This interview is one in a series of interviews with recipients of the 2022 ACGME Awards. The awardees join an outstanding group of previous honorees whose work and contributions to graduate medical education (GME) represent the best in the field. They will be honored at the ACGME Annual Educational Conference, taking place virtually March 30-April 1, 2022.
2022 Parker J. Palmer Courage to Lead Awardee Dr. Mark C. Wilson is the associate dean and associate hospital director for GME at the University of Iowa Hospitals and Clinics and the University of Iowa Carver College of Medicine.
ACGME: How did you become involved in medicine, and in academic medicine specifically?
Dr. Wilson: I entered internal medicine residency in 1985, the year the specialty had its worst match with multiple programs across the country going unfilled. I experienced both the wonderful and stodgy traditionally hierarchical aspects of that immersive clinical experience. That awareness became the planted seed to help me see that rigorous clinical education could be much better, and much more engaging and fun.
During my senior year of residency, I was relieved to be invited to stay for an additional Chief Resident year. I was attracted to the tremendous clinical consolidation and continuous opportunities to keep growing my teaching skills in a range of settings, and the relief I felt was being permitted to have more time to figure out how to craft my career. As my Chief year unfolded and after pursuing several subspecialty interviews, it dawned on me that I wasn’t so passionate about a single specialty but rather I was wired as a generalist.
Next was the decision as to how to build a foundation in academic generalism upon which I could build a sustainable career. I chose a three-year general medicine fellowship, offering a range of opportunities to fit diverse aspirations. That experience was transformational as I pursued growth in clinical skills, creative education, and scholarly endeavors. With generous time from talented mentors who were expert in helping me discover and refine my gifts, the new insights and capabilities gave me confidence to forge a non-traditional (at that time) academic career that emphasized clinical education.
After a seven-year odyssey to become a general internist, a major crossroad decision presented itself during my first year of faculty appointment… the offer to become a residency program director. After receiving lots of variable advice – including that taking this on so early in my academic career could be described as ‘physician-assisted suicide’ – I jumped onto this runaway GME train believing that I could lead the traditional university-based residency program into new emphases and elevated effectiveness beyond the status quo. There would be no set roadmap or playbook. I loved handcrafting both individual residents and the culture and function of the program. Challenges to overcome were omnipresent, helping me grow nuanced communication and problem-solving, team building, and leadership tactics to continuously precipitate change.
Life always presents us with twists and turns. I was still fully engaged in building educational programming and structure to facilitate growth of the best internists for the future, and I anticipated continuing as a program director throughout my career. However, in 2004, I chose to shift into what felt like a daunting and noble and probably near-impossible endeavor to become the first physician leader of GME for the University of Iowa, creating and managing a new clinical education culture.
I believed I could use my gathered experiences, insights, and wisdom from being a program director of a large residency to help lead GME on an institutional level across a myriad of specialties. Particularly, in addition to continuing to create new programming and handcrafting individual residents, I could also help elevate the capabilities and culture of our educational leaders – over 100 program directors, who could then do better by their respective resident and fellow physicians. I’ve blinked, and 18 years have raced by. It’s been a grand and tough adventure.
ACGME: What does this award mean to you?
Wilson: First, my ability to respire for three decades as an academic GME leader is mainly a reflection of the immense contributions of GME team members, program directors, and the resident/fellow physicians I have been privileged to work alongside. They have made the journey productive and immensely enjoyable.
It was humbling when our GME team decided to nominate me for the Courage to Lead Award. Institutional GME leaders – and in fact all physician leaders – tend to underestimate how much impact we have on lives of others. Beyond providing opportunity to reflect on how I may have impacted our large and complex GME enterprise, this recognition reminds me to never take for granted every interaction and the special connections that occur throughout each day as I maneuver through life as a clinical education leader.
ACGME: What do you feel is the most important job a designated institutional official has?
Wilson: Job #1 is to hold tight to core governing values as an institutional leader who must react to evolving health care delivery systems and other external forces while continuously precipitating new initiatives and changes to improve clinical work and learning environments. Core values I’ve held tightly include: people matter; clinical education is an intensely relational endeavor; mutual respectfulness; growth mindset; inclusivity; fairness; and chronic dissatisfaction with the status quo.
ACGME: What is the most rewarding part of your job?
Wilson: Facilitating professional growth and development of others so that they can do right by their team members and patients. This typically requires anticipating, identifying, and developing next steps and initiatives to address evolving challenges within our clinical learning environments. Opportunities to be creative (often outside established boxes) abound for both critical evolution in educational emphases and programming as well as for necessary – albeit less aspirational – logistical impediments to educating the best physicians for the future.
Ultimately, I take seriously my responsibility to help create educational environments within which our resident and fellow physicians can fall in love with the privilege, challenge, and joy to care for another human being.
ACGME: What is the most challenging?
Wilson: The same ‘anticipating, identifying, and developing next steps and initiatives to address evolving challenges within our clinical learning environments’ as was noted in the most rewarding aspects of my role. It feels important to clarify two particularly challenging aspects of serving as an institutional GME leader:
- The tendency in academic medicine for relatively rapid turnover of other major institutional leaders can slow progress addressing important complex problem-solving and necessary value judgments affecting new resource allocations for clinical education (I’ve now worked with five CEOs and four Deans). It can be viscerally and emotionally wearing whenever efforts and progress fall short of doing right by all our clinical learners.
- Very challenging – and sometimes rewarding – are the periodic needs to create effective and timely counter-messaging to external threats that could disadvantage clinical education. Particularly challenging has been a slide towards such intense partisanship that distasteful decrees and laws have passed (e.g., chilling attempts to ban ‘divisive concepts’ in education). It has been very important to ensure that our GME community and institution hear we uphold that our program directors are charged to educate the next generation of physicians. No one else has the insights or capabilities to alter that inviolable responsibility that our GME leaders must bear.
For example, for resident/fellow physicians to provide excellent patient care, our program directors remain responsible to ensure that topics like inclusivity, systemic racism, humble curiosity for shared decision-making, and health care disparities are integrated thoughtfully into their programs, and no permission to do so ever needs to be sought. Just as we creatively addressed our responsibility to continue comprehensive specialty education during the pandemic, we must similarly ensure that other potential erosive threats to development of complete physicians are never tolerated.
ACGME: What advice do you have to residents or fellows who may be interested in pursuing a career in academic medicine?
Wilson: Invest time to discover who you are and what your passions are, which can sustain you throughout your career odyssey. Find others who can be a listening and sounding board to help you identify where you can best contribute by going beyond the status quo.
Embrace a growth mindset, reflective practice, and deliberate practice as you engage in mastery pursuit. Continuously build an ever-stronger foundation in whatever aspects of physicianhood, clinical education, and/or scholarly endeavors you may desire, so you can unleash future creativity within environments that are full of wonderfully challenging dynamic tensions.
Judiciously explore and take advantage of serendipitous opportunities that will come your way.
Don’t fear following your discovered passion, including if it is outside of current traditional sensibilities.
Seek out and/or create diverse teams with which to collaborate; the work and outcomes will be more stimulating, robust, and fun.
ACGME: Is there anything you would like to add that we haven’t already asked about?
Wilson: Thanks for this opportunity to reflect on my career that has been as a ‘GME Lifer’ and to be able to share a few nuggets that might help others who happen upon the blog and decide to dive in.
It is not an overstatement to say that I am addicted to the privilege of working directly with resident and fellow physicians and their program directors. Together we can create dynamic learning environments worthy of their aspirations.
Learn more about the ACGME’s Parker J. Palmer Courage to Lead Award and nominate a deserving DIO for the 2023 Award – nominations are due by April 6, 2022.