Comprised of 27 departments, 3,000 faculty, and over 20 centers & institutes, the University of Minnesota healthcare system trains over 70% of healthcare professionals in the state of Minnesota. Thanks to both the University of Minnesota and Mayo Clinic in Rochester, the state of Minnesota is a national leader in healthcare innovation. And yet, many healthcare providers don’t have space to ask the “big questions of life.” These facts make UMN and Mayo Clinic incredibly fertile ground for Christian witness and formation.

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At Anselm House, formation and integration is in our DNA. We are excited to announce the Anselm House Healthcare Initiative and its leader. This initiative will foster a network of Christian faculty, students, and healthcare providers working at the University of Minnesota and Mayo Clinic and in the larger Twin Cities/Rochester community, and will support this community to faithfully serve God through their vocation of healing. This January, we hired Dr. Phil Letizia to lead this initiative and catalyze the excitement and energy that is already present. Phil is a pastor-theologian joining us from south Florida, where he has served in various pastoral roles for nearly 20 years. Through the experience of parenting a child with Down syndrome, Phil began asking questions about disability and faith that led to a Ph.D. in Disability Theology from Aberdeen and a new book titled Held in the Love of God: Discipleship and Disability (reviewed by my colleague Casie in this edition of Ampersand).

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In March, Phil traveled to the Mayo Clinic to meet with physicians, faculty, and students. While he was there, he sat down with Dr. Andrea Leep Hunderfund to discuss virtue formation in healthcare education. Andrea is a brilliant neurologist and researcher, and we’re incredibly thankful that she was willing to make time to talk with us about her fascinating work!

     —Arend J. (AJ) Poelarends, Director of the Center for Faith & Learning (CFL)

Phil Letizia: Can you tell me a little bit about your work and your position at the Mayo Clinic? 

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Andrea Leep Hunderfund: I came to Mayo Clinic as a medical student in 2001, then stayed at Mayo Clinic for my Neurology residency and a Clinical Neurophysiology fellowship. I joined the Education Division of the Neurology Department in 2010 and have been working at Mayo Clinic ever since.

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Clinically, I practice outpatient neurology, perform EMGs, and monitor surgeries. I have a background in quality improvement and think a lot about patient and staff experience. I also really enjoy teaching and helping lead education-related initiatives for our medical school, residency and fellowship programs, graduate school, school of health sciences, and school of continuous professional development. Most of my research focuses on medical education. I help lead the Mayo Clinic Values Council and the Program in Professionalism and Values. These groups are charged with promoting Mayo Clinic values (e.g., “The needs of the patient come first”), inspiring and supporting people in putting Mayo Clinic values into action, and perpetuating Mayo Clinic’s Franciscan Legacy.

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Phil: You’ve been using the word values—can you define “values” and how they might differ from virtues?

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Andrea: I think of a “value” as something a person or organization considers important and uses to guide decisions and actions. Virtues, on the other hand, are habits of character that incline us to think, act, and feel in morally excellent ways. These concepts overlap in practice because we commonly value virtues. Though of course, it’s a lot easier to espouse virtues than to consistently live them out in tangible, sacrificial ways. For example, one of the things I value in medicine is compassion. But it’s not always easy to show compassion when I’m tired, running late, and still have multiple notes to write. For current and future healthcare professionals, it’s helpful to spend time reflecting on what it means to put our values into action and how we can cultivate habits, practices, and relationships that will help us do this.

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Phil: Why does the cultivation of virtue matter in medicine?

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Andrea: The practice of medicine is rarely a straightforward endeavor. As physicians, we often have to navigate situations that are time-pressured, complex, and novel. Often we have unmet needs ourselves. We can be hungry, angry, lonely, or tired. We are constantly in situations where different commitments compete. For example, choosing to spend extra time with one patient may make me really late for my next patient. Choosing to come in early for a work conference may mean my kids don’t have a parent at home to get them ready for school. 

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As physicians, we need well-honed habits of attention and action to navigate these sorts of complex and conflicted situations. We need practical wisdom to discern how to do the right thing at the right time in the right ways for the right reasons. I appreciate virtue ethics because it reflects how I experience the practice of medicine and medical education: as a person navigating particular situations. 

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Sometimes we think of virtues as abstract, philosophical concepts. But in reality, virtues are embodied and enacted in concrete ways by real people in the real world. For this reason, the same virtue is enacted in different ways by different people in different vocations. The virtue of courage, for example, will look different for me as an outpatient neurologist than for my colleague who is a neurosurgeon, or my colleague who is in the military, or my colleague who is a healthcare administrator. 

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Phil: You’ve mentioned compassion, courage, and practical wisdom. What other virtues are particularly important for healthcare professionals?

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Andrea: One of my favorite books is Healers: Extraordinary Clinicians at Work by David Schenck and Larry Churchill. This book summarizes insights from 50 clinicians who were identified by their peers as being exceptional at establishing and sustaining healing relationships with patients. The eight virtues these clinicians exemplified included compassion, courage, integrity, respect, patience, justice, empathy, and humility. At Mayo Clinic, we also talk about teamwork, innovation, excellence, and stewardship. As a Christian, I think about faith, hope, and love in the context of my work and the charge in Micah 6:8 to do justice, love kindness, and walk humbly with our God. 

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One of the virtues I’ve been thinking about a lot recently is the virtue of humility. Some colleagues and I recently reviewed the literature on physician humility. We found that humility is critical for learning, navigating errors, managing uncertainty, building trust, and teaming effectively with other staff and patients. Humility also plays a role in the vulnerability of the medical encounter. Physicians often interact with patients in times of crisis, and humility allows the physician to receive the patient with care and love in a beautiful way. 

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Phil: To what degree does the practice and culture of medicine cultivate these virtues?

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Andrea: Medicine definitely cultivates certain virtues, like teamwork, excellence, and perseverance. But the practice and culture of medicine can also distort and disorder virtues or even incentivize certain vices. For example, when we work long hours, we can start to become entitled and judgmental. When we have knowledge and expertise, we can become prideful. We can start to link our identity and sense of worth to our work, which can lead to overwork and cause us to neglect other important relationships, commitments, and activities.

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Author and journalist David Brooks writes about “resumé virtues” and “eulogy virtues.” Medicine does a great job at cultivating resumé virtues, but it’s less reliable at cultivating eulogy virtues. For example, I see my medical students wanting to get publications, wanting to pass their big exams, wanting to get honors, wanting to get their top residency spot. It’s easy to think of these performance pressures as a necessary part of the training process, but once you finish residency and enter practice, different performance pressures appear. They keep showing up in different forms. So, it is important to step back sometimes and reflect on how our profession is shaping our lives—to ask ourselves, “Where do I need to incorporate boundaries or accountability structures? What habits and practices do I need to prioritize? What counter-liturgies do I need in my life to stay oriented toward eternal goods? And where is there a community of people that can help me do this?”

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Phil: Do you think that healthcare education allows space for students to be reflective in that way?

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Andrea: There are definitely schools out there that are creating space in their curriculum for students to be reflective about professional virtues and professional formation. Part of the challenge, however, is that professional virtues require moral narratives, traditions, and communities external to the practice of medicine to undergird and sustain them. 

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So, one of the things we need to do as educators is to encourage our learners to reflect on the roots that infuse their professional values with meaning and purpose—the underlying beliefs and commitments that will help them live out their values when the going gets tough—and then to find other people who share their convictions and can help root their convictions in a community of practice. 

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Anselm House has a unique opportunity to support students in doing that: to create a place where students can connect their faith with their vocation and connect with a community of other people trying to do the same thing. This combination is a culture medium for effective personal and professional formation! I’m really excited about the new Healthcare Initiative that Anselm House is launching and eager to see how it grows and evolves over time.

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Phil: What are you currently most excited about in your own work?

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Andrea: We’ve talked about virtue as something that is embodied within a person and about the importance of practical wisdom in enacting and rightly ordering virtues within our lives. Lately, I’ve been thinking a lot about if and how these concepts apply at a school, program, or organization level. Can a school or organization be virtuous or practically wise? Metaphorically, I think they can. 

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We already talked about how the places where we learn and work shape who we are and who we are becoming. A virtuous organization, therefore, will have structures and processes that value, recognize, and reward virtue, support the development and expression of virtue, and enable the organization to wisely navigate competing pressures and concerns. 

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For example, healthcare organizations must simultaneously attend to goods that are important to the practice of healthcare (health and care), and goods that are important to the well-working of healthcare organizations (productivity, efficiency, and financial viability). It takes practical wisdom to navigate and integrate these potentially competing concerns, and the right approach will vary depending on the local context. Each organization will have particular affordances and constraints that require careful consideration, just as each situation we face has particular affordances and constraints that also require careful consideration.

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I see Anselm House as developing and equipping future practitioners and leaders who can do this work wisely and well. 

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Phil: What are you excited for with the Healthcare Initiative at Anselm House? 

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Andrea: Anselm House has a really unique opportunity to build a strong, thoughtful community at the center of the Venn diagram between vocational practice and Christian community for medical students and faculty at UMN and Mayo Clinic. I love thinking about how to connect the dots between what I believe and how I feel called. But you have to connect those dots in community, with intentionality, and with intellectual rigor. So, I’m excited that Anselm House is starting the Healthcare Initiative to make room for those conversations to happen for medical students, faculty, and practitioners.