Dean's Blog

On Wednesday, CMSRU was very proud to receive an SNJ Business People Impact Award for our contribution to economic growth in southern New Jersey. At this very early stage of our development, we truly appreciate this recognition – even before our Medical Education Building is completed and before our charter class begins their education next August.

But there is more to come for CMSRU and for Camden and the region. Medical schools have been demonstrated to be big economic engines. Given the challenges the country is facing, we are very pleased as a new and growing school to be able to play a part in reversing the current economic situation.

In 2009, the Association of American Medical Colleges (AAMC) published data gathered by Tripp Umbach that measured the impact of AAMC member schools and teaching hospitals. In 2008, the total was more than $512 billion and more than 3.3 million full time jobs. Surprising to me at least is that this number of jobs equates directly or indirectly to one in every 43 wage-earning positions!

So how do these numbers add up? In addition to employment opportunities, medical schools and teaching hospitals and their staffs spend money on goods and services; spending by medical students and patients and their families also contribute significantly. As the AAMC points out, these are “direct” expenditures – these dollars “re-enter” the economy through re-spending by those who received the funds initially thereby generating a “multiplier” effect. Tripp Umbach data indicate that in 2008 this multiplier was 2.3, generating an even greater return!

For CMSRU, one of the ways in which this community benefit is now being realized is through the construction of our $139 million, 200,000 sq. ft. Medical Education Building. We’re very proud that this magnificent structure is being built primarily by New Jersey-based companies at a time when the construction industry is struggling. The purchase of the bricks and mortar, plumbing, lighting and the too numerous to count building components from local companies is having a positive impact as well.

We are delighted that local residents are being put to work; we track the number of workers on site and where they are from. The “metric” of hours worked by city of Camden and Camden County residents is above benchmark – and we hope it becomes the new standard against which other projects are measured. As the number of workers grows to up to 350, we believe this will increase even further.

But beyond the construction of this building, we anticipate many economy-boosting effects from CMSRU, such as the over 100 employees located in this building plus the 400 students  who will eventually  study, live and spend in the city and region.

In a recent blog, I wrote about the social missions of medical schools and the metrics associated with these missions.  Part of that social mission includes supporting our community – not just supporting physical health, but economic health as well.  We hope the next economic “annual physical” demonstrates that the patient is on the mend and well on the way to robust health!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

Last year at this time, I wrote a blog in which I listed some of what we at CMSRU were thankful:

• • Strong institutions in Rowan University and Cooper Health System with social missions committed to the region
• • A great history of education at both institutions
• • Active participation by broad constituencies in the creation of our school
• • Impressive bipartisan support at the state level
• • A state-of-the-art Medical Education Building now under construction
• • A planned curriculum aimed at preparing our graduates to practice in the changing health care landscape

The past year has gone quickly by and we are again appreciative of these things – but this year we are grateful for so much more:

• The admission of the Charter Class. It’s hard to put into words how exciting this is for all of us! Exciting not merely because we get to interview bright and committed young men and women who are interested in careers in medicine, but exciting because we are identifying future students who are energized about the chance to live our mission. The remarkable commitment to serving those most in need of care, their desire to venture as “pioneers and partners” with us to shape the future of medical education and care, their willingness to explore new ways of thinking and learning – these attributes will ensure our success. Our city and region will reap the benefits of the skills, competence, and enthusiasm that these new CMSRU physicians, the Class of 2016, will bring to the community.

• A growing faculty of true believers. Starting a new medical school and moving the medical education compass is not for everyone. CMSRU could easily retreat into becoming a “me too” medical school – but that’s not what we are about. Our 400-plus faculty members are leading the efforts to do something different, to do something special. This is reflected in our admissions process, curriculum and service experiences. Our faculty doesn’t want a medical school that is a mirror image of other medical schools – they want to be leaders, not followers.

• A clear vision for the future. The process of accreditation and the execution of the plans for the arrival of the Charter Class in August have given us time to refine, polish and put a finer point on where we see CMSRU going as an institution. Our community partners and organizations are helping us implement the vision for the school and we are starting to see glimmers of the impact we will have. This is a critical time for us to ensure that we are headed in the right direction. We’re getting there!

• The support of our families and each other. Make no mistake – starting a medical school is heavy lifting.  There are an enormous number of moving parts and, as incredibly rewarding as creating CMSRU is, the hours are long. I know the sacrifices that are being made and the incredible support we get from our loved ones makes a huge difference – they are as much a part of this journey as anyone. We also have the great support from and camaraderie of each other on our great team. For this, I am especially grateful.

The list of things for which we are thankful continues to grow, and we reflect during this holiday of thanksgiving on how lucky we all are to be part of such an exciting and rewarding venture.  We wish the best to our friends, families, colleagues, and future students, and hope all of our readers have a holiday to remember!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

While my “real job” as Associate Dean for Program and Business development at CMSRU includes a myriad of planning and organizing projects that support the long term goals and objectives of the institution, I also teach and take one or two yoga classes every week.  I find that the time I devote to my yoga practice really supports the rest of my life, including my family, my friends, my career and my physical and mental well-being.

Recently, I attended the first annual Yoga Alliance Leadership Conference for registered yoga teachers.  It was an opportunity for people like me (well, sort of like me – most participants teach yoga full-time)  to learn about the various ways that yoga, mindfulness and overall healthy living can benefit one’s life and the lives of those they teach.

While I expected the majority of the conference to provide insights on how I could make my classes and my own practice more inspiring or beneficial, my greatest insight was that much of what yoga offers could provide a great deal of benefit to medical students and their educators, as well to their future patients.  I recall a few recent articles I’ve reviewed which cited studies surrounding the level of stress, anxiety and depression among the medical profession and, in particular, medical students.  A recent NY Times article stated that ‘Students enter medical school with mental health profiles similar to those of their peers but end up experiencing depression, burnout and other mental illnesses at higher rates’.

Another article in Academic Psychiatry in 2008 stated that physician impairment is detrimental to the field of medicine, since these physicians are more likely to lose their licenses and careers, and to patients, since impaired physicians deliver suboptimal care.  In the past 20 years, attention has been given to helping the impaired physician, but less attention has been paid to preventing impairment and increasing the overall well-being of physicians. One aspect of this is the promotion of positive self-care which should begin early in medical training.

Based on the above, CMSRU is considering taking proactive steps to provide new medical students with tools to take care of themselves.  Taking time to breathe, to clear one’s mind and to focus on their own well-being can only serve to nurture our students’ physical and emotional health during their rigorous medical education.  Yoga is a terrific place to start as the benefits reach beyond the physical and have the potential to enhance their future careers and patient care.  Some of the potential benefits of yoga include stress reduction, increased fitness, management of chronic health conditions and weight loss.

I also learned at my  yoga teacher training ‘vacation’ that there are many people out there already using the tools yoga provides to help  a broad array of people in need.  Take Molly Lannon Kenny, for example;  she was once a speech pathologist who turned her passion for yoga into a career in which she uses integrated movement therapy to help all kinds of patients, from those with autism spectrum disorders to PTSD.   She also started the Samarya Center, a non-profit organization dedicated to bringing the healing benefits of yoga to underserved populations.  Another teacher I met spent most of her days teaching seniors, the disabled and stressed out business people how to do ‘chair yoga’ for 15 minutes a day.

Finally, last week at the Association of American Medical Colleges, I was pleased to see an offering of yoga for attendees of the meeting; the sessions were so popular that they added an additional class. Clearly, physicians are seeing the benefits of yoga for themselves.

In short, yoga is growing by leaps and bounds across the country and there are numerous ways that it can benefit the CMSRU community.  From our students to our staff and faculty to the residents of Camden, the possibilities are endless!

Namaste

Patti Vanston
Associate Dean for Program & Business Development
Cooper Medical School of Rowan University

November 11, 2011 (11/11/11) is noteworthy for much more than the interesting numerology of the date. Like many “holidays”, Veterans Day is a time when we should all spend a few minutes thinking about the true reason for the day – giving thanks to those who have served and sacrificed for our country.

But, as is the case with most holidays, there is a tendency to quickly move on to the personal world we face.  With regard to our veterans, this transition back to our own immediate world may not permit us to reflect upon the ongoing needs and challenges that our service men and women must deal with once they leave the military.

The Department of Veterans Affairs (DVA) has appropriately taken a true leadership role in responding to these needs. The difficult economic times exacerbate many of the travails our veterans must confront as they return to civilian life. Despite the efforts of the DVA, many veterans have fallen through the cracks. Lack of work, homelessness, drug addiction, mental illness and service-related conditions and disabilities plague many of those who have served. Additionally, a growing pool of women veterans has required the DVA to expand its services to address gender-related issues.

Homelessness has become increasingly prevalent among veterans. Estimates range up to 200,000 for the number of veterans who have been homeless within the last year. In the state of New Jersey, that number may be as high as 8,000. Our U.S. senators Lautenberg and Menendez announced in July that two sites in New Jersey had been awarded nearly $2 million to help address this problem; Catholic Charities, Diocese of Camden was one of the recipients to help meet the needs in southern New Jersey. A positive step in the right direction.

For many veterans, medical problems are prevalent, including drug and alcohol dependence, suicide, post-traumatic stress disorder (PTSD) and brain injuries. Following hearings last summer that focused on long wait times for mental health services for veterans, Senator Patty Murray (D-WA), chair of the Veterans Affairs Committee, called on the VA to survey their behavioral health providers to determine the extent of the problems. The September report of this survey, “A Query of VA Mental Health Providers”, indicated that there is a considerable need to improve timely access to care, in part due to an inadequate number of providers and limited space for care delivery.

The increasing number of women, who now account for about 8% of all veterans, has also required additional services. The Women Veterans Health Strategic Health Care Group was created in 1988 to help meet these needs. Women veterans are considerably younger than their male counterparts: 48 versus 63 years, respectively. Of note, the three leading diagnoses for women accessing VA health services are PTSD, depression and hypertension. Roughly one in five women veterans seen at DVA facilities reports that they have experienced military sexual trauma (MST) defined as “experiences of sexual assault or repeated, threatening acts of sexual harassment”.  Significant problems, indeed.

All health care providers, regardless of whether or not we practice within VA health care facilities, need to be cognizant of these challenges. It is incumbent upon us to ask our veterans seeking care about these issues. While these medical and behavioral health problems are not unique to our veterans, we must pay special attention to this at-risk group.

Not only on this Veterans Day, let us be continually mindful of the ongoing needs of those who have served us.

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

Follow us here as we share in real time what we are learning at this year’s annual AAMC meeting in Denver. This important meeting brings together nearly four thousand academic healthcare professionals to discuss current issues in medical education and healthcare, present research findings, and provides a wonderful opportunity to meet colleagues from around the country and the world. CMSRU is out in force to both present our new school to these colleagues, as well as to learn as much as we can from them.

Tuesday, November 8

• Competency-based Curriculum – Speakers form the AAMC, UCSF and Ohio State spoke about the focus on moving to “outcomes driven” curricula. Competency-based medical education (CBME) derives its power from an emphasis on evaluation of outcomes and knowledge of learners in a non-hierarchical path of learning in which students and teachers bear the responsibility for learning. In the recent and evolving models, evaluation is by authentication of the competency “in the trenches” using objective and multiple measurements. These “entrustable professional activities” allow assessment of competence in a variety on domains and allow the determination of the attributes needed of medical professionals. CMSRU has developed a creative competency-based curriculum in which emphasis in teaching, learning and evaluation are central.

• Diversity Research Forum – This session focused on the two new LCME diversity standards, IS-16 and MS-8.  Highlighted were areas of focus for compliance with these standards, including faculty and staff recruitment from diverse groups, cultural competency in med ed, community outreach and pipeline programs.  Schools that have recently gone through the reaccreditation process presented their approaches to these standards.  Florida State University-College of Medicine demonstrated tremendous strength in the area of pipeline programs and retention of physicians practicing in Florida.  Boston University has been very successful in the area of diversity and inclusion especially as relates to the LGBTQ community.  There was great discussion from the audience regarding best practices and sharing those practices with others.  The AAMC continues to hear the challenges that schools have meeting these standards and will work to facilitate sharing of best practices.  CMSRU is proud to have made it through the LCME review process in full compliance of these and all other standards.  We will continue to grow our pipeline programs and community outreach programs.  We look forward to collaboration with other medical schools to address diversity and work together toward the goal of health equity for all.

• Global Health Learning Opportunities – In order to meet demand of students seeking international opportunities/electives from medical schools, AAMC is launching Global Health Learning Opportunities (GHLO) to foster collaboration between US and international schools for student mobility thru a robust web-based application service. The mission is to provide a global health network that facilitates educational mobility for health professionals; the vision is to be the premier global health educational exchange program.  In 2013 the web-based GHLO software will be available and AAMC will be engaging new med school partners at that time!!

• What We’ve Learned from the New Schools - Deans from Florida State, Texas Tech, Virginia Tech Carilion, CMSRU (!), and OU-William Beaumont discussed their approaches to innovation and social contract with the community.  All the new schools are focused on community engagement, but there are differences in some of the approaches. Florida State’s curriculum is more traditional for first two years, but in the 3^rd and 4^th year each student trains individually with a community physician. They have a pipeline program that begins in 7^th grade and they work with underrepresented in medicine college students through tutoring and help with MCATs.  At Virginia Tech Carilion, clinicians often bring in the real patient that the paper case was based on.  OU-William Beaumont is focused on culture.  Every dean was selected for talent and emotional intelligence.  David Steele from Texas Tech began by observing that there is no blank slate.  All new schools come with people with prior experiences, expectations, and perceptions. Many of the new schools are similar to CMSRU, a partnership of an academic center and a healthcare system, each with its own mission. This creates opportunities for us, but also requires a great deal of social intelligence. All the schools discussed the challenge of managing expectations.  Dean Katz was able to share how CMSRU has demonstrated its commitment to the community through our four-year Ambulatory Clerkship and Scholars’ Workshop courses, commitment to service learning, to putting Camden back to work and our commitment to ultimately being judged by the improvement of healthcare in the Camden community.  Great way to learn from our peers in this process!

Follow us here as we share in real time what we are learning at this year’s annual AAMC meeting in Denver. This important meeting brings together nearly four thousand academic healthcare professionals to discuss current issues in medical education and healthcare, present research findings, and provides a wonderful opportunity to meet colleagues from around the country and the world. CMSRU is out in force to both present our new school to these colleagues, as well as to learn as much as we can from them.

We will update frequently throughout the meeting – so check back often!

Monday, November 7

• Leading in a Time of Uncertainty - The overarching theme: ‘You never change things by fighting existing reality; to change something, build a new model that makes the existing model obsolete’.   The panel did an excellent job of providing concrete examples of what they are doing to thrive in these challenging times. Dean Klasko from USF gave three keys for moving forward successfully: 1) be bold, 2) stop whining (we LOVE this one!!), and 3) show ROI. This is a great time for creativity. Medical schools are highly leveraged and with all traditional revenue sources collapsing at once, it is time to adapt, show value and find new revenue sources. It will be imperative for teaching institutions to provide outcomes data and to communicate in a voice/language that the government, patients, donors and others can understand and appreciate!

• Transformation Arc:  Transforming Ourselves – In the final Transformation Arc session, we were presented with the most difficult thing to change:  Ourselves.  Joseph Grenny led the discussion on changing behaviors – and convinced the crowd that we have less control over our own behaviors than we might believe.  He presented the “change problem” – that we know we SHOULD change, that we WANT to change, but that we DON’T change.  As in some other sessions, it was suggested that we look for successful strategies used by others, or – more likely to work – by ourselves, i.e., we should become our own research subjects to determine what has worked for us to elicit change.  A thought-provoking session that certainly can inspire many of us to go back to the drawing board when it comes to transforming ourselves!

• Campus Violence – Leaders from Vanderbilt and Virginia Commonwealth discussed preventing and diminishing the impact of violence on medical school campuses.  It was noted that there is almost no literature about violence at medical schools.  The last several decades have seen a growth in complex psychological issues and needs in students.  Medical students are vulnerable because of lack of social support, high stress, sleep deprivation, and easy access to drugs and alcohol.  Campuses are frequently not prepared to deal with these issues.  Approach should include 1) easy access to screening tools, 2) rapid and effective response once mental health issues are identified, 3) reducing stigma of mental health issues, 4) education of faculty and students to recognize signs of mental health disturbances, and straightforward methods to report.  Sugggestions to create a safe environment included usage of “code words” by faculty and staff to signify potential problems and alert when help is needed, and identification of exit strategies to protect students and staff.

• Positive Culture Trumps Curriculum and Just About Everything Else – Folks from the Indiana University School of Medicine discussed how they changed the culture – the “hidden curriculum” – at their school in response to student dissatisfaction (despite above average USMLE scores).  The process they used included over 1000 people over nine campuses, and used Appreciative Inquiry and other methods to focus on the positive attributes of their culture.  Themes included connectedness, the “wonderment of medicine”, passion, and the capacity of all individuals to grow.  What came to be called the Relationship-Centered Care Initiative resulted in changes in attitudes and behaviors, changes in admissions, the work environment, and improved student satisfaction with their experience.  The presentation culminated in the showing of a workshop where IUSM leaders spoke of their experiences with life-threatening illnesses (“doctors as patients”) and included discussions with their spouses – a truly moving presentation for us all!

• AAMC Town Hall – The very well attended presentation (that was also streamed live across the web) included a variety of topics.  Diversity was a topic discussed several times, including focusing on diversity as the path to true excellence, the holistic admissions process (which we at CMSRU practice absolutely!), and challenges to students due to financial disadvantage.  Advocacy was also discussed, with AAMC President and CEO Darrell Kirch, MD, reminding the group that WE are the agents of change, and must make our voices heard in Washington, particularly with respect to urgent, current issues of GME positions and funding.  Also introduced was the “Careful What You Cut” campaign, messaging focused on preserving GME funding and monies for medical research.

Follow us here as we share in real time what we are learning at this year’s annual AAMC meeting in Denver. This important meeting brings together nearly four thousand academic healthcare professionals to discuss current issues in medical education and healthcare, present research findings, and provides a wonderful opportunity to meet colleagues from around the country and the world. CMSRU is out in force to both present our new school to these colleagues, as well as to learn as much as we can from them.

We will update frequently throughout the meeting – so check back often!

Sunday, November 6

• Structure of Medical Education:  Time for a Change - Dr Victor Fuchs, the father of health care economics and a senior researcher from Stanford, gave a seminar on the potential reform of medical education.  Currently physicians need to know 6,000 drugs and 4,000 procedures. There are 36 specialties and 116 subspecialties in the US, higher than any other country – with no evidence of benefit of this specialization.  He suggested three major radical changes in med ed:  1) restructure admissions process to identify physician-scientists and physician-humanists, 2) shorten the total college and medical school years from 4+4+3 to 4+2+3 (varies depending on specialty), 3) include only two years of combined basic science, clinical, and health population education.  Students go on to specialize after only two years of medical school.

• The Evolution of the Promotion & Tenure System – MedEdPORTAL sponsored the Evolution of the Promotion and Tenure System. Schools are grappling with how best to reward clinical care and teaching. New pathways for educators and clinicians are evolving. New criteria for promotion increase the emphasis on teaching and education and broaden the definition of scholarship. Creative teaching, educational leadership and educational methods that advance learner’s knowledge can all be part of the scholarship of medical education. CMSRU’s Appointments and Promotions policy includes a clinician educator designation. The information from this session will be valuable to our faculty who excel in clinical and educational activities.

• Nuts and Bolts of Mentoring – Mentoring is, at its core, a relationship.  Mentees should be willing to share successes and difficulties with the mentor, respect the mentor’s time, and provide feedback. Mentors should be altruistic and act as role model and advisor. The relationship should be sustained and reciprocal.  Two types of mentors were discussed, content and career.  Content mentors develop intellectual scholarly careers, should have expertise in the Mentee’s area of interest and provide resources, with meet frequently.  Career mentors provide overall career guidance and support regarding promotion and helping the mentee negotiate for self, and meet 1-2 times per year.

• Engaging Our Neighbors to Transform Care and Improve Health - Inspirational presentations this afternoon from three schools with a commitment to their communities similar to that of CMSRU. Representatives from U of Oklahoma, Duke and Tulane shared how they have engaged their community to help transform care and improve health for those in their underserved areas.  And in the case of Tulane, in devastating conditions post-Katrina. They shared their successes and obstacles – all of which will be helpful as CMSRU forges forward with its plans of engagement with the Camden Community. We are proud to be a part of a cooperative of 9 medical schools who meet regularly to collaborate on ways we can work together to improve health in urban settings.

• Social Media:  Friend or “Frienemy” – Terrific presentations by Dr. Peter Greene from Hopkins and Jeffrey Tangney from Doximity on social media and medicine.  Hopkins has a great social media policy that doesn’t go the old cautionary route of telling students and faculty what they shouldn’t put out there, but guides w/r/t best practices in posting – regular posts, neighborly (i.e., retweet partner institutions), aligned with the academic calendar, etc.  View is that social media can and will be transformative in communication between medical teams, docs and patients, students.  Doximity has an interesting platform that is similar to LinkedIn, but just for docs.  Already has 30K docs on board, with HIPAA compliant messaging, “find the expert” options, and looks to be a great way not only to network, but to add real value by leveraging doc to doc relationships.  Our bet – in two years we won’t be talking about social media as a tool – we’ll just be using it as a matter of course.

• Leadership Plenary:  Holding Up the Sky – Dr. Thomas Lawley, Chair of the AAMC, discussed his experiences at Emory with “the sky is falling” events.  He related, in one example, how Grady Hospital, the largest hospital in Georgia and the only public hospital in Atlanta was near closure due to financial challenges, and through the work of Emory, Morehouse, and others, was able to restructure, reorganize, and create new governance to stay open, and – most importantly-  retain its mission to serve the poor of the region.  Dr. Lawley charged the attendees to find those innovative solutions to the current “sky is falling” challenges.

• Leadership Plenary:  The New Excellence – Dr. Darrell Kirch, President and CEO of AAMC, discussed the varied paths to excellence, including events paving his own path to becoming a physician – when he witnessed the tragic crash of a plane carrying the Wichita State University football team at the continental divide in Colorado.  He discussed that excellence in medical education cannot be masured by rankings in the media, but must be measured by our impact on the health of our community.

• Leadership Plenary:  Let Me Down Easy – Playwright and actress Anna Deavere Smith performed excerpts from her latest work, that included amusing, tragic, maddening, and ultimately thought-provoking interviews with a variety of patients and providers.  These interviews included a physician from Charity Hospital in New Orleans who stayed with his patients through Hurricane Katrina and the aftermath, cancer patient and former Texas Governor Ann Richards, a diabetic in New Haven facing the prospect of dialysis, and an Idaho rodeo bullrider who, despite injuries and challenges, remained eternally optimistic.  Quite a memorable hour!

• Transformational Power of IT in Medical Education - Sal Khan, founder of the Khan Academy which provides free and widely popular K-12 YouTube-based educational modules, spoke about the value of open web-based access to information as a means to best utilize time in the classroom. By allowing students to “master” material on their own time and at their own pace, educational sessions with faculty and peers can be used to focus on team learning, reinforcement of content and exploration of new material. He’s recently started working with Stanford to develop content for medical students. CMSRU will develop a portfolio of video capture, online material and podcasts that will maximize the value of time in the classroom or active learning group for our students.

• Transforming our Community – Terrific discussion by Chip Heath from Stanford about CHANGE.  We all know change is difficult, but he gave some guidance on how to elicit change, including finding the “bright spots” of success upon which we can build and shape the path to success, rather than focusing on what is wrong and the magnitude of the change necessary.  We must use paradigms like this to find a way to change healthcare delivery in our country.

• Question of the Year – The question is “What improvements in medical education will lead to better health for individuals and populations?”  Presentations answering this question included integrating public health into medical education, involving librarians in curriculum development, and the importance of nutritional education.  We agree!

• Integrating Arts and Humanities into Medical Education – Folks from the University of Colorado discussed the use of arts and humanities in med ed, and demonstrated ways in which they help students to 1) enhance observational skills, 2) increase understanding of the human condition, and 3) improve self-expression and clarify values.  More medical schools are requiring courses in humanities, and with the rapid advance in technology, we need to balance the high-tech, low-touch version of medicine with the high-touch ART of medicine.  U of C uses an interprofessional approach to this integration, encouraging innovative collaboration among faculty across the campus.

Follow us here as we share in real time what we are learning at this year’s annual AAMC meeting in Denver. This important meeting brings together nearly four thousand academic healthcare professionals to discuss current issues in medical education and healthcare, present research findings, and provides a wonderful opportunity to meet colleagues from around the country and the world. CMSRU is out in force to both present our new school to these colleagues, as well as to learn as much as we can from them.

We will update frequently throughout the meeting – so check back often!

Saturday, November 5

• Legislative Update – Lots of important info in this session.  Major implications for med ed in current budget negotiations.  Current average medical student debt is $162K with payoff cost over $350K. Changes to the Stafford Loan program alone will cost the average medical student an additional $10-20K.  New money will be needed to continue the Perkins Loan program beyond 2014.   HCOP is under attack in both congressional bills (S-1599 and HR-3070).  Potential targets:  Medicare/GME. Proposed cuts range from $650 million to $4 billion. AAMC’s message with congress has been 1) Academic Medicine plays a vital role in education, patient care, and discovery, 2) disproportionate cuts to member institutions of AAMC will reduce the number of physicians trained at a time when the US is facing a physician shortage, 3) cuts to providers should not be focused on a small group of institutions.

• Appreciative Inquiry – The session focused on a method of organization change that looks at what works well.  It can begin by asking people what they do well, then delving deeper through questioning to move an organization forward. At the University of Arkansas this technique has been used for faculty exit interviews for faculty who have left the institution. At the UVA Health System appreciative inquiry has enabled the system to build a more collaborative culture.  Appreciative inquiry requires trust and respect, a willingness to be vulnerable, and a release of roles.  It shows the power of story to motivate groups to tackle difficult problems and build positive institutional cultures.  CMSRU has many positive stories to share.  They can be the impetus for improving the health outcomes in our community.

• Transforming Our World – Don Tapscott, author of Wikinomics and Macrowikinomics speaks on the “Age of Networked Intelligence.”  Drivers for change incude technology, the “net generation”, and the rise of collaborative communities.  There is a paradigm shift in education to more student-focused, multimodality, customized, and collaborative.  CMSRU’s curriculum fits this move!

• Medical School Expansion – Who are the New Students? – The new University of Oklahoma school at Tulsa has developed a School of Community Medicine in response to dreadful health inequities in the local community.  They use a multipronged approach to improve the health of the local community and the sophistication of their medical students in community health.  This presentation emphasized the importance of engaging the entire health system in the endeavor.  We have much to learn from them!

• Unintended Consequences of Increasing Class Size – Marc Kahn from Tulane discussed the cost to educate a medical student ($63,000 avg, as low as $38,000).  Even at the low end, only a third of medical schools can cover this cost – and these schools are all private.  Texas A&M discussed their experience growing from 80 to 200 students/class.  Had an interesting process with gross anatomy – rotating students on the cadavers, and making those that actively dissected on a given day responsible for teaching their classmates who were not actively dissecting – and the “teachers” were evaluated based on that aspect!  Henry Sondheimer from AAMC also presented data on medical school grads and GME slots – and by 2015, graduating students will exceed available GME positions.

• Transforming Academic Medical Centers – Initiatives undertaken by the Medical College of Virginia hospitals include the Virginia Coordinated Care program – responsible for care of 30,000 indigent patients.  50 providers are included in that program, a partnership between the hospitals and physicians – particularly community primary care docs.  The program has shown a reduction in inpatient admissions and a significant reduction (30%) in emergency room visits.  University of Okla folks also presented a unique program called “Family Faculty” – family members of patients with disabilities present them to students, demonstrating the effect of the disability on family dynamics.  Terrific approach, and truly innovative!

• “Gestational” vs. “Developmental” approach to competency-based medical education – Differences between traditional input-based models (what we teach the students) vs. outcomes-based models (what the students demonstrate they have learned about patient care).  Discussed that med ed should lead to activities that the student is trusted to perform unsupervised.  At CMSRU, we have created a system that is “developmental” or milestone-based for our students, based on our core competencies.  This approach will allow us to provide students with an education and experiences that help them grow to their full potential in delivering excellent patient care.

• NBME Updates – USMLE exams are going to change – review is ongoing now.  The technology has advanced, med ed has evolved, and thus far, the USMLE’s rate of change has not kept pace with these two factors.  The Committee to Review the USMLE is looking at change in 5 areas.  1) The exam should reflect both supervised and unsupervised practice, 2) it should be based on a competency schema – consistent with the ACGME competencies, 3) foundational science should be incorporated into Steps 2 & 3, with increased emphasis on epidemiology and biostatistics, with an awareness of the need to consider patient safety and quality improvement, 4) increased emphasis on clinical and communication skills, 5) evidence-based decision making, including critical literature analysis.  CMSRU is approaching our curriculum in ways that are aligned with these proposed changes, but which also support the current schema.

Follow us here over the next 5 days as we share in real time what we are learning at this year’s annual AAMC meeting in Denver. This important meeting brings together nearly four thousand academic healthcare professionals to discuss current issues in medical education and healthcare, present research findings, and provides a wonderful opportunity to meet colleagues from around the country and the world. CMSRU is out in force to both present our new school to these colleagues, as well as to learn as much as we can from them.

We will update frequently throughout the meeting – so check back often!

Friday, November 4

• How ACOs and Healthcare Innovation Zones Will Steer Health Care Delivery – Speakers from AAMC, BJC Healthcare and others discussed issues with the current ACO model.  Duke, Virginia Mason, and others incentivized residents to achieve specific goals in quality and safety (e.g., patient satisfaction, hand hygiene, lab utilization).  Terrific use of trainees in system re-engineering teams!  Will be critical as we enter the next era of health reform.

• Social Determinants of Health (Plenary Session) – University of New Mexico weaves public health content across all years of medical school.  Overall, there is a push to integrate the social aspects of patient care (so important for physicians to understand!) into med school curriculum, particularly as a method to educate students on health disparities.  A student from the University of Washington formed a student-led research and advocacy group – the Health Equity Circle – to address specific inequities in care in the Seattle area.  CMSRU’s ambulatory clerkship (a 4-year longitudinal course) will provide an opportunity for our students to see first-hand the impact of social issues on a patient’s and family’s health.

• Voices of a Diverse Faculty – Representatives from the medical schools at Johns Hopkins and the University of New Mexico presented results from a survey on culture change in medical schools, showing a relatively negative culture at academic institutions, particularly for those underrepresented in medicine (URM) and women. These two institutions presented how they are actively working to address these issues.  As a new school, CMSRU has the opportunity to be a catalyst for change in diversity reform. The opportunity is there – we just need to seize it!

• Best Practices Integrating LGBT Health in Medical Education – Boston University School of Medicine has made great strides making LGBT faculty and students feel welcome, with more than 10 hours of LGBT-specific curriculum.  CMSRU has already formed a faculty diversity interest group that will address this issue, among others, and we hope to have a student group to do the same next year.

Two weeks ago, I had the opportunity to attend a celebratory luncheon hosted by an important anchor institution in Camden, NJ. As part of the event, lunch was served; one of the speakers invited the children in attendance to enjoy their special entrée of chicken tenders.

I’ll come back to this.

At about that same time, the October 14th issue of the Centers for Disease Control Morbidity and Mortality Weekly Report contained an article entitled “Prevalence of Coronary Heart Disease – United States, 2006-2010”. There was encouraging news here – more data showing the reduction in self-reported coronary heart disease (CHD) from a prevalence of 6.7% in 2006 to 6.0% in 2010. These data were derived from the Behavioral Risk Factor Surveillance System which randomly surveyed over 400,000 people by telephone.

Not surprisingly, those over 65 were more likely to report CHD (defined as being told by a health care professional that you had angina, coronary artery disease, a heart attack or myocardial infarction) and men were more likely to report CHD than women. Those who graduated from high school were less likely to report CHD than those without this degree (7.2 vs. 10.3%, respectively). The highest racial/ethnic prevalence was in American Indians/Alaskan Natives (11.6%) followed by African Americans (6.5%) and Hispanics (6.1%).

So, the really good news is that we’re continuing to see a decline in CHD. What is less good is the skewing towards minority and less educated populations. Which gets me back to chicken tenders.

The Bogalusa Heart Study is a 40 year study tracking a biracial (black-white) population of children in southeast Louisiana. This project has resulted in more than 800 publications and has been of enormous value in advancing our understanding of early CHD and essential hypertension. This body of work has convincingly demonstrated that the major risk factors for adult CHD begin in early childhood including the preschool years. Fatty streaks, anatomic harbingers of coronary artery disease, can begin to be seen between ages 5 and 8.

Obesity, including childhood obesity, elevated lipids, and hypertension are among demonstrated risk factors for CHD; sadly, recent data indicate that 31% of U.S children are overweight or obese, placing them at increased risk. Therefore, it is important for parents, health care providers and schools, religious institutions and community organizations to accept this challenge head on.

In the August issue of Childhood Obesity, a group from California published the results of study in which they monitored the lunch time purchases of 544 families in a well known fast food restaurant, interestingly located in a children’s hospital. Through reviewing purchase receipts and by surveys the authors reported some staggering results.

The average caloric intake of 2-18 year olds at these lunches ranged remarkably from 36 to 51% of age- and gender-specific needs for an entire day, with the highest percentage of daily intake in preschoolers! The meals were typically high in fat and sodium and low in fiber. The most frequent purchases included French fries, sodas, chicken nuggets, and burgers; sodas were bought for 60-97% of children. The survey revealed the parents’ primary reasons for lunching at this restaurant were convenience (rather than a cafeteria located in the same building with healthier choices), family preference and cost. More than half of the parents chose the fast food restaurant as a “reward” for going to the hospital.

While the authors recognize potential flaws in this study, there are lessons to be learned, especially given the documented role of fast food in contributing to obesity and ultimately CHD. In a city such as Camden with a predominantly minority population already at risk for heart disease, it is incumbent upon all of us to do better in helping to make healthy food choices available to our youth and adults. In Camden, a poor city with limited access to grocery stores, a national problem is exacerbated.

We can do better. Through providing good, healthy food at our schools and city social institutions, through improving the availability of fresh foods in nearby stores and restaurants, and by educating our citizens, both young and old, about nutrition, exercise, smoking cessation and CHD risk factor reduction, the prevalence of heart disease in our city and nationally can continue to drop.

Let us all work together to achieve this goal.

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University