Learning Paths Podcast
Michelle Lizotte-Waniewski
Though she didn’t always plan on a career in education, Michelle Lizotte-Waniewski clearly has a lot of passion for helping others succeed. As the lead course director for basic sciences and the director of student success and wellness at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Dr. Lizotte-Waniewski has supported many medical students on their journeys. Along the way, she’s learned a lot herself about effective approaches to both academic and personal development.
Episode Transcript
Ben Rubenstein: Well, Michelle, thank you so much for joining us here today on the Learning Paths podcast. So maybe to start, I know that you studied science as an undergrad and as a graduate student – did you always think that academia was going to be your path? I mean, what were your initial career plans?
Michelle Lizotte-Waniewski: That’s a great question – so certainly not, I did not think that I was going to end up in academia. It’s really funny to look back now and see how different my life ended up than I thought it would be.
When I was in high school, I always loved science, and the summer between my junior and senior year, I took a couple couple of summer courses at Tufts University. I was at a small school, my parents wanted me to have exposure to college, so I took a summer course and one of those courses that I took was human genetics. And I became completely enamored with the genetics – that was back in the ‘80s when molecular biology was really just taking off in a way that was more meaningful. So when I enrolled at Smith College I knew that I wanted to be a biology major and had it in my head, I was really convinced that I wanted to work in a biotech company, because that seemed to be a really hot, up-and-coming field.
So I started work in a research lab and, soon, I was doing bench work, which I really enjoyed. And, as I moved through my master’s degree and my PhD, I also knew that I loved to teach. I taught classes all throughout my graduate career, and really had some phenomenal professors at Smith, who taught me how to be a great teacher, in particular my research PI, Steve Williams, was one of the most effective professors I had ever seen. It really seemed to boil down for passion, for love of the content; he had really a gift for explaining complex concepts in a way that was easy to understand, along with a true desire to help students learn. There’s something I find really magical about that moment, when you have seen a student struggle to understand something, and you can literally see the light bulb go off, a recognition in their eyes that shows they finally got it. And I really wish that I could bottle that feeling and have it all the time.
So, I was still doing bench science and teaching graduate courses in molecular biology when I moved to the Charles E. Schmidt College of Medicine, which is at Florida Atlantic University, in Florida. I was working in the biomedical sciences department until sort of a serendipitous occurrence happened. I happened to be in the office of a colleague, and it’s interesting, I remember exactly when it was, it was on a Tuesday morning – and a phone call came into her office that I could tell right away was distressing.
Apparently, a faculty member was suddenly unable to give two lectures to the medical students on antibiotics and antibiotic resistance which were scheduled for the next day, so for Wednesday and then that Friday. And my colleague was very distressed; she was one of the course directors and I could tell by her body language that she really wasn’t sure what could be done. So she was speaking on the phone and she told this person to hold and she said to me, ‘didn’t you study antibiotics and resistance for a long time?’ And I told her that I had worked in that field for about six years as a research scientist at UMass. So she asked if I would be willing to give the two lectures to medical students and she was so distressed I told her not to worry, I would do it, I would take care of it.
So I spent most of that day working on the presentation and I was giving the presentation to the medical students the next day when really the strangest thing happened, something that had never really happened to me before and rarely since. An indescribable feeling came over me, a sense of peace and purpose, almost like an epiphany I guess is how I would describe it, that I was in that moment doing exactly what I was meant to do. I think of it sometimes as divine intervention and at that time, it seemed like a ridiculous notion, because I was a research scientist working on a grant, not a medical educator. I was doing already what I loved and I never really considered doing anything else. I’d decided working at a company wasn’t for me, that I was happy doing bench science in academia.
So unbeknownst to me, someone else showed up to the lecture that day, somebody I wasn’t expecting. It was a different course director who sat in the back of the room and was watching the whole time; I don’t even think I noticed her. And she came to me after the lecture and told me that I should really be teaching medical students, which I thought was sort of a polite comment, like, ‘thank you for helping us out, really you should be teaching medical students.’
But shortly after that time, a full-time medical educator position opened up. And those in academia know that when you work on a grant you’re working on what’s called soft money, that is, your salary is contingent upon getting future grant funding and really your funding runs out when the grant runs out. And so, this position was on what we call hard money, which is a permanent faculty position. And I really had to take some time soul searching about that and our medical education dean, who had heard about me from the course director, was kind of prodding me that this is something that I should consider, but I didn’t want to abandon the PI that I was working with doing research. So I got his blessing and ended up applying for that position as a medical educator.
I interviewed and was offered the position and then after I was course directing for a while, I ended up applying for a position as the director of student success and wellness. Which was totally crazy, I don’t know how it happened, but I’m pretty sure that I ended up with the best job ever.
Ben Rubenstein: That’s a great story, and you know it’s kind of like you were auditioning for a job and you didn’t realize it at the time. And I definitely do want to get to your work as the director of student success and wellness, but I wonder, you know, did you find it difficult at all to kind of continue to have that sort of magical feeling that you had in those initial lectures as you continued in the role as a professor and actually were teaching on a regular basis, did it remain kind of at that level for you?
Michelle Lizotte-Waniewski: I mean, I think I always loved teaching. I never really pictured myself as someone teaching anything other than graduate students, who are of course very bright, but medical students were a little bit different. I always love teaching them, and I think what was especially important to me, which I realized at a later time, was that when you’re teaching medical students, you really have the opportunity to touch thousands of lives without really realizing it, because each medical student will go on to treat thousands of patients in his/her/their future and you have the opportunity, if you have provided a good education and supported students, to really have an impact on the lives of all of those people. So I’m still very excited, every lecture that I give – right now, I give lectures on microbes in the first basic science course – which I absolutely love, I’ve never lost my passion for them. And I do always have that magical feeling; I rely so much on the student feedback, just the way that their faces look as to whether they’re understanding what I’m saying, and I really still get a thrill out of teaching them, they’re so bright and so energetic and a person really feeds off of that energy.
Medical students are a very unique set of folks; they are highly motivated, they have incredibly high standards for themselves, and expectations. And in general, right, they’re altruistic; they really care very much about other people and they put other people first. The thing that I like about them, as someone in academia, is how intellectually curious they are; they really do care about learning things well and thoroughly and they ask great questions and they really force me to keep striving to be at the top of my game. I love to learn new things, I never fail to learn something every lecture that I give or attend. And they really keep me from getting complacent; I don’t ever want to get too comfortable in my teaching, because then the learning kind of starts to lag a little bit.
I‘d say that the challenge with working with medical students is also, you know, what’s so rewarding about working with them. I would say in a lot of cases they have unreasonable expectations of themselves in combination with varying degrees of imposter syndrome. So imposter syndrome is the phenomenon that we see in high-achieving individuals who, rather than attributing their success to their abilities, attribute it to some external factors such as luck and, in general, that means that medical students tend to be self-critical. And their perfectionism, that’s married with an inability to recognize their own human limitations, can have serious consequences for them, can cause things like anxiety or depression and burnout and I think in the age of COVID it’s never been more clear than it is now that that is definitely something that medical professionals are susceptible to.
Ben Rubenstein: Definitely, and I know you’ve ended up focusing on that aspect of medical education moreso in recent years as the director of student success and wellness. Can you tell me a little bit about what the adjustment to medical school is like for the students that you work with in that first year, and how you’ve gone about addressing some of those challenges?
Michelle Lizotte-Waniewski: Absolutely. At the very beginning of medical school, students – most students I would say – undergo a really intense adjustment period, where they realize that they’re now in an environment among true peers, people who are every bit as intellectually gifted as they are. And medical school is, of course, geared towards that intellectual elite and therefore their first couple of exams or quizzes assessments really can shake their confidence, as they often get grades on those assessments that really they’ve never seen before. And that is a new experience for them, because they’re used to being very confident in their academic abilities. Somehow they are able from that experience to convince themselves that everyone else in the class has got everything together and they’re somehow lagging behind or inferior by comparison. They find that they really have to work harder than they’ve ever worked before, not just to gain sort of vast amounts of knowledge at a very fast pace, but also clinical skills and time management become an issue where it never has been before.
During that time it’s really frustrating, sometimes, for me, because I really wish that I could get them to see themselves more through my eyes. Because I know, without a doubt, that they’re going to make it through medical school, that they’re going to be incredible doctors. But it takes some time before many of them are really able to see their future the way that I see it.
And that unique distress of first-year medical students is one of the major contributors to the development of our student success program, and to the HealthFirst health and wellness initiative that I direct. I was a course director, as you know, for several years, directing the first basic science courses that the students take when they arrive at medical school, an integrated course that lasts about five months. And I noticed these recurrent themes which kept playing out, this lack of self-confidence, this adjustment to new standards, new expectations. Students had to really quickly learn some skills that would help them with studying and time management in medical school, but they also needed to be trained in self-care.
Particularly because it seemed like the first thing that they would cut out when they got academically challenged were things like eating well and exercising, tending to their spiritual needs, their prayer life, all of these things that are really important to maintain a sense of grounded-ness. Many also had no idea how to manage the kind of stress that medical school brings because really they’ve never been in an environment before that brought on any sort of academic success; they sort of skated through high school and an undergraduate years, so this phenomenon, this feeling of not being on top of everything is very new to them, so I began searching for tools and resources that I could use as a course director to help the students.
We noticed early on that some of the biggest, most challenging topics in that first semester were things like biochemistry and immunology and pharmacology, and because of varying backgrounds some students had some exposure to those things and some students had very limited exposure to those things. So we started working with some colleagues at Harvard using the HMX immunology course modules as part of our pre-matriculation requirements, that was part of the development of a student success program. And I had, really those HMX modules were a game changer for our students because, regardless of their background, they all ended up coming in well-prepared with the basics of immunology, they had all had that experience so when they were working in small groups and they were talking about immunology topics, they would say things like, ‘oh, remember the module where they talked about this’ or ‘remember the clinical example of that.’
So they all had that, those modules in common, and they really allow them to hit the ground running to the more advanced immunology content of the medical school, and it’s interesting because we just had our first exam last week, and a lot of what I heard around the studying time for that exam was, ‘thank goodness that we did those modules over the summer, because I don’t know how I would have learned this material for the exam without that.’ They may not have appreciated it fully before, but they certainly appreciate it when those first assessments come up, so that was one of the things that we implemented that I felt was really helpful and important for them to put everybody on a level playing field.
I would say also in 2016 we began the HealthFirst health and wellness initiative to address that issue of self-care, to teach students how to take care of themselves so that they can better take care of patients. So we created three pillars, nutrition, exercise, and stress management. And I emphasize to the students that I believe that wellness is a clinical skill, it’s just a skill that they practice first on themselves before they start counseling their patients, kind of like on an airplane putting on your own oxygen mask first before you try to assist other people. So, by having instruction on nutrition and exercise and how to manage their stress with techniques such as mindfulness meditation, cognitive behavioral therapy and other mechanisms, the students are better able to counsel their future patients from a place of experience, rather than ignorance. So if you’ve never been on a dash diet, if you’ve never had an exercise regime set out for you, if you’ve never meditated, it’s hard to relate to your patients, to counsel them from a place of experience – ‘I know how challenging it can be to sit still for five minutes, I know that you’re going to be distracted when you first try to meditate, I’ve been through that, let’s work through that together.’
And so we have these really great integrative wellness workshops that really integrate into our curriculum in logical places. We have mandatory activities that are embedded in the curriculum; so an example of that would be this Friday, our students in the cardiopulmonary course are going to do a session called Just Breathe, with a mindfulness meditation thought leader, and the idea is how breath meditation, the pulmonary part, affects things like heart rate and blood pressure, so we can see the benefits of meditation, so it’s both a requirement of the course but also we’re teaching them the skills too, giving them the practice at something which hopefully they’ll be able to incorporate into their own medical training and carry with them as they go.
Ben Rubenstein: I can imagine a student coming into medical school and maybe at first being like, ‘oh this wasn’t what I thought I would be learning about to start,’ right, and and maybe feeling a little bit of overconfidence that they don’t need to focus on this. Have you run into that, and, you know, how have you responded to that?
Michelle Lizotte-Waniewski: It’s a really interesting question, and this is where having a PhD in molecular and cellular biology really paid off. I’m a skeptic, right, so by design I’ve been trained to be skeptical and to design experiments and to really focus on the data, and as a medical school, anything we teach, you want to be evidence-based, data-driven, so I avoid all of those issues by just leading with the data. So I show them the studies that indicate to them what the immediate practical benefits of something like meditation can be – improved working memory, focus, concentration, and ability to manage your stress, keep the cortisol levels down. All of those things have data behind them, and so, in order to break through some of the early resistance, I start off by just going through the data. And then we get to a place where we’re ready to, right during orientation, to really just practice a meditation to give them the experience. So they can start to say ‘Oh, you know I noticed that my heart rate really slowed down a little bit in those five minutes that we did that meditation’ and, once they have that experience and start seeing the benefits, it really does get easier to get them to see the practical advantages.
I think that the students coming in, particularly now, particularly after the pandemic, students are far more open to things that help them to manage their stress and anxiety, like meditation. Last year when we started our curriculum remotely, which was really challenging. I offered optional sessions, a five-minute meditation before assessments. And when we were in person, I could get from a class of 64 maybe five, seven students who would regularly attend those sessions. Last year, I had between 15 and 18 out of a class of 64, so I think the students were much more open to the idea that stress is for everyone, that, that life is short and that managing stress is a key skill for health care providers because they’ve sort of seen firsthand the negative impacts that that kind of stress and overwhelm can have on a person and they know now that the field that they’re entering is a dangerous career that’s going to require them to have special tools and skills, so I’m getting less resistance now than I used to. I do still lead with the evidence, with the data, because that’s important to me, as a scientist, but also because medical students are very logical and if you can prove to them that something will benefit them then they’ll be more likely to bend their knees and follow you there.
Ben Rubenstein: I think it’s helpful, too, that you are, you know, integrating parts of it into the curriculum and making it a shared experience, not something necessarily that, you know, only those who raise their hand and say, ‘I want this, I need this,’ because it helps, just as you were talking about the HMX modules, helping sort of level that playing field and helping people sort of have some shared experience and knowledge in the same way, they can apply some of these things they’re learning together and see that, you know, everyone can benefit from this.
Michelle Lizotte-Waniewski: Absolutely.
Ben Rubenstein: You know, you mentioned the pandemic and some of the impact that that has had, even a little bit I guess on the positive side. But I wonder if you can talk a little bit more about what that’s been like, you know, running a medical school program amidst a pandemic.
Michelle Lizotte-Waniewski: I never in a million years would have thought of any of the solutions that we came up with. As you know, Florida was one of the hardest hit states during the pandemic for a variety of reasons, both the first time around, and then with the most recent surge. Our hospitals became overrun with patients; they’re just now starting to level off in terms of not having all the beds occupied with COVID patients. All of our health care professionals became really stretched, then there was a nursing shortage, there were all sorts of issues, and since we’re a community-based medical school, we have five partner hospitals, six partner hospitals that were really forced to make some tough decisions about, about all of their missions, right, so they have the mission of patient care, but they’re also in the business of training medical students and training residents. And that was a particular challenge for them; you know, elective surgeries, non-emergency surgeries were put aside. And really the hospitals were focusing very much on just putting one foot in front of the other to get through the day.
From the medical school side of things we worked with our hospital partners, but there was a period of time that our year three students were pulled out of rotations because the hospitals couldn’t complete both of their missions on the pre-clinical side of things. We were in a very unique situation we had our LCME site visit, that’s the accrediting body for medical schools. That came in February, at the end of February 2020. And that was just when the pandemic was really ramping up down here in Florida, so we had that site visit, which was the culmination of two years of intensive self-study and preparation. The visit came and then in March of 2020 our students have a spring break for a week and, within that in that week we put our entire medical curriculum for years, you know, one, two and three, online, which was, I have to say, looking back at it now, I’m not sure exactly how we did it, it was kind of a Herculean task, all of our lectures had to be recorded and we’re talking about hundreds of lectures by faculty who really didn’t necessarily have a lot of tech experience. So it involved training faculty and having them, you know, record lectures. Our problem-based learning cases which are done in small groups in person, had to be transferred to a virtual platform and our faculty had to be trained how to facilitate those small group cases remotely.
Our admissions team had to figure out how to do all of the interviews to go through the candidates, all of that virtually, and we all had as the primary goal in mind to not let the student experience suffer in even the smallest ways. Anything that we could do we were sort of really dedicated to doing, and as we are clearing out now, as we’re coming down a little bit, there are definitely some silver linings that happened as a result of all of those experiences.
Ben Rubenstein: What sort of big lessons, I guess, can you take away to kind of shape the learning experience going forward? Is there anything that specifically comes to mind of this is a you know, this is a process we’ve changed for good? Or is it more kind of just a way of sort of looking critically and everything you do and being open to change?
Michelle Lizotte-Waniewski: I think it’s probably a combination of both things. That’s the first thing that really surprised me and sort of looking back from the other side of this is just how much can be accomplished. People with the same goal and purpose in sort of unfathomable circumstances, it really reminded me that human beings are amazing problem solvers. And although this was not anything that any of us could have predicted or expected, we really, all the students, the faculty, the staff, everyone pulled together in a way that was really uplifting. And I think that being open, as you said, being open to, ‘okay well, what are the lessons learned here, what are the silver linings because we don’t want to throw out the baby with the bathwater?’ We’ve done some things now that have taught us some lessons and we want to step forward into our future approach by using best practices, regardless of whether they were developed in a pandemic or not.
So I would say that the first thing that surprised me was that our students, our pre-clinical students, first year, first semester medical students, perform just as well remotely as they did in in person, so, at least in the basic science courses what we saw was the means on assessments was the same, the overall performance in the course was the same. It’s really challenging to migrate a clinical curriculum online and I don’t want to mislead you when I say we, we got the whole curriculum online in a week, we were really just one step ahead of the students, so we got what we could done as quickly as we could, recognizing we weren’t going to have an entire semesters worth of coursework online, you know, on day one, I think. What we learned, though, was that the remote platform was not as impersonal and disruptive as we thought it might be. So the small groups, although it’s not ideal to do it remotely – you can’t see body language, and there were issues with, you know, people being polite, not wanting to interrupt each other, and, you know, that lag time that comes when you’re participating in an activity and we’ve got people on all time zones trying to participate in this. It was a bit of a challenge, but I think that what we learned is our faculty are really a lot more flexible than they realized, they were able to step into this role kind of seamlessly. We got a lot of faculty development done in a very short period of time, and all of those faculty are carrying that forward with them. So that will change their future lecture presentations now that they have some of those tools and skills behind them.
I think we also decided, and as someone who interviews for admissions, we also decided that virtual interviews were a way of leveling the playing field for people from all different socioeconomic backgrounds. So we know that it can cost a lot of money to interview for medical school, and that students who don’t have access to extensive resources may have to be more selective about the number of interviews that they go on and that may limit some of their options and so I think not just our medical school but all medical schools realized, you know, if there are advantages to interviewing students remotely. They were less nervous; I could tell that they had an easier time answering questions because they were in their own surroundings, they weren’t in the intimidatingn office of a medical professor being grilled, if you will, with all of these questions; they were in their home environment in a place that they felt comfortable. And I feel like we got a better read on the applicants that way than we do in person, and so we have decided to carry forward as a lot of medical schools, most medical schools, I think, have decided that, you know what, for interviews and not just for medical school but also for residencies, that can be a real plus. And then we have to examine, do we really need lectures to all be synchronous, do we have to have all of the students in the same room at the same time? And for some lectures, for some presenters, we decided we do, because those lectures have very interactive elements; they’re posing questions that rely on student participation, and for those lectures probably it’s better to be in person, but for some lecturers, who have fewer elements like that sometimes, or community faculty, because we have a lot of community faculty coming in to give lectures and it’s challenging for them to balance their clinical practice with running into a medical school to teach a lecture. And we can see that now, they can record their lectures, or perhaps they can give their lecture synchronously but also remotely and no one really is shocked by that. So it opens up a whole new set of opportunities, you can have guest lecturers come in from wherever you’d like if they’re participating remotely, so there’s lots of, lots of pluses, lot of lessons learned that are going to make us pedagogically more innovative I think and that’s a real exciting, that’s a very exciting place to be right now, realizing that there are all these tools at your disposal that you didn’t realize you had, and now you have them, so what are you going to do with them moving forward?
Ben Rubenstein: Well yeah, that is exciting and and challenging in its own way for sure. Now regardless of what medical school may evolve into, may look like in future years, you know, you’ve had a lot of opportunity to see kind of what makes for a successful medical student. I’m sure we’ll have some, either students who are thinking about medical school, maybe somewhere in the application process, or maybe are in medical school and wanting to make the most of it, be as successful as they can, I mean what advice might you have for people like that?
Michelle Lizotte-Waniewski: I would say, for people who are not yet in medical school, during your undergraduate years, doing your best to hone time management skills setting goals for your study sessions and really avoiding the whole, cram-two-days-before-the-exam approach. If you’re going to be a physician you really can’t afford to binge and purge information right, so you have to learn the information. But you also have to retain it for years and years, you can’t just conveniently forget it when the exam is done, so starting to use study methods that promote long-term retention like interleaved practice and coming up with your own test questions to really quiz yourself, to use some of those long-term skills, rather than just memorizing and forgetting, is really important during undergraduate years.
Also you’re really never going to be less busy than you are when you’re an undergraduate, so those are the times really to start putting tools in your toolbox for self-care, things like learning how to meditate, how to exercise, you know, staying deep in your spirituality, whatever that is, developing hobbies, all of those things that help keep you centered and grounded, you’re going to need those when you get to the stressful environment of medical school, and if you have those skills coming in then I think you’re ahead of the game. You know, people who have to really struggle throughout their undergraduate years have a little bit of an advantage in medical school because they’re used to that, they’re used to having to work, really, really hard just to stay competitive, so sometimes the, having that experience early on, can be a benefit in medical school, as compared to someone who just sort of skated through everything really easily and and isn’t used to having to be challenged like that. I would say when you’re applying to medical school, it’s important to know what it is you’ve signed up for. So a lot of times, you know, if you watch TV you get this romantic notion about what being a physician is, about what being a doctor is, I think. The news during COVID has done quite a bit to, you know, to disabuse people of some of those romantic notions.
But really, as someone who interviews candidates for medical school, it’s important for me that the candidates have sought out meaningful volunteer opportunities, shadowing opportunities to watch other medical professionals, doctors, so they get immersed in what the culture of medicine is all about, what the culture of altruism is all about, and really the realities of medicine are challenging; there is really no substitute for rolling up your sleeves and working in an emergency department or pediatric office, really shadowing and having some of those experiences. I want to know that people know what they’re signing up for.
It’s also a huge plus to have research experience – you’re working on a team, you’re getting used to things not working out right the first time, a lot of trial and error, which of course is also indicative of medicine.
Students who’ve had unique life challenges, you know, perhaps they’ve had to be the caregiver for a sick parent or they are a parent themselves, or they’ve been in the military, those experiences really give candidates perspective, and they are very valuable to creating diversity within a class.
You know, of course, letters of reference are important, your metrics are important, your GPA, particularly your science GPA, your MCAT scores, those are sort of a given. And these days, many medical schools, if not most, are using this multiple mini interview, which is called MMI, platform, rather than traditional half-hour interviews, so it’s good to be familiar with that format and the kinds of questions you may end up getting when you are interviewing for medical school. I would say, for medical students in addition to some of the other things that we’ve talked about about self-care and really, you know, managing time, managing your state, learning how to stay motivated, for me, the most important thing is that a medical student needs to recognize that who they are is separate from what they do. So career, what you do for a living, is part of your identity, but it shouldn’t be the only and defining feature of who you are. So your value and your worth are intrinsic and that doesn’t depend on what medical school you go to or what residency program you match into or what specialty you practice or really anything to do with medicine at all. The defining features of success are entirely internal; they’re not external.
So the true definition of success in my mind is is being able to be physically and mentally well, having balance in your life, loving what you do for your career. But also being a whole person and recognizing that a whole person is just better at their job because they do have that perspective and their self-worth and identity is not inextricably linked to what they’re doing, because what happens if you can’t do that anymore, then what becomes of you? So that’s something that I really would love to impart to every medical student.
Ben Rubenstein: Well, I want to thank you so much for sharing all this today; it’s clear that you love what you do as as your career and that really does come through and I’m sure all the students that you work with really do benefit from that. And I will look forward to learning more about how you continue to change things and adapt to whatever the next challenges may be. So thank you again.
Michelle Lizotte-Waniewski: Thank you so much for having me; this has been tremendous fun.
Listen to more of the Learning Paths podcast
Read about FAU’s experience using HMX courses