VOL 3, No 7, August 2001
Reves finds opportunity to return to MUSC 'irresistible'
Editor's note: The following is a condensed version of an introductory address by Jerry Reves, M.D., new vice president for medical affaiirs and dean of the College of Medicine, given to the COM faculty on July 9.It is an extraordinary privilege to be among you: it is humbling and daunting to think that you might expect something from me when it was you that drew me back to MUSC. Of all the factors in any decision about an institutional affiliation none is more important than the faculty one joins—their ability, their accomplishments, and most importantly their ambitions. You are doing things that were not being done when I graduated in 1969, your interests are now far broader and aspirations are much higher than those of the faculty of the college of medicine I knew. And there are things you still want to do, even more challenging and more important.
Dr.
Jerry Reves
All institutions go in cycles: they have ups and downs in quality, finance, popularity, reputation and morale. In researching the history of our Medical University during the past several months, I read what I trust you already know in Waring’s “History of Medicine in South Carolina.” The medical activities in Charleson ranked with those in Philadelphia, New York and Boston, the other thriving cities and medical centers during the first half-century of this country’s life.
The very men who formed this medical school were national leaders – their contributions being in anatomy, hospital organization, medical journalism, epidemic prevention and treatment (particularly yellow fever), and lastly but as far as we are concerned certainly not least—the establishment of the first medical school in the South and one of the ten oldest in the U.S. still remaining in operation. We thus have a long and from the beginning distinguished pedigree as faculty of this school of medicine. It is an honor for me to join you as a member of this very old faculty.
When Drs. Ray Greenberg and Rosalie Crouch offered me the opportunity to join you, and do whatever I can to assist you in your several missions I found it irresistible. Irresistible because the thing through my career that has brought me the greatest satisfaction is watching those around me do things they though impossible, and that is the journey we are together setting out on today.
I have no desire, even if it were possible, of trying to make this another Duke University. I believe that MUSC must make its own way in the world, we have and will continue to carve out our unique niche among all academic medical centers and we must—most of all—make the most of our unique talents represented by you the faculty, our place as the major academic medical center in this State, and the precious resources we have at our disposal—resources provided by our efforts and a generous society through its state government. We are housed in Charleston that is a world-class tourist destination because of its architectural preservation, it has as prominent arts and a worldrenown arts festival and it deserves a world-class medical university. Our geography also allows us to do unique and important health science research regarding disease among the underserved. We have a state, too, afflicted in high proportion with the diseases that ravage most of the Western World. All this propels us to do vital work of interest to the world.
When I spoke to our Trustees just after appointment, I said that MUSC should be known for three S’s—in contradistinction to primary education, known for the three R’s. Our three S’s are service to our students, service to society, and service to science. This is our duty and how we succeed in these will determine our place among all academic medical centers.
These are difficult times for all schools of medicine. At times like this it is easy to look outward rather than inward for the solutions to our problems. This is a mistake. I believe that you have the solution to most of our problems. You will recruit other faculty—an even more diverse and talented group than at present to make us stronger. We look for more minorities and women, as well as proven investigators, educators and clinicians. You, the faculty, will dictate how we change, how we improve, and ultimately what we accomplish in the next decade. You will determine who our students are, what the quality of our teaching and research is, and the nature of our clinical programs and how they contribute to our state and nation. This conviction and trust in you will be the hallmark of our administration.
The current financial difficulty of MUSC and that of other medical schools reminds me of the very beginning of this school as revealed in Lynch’s history entitled, “Medical Schooling in South Carolina.” As you probably know, the state legislature created the Medical College of South Carolina Dec. 24, 1823 (Christmas Eve) passing an Act allowing the Medical Society to organize a Medical School. There were no state appropriations with this Act (no Christmas present) and in the very first report of the committee charged with organizing the School, the following quote appeared: “there exist certain difficulties… the one indeed which includes all the rest and from which they all spring, is the want of money.” This is hauntingly familiar isn't it? Further, the first faculty reported the solution to this problem: “we cannot believe that there is among us a single individual who if chosen… would not freely contribute his share of the necessary expenditures.” Thus, from day one of this medical school began a noble and generous tradition that carries on still today of faculty donating a portion of dollars coming from clinical services to build and sustain the medical school. Last year the clinical enterprise sent nearly $4 million to the school alone and that does not count the many uses of UMA funds within the departments. I am not certain how well appreciated by society and everyone even in the medical school today this continuing life sustaining contribution by clinicians is, but I can say to you today that I am aware of it and deeply appreciative of the clinicians who make these funds available by their hard work, skill and sacrifice.
What do I want to see happen over the next several years? First is the enhancement of each faculty member's career, and second is the establishment of interdisciplinary programs that enable the faculty to grow synergistically. The second goal is a means to the accomplishment of the first. The creation of successful interdisciplinary programs while preserving the departmental structure that is essential to all academic medical centers, will create an environment that fosters and supports the collaborative interaction of basic scientists with clinicians, different clinical departments with each other and this school of medicine with the other schools in MUSC and even other universities of this state and nation. I see us doing this by creating first-rate programs in cancer, cardiovascular disease, children’s and women’s health, neuroscience and aging. These are areas of importance to the society we serve and they lend themselves to great interdisciplinary cooperation.
We have three core missions. All three are fundamental to our success
in the school of medicine. First is clinical care. It is a privilege to
be entrusted with the medical care of another person. When a patient comes
to us we take an awesome responsibility shown by that patient’s trust and
confidence. We must be up to that responsibility. We will
provide the most effective diagnostic, therapeutic and compassionate
care possible. We do this cognizant of the limited resources available
for the care of patients. We have the additional need to communicate clearly
and quickly with those who have referred us patients for care.
We have to be the clinical resource that physicians in this state look to for care of the complex patient and that society knows is available to them for even the most straightforward problems. These are simple things to say and not so easy to always do. Nevertheless, we must. Having a robust and growing clinical enterprise will also enable us to be successful in our teaching and research missions.
Before leaving patient care I would be remiss if I did not comment on a real danger. We sometimes think we know something to be true when it is not. We think we are doing the right thing for patients when we lack good evidence that this is so. The history of medicine is strewn with clinical practices painfully late discovered to be improper because we believed them to be proper. In our patient care we have an obligation to continue to explore not only new approaches but examine old ones.
This brings us to research: this is one thing that sets us apart from other groups who engage in clinical care. My own interest in research began over in what is now the Walton Research building, actually in Dr. Robert Walton’s cardiovascular pharmacology laboratory. The excitement of advancing the field through basic science or clinical research is one thing that keeps academic medical centers vibrant. If there were no hope for new discoveries, better understanding of the mechanisms of normal and abnormal biology, all of which lead to better diagnostic methods and more effective therapy—then we would surely be hopelessly adrift. MUSC, like every other medical school, cannot lead in every sphere of research, but we can and must be leaders in some. This enables us to keep the excitement alive that attracts young faculty, keeps productive ones here, improves patient care and draws students into academe.
Educating medical students is the only reason that this school was created in 1824. Teaching medical students and preparing them to serve society is a major reason that our state sends us millions of dollars each year, that students and their families give us tuition, and that residents work for low wages. Teaching and making this a great medical school is an obligation we cannot shirk. We have experimented with the curriculum of late and made innovative changes, as we must. Our medical students and residents do not always seem to perceive our devotion to their learning or even to them, and we can improve on this. The problem with education is that excellence in it is harder to document, the preparing time it takes to do it well is snatched where we can find it, and regretfully, it is an activity that rates behind clinical care and research either because of the time it takes for the amount of revenue generated or because promotions committees don’t know how to reward it. Nevertheless, educating the next generation of physicians and scientists and turning them into leaders is our raison detre. It brings great personal reward—to see students learn and ultimately become better than we are, and it is enormously satisfying. I think there is nothing more gratifying nor important than this. Whereas not all members of our faculty participate in clinical care or investigation, nobody on the faculty is excluded from the privilege of participation in mentoring and education.
I offer now some brief observations and opinions developed over the last three months. These are based on multiple meetings and readings (including e-mails). Our basic sciences are probably in the best condition ever. They are of national standing as are many of our clinical programs. We have, however, some gaps in our clinical coverage and overall a very precarious financial status and this has understandably led to morale problems and even a lack in confidence on the part of some.
As with one’s personal finances, institutions cannot spend more money than comes in. We are perilously close to doing this in many instances and have done so in others. We must live within our means in the future. This is going to require a new accountability and greater responsibility on each of our parts. You, of course, need more fiscal information to help you be responsible. I understand this. We will provide you these data. We need to be as concerned for the hospital’s financial welfare and the UMA's, as we are for each of our departments and centers because we are inextricably related and if one fails it has the potential for all to fail.
How do we proceed? The answer is we must be careful about our budgets. We must provide you with good financial data—information on funds flow. What are we spending and earning in our various endeavors? We will have to decide what we collectively can and must do as opposed to all the things we want to do.
The hospital authority has been the subject of several conversations
and reports. There are three major issues that relate to the school of
medicine and the hospital. First, is the fact that the clinics are hospital
based and because of this the hospital through an agreement sends to UMA
over 30 million dollars each year to operate the clinics. This is a very
considerable sum that has enabled our departments to use dollars that otherwise
would be siphoned from our clinical and academic programs to run our OR’s
and clinics. It is generous and it is vital to our success as an academic
medical center.
Second, the hospital also is paying UMA for the support of the
primary care practices that are part of the health system and who assure
us of a certain patient referral base.
Finally, the hospital is strapped for cash and the best manifestation of this is the condition of the hospital that is in dire need of replacement. It will take extraordinary work to acquire a new facility, but we must find a way to accomplish this —together. We are developing means by which the physicians and hospital share in financial risks and benefits with our major programs—this is the best way to align the incentives of our physicians with the hospital. This strategy should benefit UMA and the hospital. The entire school—basic and clinical sciences are dependent on a healthy hospital.
To review our aim is to improve MUSC through your professional growth enhanced by creating meaningful, interdisciplinary programs that bring basic scientists and clinicians together in synergistic ways that support our clinical, educational and research programs. Over the next three months, I will be spending time in each department and center continuing to learn more about you and how we can assist you reach your goals.
I will end by quoting the words of Layton McCurdy spoken at a dinner honoring him as the very successful dean and leader that he has been for the past 11 years. Dr. McCurdy said: “I have not always been proud of MUSC, but I am today. In the past two decades we have seen a transformation that stirs my heart and sets the stage for a future of limitless achievements…Our best years are ahead.” These words could have been uttered by any of us, especially those of you who have been at MUSC over the past 10 to 15 years. I would not have come here had I not sensed the desire, the ability and even the destiny for MUSC to achieve even more in the future than it has over the last decade.
I look forward to helping you do so.
MBM keeps pace with changing times
If there's one constant in medical education, it is that there are no constants.Freshman medical students will learn that lesson early with the fall course, Molecular Basis of Medicine (MBM).
Dr.
William Stillway
“Our foundation of knowledge changes rapidly,” said course director William Stillway, Ph.D. “The Human Genome Project, as one example, will definitely broaden our knowledge of cellular and molecular biology, especially when applied to medicine.”
MBM's primary goal is to give students a basic understanding of medical concepts at a molecular and cellular level that form the foundation of modern medicine. In addition, students are nurtured as developing professionals, scholars and life-long learners.
“We want them to be independent thinkers, to be creative and to challenge and change the status quo,” Stillway said. “We also want them to enjoy the hard intellectual work.” This is accomplished in part by non-didactic activities in addition to lectures and laboratory work. Students may choose from among approximately 20 “Selectives.” These consist of specialized medical topics that could involve additional small group study, laboratory research with an established mentor, or individual study resulting in a comprehensive research paper. Selective facilitators can be any faculty member within the MUSC community. These activities teach students how to search for and read the latest medical literature. All students are required to write a research paper in a journal-style format, and each student paper will be considered for publication in the South Carolina Journal of Molecular Medicine, an MUSC online journal created primarily for student publications. The MUSC Library and its staff are key components of the MBM course.
Obviously, this course is heavily into science, which may put some students on notice. “Those who are weak in chemistry or biology tend to struggle a bit,” Stillway said, “but they always seem to catch up.”
A few examples of selective topics include: “protein and proteinases of the brain and their roles in health and disease;” “medical chemistry;” “calcium metabolism in health and disease;” “therapeutic approaches to genetic diseases;” “biochemical basis of cancer chemotherapy” and “from cosmos to genes to self-healing systems.”
diseases;” “biochemical basis of cancer chemotherapy” and “from cosmos
to genes to self-healing systems.”
Following are general descriptions of the three methods of selective
options:
Small groups—meeting with a faculty facilitator, students will research a topic of their choice, make an oral presentation to the group and write a research paper. Students will be graded on a number of factors, including performance on examinations, written assignments, oral presentations, research paper and participation.
Laboratory—under the supervision of a faculty mentor, students are expected to spend a minimum of four hours per week in the lab. They will be graded by their faculty mentor based on their laboratory performance and a research paper.
Individual study—Students may choose a biochemical topic in consultation with Stillway, research that topic and submit a 20-page research paper. The paper should attempt to answer a biochemical question, which may not have a final answer. Therefore, the student will need to include current medical information and include his or her opinions based on the current literature.
Faculty who have participated as selective facilitators have commented
that their experience with students and selectives has been very positive.
The quality and diversity of topics with respect to selectives and student-written
research papers has been nothing less than phenomenal. “I have no doubt
that MUSC is educating some of the finest medical professionals,” Stillway
said.
Continuing Medical Education
The following conferences are sponsored by MUSC. All conferences are to be held in Charleston unless otherwise noted.September
1 - 2
71st Carolina Urological Association Meeting
Harbor Hilton Hotel, Mount Pleasant
14 - 15
Pitts Lectureship in Medical
Ethics
MUSC Campus
14-15
CME Sympawsium
Madren Center, Clemson
21 - 23
Achieving Excellence in GME
Mills House Hotel
22
Update on Treatment of Hypertension
Holiday Inn and Suites, Florence, S.C.
24 - 29
10th Intensive Review of Emergency Medicine
Embassy Suites-Convention Center
27 - 28
7th Diabetes Conference
Embassy Suites-Convention Center
October
4
Day of Discovery
Institute of Psychiatry Auditorium
25 - 26
Advanced ERCP Tutorial
MUSC
November
4 - 7
11th Annual International Soc. of Exposure
Analysis Conference
Embassy Suites Convention Center
9 - 11
Neonatal Pharmacology Conference 2001
Embassy Suites Convention Center
November 30 - December 2
4th Annual Frontiers in Pediatrics
Westin Francis Marion Hotel
February 23, 2002
Liver Disease and Transplantation Symposium
Lightsey Conference Center
Teaching Tips
A “Teacher’s Dozen: Fourteen General, Research Based Principles for Improving Higher Learning in Classrooms From Thomas Anthony Angelo’s, Director of the Academic Development Center at Boston College1. Active learning is more effective than passive learning.
2. Learning requires focused attention, and awareness of the importance
of what is to be learned.
3. Learning is more effective and efficient when learners have explicit,
reasonable, positive goals, and when their goals fit well with the teacher’s
goals.
4. To be remembered, new information must be meaningfully connected
to prior knowledge, and it must first be remembered in order to be learned.
5. Unlearning what is already known is often more difficult than learning
new information.
6. Information organized in personally meaningful ways is more likely
to be retained, learned and used.
7. Learners need feedback on their learning, early and often, to learn
well; to become independent, they need to learn how to give themselves
feedback.
The rest of the “Dozen” next month!
Don't miss this
American Association of Medical Colleges 112th Annual Meeting "Facing the Future" Nov. 2 - 7. Washington, DC.For more information, go to <http://www.aamc.org>
The Generalists in Medical Education 22nd Annual meeting held concurrently with the AAMC meeting. "Medical Education: Progress, Problems, and Priorities. Nov. 3 - 4. Washington, DC. For more information go to: <http://www.thegeneralists.org>.
The Medical Educator is produced by the Office
of Public Relations