Q&A with Dr. Kimberly Manning, 2022 AΩA Visiting Professor

Kimberly Manning, MD, on Justice, Twitter, and the Hidden Curriculum

On Tuesday, February 22, Dr. Kimberly Manning joined the Pritzker School of Medicine and University of Chicago Medicine communities virtually as the 2022 Alpha Omega Alpha Visiting Professor. Manning, a Professor of Medicine and Associate Vice Chair for Diversity, Equity, and Inclusion in the Department of Medicine at Emory University, made time during the day to have a wide-ranging conversation with fourth-year Pritzker students Shira Fishbach and Russell Simons. The following Q&A has been lightly edited for clarity.

Russell Simons: The first burning question we have is, I know earlier you were wearing a tutu in honor of 2/22/22, but: Is the tutu here with us for this interview?

Dr. Kimberly Manning: And it’s a Tuesday! [KM stands up to show off her tutu.] Obvi! And I had to teach this morning. I had to teach the residents this morning right before I started with you all so my day is more full than Dr. Arora* even realized.

*Vineet Arora, MD, MAPP – Dean for Medical Education at the Pritzker School of Medicine

Shira Fishbach: To be busy in a tutu is probably the best way to be busy.

KM: Right? Somebody on Twitter did a workout in a tutu and I was like “Dang!” because my tutu is kind of a knee-length work tutu because I knew I would be at work.

SF: A business tutu!

KM: A business tutu. But I should have gotten a workout tutu!

SF: Maybe Nike will start selling those. I actually really wanted to ask you about Twitter specifically since both of us are longtime @gradydoctor followers and fans. We would love to hear about your journey on Twitter: How did you get started using it, and what do you think is the power of social media for physicians?

KM: I think about this so much, so I’m glad you asked me. I opened my Twitter account in 2010 and I didn’t really use it at all. Back then I liked social media but I didn’t understand it. That was when Twitter was at 140 characters and it was like drinking from a fire hose. I just didn’t know what was going on. A lot of doctors weren’t on it yet. And then around 2017-2018, I went to the Academic Alliance of IM Week, and while I was there there were people who were live tweeting at that meeting. And I would see people live tweeting at SGIM and some other conferences but never really got into it. But I was at a workshop and somebody was talking about using Twitter in medical education. So I kind of thought it was interesting and started following a few people. Then what ended up happening is that, in this talk that was given by Dr. Avi O’Glasser and Michelle Brooks and a few other people, they were talking about mission-based tweeting, sort of thinking about using Twitter based on what your personal mission is. I had never really thought about that. I had thought about that with blogging and writing narratives but I had never really thought about that with social media. So I realized I didn’t really have much activity on Twitter so it was a place where I could start fresh, whereas my Facebook account, most people who follow me on that are people from college, people who know me from real life.

So for Twitter, I am extremely intentional about everything I say and do. It’s not in a phony way! I realize that most people I interact with on Twitter do not personally know me. And so I operate in that space as if I’m mostly with strangers. But not strangers, you know? And then I think about, I call it “tweeting in the box.” There’s a box of things I’m willing to talk about on Twitter. I’ll talk about medical education, diversity, equity, and inclusion, humanizing patients, justice, I’ll talk about those things, but, you know, Michelle Obama’s bangs at the inauguration, even though her outfit was awesome, that’s not something I’m going to tweet about. I don’t tweet that much about politics because whatever you tweet will draw those people to your timeline and I know that’s not the space where I want to engage people in that way. Once I started getting more followers, people all the time will reach out and ask “Hey, will you endorse this person?” and I say “mm-mm” [shakes head no] because I don’t want that energy coming toward me. So I started doing that, and then kind of on accident, I just wanted to know what it might be like to tell a story in the format of a thread because I was enjoying some of the “tweetorials” that explain and taught things. I told a story once and people just responded to it, and I was very surprised. I was like “Wow, okay.” It was a nice sort of cognitive challenge to myself to try to write in that format because I’d never done that before. That’s how I got to it, and that’s about it!

RS: You mentioned justice as being within the box of things you’re willing to tweet about. Do you think social media has enhanced our ability to advocate for justice either as individuals or as a collective?

KM: Definitely. I think that what social media showed me is that you can get a message out a lot faster using social media than you can doing a lot of other things. We saw with some recent events, how some awful things happened and were perpetuated by social media, but I’m an optimist so I like to think about the positives. I think the thing that I’m most proud of that happened over social media in the last year or two is when I made up my mind that, I thought about myself as a Black American who works at a safety net hospital, and who is very steeped in the Black community—I’m involved in a lot of things in my community—I wasn’t seeing the voices or hearing the voices of the people that I see all the time in these articles I would read. I would think, “That’s not what Black people think,” or “That’s not true.” But I could show you better than I could tell you. So instead of just telling people “that’s not true, don’t say that about us,” I can just tell you a story. And I’ll let you decide what that means to you. If I tell you that I’m walking out of the grocery store and I start talking to somebody, and they say this, that, and the other, and they’re a Black American person, I didn’t tell you how to think, I’m just telling you what happened. And then you’re like, “Dang.” And also recognizing that we don’t often let people in to the most authentic aspects of who we are culturally.

So I’m sure all of us have culture, I’m sure both of you belong to cultures where there are spaces there that the people who are in your culture know all about it. They know the food, they know the jokes, they know everything. Whereas me, I might not know. And I’m not privy to it unless I somehow find myself, I somehow snuck into the space of where y’all are. That’s usually how it is with Black people because we’re trying to protect ourselves. Like I was saying today on Grand Rounds*, a lot of people will code switch to kind of keep themselves sort of vanilla so that they don’t draw any negative attention to themselves or fit a stereotype. What everybody is really hungry for is an authentic piece of who we are. When I freed myself up to stop codeswitching, it made a really big difference in my writing and my teaching and how I interact with people because then they feel comfortable being themselves because I’m not stiff-arming you by pretending I’m somebody other than who I am.

*Dr. Manning presented “The Space Between: A Narrative Journey Through the Hidden Curriculum” for the Department of Medicine Grand Rounds.

SF: I think that’s so powerful to think about the power of communicating by showing rather than telling. We were obviously at Grand Rounds, and it was incredible—everybody was so moved—but one of the things I was thinking about with the hidden curriculum is how much of it is exactly that: It’s shown but not told. Like you were saying, it’s implicit, not explicit. We were thinking about how at Pritzker, from day one it feels like, medical students are asking a lot of “Okay, but why?” and thinking really critically about the curriculum. It feels like maybe we’re at a moment where students are thinking more critically about the curriculum that they’re being taught. How do you think we, as trainees, can best challenge some of the more harmful lessons we’re taught in the hidden curriculum?

KM: I think a lot more people now are doing implicit bias training. That piece, that’s a start, but one of the things with implicit bias training is that people are left with moral distress, and then they don’t know what to do. And so I’m very interested in the action part of it, the what-to-do part of it, and that’s bystander and upstander training. As I look back on that experience where those folks were talking [negatively] about my friend, I didn’t have the tools to speak up for her as an intern. I didn’t know how. I didn’t even have the courage to not laugh at the joke. And it was so mean! She was so not deserving of that; she was so good to me. If you think about, if I had had the tools to say something, I could have just not laughed at the joke. I could have done something to distract them from talking about her. I could have said, “Hey, that’s not cool.” I could have thrown down a speed breaker to force them to think about how mean this was. I could have done a few things but I didn’t know how then. I know how now. I do think that upstander and bystander training is a huge piece that would help people with aspects of the hidden curriculum because then you call it out.

If I’m telling you that I’ll come and round with you guys at 4 a.m. or I’ll round with you on a Saturday until 10 p.m., and you know I have children, if we’ve created a place where the hierarchy is flattened enough where you can actually ask me about that, ask me “Who’s with your family right now?” or ask me “I want to have children someday, I wonder, how do you balance that?” Those are things I think about. I think more about how to intentionally do positive things with the hidden curriculum. So onwards, for example, when my team is off, I mandate they do something other than laundry, reading, or sleeping. And I need photographic evidence. I tell them that for me to see them as a balanced resident, it will be reflected in their evaluation. I might say it as a joke but I do the same, I send them pictures of me doing fun stuff. I’m like, “Oh, me and my kids are here doing this, I’m here trying sangria at this place, have y’all ever been here?” And then the team starts to do that, and it starts to normalize diastole and not only value people working and working and working and working.

RS: On the topic of your grand rounds lecture this morning, I’m curious how you came up with the title “The Space Between.”

KM: Cause I’m a Dave Matthews Band fan. It’s not even that deep. That’s legit the truth. It surprises people when I tell them that I’m a DMB fan, but I am, and I like that song. What happened was I didn’t have a title yet, and I was working on the talk and I had that slide of me as an M1 and me as an M30, and I was like, “Oh, the space between who I was then and who I am now is really all shaped by the hidden curriculum.” And some formal curriculum! But for the most part the hidden curriculum. I wish I had a deeper reason for you.

SF: I was actually thinking of asking you what music you like!

KM: Well, a lot of music! My older brother is one of those crazy DMB fans, he goes to five concerts in five days. He just got back from Mexico where he went to a three-day DMB concert. Because I’m close to my brother, I started listening to their music too, so me and my siblings, we all enjoy the Dave Matthews Band. We’ve all been to several concerts.

SF: That’s awesome. Would you say that’s the best concert you’ve ever been to?

KM: You know what, I would say the best concerts I’ve ever been to are concerts where I know every word to every song. And I like a lot of different types of music. But probably the best concert I’ve ever been to in my life was at the Hollywood Bowl when I saw James Taylor. I cried the entire time. It was one of the most beautiful, most perfect, weather was perfect, it was about a year or two after my older sister had passed away. We all liked James Taylor, but me and my younger sister really found a connection with his music after she passed, and I’m telling you, every song he would start out with, I’d start boohoo crying and singing every word.

RS: My dad is a James Taylor fan, too. That’s become the background soundtrack to a lot of my childhood so that resonates with me for sure.

KM: I may or may not be your father’s age so I don’t know how to feel about that.

SF: Well, the best concert I’ve been to is a Rihanna concert, so…

KM: You know what, that’s my girl. I’m ready for her to stop with all this makeup and go on and give us some music.

RS: You spoke about the nod this morning as part of the hidden curriculum in your own life, which I know you wrote about in JAMA in 2020. On the topic of your JAMA writings, another piece in 2014, “If These Walls Could Talk”, you wrote, “I need you to know that when you don’t turn anyone away, sometimes your table gets full. You end up pulling in chairs from outside the garage to accommodate the unexpected guests, and you try to make sure everybody gets a full serving.” I know you’ve dedicated your life to caring for patients from all walks of life. I also wondered, hearing this: When you’re sitting at your own table, how do you make sure that you get a full serving?

KM: You always have to put the oxygen on yourself first. That’s something I say all the time. My husband and I have this joke with our kids, and it’s not a joke—it’s serious, but they think it’s a joke. I always say the most important person in this house is your dad, and he says the most important person in this house is your mom. We say that because, if we take care of each other, they know they’re taken care of. I generally try to prioritize my relationship with my husband as a way to protect my children and the same goes for me and patient care, I try to make sure I’m taking care of myself. I think very much about how much sleep I get, I think about what I put in my body to eat, I strength train, I run, I do things to try to take care of myself so that I can be sustained but also so I’m not unraveling when I’m trying to do things.

The other thing I realized is we don't need as much as we think we need. That’s the thing I really found out. You think everybody wants so much from you but they don’t. Students, for example, walking out of the medical school. I hear “Oh, students always stop you, you’re talking to everybody.” I’m like, “They don’t want more than 20 seconds. They want you to stop, register them, notice them, and they keep going.” Everybody doesn't want to meet with you for 30 minutes. But sometimes they do, and when things start to stack up, you can say no. I would say one of my biggest wellness activities is the word no. So that I can really say yes. And I’m willing to let people help me with things, and before I used to not. I used to think I could do everything. So today, I’m a small group advisor at Emory, and normally I would be teaching small group at this time. But I really wanted to spend time with the students at the University of Chicago today. That’s what I really wanted to do. Because students invited me, and that’s something on my list of priorities—to be there for students. So I went to one of my mentees and coached this mentee to teach my small group today, and she’s done a great job. My students already texted me saying I should send her more often so now I feel like I’m gonna get fired. My students like my M4 better than me.

SF: When Russell and I were preparing for this interview, he came up with this really beautiful question that I’ve been thinking about a lot. I feel like you have so much wisdom to share with us and come across as someone who knows themselves, who knows what they need and what their mission is. In Grand Rounds you told us one of your favorite quotes is “Becoming is better than being.” How did you come to know yourself better, to be in the process of becoming this person, and what wisdom do you have for us as we strive to become physicians and mentors to students and advocates, as we are becoming?

KM: It was with a lot of mistakes. I still make a lot of mistakes. Surrounding myself with people who are kind to me and redefining relationships with people who do not have the capacity to be kind to me. People who are hurting can’t be kind. If you can’t be kind, then you make me tired. If you’re treating me unkindly, that is something that I think when I was younger I wasted a lot of time doing. This is not just with romantic relationships. This is with friends, colleagues—everybody doesn’t deserve to be in my innermost circle, so I’ve become protective of that. And I’m really proud that at this point I’m surrounded by people that do not compete with me, who celebrate me, who I can celebrate, who listen to me, who I listen to back. I don’t hang out with all of those people every single day, but I find that’s really helped me a lot. I’m fortunate. I was born to parents who cherished me. A lot of what you see out of me is what it looks like when a kid grows up cherished. That’s basically what it looks like. People listening to what I have to say, expecting me to be excellent, showing up, teaching me how to have a growth mindset. My parents praised my effort way more than the things I did. And I passed that on to my kids. If my kid makes some team, I tell him “Because you worked hard all summer, because you did speed work, you were fast enough to make the relay this year. Congratulations on your hard work.” Not “You’re fast, you’re just a natural!”

And I spend a lot of time in reflection. Though I have good social skills, I’m an introvert. I like time with myself, I like to think about things, to think about what I thought about, write it down and kind of sit with things a little bit. I like intimacy, I like intimate conversations with patients, I like intimate conversations with learners and people. In that process, I’ve gotten to know myself a lot better. More than anything, I just don’t let people treat me unkindly. And I don’t treat me unkindly. Probably the last person I had to deal with who was treating me unkindly was me. Saying things about myself like “Oh, you’re so stupid, why did you do this?” I don't do that anymore. That gave me the space to be able to take a step back and look at what I needed to do and surround myself with people I trust who will tell me the truth.

SF: It’s so funny how we’re often the person in the way of the process of our own becoming.

KM: So funny, and so sad, too.

RS: You mentioned how, as an introvert, reflecting and making space for yourself is really essential for your wellness. I imagine writing has some connection to that reflection and intimate process. I have a big personal interest in the role of writing as a tool for medical education and one quote that’s really stuck with me over the years is from a doctor named David Eisenberg who says that writing compels him to make room in the black bag for words and their magic. I’m curious: what have you found the magic of writing and words to be in your life, that makes it such a central part of your day-to-day practice?

KM: For me, I am very motivated by a quote by Toni Morrison. She wrote her first book The Bluest Eye, she wrote that book so that she could read it. It was a book she couldn’t find and the story that she wanted to hear. For me, particularly as a person from a historically excluded group, I try to tell the stories in the ways that I wish I could hear, that I wish represented Black joy more than just the slow singing and flower bringing. Again, as we talk about justice, people will talk about the saddest aspects. People will say, “Oh my gosh, you’re a Black mom and you have Black teenage sons, that must be so hard for you.” But my kids are hilarious. They are funny. I was braiding my son’s hair the other night and he was cracking jokes, and we were dying laughing, and it was awesome. There’s all these aspects of my identity that I think stories allow me to show people a little, to welcome them into the space.

That piece, “The Nod,” I talk about how we started doing the nod, I think Black people do the nod to tell people “I see you.” It’s unspoken. But everybody wants that! Everybody wants to be seen! I think we can do more of that. We can metaphorically give each other nods all the time. It’s a thing we can do. I think it starts with just being yourself. I had a student tell me “Dr. Manning, you’re one of the only people I know that’s the same when you’re talking to me as when you’re talking to Black people!” And I said that’s because I don’t have the energy to be doing that anymore. I don’t do that anymore. I just talk like I talk, and I break people into formal and informal. Formal is how I talk to my father’s friends and to patients that I don’t know, and informal is how I talk when I’m relaxed.