KI's new president Annika Östman Wernerson - Kidney specialist with a passion for education
The new president of Karolinska Institutet, Annika Östman Wernerson, is professor of renal and transplantation science and has a passion for pedagogical research. Internal culture and building ‘one KI’ by strengthening the dialogue and communication between management, departments, staff and students is one of her biggest driving forces.
Name: Annika Östman Wernerson
Title: Professor of Renal and Transplantation Science at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet and consultant in clinical pathology at Karolinska University Hospital in Huddinge. Assumes the presidency of KI on 1 March 2023.
Age: 61 years.
Family: Husband, three daughters, two grandchildren and a miniature schnauzer called Molly.
How I relax: By taking walks in the fresh air, skiing, walking the dog, meeting friends.
Motto: Never ever give up.
Inspired by: My younger research colleagues, but as my role models I’d like to name my doctoral supervisor Professor Finn Reinholt (who was direct, honest and supportive), Professor Annika Tibell (who is wise, dynamic and generous), researcher of pedagogy Håkan Hult (who is a receptive, curious and creative person who thinks outside the box) and my boss, Professor Peter Stenvinkel (who is a productive and responsive researcher who wants the best for everyone).
Best qualities as a researcher: I’m persevering and systematic. And I like teamwork.
Text: Cecilia Odlind
How can we create the optimal learning conditions? Feeling good is an important start, according to KI’s new president Annika Östman Wernerson.
She has been engaged in student wellbeing, both in her previous role as academic vice president for higher education at KI and as a researcher of medical pedagogy. One of her objectives as she enters her new office is to make sure more space is given to higher education.
While teaching as a doctoral student early in her career, Annika Östman Wernerson noticed that her pupils became more interested when she based her lessons on genuine patient cases.
“If you’re curious about something, you want to understand it. And if you understand it, you’ll retain your knowledge about it, and you don’t have to cram it in,” she says.
It isn’t so easy in the beginning
Emotions can also influence learning, as an interview and survey study of students who attended autopsies showed. Some of the group thought it was fascinating and highly instructive.
“But another group stood pressed up against the wall,” says Professor Östman Wernerson. “Maybe they’d never seen a dead body before and were tense and unable to concentrate. That group didn’t learn much at all.”
She and her research group found this interesting and they wanted to understand more about the kinds of situation that medical students consider distressing. Interview studies showed that clinical placements that involved working with serious disease and death and ethical dilemmas were emotionally difficult, as were the occasions when colleagues focused too much on the diagnosis and didn’t really acknowledge the patient.
“It takes energy and time to come to terms with all the thoughts that such things arouse, and there’s little support, if any, for dealing with them,” she continues. “I have no quick fix but I think it’s vital that space is created for reflection with others in the same situation.”
She also believes that more senior colleagues need to remember that it isn’t so easy in the beginning.
“We must take care of our younger colleagues and show some empathy,” she says. “This is easily forgotten.”
An as-yet unpublished study by Professor Östman Wernerson et al shows that over half of all medical students are worried about burnout.
“Surveys of medical students show us that many are insecure and lacking in confidence. Female students were particularly unconfident and more susceptible to mental heath problems. They need more support, especially from colleagues.”
Was an assisting nurse before becoming a doctor
She was herself highly motivated when she first began to study medicine.
“As soon as I left school, I spent a few years working as an assisting nurse, and it never crossed my mind to be a doctor,” she recalls. “Neither of my parents are academics and I thought you had to be superhuman to become a doctor.”
But with time she realised that doctors are normal people too, and the profession could be something for her.
“As a student I already felt at home in the medical environment and had many questions I wanted answering. But I definitely remember also feeling insecure and anxious.”
She specialised in pathology with a focus on kidney and transplant pathology, and it is in renal medicine where Professor Östman Wernerson has her other research interest. She is passionate about bringing kidney diseases, which she believes to be relatively overlooked, to the fore.
“At least ten per cent of people in Sweden and around the world are affected, and the problem is growing,” she says. “But it’s relatively unknown as it is often concomitant with other known diseases such as diabetes and cardiovascular disease. We need more specific treatments and suppressants.”
Took off to El Salvador
Professor Östman Wernerson has also taken an interest in CKDu (chronic kidney disease of unknown cause), which affects many young men who do physically demanding labour in hot countries, such as plantation workers in Central America. She travelled with a doctoral student to El Salvador and conducted a minor kidney biopsy study to understand more about the damage done to the kidneys of these people. They have also since taken samples from patients in Nicaragua, Sri Lanka and India and seen similar damage.
“It’s been speculated that pesticides could be part of the aetiology, but this isn’t backed up by epidemiological research and other studies. Instead, we think that the disease is attributable to repeated damage caused by poor oxygenation due too excessive physical labour in a hot climate.”
It was an eye-opening experience for her to meet people in these low and middle-income countries. Access to dialysis and kidney transplants is nothing like that in Sweden, and disease-related fatalities are high.
“There are villages where there are hardly any able-bodied men left,” she says.
Another research group in Gothenburg has conducted intervention studies showing that the damage can be prevented by sharpening billhooks, introducing rest periods and ensuring access to water.
“It doesn’t take much to make great improvements.”
Conditions for people with kidney diseases are very different in Sweden, where, unlike in many poor parts of the world, advanced treatments are widely available. Despite this, much still remains to be learned – the prognosis for common kidney diseases such as IgA nephropathy and diabetic nephropathy, for example. To address this, professor Östman Wernerson has started a biobank project in which tissue, urine and blood samples from patients with kidney disease are stored in order to ascertain how gene and protein expression and other variables can be linked to the onset, prognosis and progress of the diseases.
“It’s quite risky to take tissue samples from the kidneys, so you can only take a tiny amount. It’s only now that we have the technology to make qualitative analyses on such small samples.”
The aim is to understand why some patients fare better than others. A third arm of her kidney research involves transplants.
“Patients with kidney transplants generally do very well. But sooner or later problems can arise, such as immunological damage resulting from rejection. We monitor these patients accordingly to identify risk and success factors.”
Different research fields complement each other
Professor Östman Wernerson finds researching two so very different fields rewarding, as it gives insight into different types of research and how they can complement each other.
“Studies in medical education are often qualitative and involve fewer individuals, which is uncommon in medical research and therefore occasionally contested. But interviews can be used to identify interesting questions that can then be interrogated by surveying larger groups. It seems to me that the field has a lower status, which is problematic, not least because it makes it harder to get grants for this kind of research. I think we have to recognise differences in methodology, for example, and pedagogy research is needed if we’re to engage in evidence-based education.”
The knowledge generated can also feed into other contexts.
“We talk about lifelong learning,” she says. “It’s also good to know how best to communicate at scientific conferences and other learning situations.”
She also thinks we are in a particularly interesting and instructive situation right now.
“The pandemic forced us to do much of our teaching remotely for a long time,” she explains. “There are today two student camps, one that thinks remote teaching is the best thing since sliced bread and one that thinks it’s the pits. But how does it affect learning? We need to find this out so that in future we’ll be able to choose the setup that works best, which might be different for different subjects and different parts of a programme. The most important thing is that our students are well-prepared for their future careers.”
The best things about KI according to the President
What’s the best thing about KI?
“The commitment and enthusiasm of the staff and their willingness to influence and improve. KI has an incredibly inspirational environment that induces and embraces competence, talent and creativity.”
Where do you think KI can improve?
“There are sometimes signs of a culture of envy and unnecessary spite that’s lacking in empathy and understanding of other perspectives. I’ll be working a lot on our internal culture and on strengthening the sense of community here, the ‘we-spirit’. Every one of us must do our best in the roles that we have, but also contribute to KI as a whole.”
Why do you think you were put forward as KI’s new president?
“I think my background had a lot to do with it, the fact that I’ve been working in both research and education at KI for a long time and also have clinical experience as a doctor. On top of this, I’ve had managerial positions as dean and academic vice president, and have built up an extensive network over the years that has made me very familiar with the context in which KI operates.”
Why did you want to be the president of KI?
“Because I think I can take KI further given the background that I have. It will be a huge challenge but I’ll be helped by my many wise colleagues at KI.”
What issues will be priority for KI in the coming years?
“Our internal culture and building ‘one KI’ by strengthening the dialogue and communication between management, departments, staff and students. We must work not only to improve the general conditions for research and higher education but also to optimise our resources locally. We’ll also need to evaluate and follow up on KI’s Strategy 2030. Our collaboration with Region Stockholm is another important aspect of strengthening clinical research and clinical placements. We’ll also need to work with the lessons of the pandemic, engage in responsible internationalisation and promote academic freedom.”
You’re deeply involved with issues of higher education, especially compared with your predecessors. What might this mean?
“I think KI needs to give more space to higher education and that we can develop the interaction between higher education, doctoral education and research even more. Our research makes a fantastic contribution to medical progress and to human health, while our education contributes skills and knowledge to the healthcare and life science sectors, amongst others. Our students are also our future colleagues – and here too we need to enhance the concept of ‘one KI’.”
What is KI’s most important role in society?
“Health issues are one of the most important societal sectors by far and constitute one of the global goals. Just look at how we’ve been affected by the pandemic. Our research and education make an incredibly important contribution to human health nationally and globally, and KI has a vital part to play as a regional, national, EU and global actor. As a world-leading medical university we must continue to have a voice in the public discourse and drive developments on the basis of evidence, knowledge and engagement.”
How would you sum up KI in three words?
“Creative, knowledge-driving flagship.”