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Dean Katz's Blog

Being “a Professional” and “Professionalism” — Not the Same

September 15, 2014

This week we’ll celebrate a grand event – the White Coat Ceremony – where we welcome the Class of 2018 to the profession of medicine. While many schools hold this ceremony at the beginning of the school year, we do so prior to the “Week on the Wards” a full-time immersion experience where CMSRU students rotate through the different inpatient services.

And while the day will “formally” welcome these 72 future physicians to our profession, this welcome also occurred on their first day of orientation. At that time, I told them that, right or wrong, like it or not, they were now part of the profession, and they would forever be judged, viewed, and measured in this way. I also mentioned that the first evidence of this might happen as early as Thanksgiving break, when their Aunt Sally asks for an evaluation of her:

  1. Arthritis
  2. Rash
  3. Best friend’s diabetes
  4. Fill in the blank
  5. All of the above.

But really, their lives are now forever changed. Not only in those situations with patients and their families, but all of the time. 24/7. Being in this wonderful line of work is associated with great privilege but also with great responsibility. So, I tell our first years that the “burden” of this is with them at ALL times – not just in the classroom or at the bedside, but all of the time, no matter what they are doing.

At CMSRU, we’ve talked a lot about “professionalism”. It is one of the nine competencies for our students and it something upon which they are, in fact, evaluated. Passing the exams is expected. Likewise is behaving professionally.

Being in a “profession” does not always equate with acting “professionally”. No doubt, recent National Football League (NFL) outcast Ray Rice was in a profession. Professional football. His heinous behavior off the field demonstrated a lack of professionalism – at the very least.

NFL Rule 12 – Player Conduct; Section 3 – Unsportsmanlike Conduct; Article 1:
“There shall be no unsportsmanlike conduct. This applies to any act which is contrary to the generally understood principles of sportsmanship.”

Well, it’s a bit more than a 15-yard penalty this time, Mr. Rice.

For those in our wonderful field, professionalism must be a constant part of our lives and yes, I believe we should be held to a higher standard than most. Professionalism in the hospital, on rounds, in the clinic is expected, of course. But also beyond the clinical setting – in the classroom, among colleagues, on Facebook, at the grocery store, at a party. We are accountable for own actions and we must hold our peers to the fundamental tenets of professionalism.

So a warm welcome to the CMSRU Class of 2018!  We know that you can and will continue to raise the bar – not only for excellence in the delivery of care, but also in setting the standard for professionalism in medicine.

Paul Katz, MD
Dean
Cooper Medical School of Rowan University

 




Summertime and the Livin’ is Easy?

August 27, 2014

As the summer winds down and as now we are firmly in the 2014-15 academic year, I think it’s a good opportunity to review what’s been going on at CMSRU over the last few months.

Needless to say, we’ve been busy! Between wrapping up last year and preparing for the exciting things ahead, the team has been hard at work. What follows is a very brief summary of a few of the things we’ve been up to.

Provisional Accreditation from the LCME. In this blog, we’ve previously talked about the journey to full accreditation for a new school. In 2011, we received Preliminary Accreditation from the Liaison Committee on Medical Education, thereby allowing us to enroll the Charter Class in August, 2012.

In June we received the good news that we had been granted Provisional Accreditation – the second of three steps. In addition to receiving kudos from the site visitors, we were found to have no deficiencies, similar to our first visit! Notably, we received comments that we were “creating the medical school of the future”, something that makes us quite proud.

Next step? The LCME visit for Full Accreditation will occur in the spring of 2016, during the Charter Class’ final year. Just this week, our team began the process to prepare for this important event.

Phase 1 Retreat. The summer heralded the completion of Phase 1 – the first two years of the four-year curriculum – and what better time to review what had occurred? In a daylong retreat involving the faculty and staff who had shepherded this Phase, a thorough review of the accomplishments and challenges were discussed, with implementation plans created for some changes in this academic year. As a medical school committed to continuous assessment and quality improvement, we look forward to seeing the impact of these changes – and while our fundamental curricular structure is largely unchanged, we believe that these edits will further enhance the CMSRU experience.

Cooper Longitudinal Integrated Clerkship (CLIC). Last month, the Charter Class began Phase 2 of the curriculum in the CLIC. Typically, this year is largely hospital-based with sequential 4-8 week rotations (e.g. Surgery, Psychiatry, Neurology, etc.). But medicine is really not practiced this way anymore – it’s following patients across the continuum of venues (inpatient and outpatient) and managing illness over time. And don’t forget prevention – so critical to the nation’s health.

More closely mimicking the way medicine is and will be practiced, the Charter Class embarked in early July on the CLIC. Focusing initially on hospital immersion in the six core medical disciplines, in this novel clinical curriculum, the class continues to build their “own” portfolio of patients (expanding that which began in the first month of their first year!) under the tutelage of faculty physician preceptors. As they follow their cohort of patients over the year, the students will come to understand the critical elements of the continuum and transitions of care; and the necessary development of relationships with patients, faculty and all members of the health care team; and each other. We truly believe that this approach will embed knowledge and experiences that will serve our graduates throughout their careers.

Our Neighborhood. There is a LOT of activity in the Lanning Square neighborhood that is our home. Immediately south of the CMSRU building, construction is well underway on the KIPP Cooper Norcross Academy, New Jersey’s first renaissance public school. This month, 100 kindergarten students from Camden will start their education. Growing to K-12 with over a thousand students, we are excited to welcome our new neighbors and we look forward to building on the interactions that have already started with CMSRU.

 To our east, directly across South Broadway additional construction has started – a block long array of buildings that will house over 100 beds of apartment housing for CMSRU students as well as ground floor retail. With occupancy planned for the summer of 2015, this important project is well underway.

While there are other items on the “list of summer time activities”, this space will permit no more and I look forward to sharing more in the weeks ahead. So while the livin’ hasn’t exactly been easy, it has been exciting!!

Paul Katz, MD
Dean
Cooper Medical School of Rowan University

 

 




Keeping the doctor well: National Stress Awareness Day

May 5, 2014

Recently, CMSRU’s chapter of the Student National Medical Association (SNMA), the oldest and largest student-run organization focused on the needs and concerns of medical students of color, helped our school celebrate National Stress Awareness Day (NSAD). NSAD was started by the Health Resource Network (more info here) in 1992 to raise awareness of stress.  While stress is a national issue, among medical students it is even more troublesome.

A recent pilot study (here) from the Association of American Medical Colleges (AAMC) revealed a high prevalence of psychological distress among U.S. medical students, and noted that the effects of stress may be more deleterious to the well-being of the groups that are traditionally underrepresented in medicine.  The negative consequences of distress during medical training, such as reduced empathy, lower ethical conduct, and substance abuse are problematic, particularly if they undermine the goal of graduating knowledgeable, effective, and professional physicians.

In light of these troublesome data, several medical schools are working to develop wellness initiatives to mitigate student stress and its long-term consequences. Take for example, Vanderbilt Medical School in Nashville; it is among the most innovative and forward thinking schools as pertains to wellness. Just two weeks ago, CMSRU’s Chief Student Affairs Officer and I visited the school to learn more about how their students are incorporating wellness into their curriculum. Vanderbilt’s program is a student-run initiative comprised of five committees, each supporting a different area of student well-being—physical, emotional/spiritual, interpersonal, academic/professional, and environmental/community. Throughout the year, the committees organize various program events and offer resources for medical students including an annual, daylong wellness retreat where students are excused from their classes and clerkship obligations to focus on their own well-being.

Therapy dogs provide a welcome respite from medical school stressors at CMSRU

At CMSRU, we’ve established our own Wellness Committee comprised of faculty, staff and students that have both passion for and expertise in a variety of wellness applications including yoga, meditation, fitness, psychiatry, nutrition, and research. This Committee is focused on understanding the needs of our student community in order to build programs that will best serve them. Thus far, our committee has established a mission and vision and has secured dedicated space in our educational facility to support wellness activities. The Wellness Committee is also working to incorporate wellness awareness and activities into CMSRU’s curriculum.

As mentioned earlier, members of the Wellness Committee recently worked in conjunction with the SNMA group on CMSRU’s National Stress Awareness Day activities. With the goal of reducing stress for their peers, members the SNMA group planned a day that included fresh fruit, a quiet ‘meditation’ room, lunchtime chair massages, and the biggest crowd pleaser – therapy dogs. Two dogs and their trainers were available during the day to help promote a stress-free envi­ronment for our students. All agreed that it was a resounding success!

It will be important, going forward, to examine whether these interventions reduce the perceived stress of medical students and, specifically, if they are helpful for the student subgroups that were recently identified as those most negatively affected by the medical school experience.  With the advent of the Affordable Care Act (ACA), there is a new focus on preventive medicine and on keeping people well. If we intend to prepare physicians to think differently, it’s time that medical schools begin taking a different approach – one that not only teaches students how to make patients well, but how to be well and stay well themselves.

 

Patricia Vanston, MS
Associate Dean for Program and Business Development
Cooper Medical School of Rowan University




Thank You for Not Selling!

February 21, 2014

When I was a medicine resident at the University of Florida, the cheapest place to buy cigarettes in Gainesville was the Veterans Administration Hospital. The great irony of this was not lost on my colleagues and me.

We covered inpatient units filled with servicemen (there were few women at that time), many with chronic lung disease, head and neck malignancies, cardiovascular disease, lung cancer and permanent tracheostomies. Our efforts to make them well were seemingly counterbalanced by the large “Smoking Lounges” on each floor – complete with large screen (at the time – 26 inches!) TV’s, comfortable seating and ashtrays where the cigarettes purchased on the lower level of the hospital could be savored.

Eventually, the VA discontinued this practice as more and more data appeared about the risks of smoking. And while the first Surgeon General’s report (www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm) on the adverse consequences of tobacco usage appeared five decades ago, we only just now see a major tobacco retailer, CVS Caremark, halting sales in its stores. Change takes time.

CVS, the current leader in sales nationally among all drugstore chains, has gotten into the business of providing health care. With CVS’s almost 8,000 U.S. stores and nearly a thousand MinuteClinics® –  providing medical care delivered by primary care nurse practitioners and physician assistants, pharmacist-administered vaccinations, medication counseling, blood pressure monitoring and routine laboratory testing (no appointments needed and most insurance accepted – thank you very much!)- combined with millions of people now able to access care through the Affordable Care Act, the company is clearly positioned for expansion of care delivery services. So, CVS has come to the same conclusion as the Department of Veterans Affairs – albeit decades later – providing health care and selling tobacco are incompatible.

The financial losses resulting from ceasing their tobacco sales will be substantial, but as number 13 on the Fortune 500 list, CVS likely understands economics. So kudos to them for aligning social responsibility and business.

For those who have historically purchased tobacco from CVS, there are too many alternative options to count. But what about when the next drugstore chain or big box franchise or convenience store network does the same thing? And the next one after that? Incremental, but very public, changes in the availability of tobacco products such as this one will continue – “peer” pressure is very powerful.

While tobacco usage in our country has significantly declined since the first Surgeon General’s report, this improvement is far from uniform across age group, gender, race, personal income and educational level. There is still much to do. Let us hope that the other businesses see the wisdom in CVS’s decision.

P.S.  While we are on the topic of health promotion, perhaps we can discuss the snack food, sugar-containing soda and beer sold at CVS. Associations with adverse health outcomes exist for these too, right? Shouldn’t that stop as well? A thought for a future blog…

Paul Katz, MD
Dean
Cooper Medical School of Rowan University 




Access to Education and Opportunity

February 4, 2014

“The function of education is to teach one to think intensively and to think critically. Intelligence plus character – that is the goal of true education.”

 Dr. Martin Luther King, Jr.

 

Last month, our students arranged a “Martin Luther King, Jr. Day of Service” just as the Charter Class had done the previous year. Entirely student-organized and -led, nearly 80 young people ages 3-18 from the City of Camden were welcomed to CMSRU. The sessions planned were intended to be both educational and fun: reading food labels, the “new” food plate, exercise, the sugar content of soft drinks, anatomy of the brain, microscopy and more.

Not surprisingly the youngsters were captivated by what they witnessed as they were exposed for the first time to practical demonstrations of science and health. I am very proud of our students – they are truly committed to the City of Camden and to helping it regain its past glory – a commitment that we all share.  Imagine what outstanding physicians they will become!

The children of our city, like all children, have the right to high quality education, and while Camden has struggled in this and many other areas, the signs of hope are there. New charter schools (K-12) are imminent and the “meds and eds” are helping to drive much-needed change which brings hope and opportunity to Camden’s residents.

I recently finished reading a remarkable book, “First Class: The Legacy of Dunbar, America’s First Black Public High School” by Alison Stewart (Chicago Review Press, 2013). Stewart, whose parents are Dunbar graduates, relates the history of the Paul Laurence Dunbar High School in Washington, DC – the country’s first public high school for black students. From humble beginnings during post-Civil War Reconstruction, Dunbar became an “elite” school in the nation’s capitol after the turn of the century.  Ironically, it lost this distinction when desegregation occurred. The list of those who attended Dunbar is remarkable – political leaders, high-ranking military officials, educators, lawyers, business heads  - and the academic rigor of the high school propelled the school’s graduates into top colleges and universities.

It is hard to imagine now, but Washington was a sleepy southern town until the Kennedy family arrived and it was plagued with the same prejudices seen throughout the U.S. Prior to the creation of what would eventually become Dunbar High School, education for black children was almost non-existent in the District of Columbia, so the creation of a school that attained this stature is truly remarkable.

Unfortunately, desegregation led to the redistribution of Dunbar students and this, plus the politics of the city’s school system, resulted in hard times – poor academics, dilapidation of the building and the myriad of problems that continue to plague our cities’ public schools. And while hope remains that Dunbar will eventually return to its glory days, its future, and the future of its students, remains uncertain.

Such is the same in Camden, and it will take time, perseverance, money and commitment to get the schools to a place where students thrive and opportunities for success become the rule, rather than the exception. In the last blog, I wrote about the disturbing paucity of African-American men in our country’s medical schools – but the problem does not primarily reside with the medical schools, but with our system of public education that is lacking in so many ways.

So I hope that the MLK Day of Service at CMSRU will help depict to the children of Camden what is possible. It is incumbent upon all of us to help provide them with the education that will allow their dreams to become reality.

Paul Katz, MD
Dean
Cooper Medical School of Rowan University 




Wishes for Medical Education in 2014

January 7, 2014

It’s barely 2014 and there has already been considerable talk about the year ahead. This is a time where speculation and resolutions are rampant. Predictions about the economy, the impact of the Affordable Care Act (ACA) and mid-term elections accompany our own individual “promises” for the next twelve months. I heard last week that the typical New Year’s resolution lasts until January 17 – whether valid or not, we all know from personal experience the transience of our annual commitment to self-improvement.

So rather than speculate or resolve, I’m going to make five wishes for medical education in 2014. While nothing new, the medical education “industry”, both undergraduate and graduate, faces significant challenges that seem unlikely to be easily resolved. There are no answers in this blog, trust me. Here goes:

Wish 1 – Reduce medical student debt. Far from solved, the problem of the massive debt that graduates face needs to be addressed. Whether through loan forgiveness programs, increased Federal and state funding or other initiatives, we need to make medical education more affordable. Medical schools are under pressure to address this problem, but we cannot do it alone – there is just not enough money. Let’s keep  medical school from being accessible to only those with means.

Wish 2 – Increase the number of African American males enrolled in medical school. Despite the focus on and resultant successes in improving diversity among matriculants, there is still much to be done. Disturbing and equally perplexing are the disarmingly low number of African American males applying and being accepted to our schools, lower in 2011 than 2002. That this is solely reflective of the lower percentage of African American males receiving college degrees seems unlikely. One can venture that the focus needs to be on getting elementary and middle school students interested in both college and careers in science. Perhaps now is the time for a national task force to address this issue.

Wish 3 – Reduce the time from high school to practice. Also not a new dilemma, the time required to become a practicing physician in the U.S. is considerably longer than most countries. Reduction in the time from college to medical school and from medical school to post-graduate training has been undertaken – but it may not be for every student. Factors such as individual maturity, the benefit of life experiences and the importance of non-science courses as components of an undergraduate curriculum are among the arguments against a compressed time frame. But basing these transitions on “time served” rather than content mastery may be a flawed approach to shortening training. While considerably more complex, asynchronous learning in college, medical school and residency – where learners progress by achieving milestones, both educational and developmental – may be a solution. As we know, for many medical students, four years is adequate; but for some, it is too short and, for perhaps a smaller group, it may be too long. The same could apply to graduate medical education (GME) as well. A huge undertaking, no doubt, but perhaps worth consideration.

Wish 4 – Increase the number of GME positions. On second thought, allow me to qualify this:  Increase the number of GME positions to meet national workforce needs. In 2013, we saw a brief glimpse of the collision that awaits us – too many graduates and not enough residency positions. But this is not true for all specialties, especially the primary care disciplines, where funded slots go unfilled. Many have requested that the federal government increase the number of GME slots, but not everyone is buying that approach. Plus, where will the dollars come from? Medicare? Perhaps what is needed is a new methodology for governmental funding of GME positions based on market need. With the number of Medicare-supported residency slots frozen at 1996 levels and likely not to increase, maybe the slots should be reallocated based on the regional need for certain disciplines – for example, more primary care program positions and fewer in oversubscribed specialties. No option is ideal, but those newly insured by ACA must have access to care.

Wish 5 – Push innovation in medical education. Yes, we are doing better in both undergraduate and graduate medical education, but we need to do more. Some would posit that innovation is limited by the accrediting agencies – I think this is an excuse. Change is up to us, to those who deliver medical education. No question, this is hard work and the obstacles are many, but we have to do this. We must. This is true not only in how we deliver content (e.g., massively open online courses [MOOCs], “flipped” curricula) but also in terms of what we are teaching. Let us continue to expand our teaching and experiences in interprofessional education and care, quality and safety, technology, leadership, systems thinking, medical economics and those other areas that will allow future physicians to provide better and more efficient care.

We’re nearly two weeks into 2014 – let’s get started!!

Paul Katz, MD
Dean
Cooper Medical School of Rowan University

 

 




The Success of 2013; The Promise of 2014

December 17, 2013

Time has flown. It’s hard to believe that it has been a year since I wrote about 2012 in this blog. The past twelve months have been remarkable, indeed, and, as we celebrate the year behind us and plan for 2014, I want to extend my sincere gratitude to all those (and there are many!) who play such an important part in CMSRU’s success.

In 2013, the Charter Class completed its first year, a year that introduced our innovative curriculum; and we welcomed the 64 members of Class of 2017 last summer. We were very pleased with the educational program; as a fairly “nimble” organization, we made some enhancements along the way. Included among these was the introduction of “flipped” course work, where students review materials outside of class and then utilize classroom time for interactive exercises and team-based learning— all of which enhance retention. Our Ambulatory Clerkship, based in the student-run clinic, was a highlight for all of us. Now, functioning with teams of first and second year students supervised by our clinical faculty, the clinic is providing to care to Camden’s underserved populations and exposing our students to other health professionals as they train side-by-side with peers from other disciplines.

Service learning experiences also exceeded our expectations. Every student is required to complete 40-hours of non-health care-related service in Camden. Tutoring, coaching, serving meals and working in community gardens were among the contributions to the city. All told, the students far exceeded 2,000 hours of community service, equivalent to 40 hours of “paying it forward” every week.

CMSRU added faculty and staff to meet the needs of our growing number of students. We now number over 85 faculty and staff, not including our over 400 clinical faculty members based at the Cooper Health System. Add to this our faculty colleagues from the Coriell Institute and the University of the Sciences— our strong partners in education and research.

Considerable time was spent in 2013 in “planning” – planning for 2014 and planning for the continued growth of our school. We successfully concluded our initial philanthropic campaign – The 2012 Legacy Society – which raised almost $6 million for CMSRU. And we began planning for the early launch of our new development initiative – The Promise Campaign – which will conclude with the graduation of the Charter Class in May, 2016. (You can learn more about this campaign here.)

Significant preparation and effort went in to preparing for the Liaison Committee for Medical Education Provisional Accreditation visit in March 2014; this week, over 3,000 pages of material were submitted, culminating 18 months of preparation by dozens of CMSRU, Cooper Hospital, and Rowan colleagues and all of our second year students.

At the same time, our team has been hard at work creating the third year student experience – the Cooper Longitudinal Integrated Clerkship (CLIC). We are very excited by this longitudinal approach to clinical medicine; our students will participate in the care experiences of their individual cohort of patients as they traverse the continuum of care inside and out of the hospital. We’ll be writing more about this as the summer approaches.

Our novel admissions program continued to have great success, both in the recruitment of our current first year students and in the still ongoing process to enroll the 72 members of the Class of 2018 who will join us in August. While our interviews continue now, we have closed our application process as of December 15; for our incoming class, we had almost 5,300 applications, roughly 75 for every position.

There is so much more I could write, and in the weeks ahead we’ll talk about the many great things that are going on in Camden, the city invincible. We are equally proud of these and we are privileged to be a part of the rejuvenation of our hometown.

To you and yours, best wishes for the holidays and for a happy and healthy 2014. And special “thanks” to those who play a part in CMSRU – let us all celebrate our success.

Paul Katz, MD
Dean
Cooper Medical School of Rowan University

 




Live Blogging the AAMC Annual Session – Tuesday, November 5

November 5, 2013

Welcome to Philadelphia!  It’s another great day at the AAMC Annual Session – and Election Day!  If you are local, don’t forget to vote, and if you are not, we hope you remembered to send in your absentee ballot!  We’re still learning a lot still here…

Leadership Plenary:  Embracing Changes in Culture – Driving Organizational Success by Building a Culture of Contributors

A strong session to start Tuesday morning (and the last of the plenary sessions) brought Adam Grant, PhD to the group to discuss givers, matchers, and takers – and which type is best for organizations.  Happily, it Dr. Grant’s work appears to have shown that “givers” are, in the long run, the best type for both individual and organizational success (although perhaps NOT in the short term, surprisingly).  The most important points not only were to encourage givers (who can influence matchers and even takers to give more), but to prevent takers from “getting on the bus.”  Tips for recruitment were discussed, and opportunities to bring out the “giver” in all were suggested.  Uplifting, energetic, and informative start to the day!

MedEdPORTAL and MedAPS Update

Great update by the AAMC team on these topics - www.mededportal.org and www.aamc.org/medaps
There are significant opportunities for online publishing, collaboration, and CME among others.  New initiatives include:

  • • Directory and Repository of Educational Assessment Measures (DREAM)
  • • Khan Academy MCAT2015 Tutorials
  • • LGBT Patient Care Project
  • • Oral Health Curriculum
  • • Teaching for Quality
  • • Curriculum Inventory

Great resources for staff, faculty and students. Check out the websites!!

RIME Invited Address

This was an excellent invited dress by Clarence Braddock, vice Dean at UCLA, about patient centeredness as an organizing framework for medical education research. He made a strong case that patient outcomes should be a principal measure of the success of our medical education program. He said a good medical education program graduates excellent doctors, but a great one improves health outcomes for patients and populations.

Digitized poster session: Curriculum

This session offered seven posters related to curriculum innovations or daily practice in UME.  Topics for this session covered LCME as a vehicle for continuous quality improvement through an innovative obesity curriculum for M2 students that incorporated an SP encounter to discuss weight loss options for patients.  Great ideas for all of us to consider!

Light Years beyond Flexner: Academic Medicine  in 2033

Discussed team based models of care for patient needs, training structure and continuum of med education, technology in medicine and impact on patient physician relationship.  Beyond….Information science, decision science, social science and art back into medicine??

In the future, most of what physicians do today will be done by others.  Physicians will deal with complexity and ambiguity, become the designer, innovator and navigator as well as the leader or coordinator.   Other possibilities- “ultrasound on steroids”, holographic and lifelike robotic mannequins and situational simulation with telepresence.  Leaders will need both critical and creative thinking, competency based evaluation will take on another look and individualized medical education will be what occurs including self phased curriculum and blurring of UME and GME

 




Live Blogging the AAMC Annual Session – Monday, November 4

November 4, 2013

AAMC Town Hall

Dr. Kirch again took us through a variety of audience generated topics, including global health (GHLO - https://www.aamc.org/services/ghlo/), GME, MOOCs, and one that generated lots of buzz online and off…  this conference, and what it should look like.  Should the AAMC annual session split out educational focus from other topics (lots of concern about this one) – or research, etc.?  No one wants to give up the opportunities to network, learn about areas a bit peripheral to one’s own expertise – all available in a large, multi-focus conference.  However…  conference is super-sized and getting unwieldy for some (and venue can be challenging – as we have all seen these past few days).  Chicago AAMC meeting next year is shorter, different formats (more broad, user driven) and there will be more targeted conferences separately.  More info and more feedback is certainly needed!

GME:  What next?

A hot topic at this year’s conference.  Attendees heard a variety of viewpoints – health sciences VP, medical student (arguably the best speaker!), and DIO.  If we focus on just the student views – paints a challenging picture.  Students come to medical school NOT as pluripotent stem cells, but as individuals with already molded expectations of careers in medicine.  Can we expect them to create “parallel paths” to residency in less-competitive specialties if that is not what they are cut out to do?  As it was so perfectly put by the Dartmouth student, “If you take 100 competitive people and put them in a room together, you should expect that they are going to compete.”  Flip side is that some of those “competitive” students are not going to be able to compete, and options will be lots of debt and no ability to become a physician…  No easy answers generated today…

Innovative Organizational Models in a Time of Rapid Change

Heerad Sabeti took the audience through his perspective on an emerging new, fourth sector (after business/for profit, government, and not-for-profit) – the “for-benefit” organization.  This type of organization melds the income-generating/revenue-earning focus of the business sector with the societal benefit focus of the not-for-profit and governmental sectors.  Unlike govt and not-for-profits, these organizations are not funded primarily by grants, taxes, or donations, but by earning their income.  However, unlike the business sector, their goal is not income/wealth for their owners, but societal benefit.  Current legal and other structures are challenged by this model; we need new regulatory and legal approaches to this type of organization to make it work.  AMCs already have some of the characteristics of the for-benefit corporations, but need to push further along the spectrum.

Enhancing the Sustainability of Postbaccalaureate Programs in Medical Education: outcomes and collaboration

This fairly recent national collaborative described the development of the group with the AAMC.  The types of postbacc programs that exist, as well as the student groups most likely to benefit from their curricula were outlined.  The goals of the collaborative include the development of shared resources, support for the development of new programs, collaboration in research efforts, and sharing best procedures.

Student Surveys

This session went over the updates of the various student surveys including the MSQ.  Student wellness is now a focus of these surveys including time management and use of stimulants. The survey is anonymous but the response rate was only 18 percent. There are sexual identity questions for the first time. Females noted generally higher social support and the answers were more positive than other groups. 13 to 20 percent report using stimulants and alcohol use is even higher – obviously a very concerning statistic for us.

Innovative Uses of Clinical, Research, Education, and Multipurpose Space:  A Virtual Tour

Six terrific virtual tours of new and reconstructed spaces were reviewed, including:

The Change Imperative Plenary Session:  Embracing Changes in Culture

Daphne Koller, co-founder of Coursera, discussed the work in MOOCs.  Presented a variety of fascinating strategies and actual data on outcomes and benefits of the pedagogy.  Of interest –

Also discussed the potential to use technology to replace and/or supplement individual tutoring (which has best outcomes to learning).

Questions – what about massive offering of medical content for medical schools!

 




Live Blogging the AAMC Annual Session – Sunday, November 3

November 3, 2013

Welcome to Philadelphia!  Day 3 of the 2013 AAMC brought a fascinating array of topics – and lots of great ideas for the present and future!

Plenary Session:  Envisioning Changes in Health Care

Fascinating, frustrating, and somewhat frightening session on the future of the health care system in the age of ACA and HIX.  Futurist Ian Morrison took us on a tour of the potential futures, with his prediction that the US will end up with massive healthcare provider consolidation, ultimately ending up with 100-200 large regional centers. The question is will all AMCs be in that group, just some, or none? Private exchanges are likely to take off, and healthcare is likely to go the route of pensions:  defined contribution instead of defined benefit.

Four potential scenarios were proposed:

  1. Managed Competition Nirvana – Public and private exchanges grow, individual consumers are primarily driven by price, with resulting focus on managed, low cost networks assuming population risk
  2. Minor Miracle – Public exchanges are the primary source of HIX – and the success or failure of the current California plan is key
  3. Single Payer (Player) – Public exchanges grow enormously in the long run, with the resulting environment looking like Medicaid for all
  4. Meltdown – Exchanges are a complete failure in states with high numbers of uninsured; mandate is too weak and unenforceable; young healthy individuals stay away from HIX and high risk individuals sign up, creating a prohibitively expensive program.  Healthcare is the primary 2016 election issue.

Khan Academy for PreHealth Preparation, the MCAT 2015 and Beyond

This session provided some history of the joint effort between the Khan Academy, AAMC groups, and the Robert Wood Johnson Foundation to produce high-quality, open access educational materials specific to concepts tested on the new MCAT.  The work to create a freely accessible content library for premedical students is part of the larger effort to remove barriers to medical school, and has been strongly supported by The AAMC and the general academic medicine community.  The balance between fact retention and problem solving within a conceptual framework on the new MCAT was a point of question, but no clear answer emerged during the session.

Town Hall – GSA (Admissions)

Many admissions officers spoke of their concerns regarding the removal of the recruitment activities from future AAMC national meetings.   Future recruitment events and related logistics will require all involved groups to work together.

Town Hall – GSA (Group on Diversity and Inclusion)

Open discussions about the efforts needed to dissolve the silos between GSA groups. Some very good ideas were offered, and everyone was enthusiastic to continue the progress made thus far, in addition to improving communication within GSA.

 

Digital Literacy for Educators and Learners

Social media experts from med ed discussed approaches to online media and the new AAMC “Toolkit” (available at https://www.aamc.org/members/gir/gir_resources/359492/digitalliteracytoolkit.html) for digital literacy.  The group reviewed several of the case studies and had a lively discussion on the “right” answers…  and discussed the ongoing and dynamic nature of how physicians and their patients communicate – both online and in person.  Educators have an obligation to prepare our students for the world of communication with patients – beyond the one-on-one.

Assessing personal competences in the 21st century

This session discussed research leading to the potential use of a new medical schools admissions test that is comprised of situational judgment tests that address interpersonal and interpersonal competences.  There is also potential to use this as a measure of ability to move from one level of medical education to another – i.e., from preclinical to clinical training.

Cohen Humanism Lecture: Health Care in an Information Age: How Doctors, Nurses and Consumers Can Make One Another Better  

All around a wonderful (and jam-packed) session.  Journalist Anna Quindlen compared the gap between providers and consumers to that between newspapers and consumers. Neither have met the changing needs, but unchanged wants, of readers/patients.

She challenged the notion of “MDieties” and asked the profession to focus on “just being kind.”  Patients ask their doctors, “Do you know who I AM?”  We need to be able to answer yes.

Making the case for health systems competencies to improve care: integrating patient care, research and education

We must teach quality improvement across the curriculum.  Schools can combine didactic and experiential learning, link with health system improvement efforts, assess education outcomes in this area, and have role models for quality improvement in educational processes.

Core Entrustable Activities for Entering Residency

A task force has identified 13 core Entrustable Professional Activities for entering residency. The project was initiated to address the international focus on transitions (UME to GME to CME) and the gaps that were identified between expectations of program directors and entering resident skills, and what residents were asked to do without supervision and what was documented that they were competent to do.

Entrustable is defined as “without direct supervision” which is different from a practicing physician. Activities should be viewed as a floor (minimum competency ), not a ceiling, and should not replace mission-critical activities.

EPAs were selected as they represent day to day activities of residents, and are observable. Competencies are abstract and granular. However, there is a connection between EPAs and competencies. All selected EPAs spanned more than one competency.

The task force document identifies the EPA, aligns the EPA with competencies, and provides vignettes of “entrustable ” and “nonentrustable” students.

The longitudinal integrated clerkship was viewed as a better organizational structure for documenting EPAs.

Careers in Medicine

The site team went through a demo of the site. It can now be offered to accepted students prior to arrival using their AMCAS number with school assignment at the time the SRS is complete. We can also now offer the site with tools to our faculty mentors and greater tools to Advisory College Directors. The new site is easier to access and integrates the newsletters and sites for further information on specialties. There are plans for further expansion as well.

Transformative student initiated innovations and developments in medical education.

This session focused on five innovative student led projects in medical education that immersed students in the healthcare of their communities.  CMSRU’s own CCCP Ambulatory Clerkship is already at the forefront of best practice.  One idea presented was the concept of students as health coaches – with students empowering patients with chronic health conditions to navigate the health care system.  This is very similar to what CMSRU does in Ambulatory Clerkship and what we plan for our CLIC.  Add in our commitment to service learning and our students are learning and serving our community as part of our innovative curriculum!

The Future of Healthcare and the Learning Environment

This session saw four presentations from panelists discussing new programs for quality improvement and GME expansion.  Wayne State and Duke both instituted QI programs that involved UME and GME that also aligned with the hospital’s needs.  Duke’s program financially incentivized housestaff to achieve specific metrics.  Both programs found success through aligning educational program targets with goals that the health systems desired.  FIU and the University of Georgia discussed programs to increase GME in their own states through partnerships/funding from managed care (in FIU’s case) and the state (in UG’s case).  Both were in the early stages – more to come!

Medicare Maze

State healthcare exchanges launched fairly well, but there were very few.  Estimates are that 10,000 people will be added to Medicare rolls per day for the next 19 years.  Emphasis will need to be on quality, efficiency, and cost reduction.  Expected M&A activity will raise anti-trust concerns.  With GME, teaching hospitals will no longer be able to count the time residents spend at critical access hospitals for IME or DME purposes.

Personal Competencies: the SJT

The AAMC has a project underway to create a test to measure skills and attributes not seen in the MCAT and in grades. The test will be a balance between cognitive and behavioral issues. This is a aimed at the selection step and is at least five years from implementation. The concerns surround the effects of coaching and faking on outcomes over time and the difficulty in creating enough scenarios.

Keynote Address:  Joe Scarborough and Mika Brzezinski

An entertaining hour of political discourse ranging from the adversarial but still collegial relationship between Ronald Reagan and Tip O’Neill to the full-on war between the parties in Washington today.  Mika and Joe talked about their own upbringings – including Mika’s dinners with the Pope and Deng Xiaoping, and Joe’s father’s refusal to vote for him when he ran for Congress.  Finally, a few predictions for the 2016 elections (with a lot of hedging)…  an entertaining evening presentation!

 




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