As a pediatric cardiologist at the Herma Heart Institute at Children’s Wisconsin, Sara Creighton, MD, has faced difficult, life-and-death situations for her entire 15-year medical career. But she will never forget her first time.
She was 27 years old and nearing the end of her internship at a children’s hospital in Illinois. She was all by herself late one Sunday night in 2011 when a young girl came in. The girl, 5 years old who recently completed treatment for leukemia, had a fever and low blood count. It was a relatively standard case for a child recovering from cancer. Even though her shift was just about to end, Dr. Creighton took the case, thinking it wouldn’t take long. But as she started to examine the girl, she discovered something far more serious.
In addition to needing an unusual amount of oxygen and having an enlarged liver, a chest X-ray showed that her heart was swollen and weak — she was in heart failure. And now Dr. Creighton — still young and learning — had to break this news to the mother.
Through her tears, the mom asked the question Dr. Creighton was dreading: “Is she going to be okay?”
Dr. Creighton didn’t know. And she told the mom so.
“I remember how scared I was having to come up with those words. To say something well and definitively but with compassion,” she said. “I remember all of them.”
When Dr. Creighton finally left some three hours later, she walked across the street and tears started falling — the adrenaline now wearing off and the impact of what she just experienced finally hitting her.
Thankfully, the girl eventually recovered. And in the days and weeks that followed, Dr. Creighton heard how thankful the mom was to everyone. Still, that moment will never leave her.
“I won't ever forget that night,” said Dr. Creighton. “It's still clear in my head.”
These difficult moments, and other such topics not often found in medical textbooks, are the basis of The Good Doctor course at the Medical College of Wisconsin (MCW), the academic partner of Children’s Wisconsin. This course became a required part of the new MCWFusion curriculum in the 2023-2024 school year and is helping prepare future doctors like never before. Much of the learning in The Good Doctor course is done in Learning Communities, small groups of students and faculty that work together to support each other's academic and professional development. They’re designed to help students feel more connected to their peers, faculty and institution.
Beyond the Science
Medicine is much more than diagnoses and treatments. There are complex human connections, emotions and vulnerabilities. But most medical school curriculums only focus on the science. Topics in The Good Doctor cover everything from delivering bad news and inherent bias to spirituality in medicine and the ethics of truth-telling.
“The Learning Communities focus on the more holistic components of medicine,” said Dr. Creighton, who is also now an Assistant Professor of Pediatrics and a Learning Community Faculty Navigator at the Medical College of Wisconsin’s Green Bay Campus. “They're important concepts that you really need to understand to help make you a successful doctor.”
“We talk about things that are specific to medicine and to bearing witness to other people's needs. Doctors come face to face with a lot of pain and a lot of suffering, and that is something we were not taught to deal with,” said Cassie Ferguson, MD, a Pediatric Emergency Medicine Physician at Children’s Wisconsin and Professor of Pediatrics at the Medical College of Wisconsin who helped design The Good Doctor course and Learning Communities. “I believe that we have a moral obligation to equip these students with the ability to be present with suffering and to be a compassionate presence for their patients, but also not feel like they're getting sucked in and completely overwhelmed.”
All medical students at MCW are a part of a Learning Community and there are currently 56 Learning Community faculty navigators — 10 of whom are Children’s Wisconsin physicians. Each community is made up of just eight students who stay together through graduation. This is done to foster connection and trust.
“It gives the students an opportunity to talk about some of these more difficult, more personal, more vulnerable topics with a group of people who they know well,” said Dr. Ferguson. “What I hear from students is they really appreciate the personal stories and the vulnerability of the faculty teachers and navigators.”
These weekly, two-hour sessions can take many forms. There might be a group discussion or a guest speaker, some will feature role-playing scenarios. Dr. Ferguson leads a monthly lecture focused on well-being for the entire class that will then be discussed in the Learning Communities. Each student will also meet individually with the navigator to go over challenges, performance, growth and goals. The classes utilize a variety of instructional methods to encourage adaptability, collaboration and problem-solving. It’s about embracing and thriving in the unknown.
“This class is like an experiment. This is a completely new curriculum across the board,” said Dr. Creighton. “So, there's a lot of learning on all sides.”
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Caring for Patients … and Yourself
The classes teach medical students not only how to care for patients, but how to care for themselves too. The idea for The Good Doctor came in the wake of the COVID-19 pandemic and the toll it took on everyone, but especially those in the medical community. Endless hours, increased stress, fears of the unknown, growing distrust from the community all led to unprecedented pressure and burnout.
Dr. Ferguson had been teaching a curriculum focused on well-being called REACH since 2018. Together with Ashley Pavlic, MD, MA, an Assistant Professor of Emergency Medicine at the Medical College of Wisconsin, they expanded that curriculum to include medical ethics and professional development. That became The Good Doctor Course. Kurt Pfeifer, MD, FACP, a Professor of General Internal Medicine at the Medical College of Wisconsin, leads the Learning Communities.
“It's very normal to have struggles as a physician, and that’s something we all have to learn how to navigate,” said Dr. Ferguson. “The opportunity to vent or compare experiences with their peers is really nice. It normalizes their experiences and decreases the stigma around asking for help.”
Like REACH, many of these topics had been offered at MCW, but typically as extracurricular seminars. Dr. Ferguson, Dr. Pfeifer and leadership at MCW felt it was important to combine them and make them required — a unique approach for medical schools.
“We really felt like some of the students who probably needed it the most weren't necessarily seeking those opportunities out. If we wanted to ensure that everyone had the chance to learn some of these concepts and skills, we had to make it required,” said Dr. Ferguson. “Physicians who are well take better care of patients. All of us who are teaching these students know that firsthand.”
One especially powerful tool are guided scenarios. The students all close their eyes and imagine themselves as a patient. The navigator then walks them through different scenarios — a cancer diagnosis, it’s relapsed, there’s nothing else that could be done.
“As you're going through the scenario you can see it’s really hitting them. Learning how to say those words and practicing saying them makes the actual situation a lot easier,” said Dr. Creighton. “I reflect a lot on these sessions, and I always come away learning something about my own practice and approach.”
What Matters Most
When Dr. Creighton, Dr. Ferguson and most, if not all, of their colleagues were going through medical school, they didn’t have any formal training of this kind.
“You talked about these topics with your attendings while you were sitting around, but there wasn’t any formalized curriculum,” said Dr. Creighton. “I don't know if we ever really talked about how to handle death and dying. These Learning Communities force you to really look at things and get comfortable.”
When the classes launched in the fall of 2023, no one really knew what to expect. It was a new class, a new curriculum, a new way of doing things. But Dr. Creighton was shocked, pleasantly so, to see how quickly and easily the group opened up to each other.
“At the first class, it was getting to know you type of stuff, talking about why you decided to go into medicine. I was so surprised by how vulnerable the students got,” said Dr. Creighton. “They were talking about these really big things in their lives that drew them to medicine, and I just thought it was so cool that you could create such a close-knit group so quickly.”
Dr. Ferguson was perhaps less surprised. For her, it all comes back to what her mentor and longtime Children’s Wisconsin physician, Karen Marcdante, MD, taught her.
“It’s all about mattering, making people feel like they matter,” said Dr. Ferguson. “When we can make students feel like they matter, they are better able to do that for their patients. We talk about that all the time at Children’s Wisconsin, what matters most to our patients and our families. That idea is at the core of The Good Doctor and The Learning Communities.”
