Ep 30: Dr. Julia Cron and Dr. Lauren Meiss

#Docs With Disabilities podcast episode 30 Drs. Julia Cron and Lauren Meiss "training as a Doc with disabilities" yale obgyn residency program, from stanford medicine and the university of michigan medical school department of family medicine

In this episode, Dr. Meeks speaks with Drs. Cron and Meiss from the OBGYN residency program at Yale New Haven hospital about their article in the Journal of Graduate Medical Education titled, Training as a Doc with Disabilities. They also discuss the road to Lauren’s “match”, the process of disclosing a disability in residency applications, seeking accommodations as a trainee, Yale’s newly founded advocacy/support group for trainees with disabilities, and Dr. Cron and Meiss’s commitment to educating OBGYN programs about the benefits of training physicians with disabilities

Episode 30 Transcript

Description:

 

In this episode, Dr. Meiss and Dr. Cron expand on the themes introduced in their JGME article, Training as a DocsWithDisability, including a discussion about finding community in GME, the challenges that COVID-19 had brought to their work, and their long-term goals to make medical education a more inclusive space.

 

JGME article: https://meridian.allenpress.com/jgme/article/12/2/229/442179/Training-as-a-Doc-With-Disabilities?searchresult=1

 

Citation: Lauren Meiss, Julia Cron; Training as a “Doc With Disabilities”. J Grad Med Educ 1 April 2020; 12 (2): 229. doi: https://doi.org/10.4300/JGME-D-20-00050.1

 

 

Lisa Meeks:

 

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the DocsWithDisabilities podcast.

 

Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing the researchers and policy makers that ensure medicine remains an equal opportunity profession.

 

Sofia Schlozman:

 

Hello and welcome back to the Docs With Disabilities podcast.

 

Today we are honored to be joined by two guests: Dr Lauren Meiss and Dr. Julia Cron.

 

Dr. Meiss is currently an obstetrics and gynecology resident at Yale, and Dr. Cron is the residency program director for the OBGYN division at Yale School of Medicine.  In April of this year, Dr. Meiss and Dr. Cron published a paper in the Journal of Graduate Medication Education titled “Training as a ‘Doc With Disabilities'.’”  The article discussed Dr. Meiss’ experiences navigating medical education with a disability and Dr. Cron’s role in this process as a program director.

 

In this episode, Dr. Meiss and Dr. Cron expand on the themes introduced in that article with a discussion about finding community in GME, the challenges that COVID-19 had brought to their work, and their long-term goals to make medical education a more inclusive space.

 

We will hear from Dr. Meiss to begin.

Dr. Lauren Meiss:

My story starts as the third daughter of my parents. I was born at term and seemed healthy, but I wasn't gaining weight. Eventually, at three months old, I was diagnosed with cystic fibrosis. My mom is a nurse, so she did a great job of taking care of me. Certainly when I was younger, I very much knew that I had an illness. But I sort of saw it as something exciting about myself and something that made me unique and strong because that's how the people around me treated me. I was always very open about speaking about my cystic fibrosis because of that perspective. Throughout elementary school, my friends knew. I would show people my treatments because I thought they were cool. That continued on through middle school of course, you start getting a little bit self-conscious in those years. I chose a little bit more carefully what parts of cystic fibrosis I would share with people. But everyone always knew and I always invited friends and family to the yearly fundraisers. It was a part of myself that I was very proud of.

 

That continued on through high school and through college. Even more so I was a little bit more guarded because I started to notice that people say things that can be hurtful even though it's coming from a well-meaning place. Especially as you start to learn more about mortality or what it would mean to have a shorter life expectancy. I was actually very musical when I was younger and I had created a musical piece with the piano that sort of explained my feelings about cystic fibrosis. That was very vulnerable for me and I shared that in an open mic in college. That was my first experience of --it was actually very tough to talk to people around me about cystic fibrosis because of how vulnerable I was with what I said in that song--then not having the response that I expected, not having the warmth. I guess not having the appreciation that I expected after sharing that piece of myself, then I started to become a little bit more guarded. The decision to go to medical school was a very difficult decision actually.

 

Because of cystic fibrosis, I started to become more aware of possible limitations, I guess you could say. Or if it was a smart choice knowing that I didn't know that my health would always be there for me. So, I talked to a lot of people about that decision and ultimately decided it was very much where I wanted to be and what I wanted to learn. I did end up going to medical school and I was at UCSF; which for me was an amazing experience. In terms of having the support that I needed as someone with chronic illness, medical school and all the years before that were very flexible a lot of the time is in the classroom; If you need to miss, it can be easily made up. It wasn't much of a barrier. I actually didn't even know about the concept of accommodations or think that I was someone that needed accommodations. But UCSF knew about my cystic fibrosis and they had a great program to supply accommodations. So I had a meeting with the disability office there and they helped provide me with a letter, should I ever need it to have accommodations for my third year rotations and beyond. I used that very sparingly. I did tell all of my classmates about cystic fibrosis mostly because I was really interested in teaching them about the patient perspective. So much of our learning was that cystic fibrosis is a childhood illness. That really frustrated me because I thought it would perpetuate the thought that anyone born with cystic fibrosis could not expect to have a full or longer life. I was really interested in combating that and so I actually did teach my entire class and the classes after me about the patient perspective of cystic fibrosis.

 

In terms of telling attendings or fellows or people that were supervising me, I was much more shy about that. Knowing what I had learned about cystic fibrosis in medical school, I was a little bit scared about what they would think of me. I didn't share that letter with very many people. The letter itself actually didn't say what I have, but the interesting thing about cystic fibrosis is you can't or you're not supposed to be within six feet of somebody else with the disease. Of course, I'm at higher risk of getting lung infections, so I choose to not take care of patients with respiratory illness. It sort of made it obvious because the letter itself said that this student will not take care of patients with cystic fibrosis, and there's really only one reason that would be. So, I guess that's one of the reasons why I used it more sparingly. But whenever I did need to use it, I didn't have a bad experience and was very easily accommodated.

 

Then looking forward to the match process then, was extremely overwhelming to make the decision. Because as I said, I was very open about cystic fibrosis and it drove a lot of my passions. It drove a lot of my extracurriculars. It drove my research. I had spent two years in Sweden studying cystic fibrosis.

It didn't quite make sense as someone who was going into OB-GYN to have that much work in cystic fibrosis and no reason explicitly stated on my application. But so many people told me, "You are now applying for a job. You should not tell anyone about your health history or any barriers that you might have." Almost everyone that I sought advice from told me that in the beginning. That was disheartening because it felt like I was being told to be silent about a big part of myself that I was actually quite proud of. I wrote my whole application without any mention of myself having cystic fibrosis. I was meeting with somebody within the OB-GYN department to go over my application just in the week before it was due. That person read my personal statement and read through my application and said, "This is an excellent application, but I don't understand all of the work with cystic fibrosis. You must have some connection. Why are you interested in this?" I was very comfortable with that person and I told them a little piece of my story.

 

She was incredibly supportive and said that she thinks that is a huge point of pride for myself and that I have to share that. If I don't share that, how am I presenting myself? I trusted that person, as I said, so much. I agreed with her and I wanted to show my true self in my application. The week before it was due, I changed everything and it was scary but the other thing that I thought was, if I am going to be training for the next four years at an institution, I want to be somewhere that they know who I am and they support who I am, and they will be willing to help me out when I need it. Rather than be at a place where I wouldn't have gotten into if they didn't know that I had cystic fibrosis. That was the final decision then, to be very open and honest in my application.

Dr. Lisa Meeks:

Dr. Cron, this is where you come in. You are the program director for obstetrics and gynecology at Yale and you see this applicant. What are your first thoughts?

Dr. Julia Cron:

Yeah. It's funny. I've actually in the past several days been reflecting on that year of applications and how we were kind of introduced to Lauren. When I read personal statements, there are a lot of personal statements that are pretty generic and a lot of people say the same things. They're all lovely pieces about why they want to be OB-GYNs and take care of women. Every once in a while, you'll come across one that really stands out. It is those people that have been fortunate enough to have something in their life story that lets them stand out. Some people by their mid 20s don't have that but the ones that do and are willing to share it are always really powerful. I remember that about reading Lauren's personal statement. That was just a little piece. I think then I was actually thinking about the day that she interviewed with us. To be quite honest, it was mostly a non-issue because Lauren is such a fabulous applicant in terms of her achievements and her academic success.

So it was a small piece of the discussion about her. In that, here's a wonderful applicant and she's done really great research in cystic fibrosis and ‘oh by the way, she has cystic fibrosis.’ But to be honest, wasn't much of the discussion. We really talked about how Lauren had a great application and great achievements. On her interview day, she was a lovely person that everybody thought would be a great addition to our program.

Dr. Lisa Meeks:

Lauren, you get accepted to this program, you match, as they say. You start talking about the accommodations that you might need, and this looks a little bit different in GME. Can you speak to that process? You disclosed through your personal statement, but what were the other elements of the process that you needed to engage in once you arrived at Yale?

Dr. Lauren Meiss:

Once I arrived at Yale, really, I don't remember it being my decision to continue searching out accommodations. Not that I shouldn't have, but just that there's so much else going on, I sort of needed an advocate there for me. Dr. Cron, our program director, was more forward-thinking and she knew from my application that I may need accommodations and reached out to me before I reached out to her to set up a conversation about what I might need, or how I saw myself working throughout my intern year and anything that I may need to help me be successful.

Dr. Lisa Meeks:

The paper is kind of how I found you. It was in the Journal of Graduate Medical Education, titled Training as a “Doc With Disabilities”. I cold-called you. I was so excited to learn about the two of you and what you had done and what you're planning to do that I knew I wanted to interview you for the show. So, so Julia, tell me what about your background or your experiences or what you had been taught made you reach out to Lauren and say, "Hey, we need to engage in this process and here's what we're going to do, and we want to support you."

 

Dr. Julia Cron:

That's a really interesting question. In terms of what I had been taught, I would say actually nothing formal. I think a lot of being a residency program director is kind of on the job training. A lot of it comes from your own life experiences and your experiences both in your personal and professional life. I feel like a lot of the guidance that I give our residents is based on what I know as being a physician and how I care for my patients. Then there's kind of nothing that surprises me. Every day there are new challenges and new things that come up as a program director and you just kind of have to take your experiences and learn from those and hope that you're giving the right guidance to your trainees.  

 

With Lauren, I actually kind of reflected on my own personal experiences. I am a breast cancer survivor. I had breast cancer when I was 42 years old and went through about a year of treatment. I had similar issues in terms of disclosing that.  In terms of, do I disclose to my patients, do I disclose to my trainees, do I disclose to my colleagues? But similar to Lauren's story, I felt like it was such an important part of who I am and how it has shaped the way I am as a physician and as a person. I do always think about the settings and who I'm disclosing it to, but I think it is a really important part of who I am.

 

When Lauren joined us, I thought about how this was very similar to some of the experiences I've had. In terms of wondering when do you talk about it? Who do you talk about this to? I felt like I wanted to give Lauren the space to dictate this the way she wanted it and to make it look the way she wanted it to look. I felt like sharing my story with her would maybe help her because I thought it would let her know that I could relate on some level to the experiences that she was having. That is why I reached out to her and wanted to find out the way she wanted this to look.

Dr. Lisa Meeks:

That's amazing. You have this personally informed experience and you're using it to mentor and support someone else. Lauren, I love your story because You seem to have these two really impactful people on your journey that are telling you to embrace your authentic self and that that is okay. Not only is that okay, that it is going to make you either a better applicant or a better physician because you have this experience. You're on a magic carpet ride really from UCSF to Yale, and you get to Yale. How did it feel to have Dr. Cron reach out to you in this way?

Dr. Lauren Meiss:

I'm so glad that Dr. Cron shared that story, because I didn't want to share her story for her. But it was massive in terms of me choosing where to go and where I felt supportive. Actually, during the Yale interview day, there's five minutes only that you get to spend with the program director one-on-one. Within that five minutes, she shared her story with me and very enthusiastically and very much just to show that she thought that I was strong and she thought that my illness will be a benefit to my patients in the future because of how it shaped me. That was so powerful and we connected so quickly over that. I got the sense that she just got it and that she would support me. Honestly, that was a huge factor in me choosing where to go. it's important to have your program director on your side, and I knew that.

 

Then coming to Yale and having her reach out to me to get the process started and to get on the same page, just showed me that I had seen who she really was and that she really meant that she would support me in the process. That was exciting and it took off so much of the burden of disclosure. Which can be quite a burden because it's so vulnerable and it's such a personal conversation so to not have to reach out and instigate that for myself really made the process much easier.

 

Sofia Schlozman:

Dr. Meiss, and Dr. Cron now transition to a discussion about how they’ve utilized insights from their own experiences to spearhead new initiatives to help make medical education more inclusive.

 

Listen or read along as our guests discuss the thought process behind their recent publication, the creation of the Alliance for Trainees with Chronic Illness or Chronic Disability at Yale, and the many ways that the COVID-19 pandemic has affected their work and prompted changes within their program.

Dr. Lisa Meeks:

I have been so excited to talk to the two of you from the time that I sent that email saying, "Oh my gosh, Oh my gosh, I just found this article yesterday, just getting prepared.

 

There are episodes in the Docs With Disabilities podcast that I just feel are going to make a change, that are going to be incredibly impactful. As I sit here, I have the biggest smile on my face, to the point where my cheeks are actually starting to hurt because I just keep thinking the PDs that hear this, the applicants that hear this, like the opportunities to change people's hearts and minds about not only including people, but the way that you go about doing that, sharing these personal stories or actively recruiting people, making them feel comfortable, making the transition, which, GME  is a tough transition, making that transition easy, these are all things we can do.

 

The idea that I'm getting from both of you, both Lauren, as you were growing up and Julia, as a patient yourself, is that disability is a value-add to being a physician. That, that lived experience teaches you things that you would not otherwise know. This idea of diversifying the physician workforce that does include disability when you look at the ACGME and AAMC indicators of what it means to diversify this workforce, this is such an important part of it. And I'm just so pleased that you had this experience. But you didn't just have this experience together and then go off into this fairy tale residency. The two of you decided to do something with this connection and to do something with this information.

Dr. Lauren Meiss:

In moving forward from the accommodations that Dr. Cron and I had set up for my own training, to then making the decision to submit an article that does disclose, attached to my name that I am a trainee with disability, is not an easy step to take. But in the journey from that experience that I had with decisions around the match process, to coming to Yale, to starting my training and realizing how important it is to have the support that you need, I started to feel this sense of, I am not out here alone, but it sometimes feels that I am. But I know that I'm not. I know I have met other people with disabilities who also don't know quite where to turn yet. I find it really exciting that we're starting to have these conversations and that we're just at the beginning. I felt a sense of, I need to be somebody that is moving this process forward and moving this conversation into the light for program directors and for the trainees.

 

I feel that I'm in this very privileged position because the illness that I have doesn't carry so much of a stigma as unfortunately many others do. I felt that if I can talk about my story and start to shed some light, then maybe that will bring a space for others to continue to talk about their own stories until we get a larger and larger group of people that feel comfortable being open and being their authentic selves.

Dr. Lisa Meeks:

I'm so excited. There's something about the learners that come out of UCSF too. There are so many of you, some that I've had the privilege of working with and certainly interviewing and sharing their stories. I think that the culture that you are trained in helps create how you see the responsibility of advocacy. Certainly UCSF is a place that advocates for multiply-marginalized populations, not just disability, but they certainly have been at the forefront of disability. It's nice to see all of these residents now that were students at UCSF doing all of this work and publishing papers. Some of your colleagues have published papers on disability as well. So, I'm super excited about the work. But I also want our audience to hear about the program that you're creating. I think the national kind of agenda that the two of you have and how you plan to train other OB-GYN programs to help increase the inclusion of residents with disabilities across the country, not just at Yale.

Dr. Julia Cron:

After we wrote the response in the Journal of GME, and we thought we'd love to take this to a broader audience so we submitted a proposal to present a workshop at the annual meeting of APGO/CREOG, which is the Association of Professors of OB-GYN and the Council on Resident Education in OB-GYN. It's basically the large meeting of educators, both medical students and residents for OB-GYN. We submitted our proposal and we were accepted. I think for me, that was somewhat of a tipping point in recognizing that people are interested in this topic and they're interested in hearing from us about this. We will be presenting in the early spring of 2021. Unfortunately, probably not in-person, but virtually. We haven't yet exactly crafted what we're going to do, but I think that we have momentum and we're really excited that we will be somewhat on the national stage in the field of OB-GYN talking about this.

 

I think also Lauren's kind of creation of this organization within Yale GME was really inspirational. I think she can talk about it in more detail. But I think that the fact that Yale as a whole and GME is interested in supporting this and Lauren has people that she's working with on this, is really showing that it is something that we can bring to a larger audience.

Dr. Lisa Meeks:

I completely agree. Lauren, can you talk more about the group you started at Yale?

Dr. Lauren Meiss:

When COVID hit actually is when I sort of got the fire behind me to get this group started, but it's definitely something that I've been thinking about for a long time. Again, going off of the idea that I know that there are more people like myself who are trying to figure out this process of training as, as you say, a doc with disabilities. I've always been interested in meeting those people because whenever you find them and have these conversations like Dr. Cron and I had in those five minutes, it can be so inspiring. I've been interested in meeting them, but I didn't realize how important it would be to have each other, to advocate for each other until COVID hit. For me, because of my lung disease, I had been taken out of the hospital in the beginning days of COVID when we weren't sure how we could control the spread and what it might mean for me if I were to be infected. So I was working from home and I was doing my best to combat the feelings of guilt knowing that young, healthy people were unfortunately being affected and that I got to be safely at home.

 

I was trying to do whatever I could to support my co-residents. But there was a strong feeling of guilt and I was really seeking that community of other people who might be feeling the same way. I also felt so grateful that I had been given the opportunity to be home and to be safe. I knew that that was only because of my very understanding program director who had recommended that without me needing to advocate for it for myself. I was concerned about other people who may not have previously established or disclosed and that were just thrown into this uncertainty and maybe not knowing how to advocate for themselves.

 

So  I reached out to the director of GME here at Yale and sort of just said those things of what I was dealing with and that I really wanted to reach out to anyone else that may be dealing with those things.I didn't know anyone specific who maybe could be a part of that group, but I figured that that person may.

 

He responded almost immediately with a name of another person here at Yale that had expressed a similar interest. We started talking, and of course were very fast friends. We put together a flyer to reach out and identify those people that may be part of this group, that we ended up calling an Alliance for Trainees with Chronic Illness or Chronic Disability. After that flyer wen t out, I had about 15, 20 people from all around different programs in Yale reach out to me saying how meaningful it was and how excited they were to meet us. Since then, we've had many Zoom meetings. The first of which was one of the most powerful nights of my life, because it was a group of very similar, very strong people being able to share their story, and some of them for the very first time. To people that understood even if not, of course, their exact experiences, just many of the feelings that surround sharing your story.

 

Now, those people all have somewhere to go when they feel that they're not supported by other people, unfortunately, in their program, or if they're not sure where to go for PPE, or if they're not sure what to do as we start to have more patients with COVID in the hospital. That they can come to our group and that we can figure it out altogether.

 

Dr. Lisa Meeks:

That's pretty incredible. A couple of podcasts talk about the sense of community that is building around this and how important community is for wellness and resiliency and just having a support system and knowing that you're not alone, the things that you're talking about.

 

 

 

COVID, it was actually something that was on my list to ask you. I was so appreciative, Lauren, that you weaved that into one of your answers. Because, and Obviously, I mean no offense by this, but it is literally the worst case scenario for someone. Right, I mean, and you can't identify who has COVID. There is no way to protect you; there's no marker until someone gets sick. The whole world at this point could have COVID and we wouldn't know it. But everyone you come into contact with, you almost have to treat as if they do have it. I was going to ask you about that experience and how difficult that must've been and how you managed it.

Dr. Lauren Meiss:

Yeah. The interesting thing about COVID in the context of cystic fibrosis that a lot of my friends with cystic fibrosis have pointed out, is that it's now just that the whole world is living as we with CF have always lived. Which is that there are germs everywhere and you can't see them and they could be a threat to your life.

 

So, I think many of us who have grown up with CF are always very conscious about hand washing, about keeping a distance from anyone that's sick. And As I said before, when I started in the hospital, I did my best to keep away from the illness that was obvious, like a respiratory infection, knowing that it could be a harm to myself. But certainly now there is much wider spread of infection than there has been before. That's not to say it hasn't impacted how I interact with other people at all.

 

In the beginning, it was certainly terrifying not knowing how COVID impacts people with cystic fibrosis. Something that I haven't mentioned already is, of course, the daily work that goes into my own healthcare.I spend up to an hour a day doing respiratory treatments at baseline. You put all that work together to now I'm 30 years old, I've been doing that daily all of this time, and I certainly don't want to risk the health of my lungs at this point.

 

As the news of COVID spread and everything was changing, thinking ahead of what's my risk in the hospital, it really wasn't known. At that time, I was so thankful that I had already had this conversation with Dr. Cron and that she had already met my physician and we could all talk together to try to figure out what was best. The difficult thing was of course, that there's actually no information yet. We don't know if I'm at higher risk and we just kind of assumed that I maybe am. But as I said, it can affect healthy people as well. The guilt that goes around that was pretty overwhelming.

 

But it was actually sort of fortuitous. What happened is, I was on a fantastic vacation in Panama at the beginning, right before COVID sort of made its way to the US. I returned from that vacation and was working at night and felt febrile. I took my temperature and had a fever and was sent immediately home. I did not have COVID at the time, but I did have a fever so I had to stay home. And then since that time, I spent many months out of the hospital. Because as I was recovering from that illness, things were getting more and more serious.

 

Dr. Julia Cron:

Really to me, one of the most memorable things about COVID will be how Lauren navigated this. I think the lesson as a program director was, to really take her lead and to see what she needed and how she wanted this to play out. The fact that we had had these discussions prior to that, were invaluable. I can't imagine if the first time I was hearing about it or the first disclosure was in this acute crisis. The fact that we had had conversations about it and we had set things up and we were on the magic carpet, helped us when we were managing that acute crisis. We had a base to go with, and I think that was really helpful.

 

Dr. Lauren Meiss:

Dr. Cron, as she said, really took my lead on what I felt comfortable with and what I thought was needed. She never made decisions for my health without my input. Which I really appreciated because it did take me a while to come to terms with the fact that maybe I do have to change my training a bit to keep myself healthy. Because of course you want to be strong and you want to not be a burden for anyone else. But we did come up with creative ways that I could stay home and continue learning and continue adding to the education of my co-residents.

Dr. Lisa Meeks:

Sometimes things are a little bit of a blessing and you don't see it until you're past it. The ability to spend some time on this, like you said, that meeting, and it just makes my heart sing, when you talk about that Zoom meeting being one of the best moments of your life. I think when you find your people, you find your community, that is such a great feeling.

Dr. Lauren Meiss:

Although disclosure with Dr. Cron and at the beginning of residency, it was difficult, but it felt good to talk with her about it. I then set up accommodations with her specifically and didn't disclose my condition to anyone else that was supervising or evaluating me. When I was taken out of the hospital, of course, the attendings weren't seeing me around anymore for quite a few months. I felt that people were starting to ask questions. Then when I was making my way back into the hospital, it was still very important to me to be as safe as possible while still caring for the patients. Dr. Cron and I and my doctor spent a lot of time talking together to figure out how I could be as safe as possible. I made the decision that I would not take care of patients who are known to be COVID positive. That's different from my co-residents who are taking care of those patients.

 

And I didn't want to be, looking forward, in the position of an attending asking me to take care of their COVID positive patient or to see them for rounds. I anticipated that this would cause me to have to disclose one-on-one multiple times.

 

With Dr. Cron's guidance and direction and the help of some other attendings at our institution that I really looked up to, I made the decision to actually send out a short but personal letter disclosing my condition and my reasons for accommodations in the setting of COVID to all of the attendings at Yale and all of the midwives and all of the fellows.

 

Dr. Cron knows this was a very difficult decision because it is just so personal and you never know how people will respond or what they'll say. But I ended up doing it that way. I sent out a letter. Some of the responses, as you can imagine, were so meaningful and so supportive.

 

And For those few people that took the time to reach out in that way, I'm so thankful to feel accepted and understood. It hasn't made it any more difficult to continue working in the hospital now that people know.

Dr. Lisa Meeks:

That's incredible and honestly, courageous.

 

That's a lot of disclosure and it's making yourself vulnerable. Which, as we know, can be very scary. I'm glad that you did ultimately feel like you could share that information though. I do think its important information for people to know so that you don't have to explain in the moment when caring for a patient Is on the table and it's the conversation.

 

Sofia Schlozman:

In this next section, the conversation shifts away from COVID and towards the future, as Dr. Meiss and Dr. Cron discuss their long-term goals to improve inclusivity in graduate medical education.

 

Dr. Lisa Meeks:

We've had such an increase in undergraduate medical education students with disabilities. They have now crossed that threshold into GME. For those that were getting a really incredible, supportive, healthy experience, many of them have found themselves in GME and kind of lost without that sense of community, without that support.

 

We'll put a link in the show's transcript, a way to contact you. Of course, we'll put a link to the article that we've been talking about. But I would venture to say that you will get a lot more inquiries after this podcast airs. I think that there are institutions who would be really happy to create something similar to what you've created. I'm not surprised, I must say, that Yale's response was so positive. Yale has a long history of really supporting learners and trainees with disabilities.

 

The two of you together are building this, it's really top down, bottom up approach to inclusion within your specialty. But not only within your specialty, you're looking at GME. I mean, big sweeping, let's talk about how we can impact programs in GME and how we can support learners in GME. Which is quite amazing.

Dr. Julia Cron:

I think if we can get out those blueprints of best practices and how to help people with this, I think that's one of the big goals. Is to help people give people the tools to be able to manage this coupled with individual stories and ... I mean, I think we all work well with people's stories of like, this is how we did it. This is how it worked in our program. When people hear that, then they realize that they can do it and it's not as daunting as it may feel in a kind of hypothetical world. We have specific examples and this is our story, and this is how we made it work. I think when you hear that, you realize that it can be implemented in a very broad sense.

 

physicians with disabilities and chronic illnesses it's such an added value to our program and to the patients that our residents care for. I think emphasizing that is really, really important.

Dr. Lauren Meiss:

I would absolutely love to hear from anyone who's trying to create a similar thing at another program or from anyone who just needs support that means so much to me and I look forward to that.

 

In terms of my goals for what we're working on right now, I have to be honest that my ultimate goal is to create a standard accommodations process for GME like there is for undergraduate education, like the one that I experienced at UCSF. That you sort of fall into and it takes care of you. what's happened here has worked out so well for myself. It's sort of all based on me having to be very introspective and open and honest, in addition to my program director being so accommodating and so open to learning more.

 

I'm so glad that that's worked out for myself, but not everyone can depend on that. I want there to be a more standard protocol that's accepted and that maybe goes through a third party who is not biased in any way and not responsible for evaluating the trainee in any way. But can pass on what they know to be reasonable accommodations for the trainee.

Dr. Lisa Meeks:

Well, we share goals. GME could absolutely use a toolkit of some sort, to assist program directors and to assist ADA coordinators with situating this type of role for someone this “confidential conduit” is kind of the way that I refer to it in everyday speech. I think that that's critical. I think that when you have that in place, you will see an increase in learners with disabilities disclosing and requesting accommodations.

 

The overall goal is to make sure that everyone has access to the program in a meaningful way so that they can thrive, and that's done mostly through accommodation. I'd also like to see a toolkit that not only incorporates the policies and processes that guide GME and that are "best practice", I'd also really like to see a parallel instruction or guidance on the value of physicians with disabilities. Because until we reduce some of the stigma or we have a value-add that comes with this population, it's going to be harder to sell people on investing in a mechanism or a role or a person to adjudicate kind of those cases as they come in and you still will have less people disclosing.

 

And One of the things that really warms my heart and I'm sure will be really critical to the audience who's listening or reading the transcript, is to hear that when you went to the person at UCSF, that sounds to me like a really critical moment. That person's decision to kind of challenge you on not being your authentic self in the application, it really changed the course of your life. Because when I listen to Dr. Cron talk about reading your application and then meeting you, there was something in that authenticity that was attractive to the program.

 

I've heard many a PD say, "I would much prefer to have a learner be able to be authentic and to discuss these things as we're going through the process so that we can figure things out together than to have a learner struggle and hear kind of when they're not meeting milestones to hear for the first time that there's a disability involved."

 

So I think that everybody benefits when the approach can occur the way that it did with the two of you.

 

Dr. Julia Cron:

My lesson and my message to other program directors would be to really let your trainee tell you what they need and help them get those things that they need and let them take the lead. I think earlier I said a lot of the work as a program director is, you figure things out as they come and a lot of it is putting out fires. But this is one of those examples of learning as you go. I think that we were able to successfully navigate this by letting Lauren think about what was going to be best for her. And I think the biggest hurdle that we faced was the issue of disclosure in the context of COVID. I think Lauren did a beautiful job of thinking about it and letting me know what she did or what she needed.

 

Dr. Lisa Meeks:

People with disabilities in medicine have had to hide for so long, not disclose, feel fearful. That is not to say that they still don't. To some extent, I would validate anyone's concerns about disclosing. But as my colleague, Dr. Neera Jain says, until we have scenarios where we can have disclosure, we won't be able to reduce the stigma. It's this very delicate balance of pushing little by little to create environments where people feel safer and safer to disclose. And I love the ending to your article. I just love the way that you phrased that kind of concluding thought where you write,

 

We agree that unfamiliarity with the benefits of disability inclusion is prohibiting active recruitment of trainees with disability. Unfortunately, stigmatization may discourage current doctors with disabilities from disclosing their condition, thus prohibiting others from recognizing the benefits of disability inclusion. Residency programs consistently tout that they are looking for candidates with resilience. If this is truly what we value, the pool of applicants with disabilities is a great place to start.”

 

I love it. I am so excited to be connected with the two of you. I just see endless possibilities for the work that you want to do in this space. I am personally and professionally grateful for what you've done already, for what you're creating. I know that there are a number of people who, while they're not on this podcast right now, are also extraordinarily grateful for the space that you're making to have these discussions.

 

Dr. Julia Cron:

We on a daily basis learn from our trainees, our med students, our residents, our fellows. I think my relationship with Lauren and my experiences with her, particularly in the era of COVID and some of the recent challenges that we've had, I have learned so much. I am really, truly humbled and honored to be alongside her through this. COVID in particular has been difficult for many people on many levels, but this has been really impactful for me and I feel like I've learned so much from her that I think will really impact what I do going forward and how I am as a program director and also as a physician and I think those of us that are around her, including other attendings, and her colleagues, her co-residents, I feel like have really benefited from seeing how she's navigated this huge, enormous challenge.

 

We talk about resilience and burnout in medicine and continuously, we talk about looking for the things that bring us joy in what we do. This to me, my kind of journey with Lauren, is one of those things that at the end of the day, when I think about it, I think about this is why I do what I do and this is why I love my job. This is why I feel fulfilled at the end of the day, because I am really proud and happy that I'm able to help or navigate this not so straight road. It is the thing that keeps me going and gives me joy in what I do.

Dr. Lauren Meiss:

I can't even say how excited I was to get an email from you in response to our article. That seriously just made my year, because you certainly are one of my heroes. I would not be able to celebrate myself and my authentic self in the way that I can without all of the work that you're doing to help all of us see that we should be celebrated for who we are.

Dr. Julia Cron:

Yeah. I remember the evening. It was one of those kind of tough weeks and Lauren sent me a text and was like, "Check your email." We were like, "We both really needed this this week."

Dr. Lisa Meeks:

Well, that means a lot to me and I'm just so grateful. I was equally excited. Someone sent me the article and I was just giggling.

Dr. Julia Cron:

Thank you for having us. We are so excited about your excitement.

Dr. Lisa Meeks:

Well, you've both brought a lot of joy to me today. I know that when the audience hears or reads your story, it will be incredibly impactful for them as well. It's difficult to share your story and to do so, so publicly. So, I appreciate both of you, and I appreciate that you're sharing your personal stories with me and with our audience and through the literature.

 

I am so grateful for the support that you're creating at Yale and for presenting nationally to other OB-GYN programs. I do think it will be highly impactful. Prepare yourself for lots of questions because people will have them. We are seeing this incredible kind of groundswell of individuals with disabilities coming into medicine and disclosing and celebrating their identities. It brings me incredible joy as well. I'm glad to have partners like you in the work. I really appreciate it.

 

Sofia Schlozman:

We would like to thank Dr. Meiss and Dr. Cron for taking the time to speak with us today and for their openness in sharing their stories and perspectives with our audience.

 

Your experiences are a powerful example of the importance of community and open communication in medical education, and the impact that your work and stories have already had, and will continue to have as you continue to share your insights with larger audiences, is truly fantastic.  We are so appreciative of the work you are doing.

 

To our audience, thank you so much for joining us today.  We hope you subscribe to our podcast and tune in next time.

 

You can reach Dr. Cron at julia.cron@yale.edu

You can reach Dr. Meiss at lauren.meiss@yale.edu

 

This podcast is a production of the University of Michigan Medical School, Department of Family Medicine, MDisability initiative. The opinions expressed in this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under a creative common, attribution noncommercial, non-derivative license. This podcast was produced by Lisa Meeks and Sofia Schlozman.

 

 

Music Attributions:

-       “Aspire” by Scott Holmes

-       “Donalee” by Blue Dot Sessions

-       “An Oddly Formal Dance” by Blue Dot Sessions

-       “The Poplar Grove” by Blue Dot Sessions

-       “Rambling” by Blue Dot Sessions

-       “Gambrel” by Blue Dot Sessions

-       “Lovers Hollow” by Blue Dot Sessions

-       “Our Only Lark” by Blue Dot Sessions

-       “Highway 430” by Blue Dot Sessions

-       “Positive and Fun” by Blue Dot Sessions