BackgroundThe COVID-19 pandemic impacted many aspects of normal operations in academic medicine. While effective leadership is always important, the intensity and urgency of COVID-19 challenged academic medicine leaders to find new ways to lead their institutions and manage their own experiences of the pandemic.MethodsSixteen physician leaders from Michigan Medicine took part in semistructured interviews during April and May 2020. Participants were asked open-ended questions about the attributes and techniques that were important to effectively lead during a crisis. The authors analysed the interviews using thematic analysis.ResultsParticipants described three overarching themes of leadership during the COVID-19 pandemic: (1) bringing together a diverse team with clear, shared goals; (2) using a range of strategies to tend to their teams’—as well as their own—well-being; and (3) engaging in leadership reasoning as a way of learning from others and reflecting on their own actions to inform their future leadership practice.ConclusionThe results of this study reveal several salient themes of crisis leadership during the COVID-19 pandemic. The findings also highlight the role of leadership reasoning, a reflective practice employed by leaders to understand and improve their leadership skills. This finding presents leadership skill development as part of lifelong learning in medicine. Findings may be incorporated into best practices and preparations to inform future healthcare leaders.

Pemphigus represents a group of organ specific autoimmune blistering disorders of the skin mediated by pathogenic autoantibodies with well-defined antigenic targets. While most of these diseases are sporadic, endemic forms of disease do exist. The endemic form of pemphigus foliaceus (also known as fogo selvagem, FS) exhibits epidemiological features that suggest exposure to hematophagous insect bites are a possible precipitating factor of this autoimmune disease, and provides a unique opportunity to study how environmental factors contribute to autoimmune disease development. FS patients and healthy individuals from endemic regions show an autoreactive IgM response that starts in early childhood and becomes restricted to IgG4 autoantibodies in FS patients. In searching for triggering environmental antigens, we have found that IgG4 and IgE autoantibodies from FS patients cross-react with a salivary antigen from sand flies. The presence of these cross-reactive antibodies and antibody genetic analysis confirming that these antibodies evolve from the same naïve B cells provides compelling evidence that this non-infectious environmental antigen could be the initial target of the autoantibody response in FS. Consequently, FS serves as an ideal model to study the impact of environmental antigens in the development of autoimmune disease.

The Longitudinal Interprofessional Family-Based Experience (LIFE) was developed to address the need for longitudinal, experiential IPE opportunities that bring students together with real patient-family units with an intentional plan for multiple qualitative and quantitative evaluation measures. LIFE engaged 48 early learners from eight health science schools at a large midwestern university in ongoing team skill-based interactions coupled with real patient experiential learning over 11 weeks. Student teams were introduced and encouraged to apply the socio-ecological model (SEM) and social determinants of health (SDH) while collaboratively exploring the impact of the patient-family’s interface with the healthcare system and community during two consecutive patient-family interviews. A creative collaboration with the health system’s Office of Patient Experience, provided eight patients who had experienced chronic illness and treatment in the healthcare system, who engaged with the learners as both teachers as well as evaluators in this experience. LIFE is a framework model that has applicability and adaptability for designing, implementing, and sustaining experiential IPE. Initial summary data regarding outcomes for students are presented as well as considerations to increase accessible and sustainable authentic IPE experiences through untapped patient and community collaborations.

the positive response from our colleagues and hope that further trainee-led efforts will continue to inspire ambitious action to build a more equitable future for all on local, national, and international stages.As medical students, we have the power to create change in academic medicine. Throughout our medical school journey, we hope to use our newfound privilege as members of the medical profession to further raise awareness of the health inequities associated with climate change and to better advocate for climate justice.