Search for tag: "aamc 2012"

As we really face this changing future, it's time for us to look deep inside and ask ourselves some fundamental questions about how we carry out our work. We have to hold close to our heart the core values and core purposes that are the essence of what we do in academic medicine, training the next generation of caregivers, carrying out the important biomedical and population research, caring for populations and individuals.

But how we do it can all change, and I think we have to start asking ourselves, how do we recognize and reward our researchers? Are we recognizing and rewarding the right things? We've had a tendency to focus on the RO1 or the independent scientist at the expense really of team science, or we acknowledge certain kinds of discovery as being more important than the science of integration or application.

In the education community, there are a number of questions. We use a four year time period to finish medical school. What are the skills that you need? Time should be a dependent variable, not the independent variable that determines how long medical school is.

We need to ask ourselves about cross training and residencies and across all the health professions. And then we have a lot of questions about how we deliver health care. We have traditions and structures. We tend to focus on inpatient care, but not as much on the continuum outpatient, skilled nursing, mental health, rehab. We really need to think more broadly about it.

So it's a time of reflection, of asking ourselves, why do we do things the way we do them, and if we did them differently could we do it better and as society is telling us, do it a lot cheaper? The challenge is, of course, that making change is difficult, it's painful. People often feel a sense of loss because they liked the way things are, but I think leaders have to step up and do it. Otherwise, somebody once said, "Lead, follow, or get out of the parade," and this is the time for leaders to step up and really be leaders.

My personal passion is: How do we figure out a way to value and measure the variety of indispensable contributions that our faculty make to schools of medicine? I'm working on how do we revise our retention, promotion, and tenure guidelines to reflect the diversity of things that faculty do that make medical schools fantastic.

My problem is: How do you capture excellence? How do you measure that your faculty member is excellent?

I think part of the barrier is we have a model, that everyone is comfortable in, that doesn't really work, which says there's only one way to demonstrate excellence and that is having NIH grants and publishing and discovery science.

I think the big challenge is to change the culture so that not that we say, "Educational scholarship isn't as good," rather that we say, "Wow, there are faculty doing amazing things that aren't related to NIH and discovery science." They're doing other kinds of scholarships, and we've known for 20 years that we should be counting those other kind of scholarship, and now we're going to change our culture so people say, "That's a really valuable activity."

What I see is that we now encourage people to follow their passion, which then transforms how patients get their care, which then transforms how healthy our population is. I think it's an opportunity to really take us back home and change fundamentally how we deliver health care, because I think everyone would agree it's not yet perfect.

For our leadership to be looking for members of our faculty who may not have leadership positions but who have innovative ideas and will be people who can change how we view our institution is really important.

Some of the most innovative things that we're thinking about right now are something referred to as milestones. So in the residency world, we're being able to now identify exactly where people are along a spectrum of skills in six different areas and with the idea and vision that as people meet those skills we can move them along the pathway and again get rid of the rigid timelines that we're currently married to.

For those of us who have been doing medical education for a long time, we know some people learn faster than others, and other people learn slower. The fact that we're facing a deficit of 90,000 physicians coming up here very soon in the next decade, we really need to be thinking about: How can we turn people out more quickly? How can we ensure that we get people in the pipeline, keep them in the pipeline, and then turn them out at the end?

The thought that keeps me up at night is probably that we're not using people's time effectively. Not just individual people, but thinking about the synergy that gets created when we bring the right people together.

Our universities without the people, the faculty, the staff, the students are really just a collection of buildings and equipment and material supplies. The people who are there are the ones who make all of this work. The faculty are incredibly dedicated people. They've made a commitment beyond just being practitioners within their own field. They've decided to come back and share that knowledge with learners.

I think we've got extraordinary potential, and the thought that we might be wasting any of that really does break my heart.

When you work in an environment like academic medicine, we have so many capable individuals, and you think about what they could do if you could get the right folks at the table at the right time to look at the kinds of problems we're facing. I think the solutions are out there. But we have to talk to each other. We have to build that shared knowledge based. We have to have that ability to catalyze one another's thinking to actually get these problems solved.

There's a saying in the medical school community that when you look at one medical school, you're looking at one school because they're all very unique. I believe that we are all very unique. But I also think that among us we have such common purpose that we really should be thinking about the things where we are catalysts for something together.

It's up to us to think about how to push the frontier about healthcare for people in the United States. So that's not about us just being unique. That's about us using our uniqueness to forge something better and stronger, and I think we've certainly got the capacity to do that.

Most people tend to think about diversity limiting it to race and ethnicity. So at Morehouse School of Medicine we intentionally recruit what we describe as academically diverse students. That means students who don't have the highest GPA or the highest MCAT. We know that if we can get those students who have had different life experiences, and if we can get them to perform just as well as students who have MCAT scores of 31 when they come in, we know that we are now creating a platform for greater success for those students, and for the patients they're going to be caring for.

This is something that I think that all academic health centers should be doing. We all have the responsibility for training the health care professionals that the nations needs. The upside of academically diverse students is that you're giving a broad opportunity for people to participate in the care of patients, the demographics of the nation are changing, and so if we're not responsive to that it's great to have great innovation, and technology, but if it's not useful to the people, then what's the benefit of it.

One of the problems that we have in our university, and I think that this is the case in a lot of research institutions, is people get very focused on the projects they're working on. They're in their lab, or they're in their particular school or department, and those are the people they see and those are the people that they spend time with. Particularly in an institution like UAB, which is very research driven and very grant driven, you've got really, really bright people who are spending all of their time working on that next grant, working on that next project, and they don't have time to really get out of that space.

If you think about the role of a librarian in a large university, we know more people across the campus than anybody else because our job is to be out there. So we know when there's a sociologist who is working on a problem that somebody in neurology might be working on, and we can help make those connections.

My algorithm for innovation is that you need to figure out ways to bring people from different disciplines together and then see what happens.

A role of the leader of the organization can simply be to set a tone that indicates that it's okay to be innovative, it's okay to take risks, and if you are and you have some success, that's going to be recognized. That counts as much as the traditional things in academic medicine.

The models of how we provide healthcare to our patients, how we interact with our patients need to change. Also the models in the way we educate our students need to change. It's been very traditional. Institutions across the decades have changed. Course content has changed the way it's delivered.

But by and large, we're still heavily lecture-based. We should have programs where students can move onto the next subject once they've shown that they're competent in some area, rather than having to finish the semester in that particular class. You know, we're locked into these fixed time scales. Those sorts of models of education need to improve.

Then, also, the learner environment, I think, is also something that suffers from these traditions that we have in medicine. Students pick up a lot of subtle signs about how physicians interact in these environments. Not all of them are good.

There's something called the hidden curriculum, sort of what the students see and hear and experience in addition to what they're actually being taught. Sometimes the messages we're sending in those sorts of learner environments are not the best as well.

The practice of medicine now is very different than what it was when many started their practice of medicine. For some, the feeling is that it's changed for the worse. But if you look at the young students that are coming in who haven't known the previous environment, and the excitement level, and quite honestly, the competency level of the new students coming in is just astounding.

I think that spirit of enthusiasm of a bright future, it's going to be a different future, but it's going to be a bright future. The tools, the power that we have, that hopefully we can harness for the betterment of our patients, is just stronger now than it's ever been in the past.

Socks. Socks. So I went in to have a medical procedure, which everybody needs to have done every five years, and I was told to take off my socks. And I refused, because they really weren't interfering with the procedure they were planning to do. I engaged in a fairly long conversation with the nurse who was adamant that I take my socks off.

So ultimately I didn't take my socks off, but I think that that little parable is indicative of our healthcare system, which is from a clinical perspective totally unable to meet the needs of the customer. It really is focused on the needs of the doctor. So our locations need to be convenient to us, so we can run to our lab and on and on and on.

So one of the first things we're trying to do at Ohio State is to recraft healthcare delivery in a way that actually makes sense, that would be done in any service industry and that focuses on the patient.

I think we don't really know what patients want. So this is from the perspective of introducing technology and assuming all our patients are techno savvy, and I think you have to ask the patients what they want and how digitalized they are. A lot of our patients are older and may not adapt as quickly to this technology.

I think we need more data on what patients want, and I think patients need to be brought into the discussion. I think the movement for patient and family centered care is increasing at the same time that this digital stuff is going on, and I think if we bring patients into the conversation, we can do this intelligently and thoughtfully.

We don't need to be perfect to innovate. What kills innovation so much is that people want to dot every "i," cross every "t" before they release a product. That's not the way to innovate.

What I'm recently working on is an online simulation as a means to teach the entire spectrum of learners actually -- medical students, residents, even practicing physicians -- about how do we practice medicine in a safe environment. And I think high fidelity simulation is there for that purpose. But is there a better and more cost-effective way of doing this?

So I'm trying to think of a low budget, kind of a disruptive technology out there that will accomplish a lot of the same things. My idea is to put it all online so that it's very automated. It's a very safe environment. You could take asynchronously. Whether you be here or in the middle of Alaska, all you need is Internet.

No longer are we working within the four walls of the classroom. No longer are we bound by hardbound covers of textbooks. We just need to think big, open it up, make it free and see what happens.

I do feel a sense of urgency about solving some of these problems. I don't really think it's acceptable to . . . I don't really think it's acceptable that some people don't get the care that they need.

My interaction with the health system is very rich and deep, both as a recipient and someone who offers care to others.

We are in a position where we actually do help people. Sometimes it's one on one. Sometimes it's a very simple thing like holding someone's hand or extending an arm around a shoulder in a really difficult time.

When I started as a nurse, back in the early '70s, children's leukemia, Wilms' tumors, they were almost universally fatal, and now we look to people with these diagnoses to families and young children and we can talk about the hope of being almost always curable, and that is an amazing experience. If we could just deliver that to every single person in this country, just think how strong we would be as a nation.

I think in a lot of ways when we talk about diversity, a lot of its kind of bringing different groups together. I feel like for a lot of us that come from schools or opportunities or experiences where we may not be able to progress forward as often as other folks that maybe have the means, that it's an important thing to kind of keep in mind. For me, the only reason I was able to succeed and go through college and really do well and get into medical school was the fact that I had other people that had gone through similar experiences, that had the luck of finding somebody to really reach out to them and pull them up and make sure that this was something that was important for them so that they should continue going with that as well.

All of us are responsible for making sure, as a whole, we take care of each other, so that we don't have someone that should be at the table. How do we get them a seat there?

I think the residents have a huge amount of knowledge about using electronic devices and really engage immediately with iPads, with everything. My concern really has to do with not understanding that the Internet is not filled with experts. So there's a lot of people who proclaim you should eat this kind of supplement, or you should take this pill, who have no expertise in medicine. The Internet has a lot of bad information as well as good information, and I don't think patients know what brand is good.

As a radiologist, I'm very interested in innovation. I'm interested in PET scans. I'm interested in anything that gets me more imaging, but there has to be somebody to interpret any information that you get. So I think that that's the slowdown I would have is it's exciting, but maybe you don't what to know your genome if there's no cure for that disease. You have to be cautious about the advances of technology.

The thing about social media is it never really goes away. Medicine is not just about telling people what to do and having them do that. It's also understanding their illness, understanding what contributors there are to it. Being able to network with other people that may have your disease or being able to network with the people that are taking care of the disease or researching about the disease is a very important and very useful tool. I think that can drive innovation in solving new problems and getting new research for it as well.