Pathway to Feinberg: Jannis Brea

I never expected to kick off my 30s by starting medical school. At a time when my peers and I had climbed the career ladder to mid-level leadership success, I had chosen to step off and drop back into training.

As an entrepreneur, I was no stranger to career ambiguity and discomfort. I networked my way to my first job after college – a user experience (UX) designer for the electronic medical record & billing company, athenahealth. There, I apprenticed in user interface design and usability. I directly observed physicians, MAs, nurses, front desk and back office staff and learned about care coordination by trying to design the computer systems they would use to do so. Understanding that to err is human, I helped to conduct the EMR's first patient safety heuristic review, ensuring we minimized the risk of medication error and wrong patient documentation in the EMR.

I knew nothing about designing interfaces, conducting ethnographic research or planning usability tests when I was put onto these projects. Under a great mentor, I had space to fail and grow and to discover what I loved the most about UX: “constructive empathy.” To be an effective designer, you need to know not only how to listen without injecting your own biases but also to how to build mental models of how your users think about their work, and how to see the task through their eyes. Every usability test was a lesson in humility: your user is not like you. Designs that seemed clever often failed in the hands of real users.

Yet I loved the advocacy work involved, particularly on behalf of healthcare workers. I am a daughter of medicine: my father was a cardiothoracic and vascular surgeon, my mother an operating room nurse. I learned how to be their voice in the software development and planning meetings where decisions that affected clinicians like them were being made. However, as much as I’d try to make the screens intuitive and easy-to-use, I often grew frustrated by the policies and processes that dictated design. Meaningful user guidelines and billing realities forced me to add checkboxes and alerts that I knew my users would hate. Worse still, I knew I might contribute to their burnout, yet decisions over my work came often from rooms I didn’t have the authority to enter.

With my second startup, Docent Health, I jumped at the opportunity to tackle not just user interface design but the process challenges in service design as well. This patient experience startup sought to provide both technology and patient liaison services to help health systems make patients feel known, valued and heard throughout their healthcare journey. As part of the founding team for our very first site in central California, I interviewed maternity patients, many of whom were Spanish-speaking Mexican-Americans or indigenous Mixteco-speaking migrant farmworkers, about their recent deliveries. I shadowed nursing staff and attended Maternal-Fetal-Medicine leadership rounds to learn where patients and families needed the most support. With this, I developed a scope of practice for the "Docent" patient liaison service as one of the first docents myself: calling pre-registered pregnant mothers, educating patients about delivery and resources available, rounding in the maternity unit to assist nurses and families, and discharging patients.

While spending 12-hour days in a clinical setting, my old love for science—one I had put aside when I decided not to apply to medical school after college—began to rear its head. At MFM rounds, clinical questions posed by high-risk cases fascinated me: how *does* a pregnant paraplegic know when her contractions are starting and to come to the hospital? As I stood outside one of my patient’s rooms as she developed a massive obstetric hemorrhage, I desperately wished I had the skills to be in there helping stabilize her. As much as I loved supporting clinicians, patients and families with my constructive empathy skills, I felt that I would never truly be able to understand medicine -- to speak on its behalf and to help design its future -- until I trained in it.

In March 2017, I quit my job, studied 7 weeks to take the MCAT, and began the year and a half-long application cycle. Outwardly, I unwaveringly convinced my family and friends that I wasn’t crazy. Inwardly, I was terrified. During this time, I had the great privilege to work for BrainGate, the first brain-computer interface research group to show it was possible to give individuals with quadriplegia the ability to control a mouse cursor with their mind. Collaborating with the team’s neuroscientists and engineers to help transform their researcher-operated device into a caregiver-friendly, 24/7 brain-computer interface, I found the intersection of a future – one that combined medicine and technology, process and interface design in the spirit of helping individuals not let their health limit their potential.

Walking into medical school, I knew I would be a minority. Not because of my race, ethnicity, gender or sexual orientation, but because of my life experience. I am called “non-traditional” because it’s not polite to call me “old.” In a culture where the pursuit of physician hood serves as common ground, having an irrevocable professional identity outside of that can be alienating. Coming from a culture of startups, I grew accustomed to a certain level of autonomy and respectful tension among differing perspectives that fueled innovation. Medical education is largely proscriptive and hierarchical, molding a time-honored way of thought into minds to produce the Physician, steward of patient health.

In my time here, I have been immensely grateful to the Office of Diversity and Inclusion for recognizing that diversity in medicine takes many forms and for welcoming my voice among their rich chorus. Organizations like SNMA and LMSA inspired me to team up with a world-renowned cancer biologist, a budding physician-administrator, and former IBM consultant (aka three of my classmates) to create a similar student organization for any self-ascribed “non-traditional” student. Our organization, Winding Paths, provides a supportive space to discuss challenges, celebrate successes and continue to explore what holding multiple identities means while pursuing medical school. Like any startup in its first year, it’s had its successes and failures, but I’m hopeful that Winding Paths will continue to stand as a symbol that there are many routes to and from medicine and that as medicine continues to rapidly evolve there is room for all kinds of physicians.

As for me, medical training is the next career step, a humbling and important one, in a winding path dedicated to the people, processes and technologies that shape medicine. It is a privilege.