Listen in, Michigan: Episode 54, featuring Rob Ernst
Deborah Holdship: Hi I’m Deborah Holdship, editor of Michigan Today. In this episode of Listen in Michigan My guest is Rob Ernst.
He’s a first-gen college graduate, and one of 12 children, who at 6-foot-6 prioritized academics over athletics as a U-M undergrad. When people ask if he played basketball, he tells them he was “varsity library.” The physician also holds an MD from the Michigan Medical School. He is the university’s Chief Health Officer and associate vice president for health and wellness in student life.
Talk about a challenging gig in the year 2023, just three years after COVID-19 ravaged the globe, shutting down our societies and killing millions. Environmental disasters dominate our daily headlines, promising Armageddon just in time for spring commencement. And then this month, our campus grieved the loss of three MSU students after a horrific shooting on THEIR campus. There but for the Grace of God go we, has been the general feeling around Ann Arbor.
Tending to the community’s collective mental health is no small task – even without the unthinkable tragedy at MSU.
Fortunately for us, Michigan grad Rob Ernst has skin in this game. He’s never worked anywhere other than U-M – not counting his childhood paper route.
He’s been an internist with Michigan Medicine, a faculty member at the Medical School, and a campus administrator. He’s also a Michigan parent whose daughter is set to graduate in spring 2023.
Most recently, Rob Ernst succeeded in getting U-M to adopt the international Okanagan Charter, a detailed framework for administrators in higher education to embed health and wellness into all policies, practices, workplans, and decision-making. The charter grew from a 2015 meeting of university officials on the Okanagan campus of the University of British Columbia. The idea is that everything is interconnected, and that one cannot excel in teaching, learning and research without supporting the wellbeing of one’s people and places. The Okanagan Charter transforms theory into practice and aspiration into reality.
Rob and I had this conversation before the Feb. 13 shooting at MSU. Even so, we discussed multiple stressors students face today – some obvious, some subtle, some individual, some universal. Using the Okanagan Charter as its guide, the university can help identify and alleviate such stressors to improve the experience.
As we pick up the pieces from the senseless violence in East Lansing and return to some kind of routine, we can at least be confident that someone like Rob Ernst is on our side here at U-M. Here’s Rob:
Rob Ernst: For years before the pandemic, we have been working to try and address the imperative of student mental health and the strategy had been to add more resources [i.e. counselors]. And adding more resources seems like an important consideration.
Institutional leaders were starting to articulate frustration with the fact that we’re adding resources, and we keep hearing that the problem is getting worse.
The contemporary notion of health promotion is to acknowledge that a holistic view of wellbeing acknowledges an interconnectedness of people, places and the entire planet. And you know the approach to improving our overall well-being involves addressing some of the individual stressors.
It involves some strategies to manage our stress, whether it’s through, you know, a range of different things. But even if we’re doing that really well, but the climate is one that is associated with microaggressions against a certain group, if you’re part of that group, you’re going to struggle, you know?
So we institutionally have to think about that association of not just what we’re doing, but in what context this initiative is taking place.
COMMENCEMENT SPEECH EXCERPT
In my career I was a supervisor for the clinical faculty at Michigan Medicine in primary care, and much was made of systems of practice and how to organize systems of practice and the effort was to try and make sure that the physicians working in that practice had some professional satisfaction and really the notion of physician burnout has gotten a lot of attention and how do we address the imperative of physician burnout?
The general consensus is that you cant fully address that issue through individual. Initiatives — so you can’t ”yoga your way out” of physician burnout. I think it’s a component of the strategy, but to really move the needle you have to think on a systems- based approaches and try to identify and address some of the upstream effects.
So, the Okanogan Charter is the framework around health promotion at universities and colleges to embed health and well-being into all aspects of your policies and your sort of procedural structures. So that if you intentionally aspire to be a health promoting university, you might think of systems and policies differently.
NEWS report regarding MSU shooting, Feb. 13
RE: It really does resonate with people to think about upstream causes of stress and identifying some of those less obvious stressors is really important work.
I think about it like health insurance. Health insurance is regarded by many as having it there in case you need it. But really for many, if you don’t have it, it’s a huge stressor. So we actively work with students to connect them with insurance if they don’t have it, whether that’s through the the marketplace or through Medicaid or through other kinds of channels, so we offer a consultation service for students to try and address that.
So these are the less obvious upstream causes of anxiety beyond the, you know, academic stressors or relationship stressors and things like that, right?
NEWS Report about 2022, another year of climate change and chaos around the world…
RE: Whether it’s the presence of institutionalized racism or just the anxiety that many of us, many young people, feel about the impact of global warming on the planet itself. I mean, that’s just an overwhelming feeling that many are experiencing, so we must attend to that. We can’t center our own individual well-being if the community around us is struggling.
MUSIC: Glee Club perfoms the Victors
RE: I mean if we don’t focus on equity and inclusion, we’re not going to move the needle on well-being and mental health.
You’re all familiar with our slogan, you know, leaders and best. And I actually own the fact that I don’t love that because it’s a little too much pressure. And maybe it’s because I identify as a first generation college kid, it’s almost too much pressure. If I’m not the best, is that good enough???
The one that I prefer – the slogan — which is: it’s great to be a Michigan Wolverine. And you can just get them chanting it at this session and you can just how that is a more inclusive and connecting kind of way to bring people together.
So I think the sense of belonging is critical to the environment if we’re going to expect that people experience a sense of thriving in the c ommunity.
Universities and colleges in the United States have comparatively been, you know, behind the curve on this one. And up until recently, none of the universities and colleges in the United States had adopted this Charter, while it has had a really strong presence in Canada and Europe and a number of our international areas.
Just within the last two or three years there’s been the formation of a coalition of United States health promoting universities and University of Michigan is one of the early adopters of the Okanogan Charter in the United States and some we’re really proud of and it’s gaining momentum.
MMB: Let’s Go Blue!
DH: How does it kind of guide you in your work here?
RE: I’ve met a lot of people who disagree with a lot that I say . But I’ve never met anybody who would disagree and say: don’t sign on now put me down as a no on the, you know health promoting campus consideration.
our campus has put some resources into developing a framework and a structure and we’ve adopted the notion of a “well-being collective” to think holistically about the health and well-being of our community: students, faculty and staff, and organized around a backbone structure and a steering committee with work groups addressing some really high-level operational policy level considerations.
A couple of examples: Academic policies. Now during the pandemic, the academic affairs folks here recognized that it’s going to be really challenging for students. So they created some changes to the deadline from when you can draw classes, and the pass fail grades or a number of other policies around grading or structures to try and relieve some of the anxiety of students, understanding that it was a really difficult time and stressful time.
What we’re doing now is bringing a group of academic affairs leaders together with others from across campus and thinking through whether or not it makes sense to keep some of these policies, because it’s still stressful for students and it may help relieve some of the academic pressure or stress that students have.
So that’s a great example of having a structure. Where it makes sense to have these conversations. It’s embedded within the steering committee that has a work group that seats at the table people in a position to consider our academic policies in service to the stress on students.
NEWS REPORT: COVID 19 – the disease that changed our lives forever …
RE: When it started, you know, I was very much on the front lines as a practitioner and in student life overseeing our health and wellness, clinical resources. So, we had had some awareness of what might happen, and there’s been some structure around emergency preparedness.
A lot of of us remember the original SARS outbreak in 2003. That’s when some campus leaders first got together and realized that something terrible happening on one side of the world could come here as a vibrant internationally mobile kind of campus. So we had to be prepared, and we had a framework to think that through, but, you know, many people thought about that as just you know, drills and table tops and exercises, so when it became real, I think it became a different kind of challenge.
And from a medical standpoint, we got operational really fast. We’re used to being in situations of uncertainty and what we do as medical providers is oftentimes take information that we have, the best information available, recognize that it’s maybe incomplete, and we have a conversation about a strategy and a plan, and we decide to try something.
That oftentimes works between the healthcare provider, a patient, and their family. When you scale that up to a giant community, it becomes much more challenging.
I think probably a miss on my part was underestimating the anxiety associated with making difficult decisions in the face of incomplete information. So.
DH: Your own anxiety?
No. The community’s anxiety, right? You know, because we didn’t have all the information necessary to decide what to do next. There were no right answers, no wrong answers. This was a novel virus that was mutating and changing and we were learning on the fly.
NEWS REPORT re: hoaxes
DH: And I’m sure it was aggravating to deal with people who acted like they knew more than they did, as if they were the epidemiologist.
RE: One of the things that I observe in human nature is that the way we feel about something is driven entirely by the way we think about it. And particularly in settings of adversity, we tend to get stuck on a single thought. I’m not a therapist, but my understanding of cognitive behavioral therapy is to, you know, challenge people to think about adversity just differently. And if you can just think about it differently, you can feel differently about it. But it’s completely human and natural to anchor and ruminate about a single thought in a stressful or challenging time, and throughout the course of the pandemic there’s been a wide range of the way people will think about the same situation. And then there have been people anchored to those thoughts.
NEWS REPORT: RE: Whitmer kidnapping
RE: Being open and transparent when communicating while understanding the audience is anchored in a wide range.
DH: That’s tough you know because people are suspicious of institutions and may not believe what’s coming out of them. Everyone see it through their own lens.
RE: I think that was another thing I wish we had maybe done a little bit better: To just reiterate what our shared, common understanding about what success would look like.
I’ve been, I’ve been at the university for 35 years, you know, and I really have a deep appreciation for how important the work we do is. I was a medical student, practicing healthcare provider or faculty member of the Medical School, an administrative person. I’m a parent of a couple of Michigan students.
I really strongly believe that what we do here as an institution. Is important. And. I very much believed that getting back to doing that important work couldn’t have been more important during the time of the pandemic and — whether it’s opening the labs, which we were able to successfully do or get students back in the classroom or keep doing the important service that we do to the community.
It was just really the most important thing was that continuity of our core operations.
And we lost track of that in different conversations about other kinds of outcomes whether it was are we testing enough, how many cases or severity of case or the number of cases. So there were there wasn’t a shared understanding of what the outcomes should be to move forward. It’s really challenging and I think we could have been better to get by in on that.
GLEE CLUB PERFORMS
DH: What did you learn about yourself through this process?
RE: It’s not an accident that as I reflect back over the last few years, that I ended up being an internist as an internal medicine specialist. You know my joy comes from knowing a lot about a lot. But I think has trained me also, because it’s not the emergency room and it’s not the operating room, I’ve I think enjoyed being an internist because it allows me to sort of slow down my thinking, and I’ve reflected a lot about how people sometimes just can be reactive in a survival mode and just really quickly, you know, attach to something or react very quickly and just act like that’s truth or right.
Because of my training and my experience I’ve been able to across a range of different situations, including really difficult and high-pressure situations, to just slow down my thinking. Be curious, value more information that comes through and just try to be, you know, thoughtful and, I don’t want to say this in a bad way, like it’s slow, but it’s at least not reactive, it’s thoughtful.
So I think that does come from my identity as an internist, and again from that, even if it’s incomplete information, it feels like it’s thorough based upon the information that I have and feel then at least comfortable with making decisions in that context.
RE: I believe that the silver lining of the pandemic has been the establishment of relationships across the university that weren’t necessarily as strong as they had been before the pandemic.
One of the things, to get back to your question,n that we’re going to wrestle with is some shared metrics. The Steering Committee has already started to talk about some of these things about: What would we think would be meaningful outcomes if we were actually making some progress to being a health promoting university. Boy, that’s tough, right?
But some of the things that we’re trying to come up with would be ways to measure resiliency. You know, how do we bounce back when we do hit adversity? Are we prioritizing health and well-being as an outcome for our students?
How would we do that?
Or do students do that? Do they think about their own personal well-being the same way they think about their GPA or their internship?
The Michigan students we attract are an impressive group of young people and I think they come here with a high expectation for the Michigan experience. I think, one of the really rewarding sort of feelings about the last couple of semesters that are starting to feel … I don’t wouldn’t say normal or back to normal, but I actually think about it as kind of being able to deliver on the Michigan experience that students come here and want to have.
And that Michigan experience includes instruction for sure. It includes connections to the the next step in life. But it also includes, you know, relationships with others and finding lifelong friends and really figuring themselves out, you know. So, college is a really transformative time for young people and our success as an institution, I think is, really facilitating that transformation that happens across all of these domains.
All these precious lives, all this promise. So much to protect and preserve. Let’s hope the Okanagan Charter lives up to its own aspirations. I’m confident Rob and his colleagues will find ways to help Michigan students enjoy the freedom to explore and learn in a thriving and supportive community. I hope the researchers, medical experts, policy wonks and the rest can move the needle, as Rob likes to say, toward a more stable and supportive society. We owe that to our students. We owe it to ourselves.
Thanks so much for listening. Please take care of yourselves and look out for your people. We’ll catch you next month. Till then, as always, Go Blue!
A kaleidoscope of perspectives
He’s a first-generation college graduate, one of 12 children, and, at 6-foot-6, a likely cinch at college hoops. But Rob Ernst, MD ’91, U-M’s chief health officer, had no desire to be a student-athlete. He always prioritized academics over athletics during his undergrad years at Notre Dame and his subsequent time at the Michigan Medical School.“I was varsity library,” says the longtime primary care physician, who recently moved his clinical practice from Michigan Medicine to the University Health Service on campus. “Physicians are problem solvers and lifelong learners and that always resonated with me. It’s no surprise I became an internist. My joy comes from knowing a lot about a lot.”
That’s a good thing, because Ernst also is the University’s associate VP of health and wellness in student life. Mental health stressors in 2023 are more extreme and overwhelming than ever. Nothing drives that point home more than the Feb. 13 shooting at Michigan State that left three students dead and five others fighting for their lives. It’s woefully inadequate to describe the modern-day student experience as turbulent in light of so many existential stressors. But if anyone understands, it’s Ernst. In the past 35 years, he has served as a U-M physician, a clinical educator, and an administrator. At Spring 2023 Commencement, he will become a proud alumni parent.
Ernst credits his medical training as an internist for honing a holistic approach to problem-solving that has defined his career. While working as a clinical faculty member at Michigan Medicine, he sought to remedy physician burnout.
“The contemporary notion of health promotion is to acknowledge an interconnectedness of people, places, and the entire planet,” he says. “And the general consensus is that you can’t fully address an issue like physician burnout through individual initiatives: You can’t ‘yoga’ your way out of it. To really move the needle, you need a systems-based approach to identify and address some of the upstream effects of stress and anxiety.”
The Okanagan Charter
To “really move the needle” in higher education, Ernst advocated that U-M adopt the Okanagan Charter, a framework for wellbeing that calls upon post-secondary schools to embed health into all aspects of campus culture and to lead health promotion action and collaboration locally and globally.
Popular in Europe and Canada, the charter came from the 2015 International Conference on Health Promoting Universities and Colleges at the University of British Columbia’s Okanagan campus. Participants from 45 countries, representing educational institutions and health organizations (including the World Health Organization and UNESCO), collaborated to produce the charter. U-M is one of the first U.S. universities to sign on.
“It helps get partners around the table to talk about strategy and work toward a common purpose,” Ernst says. “It forces us to ask the question: ‘If we were really living into this aspirational goal of being a health-promoting university, would we think about this issue or policy differently?’ There may be many things to consider, but [having a framework] helps to check that particular box.”
Equity and inclusion
Today’s students share the collective trauma of growing up with school shootings, anxiety about climate change, and the pain associated with institutional racism. The ongoing effects of COVID-19 further detract from a supportive learning environment. Many students grapple with social anxiety and isolation, all while craving to belong. Decision-makers need to consider context and climate when considering mental health initiatives, Ernst says.
“We can’t move the needle on mental health without focusing on equity and inclusion,” he says. “We can’t center our own individual well-being if the community around us is struggling.”
A well-being collectiveIn retrospect, the pandemic produced an unexpected silver lining in improved cross-campus communication and collaboration, Ernst says. New pairings and partnerships are seeding the creative landscape required for the Okanagan Charter to manifest impactful and lasting results.
“I’ve met a lot of people over the years who disagree with a lot of things I say. But I’ve never met anybody who would say: ‘Yeah, put me down as a no on that health-promoting campus consideration,'” Ernst says.
With the Okanagan Charter as his North Star, he is working with colleagues to nurture a “well-being collective” on campus. A steering committee and several working groups are organized around a backbone structure designed to address high-level operational procedures and policies from a holistic purview. Due to the unprecedented stress caused by the pandemic, academic leaders amended the deadline for students to drop a course. Now they are discussing whether to adopt the policy long-term. In addition, the administration recently decided to extend the winter break by one week in the 2023-24 academic calendar, allowing students and faculty more time to rest, travel, and prepare for the following semester.
“These are great examples of having a structure where it makes sense to have these conversations,” Ernst says. “It’s embedded within the steering committee that has a working group that seats at the table people in a position to consider our academic policies in service to the stress on students.”
As a physician whose goal is to cure what ails you, Ernst knows it will be difficult to gauge success in such a subjective arena. (It’s not like working with an individual patient and their family, he says.) But the steering committee seeks to identify shared metrics to assess progress.
“We’re looking at ways to measure resiliency and how people bounce back from adversity,” Ernst says. “How do we know that people are developing a sense of purpose?
“College is a really transformative time for young people. The Michigan experience includes instruction, for sure. But it also includes connections to the next step in life: relationships with others, finding lifelong friends, and really figuring themselves out. Our success as an institution, I think, is facilitating the transformation that happens across all of these domains.”
George Best MD - 1961 med school, 1964 finished my anesthesiology residency and spent the next 54 years qAs a clinacle anesthetis
The U of M medical School and Medical center needs a HEALTHSPAN CENTER. I HAVE APPROACHED HONOR HEALTH in Scottsdale to form such a center in our city of Scottsdale. There needs to be an academic center where Physicians and patients can go for their care and information. I am 88 and for five years have been on SIROLIMAS(rapamune-rapamycin) and Depreynyl (selegiline)(for my brain). Since death is programmed it can be postponed. I have been on both for 5 years and in training for the masters track and field POLE VAULT at age 88. GO BLUE. BEST MD CLASS OF 1961
KR Cramner - ‘1990
In order to “move the needle” on mental health and substance abuse there needs to be an inter-racial, interdisciplinary “voice” to address the State of Michigan’s history of institutional racism and oppression. Health disparities have been glaringly obvious. The change starts at the very top of the hierarchies. In Bakersfield, California there are integrated campuses at Clinica Sierra Vista. The Dr, dentist, social work, substance abuse, radiology, and blood draw clinics are all on the same campuses. After a social work appt., the client can see an internist and get a blood draw, for example. Drs., psychiatrists, nurses, social workers, and counselors can consult weekly for treatment teams. This state is paying desrly for not having integrated services, but my hat goes off to Dr. Ernst for taking the long view. The whole body works as one integrated system with each part communicating with the other. Hopefully, our medical/mental health/substance abuse/dental/psychiatric and other professionals can become collaborative. The patients need a voice at the table. Clevland Clinic has a Functional Medicine clinic as well. The solution needs to be an “out of the box” one. Our current system needs to progress. THANK YOU to everyone who fought for wellness during the Pandemic. If medicine is going to make it through, these Health Heroes must be taken care of and still be seen as vulnerable as the next person to stressors and challenges. An Alaskan Inuit leader once said, “IT’S NOT US AND THEM. IT’S ALL US.” Let’s give everyone the dignity and worth they deserve!!!!
KRC Class of 1990 GO BLUE!!!!!