sorel, e editor 21st century am med ed april 20 2015

Jeffrey S. Akman, MDEdward Eugene Cornwell, III, MDArthur L. Kellerman, MD MPHStephen Ray Mitchell, MD MBA

Eliot Sorel, MD, Editor

21st Century American Medical Education Innovations; Challenges & Opportunities

Jeffrey S. Akman, MDEdward Eugene Cornwell, III, MDArthur L. Kellerman, MD MPHStephen Ray Mitchell, MD MBA

Eliot Sorel, MD, Editor

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Table of Contents

Foreword Eliot Sorel, MD . . . . . . . . . . . . . . . . . . . . 3

The George Washington University School of Medicine and Health Sciences Jeffrey S. Akman, MD . . . . . . . . . . . . . . . . . . 4

Howard University College of Medicine Edward E. Cornwell III, MD . . . . . . . . . . . . . . . 6

Uniformed Services University of the Health Sciences Arthur L. Kellerman, MD, MPH . . . . . . . . . . . . . . 8

Georgetown University School of Medicine Stephen Ray Mitchell, MD, MBA . . . . . . . . . . . . . . 10

Brief Bio Jeffrey S. Akman, MD . . . . . . . . . . . . . . . . . . 12

Brief Bio Edward Eugene Cornwell III MD . . . . . . . . . . . . . . 14

Brief Bio Arthur L. Kellerman, MD MPH . . . . . . . . . . . . . . 16 Brief Bio Stephen Ray Mitchell, MD MBA . . . . . . . . . . . . . . 17

Brief Bio Eliot Sorel, MD . . . . . . . . . . . . . . . . . . . . 19

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Foreword

American medicine has made remarkable progress in the 20th century in scientific discoveries, fighting diseases, increasing longevity and improving the quality of life. Global medicine and populations’ health - to a significant extent - stand on the shoulders of America’s research centers of excellence in medical research and clinical services.

The United States spends more than $8,000.00 per person, per year ($2,5 trillion in aggregate), yet millions of Americans do not have access to health care, our health system is markedly fragmented, and American health care outcomes rank relatively low globally.

The 1910 Flexner Report transformed American medical education, in the 20th century. The report stimulated American medicine to become scientifically sound and clinically informed. These charges were to a significant degree accomplished in the last century. We are now on the cusp of new American and global medical education innovations, challenges and opportunities.

Washington DC’s highly distinguished deans, Jeffrey S. Akman, MD of George Washington University, Edward Eugene Cornwell III, MD of Howard University, Arthur L. Kellerman, MD, MPH of Uniformed Services University, and Stephen Ray Mitchell, MD, MBA of Georgetown University are addressing these challenges, opportunities and the medical curriculum innovations stimulated by them, in this historic monograph.

Eliot Sorel, MD Washington, DC April 2015

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21st Century American Medical EducationThe George Washington University School of Medicine and Health Sciences Perspectives

Jeffrey S. Akman, MDWalter A. Bloedorn Professor of Administrative Medicine, Vice President for Health Affairs, and Dean, School of Medicine and Health Sciences, The George Washington University

Founded in 1824, the George Washington School of Medicine and Health Sciences (SMHS) was the first medical school established in Washington, D.C. and is the 11th oldest in the United States. The school’s location in the nation’s capital has enabled SMHS to enjoy partnerships with many local, federal and global agencies.

In the 21st Century, SMHS’s role is to train the health care leaders of tomorrow and create a cadre of professionals prepared to lead in an evolving health care landscape while working, training, and living within a diverse community.

To meet the many challenges in medicine and public health that lie ahead, SMHS has implemented changes to the pre-clinical years of the M.D. curriculum including in pedagogy, instructional technology, and in the delivery of core competencies by integrating clinical public health, clinical skills and reasoning, and professional development, while enhancing efforts related to inter-professional education.

SMHS has implemented a competency-based education model with well-defined outcome measures that students must satisfy prior to graduation. More performance based assessments throughout the four year curriculum are taking place and a greater use of portfolios to document our students’ progress are to be adopted.

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Enhanced educational technology supports the delivery of medical education including the opening of a new Clinical Learning and Simulation Skills Center and the move to a paperless curriculum that utilizes iPads and a variety of educational software. In addition, faculty are transforming the classroom into a very engaging and interactive learning environment to enhance our students’ ability to think critically and apply to future clinical application.

Core Competencies for Interprofessional Collaborative Practice, Many 2011 (sponsored by the Interprofessional Education Collaborative)

Brightwell, A and Grant, J (2013) Competency Based Training: Who Benefits? Postgraduate Medical Journal, 89:107-110

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21st Century American Medical EducationHoward University College of Medicine Perspectives

Edward E. Cornwell, III, MD, FACS, FCCM, FWASThe LaSalle D. Leffall, Jr. , Professor & Chairman of SurgeryDean, College of Medicine (Interim)Howard University College of MedicineSurgeon-in-Chief, Howard University Hospital

As Howard University College of Medicine (HUCM) approaches its sesquicentennial (1867-present), it becomes clear that the history of its mission and niche in American medical education has closely paralleled the changing landscape of healthcare and health policy in American history. When General Oliver Otis Howard and the Freedmen’s Bureau established a hospital that would care for the freed slaves and their descendents, the education mission was addressing the mission was who would be taught.

The original charter did not speak specifically to race, and the first graduates included Blacks, Whites and women. Fifty years into the HUCM’s existence, the Flexner report suggested a specific role for HUCM in Negro medical education, and standardized instruction, thereby establishing what students should be taught. Over time, changes in demographics, a focus on quality and patient safety and outcomes, has resulted in the core question becoming how students should be taught.

Now that we have departed the era of race based mission statements, the organizing theme for HUCM’s leadership role in education becomes the pursuit of clinical and academic excellence, particularly around diseases where outcome disparities exist. Accordingly, this presentation will focus on 2 developments in medical education that promote Howard’s mission and play an increasingly prominent role in a HUCM education: (1) outcomes research that informs the quest to identify and analyze outcomes disparities and (2) simulation lab based education that promotes the safe acquisition of technical skills, as well as the non technical factors such as communication,

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leadership and teamwork. Simulation Technology, curriculum and standardized patients will be depicted.

References

Flexner A. Medical Education in the United Sates and Canada. Washington, DC: Science and Health Publications, Inc.; 1910.

Haider AH, Chang DC, Efron DT, Haut ER, Crandall M, Cornwell EE., 3rd Race and insurance status as risk factors for trauma mortality. Archives of surgery (Chicago, Ill: 1960) 2008 Oct;143(10):945–949.[PubMed]

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“America’s Medical School”Arthur L. Kellerman, MD MPH Dean, The F. Edward Hébert School of MedicineUniformed Services University of the Health Sciences

The Hébert School of Medicine at the Uniformed Services University (USU) is our nation’s “leadership academy” for military medicine and the U.S. Public Health Service. For this reason, our curriculum combines the best elements of American medical education with cutting-edge training in leadership and military medicine. At USU, students learn in state-of-the-art classrooms and laboratories, in the nation’s premier medical simulation center, in field environments and in military hospitals stretching from Bethesda MD to Honolulu, HI.

The depth, rigor and diversity of a USU education prepare students to be outstanding clinicians and equally outstanding military officers with a strong commitment to national service. Students leave USU to perform in any clinical environment from an elite, tertiary-care hospital to a shipboard clinic, the operating room of combat support hospital or a tent in a refugee camp.

Today, as our involvement in Iraq and Afghanistan winds down, the military health system must sustain the amazing progress it made over the past 13 years of war. And while assuring readiness for future conflicts, it must successfully compete with private healthcare systems to provide the best possible at the lowest possible cost to military service members, families and retirees. For these reasons and many more, the Hébert School of Medicine at USU is truly “America’s Medical School.”

1. DeZee K, Durning SJ, Dong T, Artino AR, Gilliland WR, Waechter DM, McManigle JE, Saguil A, Cruess D, Boulet J. Where are they now? USU School of Medicine graduates after their military obligation is complete. Military Medicine, 2012;177(Suppl.):68-71.

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2. During SJ, Artino AR, Dong T, Cruess DF, Gilliland WR, DeZee KJ, Saguil A, Waechter DM, McManigle JE. The long-term career outcome study (LTCOS): What have we learned from 40 years of military medical education and where should we go? Mil Med 2012;177(Suppl.):81-6.

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The Curricular Challenge: What can we become?

Transforming lives to transform health care

Stephen Ray Mitchell, MD, MBA Dean, Georgetown School of Medicine

Today every school of medicine in the nation must face the same critical, strategic, DQG�PLQGIXO��UHÁHFWLRQ�XSRQ�ZKDW�SRWHQWLDO�WKH�VFKRRO�DQG�LWV�IDFXOW\�DQG�UHVRXUFHV�UHSUHVHQW��ZKDW�RXU�VWXGHQWV�KDYH�WKH�SRWHQWLDO�WR�EHFRPH��DQG�WKH�SRWHQWLDO�LPSDFW�RQ�RXU�ZRUOG��WKHLU�SDWLHQWV��DQG�KHDOWKFDUH�LWVHOI��

Three previous strategic plans at the Georgetown School of Medicine, focused on direction and potential, but were of necessity consumed in correcting deficiencies in facilities, resources and perceived curricular deficiencies by accrediting agencies. We have completed those road maps and now sit poised with a diverse group of the third most selective population of Medical students in the nation with altruism, innovative aspirations, and the ability to have a profound impact on the world around them.

We must respond now in thoughtful, but strategic fashion��From an integrated multidisciplinary modular curriculum, with pockets of true innovation, but a traditional lecture intense vehicle, we are now moving toward competency-based assessments. We have an innovative, school wide program to intentionally promote mindfulness, reflection, professional development, and leadership through mentor rich learning societies.

Now in the seventh year of a student research program that has students from the School of Medicine and Schools of nursing and health studies involved at every level of these efforts. Our Health Justice Scholars are in their eighth year of running the first student driven free HOYA clinic at the City’s Family Shelter at the old D.C. General hospital. We will strive in our newest effort to create a more fertile environment for the individual journey with an organic evolution of focused areas of targeted interest – usually

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identified by students with mentors, and in some cases, as a result of faculty initiatives and task forces (Populations Health and prevention).

Guided by the Jesuit tradition of Cura Personalis, care of the whole person, Georgetown University School of Medicine will educate a diverse student body, in an integrated way, to become knowledgeable, ethical, skillful, and compassionate physicians and biomedical scientists who are dedicated to the care of others and health needs of our society.

Reference

Cooke, M., Irby, D.M., O’Brien, B.C. Educating Physicians: A Call for Reform of Medical Schools and Residency, Stanford CA, Josey Bass 2010.

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Brief Bios

JEFFREY S. AKMAN, MD______________________________________________________

Jeffrey S. Akman, MD, was named The George Washington University Vice President for Health Affairs (VPHA) and Dean of the School of Medicine and Health Sciences (SMHS) in 2013 after serving as interim VPHA and Dean since 2010. As dean, he leads the 11th oldest medical school in the United States — an institution that is widely recognized for its commitment to

biomedical research, for excellence and innovation in medical and health sciences education, and for its commitment to improving the health and well-being of our local, national, and global communities. In his capacity as the VPHA, he serves on GW President Steven Knapp’s Leadership Council and as a liaison between the university and its clinical partners, including the GW Medical Faculty Associates, the GW Hospital, and the Children’s National Health System. On October 23, 2013, Dr. Akman was installed as the Bloedorn Professor of Administrative Medicine.

Dr. Akman received his medical degree from GW in 1981 and completed his psychiatry residency at GW in 1985, serving as chief resident in psychiatry. He then joined the GW psychiatry faculty where he directed the medical student courses in behavioral sciences and psychiatry and served as Director of Medical Student Education in Psychiatry. From 1991-2000, Dr. Akman also served as the Assistant Dean for Student Educational Policies before being appointed to Associate Dean for Student and Faculty

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Development and Policies. Dr. Akman was appointed as the Leon M. Yochelson Professor and Chair of the GW Department of Psychiatry and Behavioral Sciences in 2000. As chair he led the department’s financial turnaround, recruited nationally recognized faculty, and set a vision that led to national recognition for the department’s residency training and medical student education programs.

Dr. Akman held this position until 2010, when he was appointed the Interim VPHA and Dean of SMHS. In this role, Dr. Akman led the reorganization of the medical center, increased philanthropy to the school, and recruited nationally-recognized chairs and faculty members.

Dr. Akman is one of a handful of psychiatrists who defined and developed the field of HIV/AIDS psychiatry in the mid-1980s. He was the principal investigator of an NIH grant to train and educate health care professionals in medical and mental health aspects of HIV/AIDS. Dr. Akman served on D.C. Mayor Vincent Gray’s Commission on HIV/AIDS where he also chaired the Treatment on Demand Committee.

Dr. Akman has received multiple awards for medical education, community service, and humanism in medicine. He is a member of Alpha Omega Alpha medical honor society, a Distinguished Fellow of the American Psychiatric Association and is also a member of the prestigious American College of Psychiatrists. Dr. Akman has a long history of service to his profession and to the community having served on numerous nonprofit boards of directors.

In addition, Dr. Akman served as a member of the Board of Directors of the GW Alumni Association and is a recipient of the GW Distinguished Alumni Service Award.

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EDWARD EUGENE CORNWELL III MD, , FACS, FCCM, FWACS Lasalle D. Leffall, Jr. Professor And Chairman Of Surgery Interim DeanHoward University College Of Medicine______________________________________________________

Edward Eugene Cornwell III MD, was born and raised in Washington D.C. He attended Sidwell Friends School and then received his undergraduate education at Brown University in Providence, Rhode Island graduating with a degree in Biology in 1978. He then attended Howard University College of Medicine and graduated with honors (AOA Medical Honor

Society) and as class President in 1982.

Dr. Cornwell received his surgical training (internship and residency) at the Los Angeles County + University of Southern California Medical Center (1982-1987) and his trauma/critical care fellowship at the Maryland Institute for Emergency Medical Services Systems in Baltimore, Maryland (1987-1989). He has been certified and re-certified in both General Surgery and Surgical Critical Care by the American Board of Surgery. He has risen through the academic ranks through teaching and clinical appointments at Howard University (1989-1993), the University of Southern California (1993-1997), and Johns Hopkins School of Medicine (1998 to 2008). He is presently Professor and Chairman, Department of Surgery at Howard University Hospital and Interim Dean, Howard University College of Medicine. Dr. Cornwell’s career interest is in the prevention, treatment, and outcome disparities of traumatic injuries, and their critical care sequelae. He has authored or co-authored over 250 articles and chapters and has given over 340 invited presentations in the field. He has delivered the named lecture or keynote address at 20 institutions and conferences. He is a reviewer for several surgical journals and is currently deputy editor of JAMA-Surgery (formerly Archives of Surgery).

Among his activities in numerous surgical and critical care societies, Dr. Cornwell is the former Chief Editor of the Multidisciplinary Critical Care

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Knowledge Assessment Program sponsored by the Society of Critical Care Medicine; served as President of the Society of Black Academic Surgeons, President of the Surgical Section of the National Medical Association, and Chairman of Trauma Net of Maryland. He has served as head of committees, panels, or as moderator for scientific sessions of the American Association for the Surgery of Trauma (AAST), American Board of Surgery, Society of Critical Care Medicine, the American Surgical Association, and the American College of Surgeons. He is presently Secretary of the American College of Surgeons and is on the Board of Managers of the AAST.

Dr. Cornwell has received numerous awards and citations for his efforts in education, outreach, and violence prevention. He has received major teaching awards in every faculty position he has held, and was selected as the commencement speaker at the USC School of Medicine in 1996, and at the Howard University College of Medicine in 2002. In 1998 he was given the “What’s Right with Southern California” community service award by KCBS television in Los Angeles. He received the 1999 Martin Luther King Jr. Community Service Award for his violence prevention activities in Baltimore, as well as the 2000, Maryland Governor’s Volunteer Service Award. He was repeatedly named “Best Physician” by Black Enterprise and several local magazines (2009, 2010 & 2014). He received the 2003 Champion of Courage Award, Fox 45 TV, Baltimore, as well as the 2005 Whitney M. Young, Jr. Award, by the Greater Baltimore Urban League; and the Speaker’s Medallion by the Speaker of the Maryland House of Delegates in 2006. He received the Distinguished Alumni Award from Howard University College of Medicine in 2014.

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ARTHUR L. KELLERMAN, MD MPH ______________________________________________________

Arthur L. Kellerman, MD MPH, is Dean of “America’s Medical School” - the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. USU serves as the leadership academy for the United States’ military health system and the U.S. Public Health Service.

Before joining USU in 2013, Dr. Kellermann held the Paul O’Neill-Alcoa Chair in Policy Analysis at the RAND Corporation, an independent, non-profit research organization. Prior to that, he was a professor of emergency medicine and public health at Emory University, where at various points he served as founding director of the Emory Center for Injury Control, founding chair of Emory’s Department of Emergency Medicine and ultimately the School of Medicine’s Associate Dean for Health Policy.

Dr. Kellermann has authored or coauthored more than 200 peer-reviewed papers on emergency cardiac care, public health, health policy, violence prevention and the treatment of traumatic brain injuries. Elected to the Institute of Medicine (IOM) of the National Academies in 1999, Dr. Kellermann has chaired or served on several IOM committees addressing such diverse topics as the consequences of uninsurance, health promotion, biodefense, and the future of emergency care. He currently serves on the Institute’s Governing council. Board-certified in emergency medicine and internal medicine, Dr. Kellermann is a Fellow of both the American College of Emergency Physicians and the American College of Physicians.

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STEPHEN RAY MITCHELL, MD MBA ______________________________________________________

Stephen Ray Mitchell, MD MBA: A Dreyfuss National Merit Scholar at the University of North Carolina, Dr. Mitchell completed training and certification in Internal Medicine and Pediatrics at the North Carolina Memorial Hospital in Chapel Hill. He completed Rheumatology subspecialty training at Georgetown University. He currently serves as the Joseph Butenas Professor of and

Dean of Medical Education at Georgetown.

In 1988, he accepted a faculty position to provide rheumatology teaching and service in adult and pediatric rheumatology at Georgetown University Hospital, where he opened the Childhood Arthritis Center. He served as Residency Program Director in Internal Medicine from 1992 to 1999 and initiated an innovative Medicine Pediatric Residency at Georgetown in partnership with Kaiser Permanente in 1996 under the sponsorship of Partnerships for Quality Education and the Pew Charitable trusts. He has served on the Council and Secretary Treasurer of the Association of Program Directors in Internal Medicine (APDIM) from 1996-2002. He served as Associate Dean for Clinical Curriculum at Georgetown University School of Medicine from 1998-2000 and as Senior Associate Dean for Academic Affairs from 2000 until May 2002. In 2014, he was appointed by the Association of American Medical Colleges to serve on the Liaison Committee for Medical Education (LCME).

Dr. Mitchell has been honored with multiple Golden Apple awards and has been inducted then into the Golden Orchard twice for medical student education. He has received the Kaiser Permanente Award from the faculty for the outstanding Clinical Teacher in the medical center. Dr. Mitchell has received every residency teaching award in the Department of Medicine, including induction into the Sol Katz Society. He was awarded a Laureate Award from the Washington Metropolitan Chapter of the American College of Physicians/American Society of Internal

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Medicine in 2002. In 2004, he was inducted into Mastership of the College, the highest honor bestowed only on 600 living members of the 150,000 member organization. In 2012, he was honored with the Arthritis Foundation Lifetime Achievement Award.

Dr. Mitchell completed the Stanford Faculty development program in Clinical Teaching in 1994 and has delivered that clinical teaching model in many venues around the country. In 1996 he completed the Harvard Macy Institute as Clinician Educator and in 2000 completed the Leaders course. In 2005 he hosted the third reunion of Harvard Macy Educators in Washington, DC in an international conference on “a Global View of Medical Education.

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ELIOT SOREL, M.D., D.L.F.A.P.A.______________________________________________________

Eliot Sorel, M.D., D.L.F.A.P.A., is an innovative global health leader, educator, health systems policy expert and practicing physician.

Dr. Sorel is a member of the Oversight Committee on US Health Disparities at the Satcher Health Leadership Institute and co-chairs the Council on Youth Sports Safety, the Scientific Committee

of the WPA 2015 Bucharest International Congress on Primary Care Mental Health and the World Psychiatric Association’s Task Force on QRQ�FRPPXQLFDEOH�GLVHDVHV�DQG�LQWHJUDWHG�FDUH. He is a member of the Council on Healthcare Systems and Financing, of the American Psychiatric Association. He has SURIHVVRULDO�DSSRLQWPHQWV�LQ�*OREDO�+HDOWK��+HDOWK�6HUYLFHV�0DQDJHPHQW�DQG�/HDGHUVKLS�LQ�WKH�6FKRRO�RI�3XEOLF�+HDOWK as well as in Psychiatry and %HKDYLRUDO�6FLHQFHV�LQ�WKH�6FKRRO�RI�0HGLFLQH�DW�*HRUJH�:DVKLQJWRQ�8QLYHUVLW\. He is the Founder of the Conflict Management & Conflict Resolution Section of the World Psychiatric Association, the World Youth Democracy Forum at the Elliott School of International Affairs of the George WashingtonUniversity, the Cosmos Club Health Group and the Career, Leadership and Mentorship program of the Washington Psychiatric Society.

Dr. Sorel is a former President of the Medical Society of the District of Columbia, the World Association for Social Psychiatry, the Washington Psychiatric Society and has served as a United States National Institutes of Health/Fogarty International Center grants reviewer. He is a Life Member of the American Medical Association, a Fellow of the American College of Psychiatrists, and a Distinguished Life Fellow of the American Psychiatric Association.. He has developed and led health systems in North America and the Caribbean, has consulted and taught in more than twenty countries in Africa, Asia, Europe and the Americas. Dr. Sorel is the author of more than sixty scientific papers and book chapters and the editor of seven books. His most recent books are, The Marshall Plan: Lessons Learned for the 21st Century, accessible at www.oecd.

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org and ��VW�&HQWXU\�*OREDO�0HQWDO�+HDOWK accessible at www.jblearning.com. He contributed to the recent OECD publication, 0DNLQJ�0HQWDO�+HDOWK�&RXQW, accessible at www.oecd.org.

In November 2013, Dr. Sorel co-chaired with Dr. David Satcher the National Conference on Youth Sports Safety, an innovative, trans-disciplinary initiative that led to the formation of the National Council on Youth Sports Safety. In August 2013, Dr. Sorel presented the 81(6&2�6XPPHU� $FDGHP\� OHFWXUH� RQ� ��VW� &HQWXU\� 7UDQV�GLVFLSOLQDU\� &KDOOHQJHV� �2SSRUWXQLWLHV, delivered virtually from the GWU campus in Washington to the Atlantykron program on the Danube in Romania. In April 2013, he co-chaired the Scientific Committee of the WPA 2013 Bucharest Congress on strengthening health systems for southeast Europe and Eurasia via the LQWHJUDWLRQ�RI�SULPDU\�FDUH��PHQWDO�KHDOWK�DQG�SXEOLF�KHDOWK. In July 2010, Dr. Sorel convened the %ODFN�6HD��&DVSLDQ�6HD�$UHD�6WXGLHV�1HWZRUN, a Euro Atlantic, universities partnership that developed the Bucharest Consensus on +LJKHU�(GXFDWLRQ�� ,QQRYDWLRQ��'HYHORSPHQW. In June 2008, he participated as PAHO/WHO advisor, in the :+2�(XURSH�+HDOWK��)LQDQFH�0LQLVWHUV·�PHHWLQJ�RQ�+HDOWK�6\VWHPV��+HDOWK��:HDOWK in Tallinn, Estonia, that ratified the Tallinn Charter. In 2007 Dr. Sorel was a PAHO/WHO advisor to 5HQHZLQJ� 3ULPDU\�&DUH� DQG�+HDOWK� 6\VWHPV� LQ� WKH� $PHULFDV conference in Buenos Aires, Argentina. In 1997-1999 he initiated and provided the stewardship for the project 5RPDQLD� DW� WKH� 6PLWKVRQLDQ� )RONOLIH� )HVWLYDO in Washington, DC.

In June 2014 Dr. Sorel was awarded the Doctor Honoris Causa by the Politehnica University of Bucharest. In October 2009, he was awarded the 'RFWRU�+RQRULV�&DXVD by &DURO�'DYLOD Medical University in Bucharest, Romania. The President of Romania awarded Dr. Sorel the 6WDU�RI�5RPDQLD�2UGHU�RI�&RPPDQGHU in 2004.

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