Collaborations between allopathic and complementary and alternative medicine health professionals: four initiatives.

An effort to increase the understanding of complementary and alternative medicine (CAM) by health care professionals requires an interdisciplinary and collaborative approach. Between 2000 and 2002, National Institutes of Health National Center for Complementary and Alternative Medicine funded 15 educational institutions to develop curricular models for educating allopathic medical and nursing learners in CAM literacy. Four of these 15 programs, Tufts University School of Medicine, University of California at San Francisco School of Medicine, Oregon Health & Sciences University School of Medicine, and University of Washington School of Nursing, formed collaborative partnerships with nearby academic institutions that train CAM practitioners.This article focuses on these four examples of institutional collaboration, summarizing the challenges faced and the positive outcomes achieved for learners, faculty, and institutions. As collaborations between such institutions increase, future potential directions for consideration include credentialing of CAM practitioners teaching within allopathic health professional institutions, faculty development within existing allopathic health professional schools on incorporating evidence-based CAM content into their standard allopathic education, and viewing CAM as an aspect of cultural sensitivity.     

Conflict-of-interest policies for investigators in clinical trials

BACKGROUND: There is substantial concern that financial conflicts of interest on the part of investigators conducting clinical trials may compromise the well-being of research subjects. METHODS: We analyzed policies governing conflicts of interest at the 10 medical schools in the United States that receive the largest amount of research funding from the National Institutes of Health. These institutions are Baylor College of Medicine, Columbia University College of Physicians and Surgeons, Harvard Medical School, Johns Hopkins University School of Medicine, the University of Pennsylvania School of Medicine, the University of California at Los Angeles School of Medicine, the University of California at San Francisco School of Medicine, the University of Washington School of Medicine, Washington University School of Medicine at St. Louis, and Yale University School of Medicine. RESULTS: All 10 universities required that faculty members disclose financial interests to university officials. Only four required disclosure by all members of the research staff. Five universities required disclosure of all financial interests, even though federal regulations specify a threshold for disclosure. Six universities required disclosure to the institutional review board as well as to a committee on conflicts of interest or a university official. Four universities had stricter requirements for investigators conducting clinical trials than required by federal regulations. One university prohibited investigators from having stock, stock options, consulting agreements, or decision-making positions involving a company that sponsored the research. A second university prohibited researchers from trading stock or stock options in a company that sponsored the research or sold the product or device under study. Two universities ordinarily did not allow faculty members to participate in clinical research if they had what federal regulations refer to as a "significant" financial interest in the company owning the product or device being studied, but exceptions were allowed. CONCLUSIONS: Policies governing conflicts of interest at leading medical schools in the United States vary widely. We suggest that university-based investigators and research staff be prohibited from holding stock, stock options, or decision-making positions in a company that may reasonably appear to be affected by the results of their clinical research. Of the 10 medical schools we studied, only 1 had a policy that was close to this standard.     

Addressing global health through the marriage of public health and medicine: developing the University of Washington department of global health.

Widespread interest in global health issues is a common characteristic of students and faculty in schools of public health and schools of medicine. Building on strong university-based and community-based programs in global health, the University of Washington has created a unique Department of Global Health that is housed jointly in its School of Public Health and Community Medicine and its School of Medicine. The creation of this department has generated significant enthusiasm throughout the university and the Seattle community as a new paradigm for addressing global health education, research, and service. Placing the new Department of Global Health in two university schools and finding the appropriate niche for the department among the university's many global health initiatives presented challenges, as well as opportunities. This article describes the goals of the department, the process by which it was created, and what it expects to accomplish.     

Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.

The AAMC's Increasing Women's Leadership Project Implementation Committee examined four years of data on the advancement of women in academic medicine. With women comprising only 14% of tenured faculty and 12% of full professors, the committee concludes that the progress achieved is inadequate. Because academic medicine needs all the leaders it can develop to address accelerating institutional and societal needs, the waste of most women's potential is of growing importance. Only institutions able to recruit and retain women will be likely to maintain the best housestaff and faculty. The long-term success of academic health centers is thus inextricably linked to the development of women leaders. The committee therefore recommends that medical schools, teaching hospitals, and academic societies (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; (2) target women's professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women; (3) assess which institutional practices tend to favor men's over women's professional development, such as defining "academic success" as largely an independent act and rewarding unrestricted availability to work (i.e., neglect of personal life); (4) enhance the effectiveness of search committees to attract women candidates, including assessment of group process and of how candidates' qualifications are defined and evaluated; and (5) financially support institutional Women in Medicine programs and the AAMC Women Liaison Officer and regularly monitor the representation of women at senior ranks.     

Beyond borders: building global health programs at McGill University Faculty of Medicine.

Globalization has irrevocably altered the determinants of health as well as the delivery of health care. Although these changes have been increasingly recognized by governments and funding agencies, and despite the large and growing interest in global health topics among faculty and students, many medical educational programs lack courses or programs in this important area. At McGill University Faculty of Medicine, the Global Health Programs (GHP) were established to build research and training capacity in global health locally and internationally, to stimulate individuals to work in related fields and topics, and to facilitate partnerships with institutions around the world. These goals are addressed through programs that foster communication among interested faculty and students; provide resources such as project databases and easily accessed, centrally located reference materials; and provide both financial and consultative support for faculty and student initiatives. Important lessons learned in building GHP at McGill include (1) the need for a dedicated senior faculty member to lead the program while promoting activities and initiatives, (2) the need for resources to begin new projects, and (3) a willingness to work with others to achieve common goals. Most medical schools already have faculty engaged in and students interested in global health activities. By bringing interested individuals together with a modest infusion of additional resources and creativity, it is possible to develop programs that provide exciting global health educational opportunities for the medical school community and beyond.     

Making it work: the evolution of a medical educational fellowship program.

Longitudinal programs to enhance the educational skills of medical school faculty are present in many medical schools and academic health centers. Multiinstitutional programs are less common. Three health professions schools, Baylor College of Medicine, The University of Texas Medical School at Houston, and The University of Texas Dental Branch have jointly sponsored the Educational Scholars Fellowship Program (ESFP) since 2003. The evolution of this program, from one that addressed the faculty educator development needs of one medical school in the mid-1990s to a more flexible model that includes faculty and fellows from three institutions, reflects the changing needs of faculty as well as those of other health professions schools. The ESFP's strengths lie in the effective use of resources across three schools; the opportunity for an interinstitutional and interdisciplinary collaborative network; the flexibility of the curriculum offerings; and the positive impact on fellows' knowledge, skills and leadership in medical and dental education. The evolution of this program represents a cost-effective and educationally sound response to the changing needs of faculty educators.     

The University of Louisville Medical School's comprehensive programs to increase its percentage of underrepresented-minority students.

Since 1981, the University of Louisville (U of L) School of Medicine has developed several programs to increase the number of its underrepresented-minority (URM) matriculants and help them succeed during their medical education. The first such effort, begun in 1981, was the Professional Education Preparation Program for Kentucky high school students from underserved counties. Programs in Louisville's elementary and middle schools were initiated in 1996, and others continue through medical education and residency training. These existing supports for local URM students (most of whom are African Americans) were enhanced in 1996 by the Health Professions Partnership (HPP), a program sponsored by The Robert Wood Johnson Foundation and the Association of American Medical Colleges. With the HPP, the U of L intensified its focus on health careers preparation at the elementary and secondary education levels, and increased exchanges and collaboration between U of L health sciences faculty and teachers and students in the Jefferson Country Public Schools. Several funding sources have been used to maintain and develop the U of L's education pathway programs, including institutional, state, federal, and foundation funds. The authors describe the U of L's programs, focusing on the HPP, and state that as of 1998, the number of URM students enrolled in the U of L School of Medicine had reached almost 10% (up from 2-3% before 1993) and the graduation rate was 90%, (up from 76% before 1993). These increases are the result of many years of developing and implementing a continuum of preparation and retention programs.     

A curricular model for the training of physician scientists: the evolution of the Duke University School of Medicine curriculum.

Duke University School of Medicine offers an unusual doctor of medicine educational program. The core basic sciences are taught in year one, core clinical clerkships are completed in the second year, the entire third year is devoted to scholarly investigation, and elective rotations are fulfilled in the fourth year. The creation of this unique structure presented many challenges and is the product of a desire of key faculty 40 years ago to change radically the way medical education was taught. Over the years, improvements have been made, but the underlying principles of these visionary leaders have been retained: inquire not just acquire, flexibility of choice, and in-depth exploration. In the spirit of innovation that was established 40 years ago, leaders and faculty at Duke developed a new curricular model in 2004, called Foundation for Excellence, which is anchored in integrated, interdisciplinary innovation. The authors describe the process of curricular reform and provide a detailed overview of this unique approach to medical education. In keeping with Duke's mission to graduate clinician-researchers and clinician-educators, reducing the basic science curriculum to one year created a year saved, which students are now required to devote to scholarly pursuits. The authors argue that adopting a similar one-year basic science curriculum would make instructional time available for other schools to achieve their own institutional goals.     

Retraining faculty for the problem-based curriculum at the University of Hawaii, 1989-1991.

The problem-based learning (PBL) curriculum, adopted by an increasing number of medical schools, requires retraining faculty for new roles as tutors with small groups of medical students. This study describes the procedures and results of four PBL training workshops (1989-1991) given at the University of Hawaii John A. Burns School of Medicine. Eighty-eight faculty volunteers each answered a 20-item multiple-choice questionnaire testing their knowledge of PBL both before and after they participated in a workshop. The posttest results were used to identify deficiencies in the tutors' knowledge and practice of both their role and their function. The authors conclude that these deficiencies, now identified, will be addressed in a systematic fashion in subsequent workshops.     

A mentoring program for underrepresented-minority students at the University of Rochester School of Medicine.

Mentoring underrepresented-minority (URM) students poses a special challenge because most medical schools have few URM faculty and many non-URM faculty hesitate to be mentors for URM students. Some medical students perform less well in the clinical years than would be expected from their pre-clinical performances. One factor is some students' difficulty in adapting to the culture of medicine, which mentors can help students overcome. The University of Rochester School of Medicine created the Medical Student Mentoring Program to address the needs of URM students and non-URM faculty who could be mentors. The program, offered in 1995-96 and 1996-97, trained mentors, created a bicultural support group for URM students, and provided structured mentoring. Interviews were conducted with faculty and students to identify critical areas that influence the success of URM students in their clinical years; URM faculty, residents, and advanced students shared their experiences with the program students at reflection group meetings. Mentors participated in an initial orientation. Of the 42 students eligible during 1995-1997, 30 participated and were assigned to 15 mentors. At the end of the program's first year, the students and mentors gave their reactions, and although there were some differences in their viewpoints, overall they considered the program useful. Non-URM faculty appreciated the support and guidance that allowed them to mentor URM students more effectively. The program ran formally for two years, and some of the mentoring relationships continued into the third year. Loss of funding and change in administrative leadership contributed to the ending of this program. Mentoring continues to be a priority at the medical center, and a new mentoring program has been developed for URM and non-URM medical students.     

Creating sustainable curricular change: lessons learned from an alternative therapies educational initiative.

The authors describe the process by which a curriculum was developed to introduce complementary and alternative medicine topics at multiple levels from health professional students to faculty, as part of a five-year project, funded by a grant from the National Institutes of Health, at the University of Texas Medical Branch in Galveston, Texas, from 2001 to 2005. The curriculum was based on four educational goals that embrace effective communication with patients, application of sound evidence, creation of patient-centered therapeutic relationships, and development of positive perspectives on wellness. The authors analyze the complex and challenging process of gaining acceptance for the curriculum and implementing it in the context of existing courses and programs. The developmental background and context of this curricular innovation at this institution is described, with reference to parallel activities at other academic health centers participating in the Consortium of Academic Health Centers for Integrative Medicine. The authors hold that successful curricular change in medical schools must follow sound educational development principles. A well-planned process of integration is particularly important when introducing a pioneering curriculum into an academic health center. The process at this institution followed six key principles for successful accomplishment of curriculum change: leadership, cooperative climate, participation by organization members, politics, human resource development, and evaluation. The authors provide details about six analogous elements used to design and sustain the curriculum: collaboration, communication, demonstration, evaluation, evolution, and dissemination.     

Medical school in Split: intentions and achievements

This paper describes the origins, aims, and current status of the Split University School of Medicine. Split University School of Medicine was founded several times anew (in 1806, 1944, and 1974), and eventually started to operate as an independent faculty on March 26, 1997. Conceived as a small and efficient medical school, each year it enrolls 50 freshmen at the most. The whole curriculum contains 27 courses (no "majors" or "minors"), each of around 200 class hours, which amounts to a total of 5,610 teaching hours. The teaching process aims at achieving skills and knowledge necessary in general medical practice, at establishing an intellectual basis for further education, and corresponding with the specific medical needs of the coastal area ("Adriatic orientation") Student/instructor ratio is close to 2.0 and the teaching goals are defined better than in older medical schools in the region. The first results are already tangible.     

Medical Humanities at the University of Texas Medical Branch at Galveston.

The Institute for the Medical Humanities of the University of Texas Medical Branch at Galveston (UTMB) was established in June 1973 to ensure that humanities teaching and research became an integral part of the education of future scientists and health-care professionals at UTMB. The multidisciplinary faculty of the Institute-who currently represent the disciplines of art, drama, history, law, literature, philosophy, and religious studies-teach in all four years of the undergraduate medical curriculum as well as in various residency programs. In addition to its focus on students and residents in the School of Medicine, the Institute has a vibrant graduate program in medical humanities with several joint degree options, including an MD/MA and an MD/PhD program, and the Institute has always included the School of Nursing, the School of Allied Health Sciences, and the Graduate School of Biomedical Sciences in its activities. After 30 years, the Institute's commitment to health-professional education remains strong and enduring. Challenged by major curriculum reform in the School of Medicine and increasingly tight state budgets, Institute faculty members look forward to continued collaboration with their basic science and clinical colleagues to improve our evolving curriculum and to seek research funding from external sources.     

Meeting the needs of regional minority groups: the University of Washington's programs to increase the American Indian and Alaskan native physician workforce.

Minority populations in the United States are growing rapidly, but physician workforce diversity has not kept pace with the needs of underserved communities. Minorities comprised 26.4% of the population in 1995; by 2050, these groups will comprise nearly half. Medical schools must enlist greater numbers of minority physicians and train all physicians to provide culturally responsive care. The University of Washington School of Medicine (UWSOM) is the nation's only medical school that serves a five-state region (Washington, Wyoming, Alaska, Montana, and Idaho). Its mission addresses the need to serve the region, rectify primary care shortages, and meet increasing regional demands for underserved populations. The UWSOM Native American Center of Excellence (NACOE) was established as one important way to respond to this charge. The authors describe pipeline and minority recruitment programs at UWSOM, focusing on the NACOE and other activities to recruit American Indian/Alaskan Native (AI/AN) applicants to medical schools. These programs have increased the numbers of AI/AN medical students; developed the Indian Health Pathway; worked to prepare students to provide culturally responsive care for AI/AN communities; researched health disparities specific to AI/AN populations; provided retention programs and services to ensure successful completion of medical training; developed mentorship networks; and provided faculty-development programs to increase entry of AI/AN physicians into academia. Challenges lie ahead. Barriers to the pipeline will continue to plague students, and inadequate federal funding will have a significant and negative impact on achieving needed physician-workforce diversity. Medical schools must play a larger role in resolving these, and continue to provide pipeline programs, retention programs, and minority faculty development that can make a difference.     

Four models of medical education about elder mistreatment.

The authors describe four models of incorporating elder-mistreatment curricular content and collaboration with adult protective service (APS) community service agencies into geriatrics medical education. Geriatrics education programs at four academic health centers-the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; the University of California, Irvine College of Medicine; Hennepin County Medical Center, Minneapolis, Minnesota; and Baylor College of Medicine Geriatrics Program at the Harris County Hospital District, Houston, Texas-were surveyed and information collated. All programs incorporated direct interactions between learners and APS workers into their teaching programs. Learners were fellows, residents, and medical students. While two programs provided direct patient care, two others restricted learners to consultant roles, supporting the APS service providers with medical input. In addition to directly meeting curricular training needs of elder abuse and neglect, clinical cases provided valued learning experiences in applied clinical ethics, the role of physicians with community-based programs, the interaction between the medical and legal professions in cases of financial exploitation, and assessment of elder individuals' decision-making capacity. In two programs APS workers also contribute to the assessment of trainees' humanistic competencies. The authors conclude that APS community service agencies can successfully be incorporated into medical training programs to address a wide range of curricular goals.     

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.     

Survival and recovery: maintaining the educational mission of the Louisiana state university school of medicine in the aftermath of hurricane Katrina.

Hurricane Katrina devastated New Orleans and the coastlines of Louisiana, Mississippi, and Alabama on August 29, 2005. The flooding in New Orleans left hundreds of thousands of people homeless and threatened to close businesses and institutions, including Louisiana State University (LSU) School of Medicine and its two principle training sites in New Orleans, Charity Hospital and University Hospital. In the weeks immediately after the storm, LSU School of Medicine resumed undergraduate and graduate medical education in Baton Rouge, Louisiana and elsewhere. The authors discuss the specific challenges they faced in relocating administrative operations, maintaining the mission of medical education, and dealing with the displacement of faculty, staff, residents, students, and patients, and the processes used to overcome these challenges. They focus on the school's educational missions, but challenges faced by the offices of student affairs, faculty affairs, and admissions are also discussed. LSU School of Medicine's experience provides lessons about organizational preparedness for a mass disaster that may be of interest to other medical schools.     

Problem-based learning: an assessment of its feasibility and cost

As our knowledge of human biology becomes more complex and the medical school applicant pool declines, there is ample reason to consider an alternative to the conventional medical curriculum. Many authorities feel that a format incorporating problem-based learning (PBL) would be more appropriate and effective. The problem-based medical curriculum is one in which facts and principles are learned in the context of a clinical problem. Problem-based medical education began as a revision of the McMaster University medical curriculum in 1969 and was instituted in the United States as a problem-based experimental track at the University of New Mexico School of Medicine in 1979. The first completely integrated, totally problem-based, McMaster-type, medical curriculum in the United States began operation in 1982 with the establishment of Mercer University School of Medicine. Many years of experience at these three institutions have shown that the problem-based curriculum works well. Several medical schools throughout the world are either practicing PBL or investigating the feasibility of adopting it. A comparison of the costs (in faculty time) of problem-based and conventional pathology programs suggests that the PBL curriculum is quite feasible for schools with a class size of 60 or less and may be so for many schools and programs with classes of less than 100.     

Clinical faculty tracks and academic success at the University of California Medical Schools.

PURPOSE: To describe the five faculty series for medical school faculty in the University of California (UC) system, their criteria for advancement, associated challenges, and the different ways they are used by each school. METHOD: During 2001-02, the associate dean for academic affairs at each UC medical school was interviewed for information on the number of faculty in each academic series, the role of each series, and problematic issues associated with them. The averaged merit and promotion results for each series for 1999-2002 at the University of California, Davis, School of Medicine, were examined. RESULTS: The two clinical faculty series showed the most variability among the UC campuses for number of faculty, and strategy for appointment and advancement. The percentage of faculty in the Clinical X series varied from 8% to 39% at the five campuses. All campuses agreed that faculty in the Clinical X series must participate in applied or translational clinical investigation or educational investigation, and disseminate their work. All campuses required that the Ladder-Rank and In-Residence faculty devote the majority of their time to hypothesis-driven research. At University of California, Davis, the two clinical series had the highest approval rates for merits and promotion actions. The Ladder-Rank series had the highest denial rate for merits and promotion. CONCLUSIONS: Clinical series in the UC system are used differently at the five medical schools. Appointing junior faculty in series with minimal expectations as a "safe starting place" is favored for building long-term faculty. Faculty in all series tend to do well in the academic review process, indicating that these series define distinct expectations. Clinical faculty's accomplishments are increasingly understood, valued, and rewarded.     

Medical humanities at New York University School of Medicine: an array of rich programs in diverse settings.

The New York University School of Medicine has a rich tradition of cultivating programs in medical humanities and professionalism. They are drawn from the departments, centers, students, and faculty in the School of Medicine, have linkages throughout the university, and are interwoven into the fabric and culture of the institution. Some are centrally based in the School of Medicine's deans' office, and others are located in individual departments and receive support from the dean's office. This article describes representative programs for medical students and faculty. Curricular initiatives, the fundamental components of medical students' learning, include a course entitled "The Physician, Patient, and Society," a clerkship essay in the Medicine Clerkship, an opportunity for reflection during the medicine clerkship, and a medical humanities elective. In 2002, the Professionalism Initiative was launched to enhance and reflect the values of the medical profession. Its curriculum consists of a series of events that coordinate, particularly, with existing elements of the first-year curriculum (e.g., orientation week, a session during anatomy, a self-assessment workshop, and a peer-assessment workshop). The Master Scholars Program is a group of five, theme-based master societies consisting of faculty and students who share common interests around the society's themes. Programs developed for the societies include colloquia, faculty-led seminars, a mandatory student-mentoring program, and visiting scholars. Finally, the authors describe three high-quality literary publications created at New York University School of Medicine. Each of the initiatives undergoes regular critical examination and reflection that drive future planning.