Courage and Community: An Introduction to This Year’s Trainee-Authored Letters to the Editor

Although I had transported patients in the past, I quickly learned that the weight of a deceased person was a different kind of heavy…. The hardest part was the sheer volume, the sea of white and orange bags distinguished only by a tag attached to the outside. But I refused to let them become interchangeable. I read every tag, every name, every age. Before we lifted a body from the gurney to the shelf, I took a brief moment to lay my hand on where I thought a shoulder might be and whisper, “you will not be forgotten.” 1 • I hope this pandemic will have a positive and lasting effect on physician culture. Prioritizing professional community may be the antidote for physician loneliness, leading to increased capacity for physician health, fulfillment, and performance. When physicians thrive, patients do, too. 2 • The shared strife of traveling uncharted territory has given us empathy for one another, which feels distinctly familial. As colleagues, we now check in on each other in ways we did not before, and we share parts of our lives that we previously did not. 3 • In the face of adversity, it appeared that the reflexive human response was rather simple: to help in any way possible. This endeavor for a common cause deconstructed any notion of rank within the medical world; physical therapists were just as essential as orthopedic surgeons, who were just as essential as radiology technicians, who were just as essential as a second-year obstetrics–gynecology resident. Health care felt more kindred than ever before. 4 The year 2020 marked the fifth anniversary of our annual call for letters to the editor from trainees. When former editor-in-chief David Sklar, MD, began the initiative, we had no idea how popular it would become. Numbers tell the story. The first year, 2016, we received about 135 letters. In 2017 and 2018, we received between 150 and 160; in 2019, 400; and, finally, in 2020, over 560. The topics tell the story, too … what has been important to medical education? What excites learners and inspires them to send middle-of-the-night emails to mentors? We have asked trainees to explore transitions (2017), trust in medical education (2018), and “first” experiences (2019). 5 The letters we have received over the years have changed our perspectives and our hearts. This year, the idea of courage resonated as we began to consider a topic for the 2020 call. We wanted the call to be relevant to medical education and important to learners, broad enough to inspire multiple perspectives, but narrow enough to allow letter writers to focus. Just as we were developing the timeline for the call in February/March 2020, the world lurched, and suddenly everyone had a new story to share. All the letters we received were strong and wonderful. They revealed the ingenuity, the gumption, and the grit their authors demonstrated in the face of a devastating pandemic. They conveyed the heartbreak, loneliness, and confusion learners felt when they could not work in the wards, when they could not learn in classrooms, when they did not know how to follow their vocations and also keep their families safe, when their communities faced the double threat of COVID-19 and police brutality. 6 Letters revealed courage, strength, compassion, and love. We were captivated by the stories of the trainees. They wrote about a range of powerful topics including racism, volunteerism, innovative strategies, investing in diversity, moral distress, the value of the patient–family–physician relationship, the importance of human connection and belonging, virtual learning, stepping up to help people and places in crisis through advocacy, and more. They portrayed the resiliency of individuals and communities to persevere through unprecedented times and pave a direction to a more humanistic future for medicine. Letters came from learners of all levels and diverse fields—premed/baccalaureate students, medical students, pharmacy students, residents, and fellows—representing public and private institutions in the United States, Canada, the Caribbean, Ireland, Pakistan, and Wales. A common theme was community, even as many of the communities we love were dispersed and physically separated from us. As the popularity of the call has grown, we have had to consider and reconsider our process for evaluating and selecting the letters. We remain committed to providing a fair review with multiple reviewers for each and every submission, but procuring sufficient reviewers for 135 letters is very different than procuring reviewers for over 560. Editorial board members, journal staff, assistant editors, and associate editors all read and discuss letters, along with scores of dedicated reviewers, some of whom work with a few junior faculty members new to the world of peer review. Letters are not read in a vacuum; reviewers work together, sharing any concerns and their insights about letters’ strengths. We also work to ensure our accepted letters represent a diversity of themes and authors. We received more beautifully written letters than, unfortunately, we have space for. Selecting only a fraction of the letters to publish becomes harder and harder as submission numbers rise. After a rigorous evaluation, we selected only 9% of the letters for publication. The 53 letters, which will appear in this and the next 2 issues of Academic Medicine, each received a recommendation to accept from multiple reviewers and multiple editors. To show our sincere appreciation for the many other letters that received excellent reviews, we have decided to uphold the practice, initiated last year, of posting a list of honorable mentions on our website: https://journals.lww.com/academicmedicine/Pages/2020-Honorable-Mentions.aspx. As before, we have encouraged these authors to share the link with faculty, program directors, and others. The editors and editorial team of Academic Medicine value enormously the engagement with our early-career colleagues in the health professions, health professions education, and the biomedical sciences. We respect these colleagues as our partners in fulfilling the missions of academic medicine and as the people who will carry the field into the future. By listening to trainees’ voices, we can understand their experiences and perspectives more attentively and fully. By elevating their voices, we choose to take steps together toward advancing health equity by connecting with and prioritizing the health care needs of underserved and marginalized populations. We can gain insights from different disciplines to reflect on our work, advance academic medicine and the health professions, and embrace necessary change. We should never underestimate the power of community and the transformations that arise when individuals feel seen, heard, and valued. In reading these letters from the trainees of our field, we felt hope, inspiration, and profound gratitude, and we believe that the readers of the journal will feel the same. We are honored and humbled to have received, read, and shared in so many wonderful narratives. We are thankful to the hundreds who took the time to write about their experiences of courage, connection, and COVID-19. We are excited to share so many of these pieces, and hope you find in them healing, community, and inspiration.

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