Medical Marshall Plan

November 4th, 2010 by pcahn

Two days after many candidates running on belt-tightening platforms won election seems like an awkward time to endorse a plan to increase government spending. Still, a call to arms by T. Samuel Shomaker, Dean of Medicine at Texas A & M, warrants consideration.

Dr. Shomaker likens the state of medical education to Europe after World War II. The Marshall Plan cost the United States $13 billion in the short-term but earned it lasting, prosperous allies. Something similar could be done with medical students. He proposes that the federal government pay the first two years of medical school tuition in exchange for a postgraduate year providing primary care in an underserved area.

Upon completion of the year, doctors could earn forgiveness for their remaining medical school debt by staying on in the position or matching with a primary care residency. They may choose a specialty residency, but then the last two years of medical school tuition loans will be theirs to pay back.

Former Labor Secretary Robert Reich has made a similar proposal for undergraduate education. Making tuition free may sound radical, but it promises to lower barriers to entry for many students while also producing more of the educated citizens we need.

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Diversifying the Faculty

November 3rd, 2010 by pcahn

The statistics are revealing:

  • Of 130,000 medical faculty in the U.S. only 1/3 are women
  • 4% are Hispanic
  • 8% of clinical department chairpersons are women

Linda Pololi, a former professor of medicine and now senior scientist at Brandeis's Women's Studies Research Center, conducted interviews with women and minority faculty to find out why academic medicine has not been hospitable to them. She summarized her findings in a recent article from the Chronicle for Higher Education.

Her subjects described a system at odds with the altruistic values that motivated them to pursue academic medicine. They found the work environments competitive, individualistic, and profit-driven. Moreover, women and minority faculty members suffered from unconscious bias.

Faced with such a structural problem, Pololi discourages separate diversity initiatives. Rather, she calls for a change in culture that values all members' contributions.

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Lightbulb Moments

November 2nd, 2010 by pcahn

We tend to think of scientists hatching a paradigm-shifting idea while hunched over a lab bench. Even the language we use to describe these insights convey lonely genius: an epiphany, a lightbulb, a eureka moment. A new book by technology writer Steven Johnson, Where Good Ideas Come From dispels that image.

Taking examples from commerce, science, and the arts, Johnson shows how ideas with lasting impact emerge from social networks. He cites the work of psychologist Kevin Dunbar. In his research, molecular biologists achieved their greatest discoveries not through experiments, but at lab meetings. In sharing mistakes and posing theories with colleagues, they stimulated new discoveries.

It's become fashionable to decry meetings, but great ideas emerge from the human interaction that goes on in groups.

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Breaking Ground

November 1st, 2010 by pcahn

Last week, the Boston University School of Medicine broke ground on a new student residence on Albany Street, near the Crosstown Building. Mayor Menino was on hand alongside university leaders and student representatives. Not only was this an encouraging project for the economic development of Boston, but also it portends assistance to defray the high cost of medical education

Tuition, fees, and health insurance at BU's School of Medicine run $51,134 for the current academic year. Only 4 other medical schools in the country charge more according to data collected by the Association of American Medical Colleges. Of course, the median for all private medical colleges is a not-too-cheap $47,408.

By building its own low-rent apartments, BU can  help mitigate the high cost of tuition in a relatively high-cost city. This benefits more than just the institution. A recent study of primary care doctors suggests that easing medical students' debt can help increase the number of physicians who practice in underserved areas.

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Electronic Error

October 29th, 2010 by pcahn

Electronic medical records hold the promise of managing the flow of data more efficiently. When a doctor orders a test, the computerized system will automatically flag any abnormal results for follow-up.

Yet, a study at the Houston VA Medical Center showed that one-third of over 1,000 electronic alerts over a three-month period went unacknowledged. Of those cases, 45 (or 4% of all abnormal results) did not receive any follow-up at all.

In an interview with the Wall Street Journal, the study's author suggested that physicians may be suffering from information overload. Electronic medical records can send physicians up to 50 alerts and reminders each day, making it difficult to distinguish the crucial data from the less urgent.

This electronic bombardment may be exacerbated in an academic medical center, where faculty also receive regular e-mail blasts about university events and research opportunities. Some past faculty development seminars have offered tips for managing the flow of information. Based on recent response to a seminar about conducting an efficient clinical visit, we will revisit how to maximize use of electronic medical records in the spring.

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Are Men the New Minority?

October 25th, 2010 by pcahn

According to this graph of Canadian medical school enrollment, men outnumbered women by three to one in 1970. Women finally reached parity in 1995. By 2005, women made up nearly 60% of students in Canadian medical schools. At one, McMaster, women constituted over 76% of the incoming class of 2002.

McMaster eventually determined that the imbalance was not healthy and decided to offer a kind of affirmative action for male applicants. By reducing the emphasis on GPA and broadening the criteria for admission, they were able to offer spots to more male students.

I think of this disparity, too, in the faculty development events we organize. Participation in seminars and mentoring programs is overwhelmingly female. This could reflect the preponderance of women at the lower ranks of the faculty, the target audience for many of our activities. Or it could be that women are more sympathetic to the kind of professional education that we offer.

Of course, even to worry about having too many women is unfair because no one seemed to mind when men dominated medical campuses. But we do have an interest in producing both male and female doctors and scientists and making everyone feel welcome at our events.

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The NIH Bubble

October 22nd, 2010 by pcahn

One feature of a medical campus that has struck me as different from an arts and sciences campus is the casual way that research faculty get hired. No strategic plan or educational mission determines the ideal number of faculty each section should have. Rather, Principal Investigators hire on new faculty to assist with their labs. Then, if the researcher cannot establish independent funding or the PI loses a grant, that faculty member is let go.

A commentary in the Chronicle of Higher Education explains why this pattern has developed. After supplying start-up costs and some initial salary, universities can then funnel researchers into the NIH system. NIH grants, the primary source of funding for biomedical research, covers faculty salaries and provides overhead to the university. In this way, medical campuses have incentive to keep hiring more faculty, hope they obtain extramural funding, and then drop them if they don't.

The same commentary also argues that this system is unsustainable. More and more investigators are entering the system, but the overall NIH budget has been flat since 2003. The crisis can already be seen in the number of applications for training grants, which tripled from 1997 to 2007 while success rates nearly halved.

One solution would be to require universities to support their own faculty, as the National Science Foundation already does. This would put a natural limit on the number of investigators on medical campuses, but it would give each of them enhanced stability and confidence to pursue research that matters, not just research that pays the bills.

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What’s the “C”?

October 21st, 2010 by pcahn

We know what the initials  BU stand for. And we know what BMC stands for. But what about BUMC?

Look at this sign from outside the main entrance to the medical school. At the top, it welcomes visitors to "Boston University Medical Center." At the bottom, the logo states "Boston University Medical Campus."

Segal 005

This is not the only discrepancy. The website calls it the Boston University Medical Campus, but signs on buildings--including a large one overlooking Route 93--proclaims this the Boston University Medical Center.

I noticed when I was using the library to access a journal, the subscription was registered to Boston University Medical Center. The side of the mail truck say the same thing. But the letterhead and official communications call it the Boston University Medical Campus.

It may seem like a trivial distinction, but disagreement about the name of an institution can make it harder for its members to feel loyal. Boston Medical Center has a consistent name, logo, and even a slogan. Whether people believe it or not, they can recognize it and identify with it. BUMC could use similar branding.

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Medical School Enrollment Up

October 20th, 2010 by pcahn

The Association of American Medical Colleges has been pushing to expand the number of doctors trained across the United States. They have been encouraged new schools to open and existing schools to expand the number of available seats. The goal is to enroll 21,000 first-year students by 2015.

This year's total, 18,665, represents a 1.5% increase over last year, and a step toward achieving the organization's goal. It helped that overall applications also increased by a little more than 1%, to 42,742. (For those of you doing the math, it's a nearly 44% acceptance rate).

The larger pool of incoming students also reflects greater racial and ethnic diversity. Hispanic males, in particular, increased 17% over last year. All minority groups except Native Americans and Pacific Islanders registered a rise in first-year enrollments.

Sadly, these gains were accompanied by a homogeneity of socio-economic backgrounds. Eighty percent of applicants over the last 10 years have come from the top two income quintiles. It's important to have a medical profession that reflects the ethnic diversity of the population, but it's just as crucial to train doctors from working class and poor families.

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Version Control

October 19th, 2010 by pcahn

With documents like CVs that get regularly updated, it can be a challenge to locate the most recent version. This became apparent after a round of grant reviews when some applicants submitted CVs that left off publications. It's also apparent in my hard drive's folders, where I have a dozen copies of certain drafts each labeled with a different date at the end.

For tech geeks, there are several options using specialized software that helps tame the proliferation of versions. But for folks who want a simple, elegant solution, I suggest Dropbox.

Once you install this free download on your different computers, it creates a kind of shared drive where you can store files. When you make changes in your CV on one computer and sync in to Dropbox, it automatically overwrites the previous draft and makes the latest version available on all your computers.

Another neat feature is it assigns a URL to your documents, so you can send them easily to collaborators for commenting. It comes with 2GB free storage, then charges for more space. The free amount is more than enough to detangle the mess of CV versions. No matter whether you remember to add that talk or paper on your home or work computer, it's all harmonized and updated.

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