No. 358, July 2003
Editor:
Gregory Vercellotti, M.D., verce001@umn.edu
Editorial
Assistant: Allison Campbell, aac@umn.edu
Welcoming
new residents and a new GMEC chair
Starting this summer, residents
and fellows are being welcomed to the University of Minnesota by Dean Deborah
Powell, M.D., and many others in the Medical School and the office of Graduate
Medical Education who will be important to them in the next few years. While
departments have long oriented residents, these new Medical School-wide
orientations help acquaint residents with concepts they should master (the
ACGME core competencies), knowledge they need (how to teach medical students),
and services they might use (financial aid). Particularly important to Dean
Powell is instilling the idea of a continuum of medical education that begins
in the undergraduate years and continues into life-long learning for
physicians. The new ACGME duty hours policy is another focus of the half-day
resident orientation; one takes place July 2.
This year, the Graduate Medical
Education Committee also has a new chair, Louis Ling, M.D., associate medical
director at Hennepin County Medical Center. In addition, to better represent
the 81 resident training programs (62 are ACGME-accredited), the GMEC is
doubling the number of its resident members to 12. With one more to be added
soon, these resident representatives are Paul Amundson, Michael Aylward, Deniz
Aslan, Eric Becken, Peter Eckman, Mark Grim, Allison Korell, Jessica Larson,
Patrick Morgan, Megan Shafer, and Joel Wegener.
Coming
soon: an addition to USMLE Step 2
Starting with the class of 2005,
medical students nationwide must pass the new USMLE Step 2B, a clinical skills
exam. Our Education Council has established a task force to ensure we prepare
our students for this new requirement. A day-long clinical skills exam, USMLE
Step 2B is designed to mirror a physician's day in a clinic using 11 encounters
with standardized patients. This Step 2B exam differs from the Objective
Structured Clinical Exams now taken by our medical school students at the end
of Year Two and after the primary care clerkship because the encounters last
about 15 minutes each (rather than 10), followed by 10 minutes to record
medical history, physical exam findings, and so on.
Given the differences, the task
force will look at the question of whether OSCEs are the best way to prepare
for this test. Additional issues include cost---$975 to take the test, plus
travel expenses---and time. The clinical skills exam is only offered in five
sites; Chicago is the closest to the University of Minnesota. The task force on
USMLE Step 2B includes: Sharon Allen, M.D., Bradley Benson, M.D., Joseph
Clinton, M.D., Ilene Harris, Ph.D., Richard Hoffman, Ph.D., Helene Horwitz,
Ph.D., Co-Chair, Jane Miller, Ph.D., James Nixon, M.D., David Power, M.D.,
Theodore Thompson, M.D., Co-Chair, Douglas Wangensteen, Ph.D., and medical
students Lindsay Miller, Joseph Schuller, and Caleb Schultz.
Greater
Minnesota's summer opportunities
With the help of the
Minnesota Hospital Association and its staffer Elizabeth Biel, we have placed a dozen medical
students in rural hospitals around the state and in Alaska during the
first-ever summer opportunities break. Hospitals in Ada, Bagley, Crookston,
Hibbing, Moose Lake, Parkers Prairie, Willmar, and Winona, as well as an
isolated medical center in Alaska, are providing stipends and in some cases
housing to students. Minnesota AHEC is providing student support. The students,
who are on a nine-week break before they begin Year Two, will be seeking an
interdisciplinary experience by connecting with many community professionals,
including nurses, workers in nursing homes and hospice care, pharmacists,
morticians, dentists, social workers, those who keep medical records, and law
enforcement officials. These dozen are in addition to the 14 students who have
MMF grants to support research during the break.
Summertime
reading
The suggested summer reading list
given to incoming students highlights Infections and Inequalities: The
Modern Plagues by Paul Farmer. Dr. Farmer is a
physician-anthropologist at Harvard who directs the Program in Infectious
Disease and Social Change at Harvard Medical School and does field work with
Haiti's rural poor. His book shows that extreme poverty, filth, and
malnutrition are associated with infectious disease. Dr. Farmer argues that the
predictors of patient compliance are fundamentally economic, not cognitive or
cultural. Incoming students will be discussing this ethnography in this fall's
Physician and Society course.
Trolling
for talent
Talented minority
undergraduates from around the country will visit campus July 25-27, when the
University hosts a conference to introduce them to the world of research. Meet
these students at the Summer Research Opportunities Program welcome reception
July 25, 6:16-7:30 p.m., in McNamara Alumni Center. Last year, more than 500
students from 111 colleges and universities attended. Health sciences
researchers and alumni will be among the several fields presenting to students
at the conference, sponsored by the Committee on Institutional Cooperation, a
consortium of 12 major teaching and research Midwest universities. For the
complete schedule, go to http://www.grad.umn.edu/outreach/research/cic.
Teaching
professionalism, with intention
"I can go into a room and ask a
person if they have sex with men or women or both," said David T. Stern, M.D.,
Ph.D. The right to ask such intrusive questions is given by society to
physicians as professionals, he told the audience at Grand Rounds June 26.
Accompanying that right is an implied social contract that physicians have
responsibilities, such as respect for others, integrity, accountability, and a
sense of duty. During training, physicians learn these behaviors from watching
role models but, said Dr. Stern, the teaching of values involved in
professionalism should be more explicit. Don't just model professional
behavior, Dr. Stern said, explain it. And evaluate it regularly among medical
students and residents so that lapses don't become habits.
Responding to the need to
intentionally teach the tenets of professionalism, the AMA has launched
Strategies for Teaching and Evaluating Professionalism, the STEP program. John
Song, M.D., M.P.H., who directs the ethics content for Physician and Society,
won one of the 10 STEP grants given out this year. Building on professionalism
coursework and events like transition day developed by Theodore Thompson, M.D.,
Dr. Song proposes setting up learning modules for each required course in Years
Three and Four and using web-based case discussion to extend access and allow multiple
attempts at mastery. Each module will be content-specific for the particular
clerkship. Thus, students on the Obstetrics/Gynecology rotation will explore
issues related to genetics, maternal-fetal relationships, reproductive rights,
reproductive technologies, and partner abuse, while those on Pediatrics will
explore issues related to emancipated minors, child protection, and neonatal
borderline viability. We are proud of Dr. Song's leadership and his commitment
to teaching professionalism.
Time
for a tune-up
New students can
just relax---for one day, at least. On Tuesday, August 12, the day before
orientation, incoming medical students may participate in the "Self-care in
Medical School" workshop at the Minnesota Landscape Arboretum. Offered in
conjunction with the Center for Spirituality and Healing, the self-care
workshop will teach skills for coping with stress as well as methods to build
community among classmates. The informal day begins about 9:30 a.m.; details
will follow this month. To sign up, incoming students may contact Katrina
McGill, 626-0163 (larso372@umn.edu); let
her know if transportation is needed to the Arboretum.
Late last month, in a 5-4
decision, the Supreme Court upheld the University of Michigan Law School's use
of race as part of an individual review of each applicant's record and
qualifications. "This is a very important decision that appears to affirm a
compelling state interest in creating a diverse student body and endorse the
use of race as a factor, among many, in admissions decisions," said University
of Minnesota President Robert Bruininks. "The University of Minnesota has
always been committed to diversity and to creating learning and living environments
that incorporate a rich composite of experiences and perspectives."
University legal counsel will
review all current admissions processes to ensure they meet the standards
upheld by the Supreme Court. We expect our Medical School's procedures to remain
intact---and to allow us to continue to contribute to "a physician workforce that
truly mirrors our society," a goal expressed by Jordan Cohen, M.D., president
of the Association of American Medical Colleges in a statement responding to
the Court's decision.
LCME:
Governance
In late March 2004, the University
of Minnesota Medical School will be visited by an accreditation group from the
LCME. (Our GME accreditation will follow shortly after.) We are in the midst of
our self-study process and looking forward to a faculty retreat September 20.
We are also taking time to reflect on what has changed since our last LCME
visit; this month, we look at governance issues.
In 1997, LCME site visitors
expressed concern about plans announced to change the governance of the
Academic Health Center. While titles changed---the Provost for the Academic
Health Center became Senior Vice President for Health Sciences---the University
of Minnesota argued that the organizational structure did not. Indeed, the
close working relationship of the Senior Vice President for Health Sciences and
the Dean of the Medical School created an excellent situation, LCME visitors
concluded during a follow-up visit in 1999. And the fact that the Senior Vice
President for Health Sciences reports directly to the President of the
University brings Medical School issues to the highest levels of University
decision-making.
In addition, in 1997 site visitors
were concerned about discussions then taking place about merging some basic
science departments with departments in the College of Biological Sciences.
Mergers did occur; in addition, the Department of Neuroscience was created by
drawing faculty with common interests from separate departments. On the
follow-up visit, the LCME visitors determined that medical students' interests
were well-protected in these mergers, particularly in the placement of combined
departments on the medical campus.