In his book Languishing, psychologist Corey Keyes describes burnout as “finding it hard to bring joy or meaning to activities that you once found greatly fulfilling.” This flattening out of your emotions takes many forms: the parent struggling to read a bedtime story to his child; the graphic artist unable to remember the thrill of creation; or the mid-career physician who wonders, “How did I get so removed from the work I once loved?” In the medical profession, burnout is particularly insidious. Its hold is both personal and systemic, moving from institution to practitioner to patients, families, and communities. 

Fortunately, that same causality can work in the reverse. The Kern National Network for Flourishing in Medicine (KNN) has started a movement to bring connection and fulfillment back to the medical profession in the hope of transforming a system that, in many ways, is putting the health of its stakeholders at risk. The KNN is infusing a framework for flourishing into medical schools and academic medicine so that what is taught, learned and practiced is not just skill and competency, but also models of character, ethics and purpose. Recognizing the interconnectedness of medicine, and its relationship to public health, the KNN is also working with health systems and within health professions to rethread medicine’s frayed social compact. 

“With the ever-changing demands in healthcare, physicians are met with complex challenges testing their ability to make the best decisions for their patients, communities and their own flourishing as practitioners, said Dr. Cheryl Maurana, the Founding Director of KNN and professor and senior vice president at the Medical College of Wisconsin (MCW). “KNN places an intentional focus on character, caring and practical wisdom to ensure that physicians are best positioned to successfully navigate these demands.”

The theory is that centering these values and behaviors within individual students, faculty, residents, and practitioners will have a cascading effect on the profession and health systems overall. It’s not about payment reform, though market dynamics are a consideration. And it’s not about individual wellbeing, though that, too, is a part. The KNN’s framework for flourishing in medicine is inherently relational and rooted in connection with others. Though it addresses deficits in the system, it adopts an asset-based approach that involves drawing from one’s own strengths and values when making some of the most ethically challenging decisions any professional can make. 

The movement, which began several years ago, may just now be reaching its tipping point, thanks to a number of factors including two large grants from the Kern Family Foundation and the global pandemic which exposed long simmering issues within the healthcare system. As early as 2012, Foundation leaders were meeting with a group of medical educators, including Maurana, who were struggling to address growing problems within medical schools and academic medicine. These included burnout characterized by the deterioration of hopefulness and vigor in medical students and faculty. Studies have demonstrated that high rates of burnout correspond with lower levels of physician empathy and altruism in caring for patients. “We were looking for an antidote to that,” said Maurana.

By the mid 20-teens, in addition to MCW, the group included six other medical heavyweights: Dell Medical School at The University of Texas at Austin, Geisel School of Medicine at Dartmouth, Mayo Clinic Alix School of Medicine, University of California San Francisco School of Medicine, University of Wisconsin School of Medicine and Public Health and Vanderbilt University School of Medicine; along with passionate leaders like Dr. John Raymond who was early in his presidency of MCW and dedicated to helping transform medical education towards these goals. 

Many within the profession felt as though the pendulum had swung so far in medical education that it was concerned only about competence, and it had lost the idea of the whole person formation. The schools’ believed what the medical profession needed was a foundation for flourishing and they set about establishing the pillars that would lead to that outcome by working together and examining the literature. They eventually arrived at: character, based on the elements of the Jubilee Centre’s framework of moral, civic, intellectual and performance virtues; caring, described as “emphasizing an ongoing practice and approach that recognizes human interdependence and works toward a stronger democracy”; and practical wisdom, as noted in the work of Kenneth Sharpe and Barry Schwartz, which is continually developed through experience and critical reflection toward action, something Maurana calls “doing the right thing, at the right time, for the right reason.”

“What flourishing in medicine means is reflected in the solid framework the KNN has developed so It’s not just a nice word to hear – who doesn’t want to flourish? – it provides a research base to consider flourishing in individuals and systems and to understand practices and conditions conducive to flourishing,” said Christopher Stawski, senior program director and senior fellow of the Kern Family Foundation, which formally established the consortium as the KNN with their first investment in 2017. Another grant, approved in 2022, is helping to fuel its growth. 

Kimara Ellefson is KNN’s National Director of Strategy and Partnership, a position that reflects the expansion of the organization’s targeted impact. She says the focus of the KNN, and the Foundation, has grown from medical education, to all medical professions, to health systems overall, in an acknowledgement of the interdependency of these domains, once again laid bare by the pandemic. She points to work KNN is now doing with hospital systems, including large, for-profits which are concerned about the wellbeing of their residents and the effect it can have on patient care. While the systems work is nascent, individuals representing over 50 organizations within the health care ecosystems are now engaged with the KNN in a variety of ways through student chapters, organizational members, and project partners. 

“We hope that the lens of flourishing is adopted by the majority of medical schools and healthcare systems in this country so that policy decisions, education decisions, staffing decisions, and leadership decisions are made through a flourishing lens,” she said. 

Living the Movement

When asked what “flourishing in medicine,” means to him, med student Vincent Busque said “to me, flourishing in medicine means taking pride in the authentic ways in which we take care of our patients, both through medical care and especially as fellow humans, while contributing to and being supported by the broader medical community.” 

Busque is a third year student at the Geisel School of Medicine at Dartmouth and has been involved with the KNN since he arrived in both formal and informal ways. He attends KNN student conferences and has led student workshops but he also incorporates the KNN principles into everyday actions like sending congratulatory notes to his classmates at the end of the year. A natural optimist with a gift for coaching, Brusque tries hard not to let negativity, like attitudes between battle-worn educators and anxious students, get him down. But Brusque is also the first to say, “med school is no joke.” As he begins his clinical rotation when the challenges of his chosen profession become very real, he will lean heavily on the KNN framework which he says gave him a unique kind of mental toughness. 

“I try to do something caring every day – even if it’s little things like getting someone a blanket or popping back in on a patient,” he said. “I think that is what is going to make me a better physician because when the going gets tough, you need to connect back to why you went to medical school in the first place and for most of us that’s about caring for people in really difficult and emotional situations.” 

“Flourishing in medicine means taking pride in the authentic ways in which we take care of our patients, both through medical care and especially as fellow humans.”

As a KNN student leader, Busque helps his classmates understand what words like flourishing, caring and practical wisdom mean in a clinical scenario, particularly a challenging one. He says use of love languages like affirmation, physical touch and acts of service can help illuminate caring. Relevant questions like how best to support a struggling colleague provide relatable examples for practical wisdom. 

“KNN has allowed me to say that it is actually OK in medical school to care about your values, your character, and your community. With time, we will all come to understand the science (of medicine), but it is these things that are going to allow us to be truly great physicians,” he said.

One of Busque’s models for professional excellence is Dr. Roshini Pinto-Powell, an educator and administrator who is co-leading the KNN curriculum development at Geisel. She is also the school’s associate dean of admissions and only partly jokes that she is personally responsible for dedicated learners like Vincent Busque. A physician for forty years, Pinto-Powell is a KNN devotee who sees the framework not so much as programming, but as a mindset shift and a pledge that permeates everything that goes into medical education. She is currently completing a masters degree, funded by the Kern Family Foundation, from the University of Birmingham at the Jubilee Centre for Character and Virtues. 

Pinto-Powell will be using the KNN framework in her “On Doctoring” class, and this coming year will include a new seven-session pilot class called “Professional Values Formation.” This is a re-envisioning of Geisel’s Coaching Program which was created in 2019 to connect all incoming medical students with a faculty coach for the duration of their studies, to maintain consistent academic & professional support throughout training. In this program, students connected with their coaches in small group coaching sessions, focusing on broad topics like the medical school roadmap, professional identity formation, professional enculturation, and self-regulated learning. Students also met with their coach to receive individualized support in building and reflecting on their goals, challenges, and experiences.

As Geisel dives into developing the new “Professional Values Formation” pilot, leaning deeply into the KNN framework, Pinto-Powell is particularly focused on bringing the appropriate vocabulary to this pilot program, which will be introduced with both students and faculty, in order to have a common vernacular she believes was lost with the secularization of education. She says that while biomedical ethics has an important role in medicine, a practical wisdom framework of thinking allows for nuance and particulars, critical to wise decision-making.

“The separation of church and state has sort of muddled the idea of morality and virtue in medicine into thinking its religiosity and it’s not,” she said. “I think our young people really lack moral vocabulary as a framework and we need to bring that back for them.” 

Pinto-Powell has a strong advocate in Dr. Sonia Chimienti, the school’s Dean of Educational Affairs. In an indication of the school’s broad perspective on health care, she also oversees the masters in public health and masters of science programs as well as the MD program at Geisel. “What we are trying to do is create opportunities to do more learning together earlier in education. This will help us to understand each other better, and ultimately improve how we work together,” she said. 

Chimienti believes Pinto-Powell’s work with faculty, as well as students, is a critical part of the KNN framework. “A focus of our work in creating our learning collaboratives is to help with the development, the nurturing, the appreciation, and the ongoing respect of our educators so they can role model and be those physicians that the students aspire to be,” she said. 

In many ways, Busque, Pinto-Powell and Chimienti are the embodiment of the KNN movement. While they acknowledge the challenges inherent in health care, they all hope to change the conversation from burnout and blame to a renewed sense of joy within the profession itself. 

“When I think about this as a movement, I think about reclaiming the narrative of what it means to be a professional, a physician, a public health specialist, a nurse in this era, in this time,” said Chimienti. “It’s about showing up every day and bringing the character and caring that you grew up with and developed to the moment that you are in; to the person who is front of you – whether it’s a student, a patient, or a colleague – and upholding the standards of the profession we all hold so dear.”