Awakened Anesthetist

Neuroplasticity for Compassionate Care | Wellness Wednesdays

• Mary Jeanne, Certified Anesthesiologist Assistant • Season 5 • Episode 84

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What if the most powerful tool you carry into patient care isn’t a device or a protocol, but the way your brain has been trained to pay attention? I sit down with one of my mentors, Dr. Cassie Ferguson, pediatric emergency physician, medical educator, and architect of The Good Doctor well‑being curricula, to unpack how neuroplasticity, mindfulness, and self‑compassion can make medicine more humane and more sustainable. 

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Whether you're a practicing CAA, AA student, or prospective applicant, this episode marks the beginning of a community-centered approach to wellness that finally names and validates your experience. Welcome in. 

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SPEAKER_00:

This Wellness Wednesday is brought to you by CAA Matters, the first comprehensive wellness and professionalism curriculum designed to truly support the AA student experience. We all know AA education is streamlined to produce competent providers in a fast-paced program. Meanwhile, wellness and professionalism often get overlooked, lumped in with medical students, or addressed too late to help. CAA Matters fills this gap, centering student anesthesiologist assistance and equipping them with the tools, resources, and mindset shifts to succeed in school and build long, fulfilling careers. It's a turnkey curriculum, fully prepared, facilitated, and supported from planning to delivery. Program leaders and AA educators can learn more, read reviews from early adopters, and explore piloting CAA Matters at awakenedanesthetist.com or by clicking the link in the show notes. And I think I said this to you before, like like-minded people in medicine who are on a wellness journey are not oftentimes at the front center stage. They are, you know, more pulled inward. They're protecting their energy. They have boundaries. They're hard to find. They're hard to have conversations with.

SPEAKER_01:

Yeah. So yeah. I totally understand that.

SPEAKER_00:

Yes. So uh I'm grateful for your time. And yeah, so maybe just start off with who you are, where you are in medicine, and maybe your work with the good doctor would be a great place to start.

SPEAKER_01:

Sure. Absolutely. My name's Cassie Ferguson. I am, I like to say that my evening job is uh pediatric emergency medicine physician. So I work in the emergency department at our children's hospital uh here in Milwaukee, Wisconsin. So that's what I do clinically. Uh during the daytime, I work um mostly with students. So I do various things in various capacities with students. My favorite thing to do, honestly, and in my entire job is to teach. So one of the courses that I am a part of and an instructor in is called the Good Doctor. Um I refer to it as the Good-ish Doctor, which sort of is just my bent on how we view ourselves and how that impacts our ability to stay present and make mistakes. But um the good doctor focuses on three different threads in medicine that aren't traditionally taught or haven't been traditionally taught. The first is medical ethics, which certainly has made its way into our curriculum in the past, um, but this is really focused on making ethics a bit more accessible to people who are learning medicine. Uh, the second is professional development. And the third thread is the thread that I am in charge of, and that is really focused on well-being. You know, well-being, I don't know, I don't think that that really captures everything that we teach or that I that I talk about in the course. I'd say really we're focused on teaching students, medical students, the skills, the very practical, hands-on skills that we need as um people who witness and um are present for the suffering of other human beings, really in order to be a compassionate presence, but also, you know, really to have a sustainable career. So that's that's what I what I most like about my job is teaching students about that. I also direct one of the other courses in our medical school, which is called Health System Science. And there's definitely a lot of overlap between health systems and um sort of learning to be whole within medicine. Um, and so you know, I talk about that a lot when I'm talking about systems.

SPEAKER_00:

And just for the CAAs, you know, my audience obviously is wholly CAAs, I imagine. Um, and they maybe are assuming that I found you because there is an AA program at the Medical College of Wisconsin, which is where you work. That's the medical school you teach with and for. Um, but actually I found you because it what seems like almost a decade ago now for you, you developed a longitudinal professional wellness, you know, curriculum for the Medical College of Wisconsin called REACH, which is an acronym. Maybe say what the acronym's for.

SPEAKER_01:

REACH stands for recognize, empathize, allow, care, and hold each other up, which I realize is probably beyond that acronym, but uh, but that's what it stands for.

SPEAKER_00:

I like it. It starts with an H. I think it works. So my listeners who know what I'm passionate about know what drew me then to you. Because I found basically a research paper that you had written in collaboration with some others talking about this new curriculum that you had created and its effectiveness and what the students were thinking about it. And I was like, oh my gosh, I just found the first person ever who's doing something that I want to do. I need to talk to this person. And I reached out to you and you were so generous to, you know, share a little bit of the excitement I had to talk to you to also be willing to speak with me. And so now we kind of meet, you know, monthly. And I'm just so excited to have you in my circle now as a mentor and as a friend. Um, and you had invited me then to drop into one of your classes. Actually, I'm pretty sure I said, Can I come to one of your classes? Uh, and you were teaching on neuroplasticity, which is something that has been hugely important in my own personal wellness journey, also hugely important for the work that I'm doing through CAA Matters, and hugely important to the work you're trying to do through the good doctor. I would love to have you explain just maybe as simply as you can what neuroplasticity is. And then we'll kind of get into its importance.

SPEAKER_01:

Sure, absolutely. And thanks for that uh that introduction. I mean, I I am always thrilled to find someone who is as interested in talking about well-being in this way as I am. I don't think that that is very common, honestly. Um, but you know, I think the this lecture on neuroplasticity is really an example of of how I like to approach teaching well-being to medical students and really anyone who is in healthcare, because I think all of us have this respect for science, um, respect for, you know, really robust research and our ability as scientists to sort of change our mind over, you know, years and decades about how our bodies work, particularly how our brain works, because I think that's probably the organ in our body that we know the least about. And neuroplasticity really sort of follows in that pattern. So, neuroplasticity, the way I think about it is that it refers to just it's a capacity of the brain. And this capacity is really to change in response to what we do, what we think about, what we experience in any given day. Now, that doesn't mean that our brain is constantly changing, you know, to everything that happens in a given day or a given moment, but the capacity is there. And I think what's really fascinating to me is I was an undergraduate student at UCLA in the sort of mid to late 90s, dating myself a bit, but um, and I was a psychology major, and uh, you know, a lot of the classes I took were focused on neuroscience because that's really what I liked the most about psychology. And even then we didn't believe or we weren't taught that the brain had this capacity. Um, it was really thought or believed that sort of all the changes that our brain was capable of of making would happen early on in our life, you know, in our childhood or young adulthood. And then that capacity like sort of dwindled to nothing. And we just over the years we would just sort of lose brain cells. And that was pretty much how our brain changed from then on. And now we know through you know several different people that the mature brain is malleable and is actually capable even of regeneration, um, and that it does so continuously throughout life. And you know, those are both um structural changes. So like we actually can see changes in volume in certain parts of the brain in response to you know a brain injury. Other areas of the brain will compensate by literally changing in size, formation of new neural pathways, you know, for the same reason. And then there's also functional changes, so changes to like the frequency of how much a certain group of neurons fires, or um, you know, it changes the amount of chemicals or chemical signals that are released between neurons, um, and so changes the way they communicate. So that changes the strength of connections between groups of neurons. And, you know, we sort of had an idea that that could happen in response to injury, something like stroke. But I think more recently, and what I'm most excited about is that we're learning that we can, as you know, sort of agents, um, or you know, with our own agency, practice or do practices that will actually change our brain, either structurally or functionally, um, things like meditation and mindfulness. And so that's really what I'm excited about and why I teach it in the well-being course is because these are practices that can be used to impact our well-being. And I feel like this is important both for you know health professional students to know so that they can actually relay these to their patients, right? Because that's like what an amazing thing to be able to talk with your patients. And you know, what I focus on is how we can um change the way, again, change the way that we're present for the suffering of other people so that medicine becomes a more sustainable career.

SPEAKER_00:

I have a thousand follow-up questions, Cassie. Yeah. Um, but first, my headphones are doing something weird. One second. My 11-year-old got to these. I know you know what this is like. So I'm I think he broke this side, maybe or something, because it won't stay in. Okay, well then that's I'll I'll just like be like this. Oh, okay. I get it. Um I think I want to first ask you because the science changed during the course of your education or you know, after residency, how did you come to find out that neuroplasticity was real? Was it a prof like a personal journey? Was it a professional journey? Were you teaching on it?

SPEAKER_01:

Yeah. So there is a researcher named uh Richie Davidson. He is a researcher at uh the University of Wisconsin-Madison, so just down the street from us, or down the freeway from us. Um, and he teaches or started the Center for Healthy Minds there. And he's written a ton. And um I learned about him when I took a class called Mindfulness-based stress reduction, which is a course that many people take. Um, it was developed by John Cabotzin many years ago, really for patients who were experiencing chronic pain. But um, I learned a lot about mindfulness and and the practices um that can help us uh sort of train our brains, right, around being more present, being more mindful. And when I learned about Richie Davidson, I was really fascinated by him because he had so much research out there and really, again, rigorous research that held itself to a very high standard. So, you know, as a scientist, I was very interested in that. So I started reading more about what does meditation really do? You know, like really what is what is it for? How does it change um how we interact with the world? And um I just was convinced enough that I started practicing myself. Um, and you know, I've never been one of those people that could sit for an hour a day and meditate because you know, who has the time? But I um am someone who fits in, you know, between you know 15 minutes of meditation, usually when I'm in my car before a shift. Yep. Yeah. Or when I get home before my kids know that I've, you know, pulled in the driveway, those kinds of times, I will meditate in my car. And the other practice that has gone along with that, that sort of is in that same under that same umbrella, are um practices related to self-compassion. So loving-kindness meditation um is one of those practices, really sort of how do you take all of that compassion, all of your capacity for compassionate action that we have as healthcare people, uh, and that we show our patients every day, how do we take that and sort of turn it back on ourselves? And and what does that do to our ability to take care of other people? And and over months and then years um of just that amount of practice, you know, maybe like two or three times a week, you know, I've been to some retreats um that focused on self-compassion, but really not, you know, I don't have all kinds of time, so like not that much, but even in that amount of practice, I have noticed, I've noticed most specifically um this sort of ability to see what it is that I'm feeling at any given moment. And when I notice that, I can see how that feeling, how that emotion, how that thought might impact, or so in some cases has already impacted the way I'm behaving in the world. So, you know, if I'm grieving something that happened at work, how does that show up when I come home and am present, you know, at dinner with my kids or or talking with my with my husband? And that I think the ability to sort of lengthen the time between between my emotion and feeling that emotion and my response has been what I've noticed the most clearly. And so, you know, and I tell my students this all the time, I'm never gonna talk to them about a practice or a concept that I haven't tried myself, that I haven't sort of put to the test. Even if it doesn't work for me, I will have tried it. Um, and that is one that practice in particular has really changed my life both in and outside of, you know, clinical medicine. Mm-hmm.

SPEAKER_00:

Let me track back to what you what I heard you say, which is how do you find your way into mindfulness as like a type A, high-functioning, um, you know, get it all done sort of person who is still actively working in medicine. And the answer is, you know, generally someone has some sort of like life event that has them ask a big question or turn to something like MBSR, mindfulness-based stress reduction, and then they see to believe it in their own life. Like, wow, this actually worked for me. That was certainly my experience as well. But I'm wondering then how you translate that to your students as well as to listeners now who are like, okay, all well and good. We've got N of two. It worked for Cassie and Mary Jean, but how do you relay that this small practice over time will likely have a result like you've had? Um, is there buy-in there? Is the are there is there a lot of skepticism that you found like within medical students?

SPEAKER_01:

Yeah, and you know, it's actually it's not necessarily for all the same reasons. I think part of teaching in healthcare in general, really, is being okay, being comfortable with the fact that not everybody is going to immediately buy into what you're teaching. You know, I think healthy skepticism is important. Um, and I I would never say that meditation or these practices would work for every person in, you know, in my class. I think there's a couple things that make it more accessible to students. I think the first is probably a bit more predictable, right? Like, like you said, like this sort of I don't have time for this, you know, like you've given me all this other work to do.

SPEAKER_00:

Correct. Exactly. Yes.

SPEAKER_01:

Um, how do you expect me to then take time to do something that may or may not actually change how well I'm doing in school or how good I feel? Um and that, I mean, that's a it's a great question. I think um, you know, I I um explain just what I explained to you, you know, how I fit it into my life. Um I like to be very clear about what it does and doesn't do, you know, for me in particular and what the research says, right? I mean, there are some things that meditation is supposed to change, um, you know, our ability to concentrate or focus and and really you don't see that realistically happen with people unless you are like an Olympic meditator, right? Unless you're spending 10,000 hours meditating. So I've never I'm I don't try and sell something that's not um true. So I tell a lot of stories when I'm trying to, well when I'm teaching clinical stories, stories about taking care of patients, times when you know I've really struggled and connect this practice with my sort of emotional recovery or just recovery in general from some of those um stories. But I think the other, in addition to sort of the time argument, I think that there's sort of I think the problem that that I've also run into is that students know that, you know, this is like meditation is we're borrowing that this is an ancient practice that we're borrowing from many other non-secular, right, religious-based um cultures, and that it wasn't designed for like all of us to like de-stress, right? Like meditation is not supposed, it's not there for us to sort of use as a tool to um decrease our anxiety. It you know, the the idea behind meditation is really to change like how we are in the world so that when we show up, you know, in spaces um with other people, we are a compassionate presence, right? The goal really is to increase the amount of compassion in the world by recognizing how um meditation changes the way we show up. And so I'm very clear about that with students because I don't ever want them to think that meditation in the absence of its you know, historical um and religious context or spiritual context, um, you know, is is what I'm trying, you know, is what we're trying to sell. Um and I think that's kind of how meditation and mindfulness gets a bad name um out in the world, is because it is sort of stripped of that underlying purpose.

SPEAKER_00:

Yeah. And I think that just as we've kind of started talking about mindfulness and meditation, and we started talking with neuroplasticity, it's almost been gamified to in a sense. Like, here's how this ancient tool is going to help 2025 CAA students and medical students. And I like to rewind it back and be like, okay, well, what's underlying this is this human capacity, this neuroplastic capacity that you can form new neural pathways on anything. You do anything repeated, well, not anything, but you know, it is it's just the fact that you're using that capability and you're using that to um, you know, develop a mindfulness practice. And the mindfulness practice, all that's doing is allowing you to pick where you put your attention, what you're gonna notice. And you're saying that what you teach your students is that, okay, you're gonna notice that you've got time between stimulus and response. And I'm teaching you to choose compassion in that moment. Um, and it's so it's just um, I don't know, I just really want listeners to understand that what we're saying is a lot of just human capacity and us choosing what how we use it. And then also the fact that these this ancient wisdom, this mindfulness and meditation has kind of like fallen into this like self-care, well-being category, not because it can't be there, but because um, I don't know, they want us to buy things. It's just like kind of commodified. But there is, but but the thing is it's an amb. There is truth to it. There is something valuable there for AA students and medical students. And it's just lovely to talk to someone who can piece that apart. You know, we're not talking about this oowe-goooey wellness, well-being, like, no, let's really talk about what's going on here. So thank you. I don't know if you have any comments after that that I went on a tangent.

SPEAKER_01:

No, I I think that sums it up really nicely. I mean, I think, you know, our brain is changing whether we are intentional about it or not. And so and most of the time we don't notice how our brains are changing. Um, you know, whether it's like scrolling, you know, Instagram or um binging Netflix or um mindlessly, you know, having a cocktail when you get home from work, whatever it is, we're we our brain is changing. And so I think that this is just even if nothing else, if if you can sort of help students remember that that capacity exists, our brain is going to change in um in response to the experiences that we have. And so, to what extent do you want to have agency in that?

SPEAKER_02:

Yes.

SPEAKER_01:

Um, and finding those, whether we call them skills or practices that will sort of help you feel or actually have some control over the way your brain is changing. Yes. I think that that's amazing.

SPEAKER_00:

Yes. I think it's amazing too, Cassie. I want everyone to have a voice like yours to understand this. I can't stress this enough. Like we are both speaking to a very particular type of mind. And the coming from the research and the evidence and the science of it does help us buy into the fact that we could have some more control over this than we maybe realize, um, which is all a choice. It's all about intention and a choice. So here's my last question, um, so that I don't, we don't talk for another hour on this, which I could do with you. But if you're speaking directly to um let's say, let's say the larger CAA community, which for this podcast incorporates people who want to become CAAs, AA students, which is like a 27-month master's program, and then practicing CAAs, which I know you're familiar with. What would you want them to understand about neuroplasticity, like as a take-home message, as like a little plant a seed, and then you're you water this and grow it yourself. You have to take this where it's meant to go for you. What would that takeaway message be?

SPEAKER_01:

So I say this a lot to my own students. I think, you know, becoming an AA, you know, the I I would imagine, just like sort of becoming a physician, our work can begin to feel technical, right? It can begin to feel transactional. Um but you know, I think CA students, you're present with patients at perhaps one of the most vulnerable moments in their lives, right? You are going to bear witness to patients who have serious illness, um, may be in severe pain, worried about what's, you know, what's to come on the other side of the procedure or the surgery, worried maybe even that they won't wake up, you know, and absolutely um I think that in just like medical students in the process of learning these skills that will help so many people, you're going to see your care team members handle that, you know, that moment of vulnerability, of witnessing that vulnerability with varying levels of skill, yes, with varying levels of grace, and just even starting with like looking around and saying, What how do I want to be in the world? You know, how do I want to be in that moment and who's doing that well, and who's maybe not doing that well, um, and recognizing that you know, nobody probably taught the people who are teaching you how to do this. Um, so I think just even paying attention to that is just a a place to start. And then, you know, finding those people, those mentors and saying, hey, how do you, you know, how do you bring that level of calm or that compassion or that whatever it is that really sort of made you stop and look um and just ask, you know, like these aren't the only meditation and mindfulness aren't the only practices that are, you know, help that can help in those moments. Those mentors can be incredibly great resources to learn all those things that maybe you're not learning in the classroom.

SPEAKER_00:

Mm-hmm. I love that. And I just I get excited thinking about the next generation of CAAs from these AA students who are having people teach them this and physicians that have you teaching this and like what change could be possible. Um yeah, it feels like it's the beginning of the world that I want to be practicing in, that I want to be practicing medicine in. Um, yeah, so I'm just so grateful to have found you, Dr. Ferguson, and I'm grateful to introduce your voice to my CAA community. And I want to have you back because I know some behind the scenes that you're writing a book and that um you are hoping to kind of expand the reach of the good doctor to other professions, to other medical schools. So I'm sure, well, I know I'm I'm gonna be emailing you, wanting to talk to you again, but have you on the pod again as well.

SPEAKER_01:

Absolutely. I'd love to, and I'm so honored that you asked me here. So thank you.

SPEAKER_00:

Thanks for listening to Awakened Anesthetist. If this episode resonated with you, share it with a CAA friend, an AA student in your life, or a perspective, and let them know why you loved it. It's the most important thing you can do to support this podcast and its mission. You can always find more ways to connect with me and this CAA community at awakenedanesthetist.com, including an invitation to join season five Mindful Connections. These are free virtual gatherings open to anyone in our Awakened Anesthetist community. And while you're scrolling the website, check out my trusted CAA partners who make this podcast possible with a special thank you to my season five sponsor, Harmony and Ashia Staffing. Talk soon.

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Mary Jeanne Roberts, CAA

Host