Over 240 advanced practice nursing students, physician associate program students, and third-year medical students filled Harkness Auditorium at the end of November to discuss power and control in health care relationships and the role that caregivers play in making structural changes that affect patient health outcomes. In addition, the attendees witnessed classmates and residents honored for modeling the responsible use of power and patient advocacy and heard experts discuss issues affecting the medical community as part of the 18th annual Power Day.
Power Day has been steadily impactful since its inception. Originally conceived as a way for medical and nursing students (physician associate students were added this year) to evaluate and reflect upon situations in which medical professionals exercised power well or poorly, Power Day has grown into a much-anticipated opportunity for inter-professional collaboration and relationship building.
Bringing different types of medical practitioners into the same room to work together as equals and share experiences is intrinsically useful. Beyond fostering trust built upon collegial and egalitarian interactions, Power Day attempts to impart a sense of the duty medical professionals have regarding their patients.
In preparation for the day, attendees read a book titled What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha.
Nancy Angoff, MD ’90, MPH ’81, MEd, opened the event with remarks that invoked the past and the tradition of the day, noted the present moment, and placed the day’s activities in a conceptual framework. Angoff started Power Day along with Ann Williams, EdD, RNC, then a professor of nursing at YSN; today Angoff continues the partnership with Linda Honan, PhD, MSN, RN.
“Over the years, our conversation has emphasized our mutual concern for the patient and our power to affect change for the good of our patients. More recently, we have emphasized a larger power that health care providers have to start and contribute to conversations that may lead to larger structural changes that affect health outcomes,” said Angoff. The author of the book chosen for this year’s discussion made such a difference when she called attention to lead poisoning in the children of Flint, Michigan after the economic decision was made to divert the water supply.
The inter-professional collaboration Power Day seeks to foster was virtually unheard of even as late as the 1990s. Then, medicine was far more segregated and hierarchical than today, in ways that negatively affected doctor-patient relationships, as well as collegiality. Power Day has steadily chipped away at this imbalance, educating future medical professionals and placing them in situations where they can collide with each other, and share learning experiences.
After Angoff’s talk, each program—Nursing, PA, and Medicine—offered awards to students and residents who modeled the positive, responsible use of power. Of special significance to YSM students was the return of Robert Rock, MD ’18, and Tehreem Rehman, MD ’18, to present awards “to recognize student activists who challenge the status quo and work toward equity, justice, and social change,” which were named in their honor. The inaugural recipients, two graduating fourth-year medical students, were Herbert Castillo Valadares and Jeremiah Cross.
“I’m happy that students will get to commemorate the legacy of student activism at YSM into the future,” said Rock after the ceremony.
Valadares and Cross had their names engraved on a plaque, which will be hung in the Cushing/Whitney Medical Library. The idea for the award was developed by Carrie Flynn, an MD/PhD candidate and student leader at the medical school. Funds for the plaque and continued engraving came from Richard Kayne, MD ’76, HS ’79, FW ’81; YSM’s Office of Diversity, Inclusion, Community Engagement, and Equity, spearheaded by Darin Latimore, MD, Linda Jackson, and Ellen Spychalla; and the Office of Student Affairs supported by Joanne Czeczot.
Eli Stark, a Nurse Practitioner graduate student at Yale School of Nursing, echoed Rock’s sentiments. After receiving his award from Philip Martinez, EdD, MSN, APRN-BC, a lecturer at YSN, he said “I feel humbled by my peers having nominated me. Nothing I’ve done at YSN has been alone.” Stark’s mother, Anne Flitcraft, received her MD from YSM in 1977.
Following the awards presentation, panelists convened to offer their thoughts on the day’s theme. Amy Wrzesniewski from Yale School of Management discussed the use of power as a function of leadership. Nicole Deziel, PhD, MHS, of the School of Public Health explained why health professionals ought to be concerned about environmental factors as well as their effects on the social determinants of health and how they may discriminate against those less fortunate. Next, Latimore discussed structural and institutional racism. Finally, Mikki Meadows-Oliver, APRN, delivered a disturbing talk about the effects of lead poisoning in New Haven’s community. Together, the panelists discussed how those issues interacted, and offered thoughts to the audience.
Latimore was particularly animated while describing his experiences, and thoughts on personal responsibility stemming from advocacy around pioneering HIV treatment in California. As a young doctor, Latimore helped hold California’s legislature accountable for potentially racist and elitist laws. “Don’t look to the left, don’t look to the right,” he said, “look in the mirror.”
Medical students felt that the day was useful, and hoped that the program would continue, or even expand. “Power Day was quite well done, and one of the best-executed events aimed at addressing these issues (how power dynamics affect provider-provider and patient-provider relationships) that we have had as part of our curriculum,” said Ezra Lichtman, a third-year student.
“This is very exciting for us as students to be able to recognize our peers for their activism,” said Elizabeth Woo, an MD/PhD candidate in her second year at the medical school. “Addressing social justice issues and being a voice for oppressed and marginalized groups are part of our responsibilities in becoming physicians.”
After the panels, PA, nursing, and medical students convened in mixed groups for discussions focused on the panel and the readings facilitated by faculty from the medical, nursing, and PA schools. The small groups were led by a variety of medical educators, including Anne Kurth, PhD, MPH, dean of Yale School of Nursing and the Linda Koch Lorimer Professor of Epidemiology. Ysabel Ilagan-Ying, a third-year medical student, was grateful for the opportunity to compare perspectives in the unusual setting.
“Learning with my peers in nursing and the PA program was an important piece of the day. Our section leader was a midwife from the Bronx and her insights and contributions were especially relevant in how we as future providers can find our own voices in advocacy and improving health outcomes for our patients in an impactful way,” said Ilagan-Ying.
Students were upbeat about the day. Lichtman was most grateful for the exposure to other students. “Opportunities for discussion among students from the different schools are extremely valuable to help foster productive and thoughtful dialogue and mutual respect and understanding,” he said.
Past works chosen as the stimulus for discussion in Power Day include Five Days at Memorial: Life and Death in a Storm Ravaged Hospital by Sheri Fink and Wit by Margaret Edson. Both authors were Pulitzer Prize winners and both attended Power Day.