotional support provided by ROI-NJ.

Informing and connecting businesses in New Jersey.

And by The New Jersey Business & Industry Association.

[MOTIVATIONAL MUSIC] - Hi everyone, Steve Adubato.

More importantly, we talk about tomorrow's physicians.

This is a series of programs we're doing on medical education and the physicians of tomorrow, and all the challenges and opportunities connected with it.

We have a distinguished panel to kick off this program, we have Patricia Costante, a long-time friend and colleague, founding member of the EJI Excellence in Medicine Fund.

Great to have you with us, Patricia.

- Nice to be here, Steve.

- You got also joined by Dr. Maria Soto-Greene, Executive Vice President and Director of the Hispanic Center of Excellence at Rutgers New Jersey Medical School.

Doctor, great to have you again.

- Great to see you.

- And for the first time, Dr. Petros Levounis, who is professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School, and the 150th president of the American Psychiatric Association.

Doctor, do I have that right?

- Yes.

Thanks so much for having me here.

- You got it.

Patricia put this in context.

We've been talking for months, and we've been partners for years.

I've been proud to emcee and host the EJI Excellence in Medicine Awards.

First of all, tell everyone what that is, as we put up the website, Patricia.

- So the EJI Excellence in Medicine Awards is an event that really has two purposes.

We honor outstanding physicians, and medical researchers, scientists in New Jersey, really to highlight the excellence that we have in the state of New Jersey.

And then the proceeds from the event fund scholarships for medical school, dental school students, as well as pharmacy students and physician assistants.

We've been doing the scholarship portion of this for about 12 years.

The actual organization is 85 years old.

- Yes, and having hosted that event with Patricia, co-hosted, I've gotten to meet, not only wonderful physicians like Dr. Soto-Greene, who won.

Did you win the 2017 EJI Physician Award?

Did you, Doctor, you admit this?

- Yes, I do admit it, with great honor and pride and humility.

- As we turn to you and your colleague, the most pressing issues, Dr. Soto-Greene, from your perspective, as it relates to medical education today, the top two or three most challenging obstacles, challenges, whatever you wanna call them, for medical education today, please, Doctor.

- So when we look at it, our communities are growing in its dimensions of diversity, so I would say diversity needs to remain at the forefront, and to really cultivate the opportunity for all, regardless of their positionality to enter medicine.

But as they're thinking about medicine and the health professions, then obviously we have to keep in mind what Edward JL and what they've been able to do is really thinking about scholarship as well, in terms of how do individuals plan their trajectory.

How can we assist them along the way so that they don't see economic barriers?

But the other end of diversity is any role models, and they need individuals who believe in them, and that they can stretch, right?

This is not uncharted territory, but that, and pretty much anyone could do it.

- And along those lines, Dr. Levounis, let me ask you, you have a unique perspective on this.

Talk about the issues of advancing, quote, "Diversity," in academic medicine, please, Doctor.

- Yeah, I couldn't agree more than what Maria said.

This is gonna be a very central piece of any physician's work moving forward, so better start with our medical students and educate them on how to handle diversity, equity, inclusion, how to fight racism, all these things, the advocacy part of our work.

Traditionally, academic medicine had clinical work, education, research, and of course, all these are incredibly important and we'll continue to teach our students these big buckets of academic medicine, but we have added the area of advocacy.

It's not enough to be a great doctor, you also need to advocate for your patients, and especially the underserved and underrepresented populations that we really are called to treat all around us.

The other thing that I would like to add here is that we have such a severe workforce issue, certainly in psychiatry, but across medicine, that our young physicians need to sharpen their communication skills so that they can be good consultants.

We're not going to be able to respond to all the need that's out there, so we need to collaborate very closely with other fields, in my world of mental health, certainly psychologists, and counselors, and social workers, but nurse practitioners, physician assistants across the board, and be able to train the trainers in some ways of teaching our expertise to other fields so that they can meet the need that is tremendous out there.

- Well said.

Patricia, let me ask you this, in light of what your two colleagues have shared.

You and I have had many, many offline conversations, and you know, in another life, I do a fair amount of leadership and communication coaching with physicians.

So when I listen to Dr. Levounis talk about the communication piece, go back to medical education.

From your perspective, not that we're trying to micromanage curriculum, but do you believe that medical education, preparing the physicians of tomorrow, focuses enough on the ability to communicate effectively to folks who did not go to medical school with you, otherwise known as patients and their families?

- Right, so I think, Steve, that's an enormous challenge because there's so much content that has to go into the medical school experience.

And many medical schools are now looking to move from a four-year program to a three-year program.

So how do you prioritize what the needs are?

However, that being said, communication is such a critical part of it.

And you know that my background is from the medical malpractice world, and almost every time we were defending a physician, the core issue in the case was a communication issue.

People don't sue doctors they like.

They like doctors who communicate effectively with them and compassionately with them.

And so the communication is an important piece that needs to be built in pre-medical school, medical school, and through continued training afterwards.

- You know, these are important points.

I'm obsessed by this communication issue that Patricia knows better than most.

But Dr. Soto-Greene, I wanna shift gears a little bit.

Talk to us about medical education and health equity.

- Yeah.

- And while you're at it, define health equity, please.

- Yeah, so I'm really proud to say that that is one of our competencies, which Petros knows very well we haven't met that through our curriculum.

So really health equity is really being able to provide that everyone has the opportunity for health and wellbeing, and we provide it in a fair and equitable manner.

What we do with our learners as they come in, I agree with Patricia.

I came from a generation of training where what happened was that we wanted medicine, we got into medical school, and then we would learn this along the way through role modeling and through activities.

Now in recent decades, it's become more and more formalized, 'cause I totally wholeheartedly agree.

But it's not just about communication.

It's being able to communicate with others in a manner that they understand.

It's not about how much I know, it's can I empower the patient.

Can I put aside, and that's where we start our first week of medical school, our biases that we have, those implicit areas where we, it's okay that we may, those are the shortcuts that we take to be able to manage and navigate decision making, but we cannot do that when it comes to taking care of another human life.

So I think when Petros hit on it, it's really bias awareness, looking at our systemic structural structures and acknowledging that there are structural factors, including structural racism.

- That's right.

- It's a system of care that we need to rebuild and really manage to be able to care for the person before me and not really look at them as different.

- Dr. Levounis, I want you to follow up on Dr. Soto-Greene's point.

How challenging is it for someone training to be a physician in medical school?

They become a young physician.

They care deeply about not just medicine, but helping people through medicine.

How hard is it to connect with people unlike them, culturally, racially, ethnically, gender, issues having to do with sexual orientation, a whole range of issues?

Oh, yeah, like, we'll just adapt.

It's organic, it'll happen.

It doesn't work that way, correct, Doctor?

- So many things to say about that.

First of all, I want to acknowledge Dr. Soto-Greene's leadership in the particular issue of accountability.

Meaning that when we have our faculty give lectures, we do help them along and we say, "Look at this.

You talked about, let's say, addiction to opioids.

There was a missed opportunity there to talk about health equity as well."

And we help, like very specifically, kind of guide our faculty in these extremely important areas.

- Hold on, Doctor, how is health equity tied to opioid, help us understand this, opioid addiction?

Please, I don't understand that.

- Underrepresented and the under-served populations are certainly more vulnerable to, let's say, campaigns that opioid people may unleash, and that has been very, very well documented.

So we need to make sure that people, that our medical students are aware of this kind of differences and disparities in health, as well as treatments, lifesaving treatments, the naloxone for overdose of opioid intoxication that you just mentioned, or buprenorphine for the treatment of opioid use disorder, have been considerably less provided to Black communities than white communities.

And again, this is something that has been very well established and very well researched.

- Patricia, I'm sorry, finish your point, Doctor, I apologize.

- No, I was gonna ask, answer the question because the question was from the point of view of the medical student as they go out there, how are they going to negotiate these communication issues.

And we have moved very much from the patronizing, a paternalistic way of communicating, I know what is best for you, and I'm gonna tell you, and I wanna make sure that you understood what I said, to a much more bidirectional exchange of information.

- And that's in the curriculum.

Sorry for interrupting, Doctor.

- Absolutely.

This is in.

- That is embedded in medical school curriculum, more than ever.

- It is, certainly for us, I taught that vast communication class for our medical students, and this is something that is become part of our everyday work.

- Okay, Patricia, we're up against the break.

Can you just do this for us as we go to the break?

Of all the challenges and opportunities, how big is the financial hurdle for people who say, "I want to go into medicine," paying for medical school, please, Patricia?

- Right, so the financial hurdle is large.

I mean, what we hear consistently is by the time people finish medical school, they're talking about, generally, $250,000 of debt.

So anything that we can do to defray that certainly is helpful.

I think the other real issue though is preparation for medical school.

Is everybody getting the same access to the coursework and the rigor that they need to qualify to get into medical school?

And that's really the next challenge that EJI is looking at.

And I'd love to talk to you about that more later on in the program.

- Now we're gonna come back and do that.

Also, I wanna bring up this.

I'm a student of wellness and leadership, meaning the connection between our wellbeing and our ability to lead.

How about wellbeing and the physicians of tomorrow?

We have a great panel talking about that, and other things, about medical everything related to medical education and tomorrow's physicians.

We'll be right back.

- To watch more Think Tank with Steve Adubato, find us online and follow us on social media.

- We continue talking about medical education and the physicians of tomorrow.

Patricia, I cut you off going to a break.

Pick up your point.

- So one of the things that EJI has started to move into is the critical things that need to happen before someone qualifies for medical school.

And the two pilots that we have in process right now that I'm very excited about.

The first is funding for a health sciences high school to provide the students there with the equipment they need to be able to have a fuller experience and hopefully moves them rather seamlessly from the high school into a four year college, with many of them having earned then significant credit toward the completion of that four year degree.

And I think that's an exciting development, but one we realized may be just a little bit too late.

And so the second pilot that we have running right now is for middle school students, providing them with intensive summer experiences that get them excited about science and research in ways that their local public schools may not be able to do, and then feed them into very rigorous high school programs.

Again, preparing them for college, preparing them for careers in medicine and the health sciences and science.

And I'm looking forward to being able to talk about that and how successful they were as we move forward.

- Dr. Soto-Greene, I know you're aware of this, it's to me, anecdotally, it sounds incredibly early, but it's not, correct, doctor?

- That is absolutely correct, and I'm proud to say that I am, being part of New Jersey Medical School, and our identity is really intertwined with giving back to the community.

And so, when the school was established in the City of Newark, part of it was that we would make sure that we would be working not only in workforce diversity, but preparing future generations.

So currently, we run programs from sixth grade all the way through faculty.

So I agree with Patricia, if we wait till high school, we will have lost the dimensions of diversity, especially, in under-resourced institutions.

But the only thing I would add, Patricia, it's great to have them and accept the students into, whether it's a winter, 'cause we have a winter program, whether it's the fall, whether it's the summer, but we also need to do some interventions with the teachers, right?

- Right.

- Because the teachers care, but what is happening is that they are also being stretched and under-resourced.

And I always said, the individual that gets left behind, sometimes it's just that middle rung, right.

There's a level of investment that they must have for those who might be on that lower end, right, to make sure that they're meeting competencies.

The highest end will really be able to function.

But the average person like myself, we're kind of left to really figuring it out on our own, and to really, if we can really provide environments and settings that they can really thrive in and really be excited.

'Cause you're right, it's about the excitement about the activities that we do, then we begin to turn around what we have.

- Wow, there's a lot to unpack there.

But again... Dr. Levounis, I need to follow up on something I said.

I'm obsessed with this topic, hopefully, in a good way.

- Okay.

- So those of us who have college aid students or just kids in our lives, and Patricia and I talk about our kids, our kids who are now not kids, all the time.

Mental health issues.

So can we talk about, if college life is stressful and challenges one's wellbeing, not just physically, but behavioral health, mental health, what the heck is going on for most medical students, A, and B, what needs to be done to provide them with the wellbeing and wellness care they need?

Please, doctor, you understand this better than most.

- Absolutely, and I like very much that you addressed both sides, the physical side and the mental health side, they're very, very much intertwined.

So sleep, diet, and exercise, major pillars of physical health, need to be there and need to be attended to, as well as the mental health side, which has to do with the reduction of stress, attention to relationships, and avoiding substances.

These are the three mental health side and the three physical side that make together lifestyle medicine, our understanding of wellness.

So I like very much what my colleague James Hill often says, "It's not a matter of avoiding anxiety in medical school.

"It's much more a matter of managing anxiety "during medical school."

And these are the techniques and the skills that we impart to our students on how to manage a very stressful situation, because as you said, it's more stressful than college.

- Is it built into the curriculum, doctor?

- Yes, it is, yes it is.

- Yes.

- Yes, and we're very fortunate to have psychologists and psychiatrists who are able to spearhead these efforts.

- Patricia, it's interesting, we picked up the EJI Excellence in Medicine Awards post-COVID, and we did some remote stuff during COVID.

From your perspective, and you've seen this for a few years, do you think it's worse, meaning the mental health challenges, the stress, the anxiety, all these issues, do you think for the physicians of tomorrow, not only them, but the physicians of today, but particularly, those in graduate medical education or medical education, am I exaggerating or overstating that it's, I don't wanna say worse, but I'm gonna say worse?

- I think it's certainly different for them, and I will defer to my colleagues here, who have this experience day to day with the students.

But when we talk to the students, for many of them, they spent significant parts of college in COVID lockdown.

For some of them, they spent the beginning of medical school in COVID lockdown, and that has created a difference in how they approach their education.

I think it has impacted their development of social skills and communication skills, so I think there are new issues to be dealt with.

I'm hopeful that with the changes in curriculum that we've talked about in this program, they're being addressed.

The potential mental health issues are being addressed.

So, I'm always hopeful.

And I think that while we had a very difficult period, hopefully, it's one we've learned from and are coming out of.

- But, Dr. Soto-Greene, in light of what Patricia has said, have you seen a precipitous drop in the number of students and the quality of those students who do apply for medical school?

Has it dropped?

Have the standards lowered, because "Oh my God, I saw what happened durin' COVID," "and physicians were on the front line," "their lives were on the line."

You're shakin' your head already.

You're ready to answer already, I could tell.

Go ahead.

- Yeah, not at all.

We actually, as a medical school, we've continued to enjoy a high number of applicants.

But I do agree with Patricia and Petros can also speak to it, because I run, as you probably heard, both pre-college, but particularly, our college level programs, where we began, we did one year remote.

And when we began to bring them on campus, there were students that were experiencing levels of anxiety and feeling even uncomfortable.

How do they socialize with their peers, right?

So when you see that you know, and part of it was what they experienced at younger levels.

They experienced it either in college, and remember, we're still moving generations through that experienced it when they were even younger.

And so they really had to really begin to learn, right, be back into how do I socialize?

How do I learn that for medicine, for us it's, we're interdependent.

It is a team's work, right, beyond what, like, Petros really highlighted clear examples.

It's not just a physician, it's our interprofessional team, and so, we really needed to be more intentional, really observe, and do a lot of intervention.

So we moved our physical and mental health, which we call it wellness, it's all in one setting.

For those who need intervention, it's all alongside.

We're not saying, we're trying to de-stigmatize, but then, we're also doing a lot of wellness program throughout the curricula and opportunities for them to really just be interconnected with one another and with us, - Patricia, I also wanna say this, we would not be doing this, if it were not for you, if it were not For your colleagues, who understand this and understand the importance of talking about medical education and the physicians of tomorrow.

Just thank you to all of you for kicking off the series on Tomorrow's Physicians.

We greatly appreciate it.

All the best, folks.

- It's so easy to have this conversation with you, Steve, because you're great.

Make sure the director leaves this in.

- You know that just got edited out.

I'm Steve Adubato, that's a great panel.

We'll see you next time.

- [Narrator] Think Tank with Steve Adubato is a production of the Caucus Educational Corporation.

Funding has been provided by Horizon Blue Cross Blue Shield of New Jersey.

Robert Wood Johnson Foundation.

Johnson & Johnson.

The Turrell Fund, a foundation serving children.

Valley Bank.

New Jersey Sharing Network.

The New Jersey Education Association.

NJM Insurance Group.

And by New Brunswick Development Corporation.

Promotional support provided by ROI-NJ.

And by The New Jersey Business & Industry Association.

- (Narrator) New Jersey is home to the best public schools in the nation, and that didn't happen by accident.

It's the result of parents, educators and communities working together year after year to give our students a world class education.

No matter the challenge, because parents and educators know that with a shared commitment to our public schools, our children can learn, grow and thrive.

And together, we can keep New Jersey's public schools the best in the nation.