Contents VOLUME 16, NO. 2
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Index to Advertisers
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In thIs Issue
MARCH/APRIL 2014
Today’s Training of Tomorrow’s Physicians By Katherine Weir, MS2
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PresIdent’s Message:
The Times are Still a Changin’ By Lisa R. Mattson, M.D.
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tCMs In aCtIon
By Sue Schettle, CEO Page 27
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The 2014 Legislative Session at a Glance By Nancy A. Haas, J.D.
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CraftIng PhysICIans of the future
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Colleague Interview: A Dialogue With Medical School Class Presidents Dane Thompson, Erica Levine, Mallory Yelenich-Huss, and Jesse Klingelhoets
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Mentors and Dinosaurs By Peter Meyers, MS3
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The SimPORTAL By Lauren Poniatowski, MS2
Page 27
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Medical Student Education at the University of Minnesota: 2014 and Beyond By Kathleen Watson, M.D., and Mark Rosenberg, M.D.
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A Long, Wonderful, Winding Road—the Path to a “Dual Degree” By Travis Olives, M.D.
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Applying to Residency: 2013 By Jessica van Lengerich, MS4
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The Cost of Becoming a Physician By Juliana Milhofer, J.D.
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TCMS Holds 2014 Annual Meeting
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First a Physician Award Presented to Sanne Magnan, M.D., Ph.D. Glen D. Nelson, M.D. Receives Shotwell Award
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New Member Profile: Meet Kevin Brown, D.O. New Members
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In Memoriam Career Opportunities
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Susan E. Crutchfield-Mitsch, M.D. Charles E. Crutchfield, Sr., M.D.
Page 32 MetroDoctors
LuMInarIes of twIn CItIes MedICIne
The Journal of the Twin Cities Medical Society
On the Cover: Medical school education today as portrayed by U of M medical students, residents and faculty. Articles begin on page 7. March/April 2014
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Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Medical Student Co-editor Katherine Weir Managing Editor Nancy K. Bauer TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.
March/April Index to Advertisers TCMS Officers
President: Lisa R. Mattson, M.D. President-elect: Kenneth N. Kephart, M.D. Secretary: Carolyn McClain, M.D. Treasurer: Matthew Hunt, M.D. Past President: Edwin N. Bogonko, M.D. TCMS Executive Staff
Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Andrea Farina, Communications and IT Coordinator (612) 623-2885 afarina@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Karen Peterson, Program Manager, Honoring Choices MN (612) 362-3704 kpeterson@metrodoctors.com Terri Traudt, Project Director, Honoring Choices MN (612) 362-3706 ttraudt@metrodoctors.com
Allina Health System........................................29 Coldwell Banker Burnet..................................10 Crutchfield Dermatology.................................. 2 Fairview Health Services .................................31 Fraser .......................................Inside Back Cover Great Plains Telehealth ....................................23 Greenwald Wealth Management .................... 8 Healthcare Billing Resources, Inc. ...............14 Lakeview Clinic .................................................31 Lockridge Grindal Nauen P.L.L.P. ...............13 Minnesota Epilepsy Group, PA ...................... 6 MOFAS ................................ Inside Front Cover MN Physician Patient Alliance .....................16 Multicare Associates .........................................19 Saint Therese.......................................................13 Sanford Health ..................................................29 Slingshot Healthcare Informatics ...................... Outside Back Cover St. Cloud VA Medical Center .......................30 U of M CME......................................................23 Uptown Dermatology & SkinSpa.................. 9 Whitesell Medical Locums, Ltd. ..................31
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The Journal of the Twin Cities Medical Society
IN THIS ISSUE...
Today’s Training of Tomorrow’s Physicians
WHAT GOES INTO THE MAKING OF A GOOD DOCTOR?
That is the question that medical education programs must continually try to answer, and the response is far from simple. The theme of this issue, Crafting Physicians of the Future, reflects the art that goes into transforming an incoming medical student into an M.D. in just a few short years. In this month’s Colleague Interview, the presidents from each of the four current classes at the University of Minnesota Medical School give their perspectives on medical education. They address a range of topics including medical technology, health care policy, as well as their own career aspirations. The diversity in their responses and viewpoints exemplifies the great diversity in students now choosing to pursue a medical profession. Peter Meyers, in “Mentors and Dinosaurs,” reminds us of the significance of having someone to learn from and look up to as we go after our goals. His article gives a humorous and thoughtful recognition to the physicians who have inspired him over the years and helped direct him to a career in primary care. Next, Lauren Poniatowski, a current second-year medical student, describes the University of Minnesota’s simulation center. The Simulation PeriOperative Resource for Training And Learning, known as the SimPORTAL, was opened in 2005 to offer training for students, residents and physicians to advance their skills through simulated medical scenarios and use of advanced technologies. The center has since grown to encompass a research branch, as well. The SimPORTAL underscores the ways in which technology has truly transformed the way medicine is taught. The evolution of the format of medical education at the University of Minnesota in recent years is further highlighted in the article by Dr. Mark Rosenberg, Vice Dean for Medical Education, and Dr. Kathy Watson, Senior Associate Dean for Undergraduate Medical Education. They describe how the University of Minnesota Medical School has adapted to new technology and works to incorporate active learning into the curriculum. Dr. Travis Olives earned the titles of Master of Education and Master of Public Health before pursuing a combined internal and emergency medicine residency. His article tells of his own educational path, as well as describes the multitude of dual By Katherine Weir, MS2 Member, MetroDoctors Editorial Board
MetroDoctors
The Journal of the Twin Cities Medical Society
degree programs open to medical students, which are ever broadening the scope of where a medical education can lead. Readers will get a glimpse into the excitement, anxiety and turmoil that underlie the residency selection process in Jessica van Lengerich’s piece. She is a fourthyear medical student in the midst of the application cycle. She takes the reader on the journey through the residency application process as it exists today. mediFunding sits at the forefront of discussions regarding medi cal education. With education costs rising and financial support dwindling, a disparity has arisen leading to a shortage of residency slots. Juliana Milhofer addresses the issues of graduate medical education funding and their implications, along with their complicated ties to the physician shortage. This month’s Luminary is a well-deserved recognition of Drs. Charles Crutchfield, Sr. and Susan Crutchfield-Mitsch, both graduates of the University of Minnesota Medical School. Through their accomplished careers, as well as their community involvement, they serve as an inspiration for many doctors following after them, including one of their own children who continues the family tradition of achievement as a physician. Finally, readers should watch for a new section in our next issue that highlights books published by past and present TCMS members. If you have a book that you would like to appear in a future issue, please email Nancy Bauer at nbauer@metrodoctors. com. Much has changed in medical education in recent years: technology and simulation have revolutionized training, student bodies have diversified in age and background, and active learning has expanded the curriculum beyond the lecture hall. But at the core of medical education, we find that much remains the same as it has always been. The students pursuing a medical education are driven to learn in order to better take care of patients, they are inspired by the mentors that have gone before them, and they look forward to the innovations in medicine to come. March/April 2014
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President’s Message
The Times are Still a Changin’ LISA R. MATTSON, M.D.
BACK IN 1964, Bob Dylan released a song entitled “The Times They Are A Changin’.” The lyrics to that song are still very appropriate 50 years later. Not everyone likes change. We all know that health care is experiencing a vast array of changes, and there is legitimate concern that not all of these changes will be beneficial. We worry about the impact of the Affordable Care Act, electronic medical records, unfunded mandates in the face of decreasing reimbursements, the cost of medical education, the effects of information our patients find on the internet, and direct to consumer advertising. None of us went to medical school to become experts in these things. Most of us just wanted to take care of patients. But even medical knowledge is advancing at a rapid pace. It used to be that medical knowledge doubled once every generation. Now it doubles every eight years requiring us to read at least 17 journals a day to keep up with all of the new information. We’re all dealing with a lot more than we signed up for. I understand that change can be hard, but it has been said that “change is the only constant in life.” Charles Darwin said “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.” We can’t go back to the days before HMOs, and the status quo isn’t an option. We have no choice but to move forward. We can choose to be leaders of the change or we can be victims of the change. We will have to take risks and try new things. As we’ve seen with the roll-out of the health care exchanges, our efforts won’t always be perfect and we’ll ultimately need to change some of our changes. Change is going to be easier for some than for others. Our current medical students and residents grew up with laptops and game boys, and I imagine they are not nearly as concerned about electronic medical records or learning robotic surgery. No doubt some of the concerns we have today will be minimized with the passage of time. While change is inevitable, we need to be cautious, and not too quick to embrace all the “latest and greatest” in medicine. During the holidays, I usually visit the local kitchen store looking for special gifts for my friends and family. Every year I notice the $30 bagel cutter. I am quite capable of cutting a bagel with a knife and getting two halves that are relatively equal in size and taste virtually the same, so for me, this would be a luxury item. But this could be a valuable gift to someone else. If I had bad arthritis or a neuromuscular disease, this device could give me the ability to cut my own bagel and provide me with the independence to enjoy something that may have been a part of my daily routine for years. The point is that not everyone needs robotic surgery, an expensive MRI, or the newest antihypertensive. Just because we can do something doesn’t mean we should do it. One of my mentors in residency once told me that he could train a monkey to operate, but a real surgeon knew which patient needed surgery and the appropriate procedure to perform. I believe that physicians are uniquely qualified to determine when and how to utilize the changes in medicine. Most of us don’t use organic chemistry or physics on a daily basis, but I argue that the mental gymnastics that we had to learn to get through those classes and that we continued to rely on in medical school and residency training helped us, as physicians, develop the critical thinking skills that are so important in the care we provide to our patients. We not only have the medical knowledge, but the wisdom and experience to practice good medicine. This is an exciting time in medicine and I look forward to this upcoming year as president of the Twin Cities Medical Society. There is a lot of uncertainty regarding the future of medicine, but I think there is a real interest in what physicians have to say and how we think the changes will ultimately affect our patients. We need to share our concerns and our stories and be actively engaged in the changes ahead of us. A famous politician once said, “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.” I believe in the physicians in this organization — our intelligence, our integrity, our energy, and our passion for our patients’ well-being. I have no doubt that we will be the ones who lead the way to positive changes in health care. 4
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The Journal of the Twin Cities Medical Society
tCMs In aCtIon SUE A. SCHETTLE, CEO
Twin Cities Medical Society 2013 Annual Report to Board of Directors The mission of the Twin Cities Medical Society is to connect, represent and engage physicians in improving clinical practice, policy development and public health initiatives. Five key strategic areas of focus support this mission: • Public and Community Health Initiatives • Public Policy Advocacy • Support the Practice of Medicine • Increase Visibility, Awareness and Benefits of the Society to Members and the Community • Effectively Manage the Society Public Health Accomplishments
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Community outreach to over 120 metro communities. 3 local communities adopted Healthy Eating Active Living resolutions. Toolkit developed with resources, information and fact sheets for communities interested in developing citywide resolutions. Mayors from Eden Prairie and Savage spoke at the November celebration and highlighted their successes and future goals for implementing their Healthy Eating Active Living resolutions.
Honoring Choices MN Gained Momentum
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Chosen for poster presentation at the Institute for Healthcare Improvement (IHI) annual conference in Orlando. Stronger relationship with U of M’s Academic Health Center. Highly successful Thanksgiving Conversation campaign. Virginia, Wisconsin, Massachusetts, NE Florida, Napa Valley and Sonoma County, California implementing HCM model.
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North Dakota, Arkansas, Colorado, Rhode Island, Washington, Texas, Utah having discussions.
Public Policy Advocacy
TCMS has a devoted group of physicians, residents and medical students serving as members on the Legislative and Policy Committee. After receiving feedback from our membership the group devoted their resources to four key priority areas of focus for 2013 which included: • Support funding for graduate medical education through MERC program. • Support legislation that protects the collaborative care model; promotes team-based health care and discourages providers from practicing beyond their license. • Maintain or increase physician reimbursement for state public health care programs. • Support an increase in the price of tobacco and more funding for public health programs. Support the Practice of Medicine
In 2013 TCMS held events and provided education to our membership on many issues related to supporting the practice of medicine. • Over 70 people attended the TCMS MNsure forum at the Ramada Hotel in September 2013. • Our journal, MetroDoctors featured entire issues on telemedicine, MNsure and the evolving collaborative medical models. • Several lunch and learn programs for medical students. Topics included non-traditional career paths, and graduate medical education funding.
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Increase Visibility, Awareness and Benefits
In 2013, TCMS increased its visibility within our membership base as well as within the various health care systems in which our physician members practice. Some of our tactics included: • Recruiting and involving physicians and medical students in our public health initiatives. • Offering opportunities for increased involvement on committees. • Soliciting member feedback on legislative activities. • Offering opportunities for members to engage with local elected leaders. Effective Management of the Society
Our financial stability remains strong since the merger of the East Metro Medical Society and West Metro Medical Society at the end of 2009 to form Twin Cities Medical Society. We now have a leaner, more nimble, effective operation. • Income has exceeded our expenses consistently since 2010. With keen oversight over $300,000 has been placed in reserve. • In 2013, income exceeded expenses by $40,000. Summary
The Twin Cities Medical Society remains a strong advocate for our members and for their patients. We are in line with our strategic plan internally and externally. Visit our website at www.metrodoctors. com for additional details on upcoming events and ways you can continue to stay involved. March/April 2014
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The 2014 Legislative Session at a Glance The 2014 Legislative Session begins on February 25, the latest start date in almost 40 years. With all 134 House Members and the Governor up for election in November the session is expected to be short and its agenda limited to allow for more campaign time. Each even numbered year the main priority for the session is the bonding bill. Governor Dayton recently proposed his bonding recommendations which total almost $1 billion and focus heavily on state building asset preservation, higher education, and transportation improvements. A By Nancy A. Haas, J.D.
bonding bill requires bi-partisan support. Garnering that support will dominate the work of legislators for this session. The November forecast showed state revenues almost $1 billion ahead of projections. About $300 million will be used to pay off debt owed to schools, leaving $700 million available for use by the 2014 Legislature. Thus far, repealing approximately $400 million in taxes raised last session seems to be high on the list of to do’s, including warehouse and farm machinery tax increases. Other funding priorities include providing wage increases for those working with the disability community, tax conformity and an omnibus transportation bill.
Several policy issues are likely to be advanced this year, including raising the minimum wage, addressing bullying in schools, medical marijuana, and policies around civilly committed sex offenders. On the health care scene, we can expect Minnesota’s new health exchange and issues arising from its implementation to be front and center. With a rocky start, the legislative auditor has already said he intends to investigate MNsure thoroughly. Nurse licensing issues (scope of practice issues) and the recently announced and substantial deficit in the MinnesotaCare program and its affect on the provider tax will receive great attention. Possible changes to no fault auto (fee schedules and treatment standards) will be discussed, along with issues relating to workers compensation. With a constitutional deadline of May 19, look for a fast and furious pace this year. Committee deadlines will likely be a month after session begins, which means the opportunity for protracted debates on controversial issues will be limited. Advocates who want to pass legislation must hit the session running, or risk seeing their efforts delayed until 2015. Nancy A. Haas, J.D., Messerli & Kramer, P.A. She can be reached at: (651) 274-5166, or nhaas@messerlikramer.com. Nancy Haas, J.D. and James Clark, J.D. will be the Messerli & Kramer team assisting Twin Cities Medical Society advance its legislative and policy goals in 2014.
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The Journal of the Twin Cities Medical Society
Crafting Physicians of the Future
Colleague Interview: A Dialogue With Medical School Class Presidents
U
niversity of Minnesota Medical School student body presidents participate in a written conversation relating to their medical school experience. Participants (as pictured from left), Dane Thompson, Class of 2016; Erica Levine, Class of 2017; Mallory YelenichHuss, Class of 2014; and Jesse Klingelhoets, Class of 2015.
Briefly describe your pathway to medicine. From a very young age I enjoyed building and fixing things. So, my first idea was to be an engineer. Late in high school, I realized that I also wanted to work directly with people. With those things in mind, being a physician, a sort of mechanic for people, seemed like a good fit. — Dane When I was 4 years old, I sat on the couch and watched a hip replacement with my father, on what I called “The Surgery Channel.” It was actually just cable programming showing surgeries on a station like TLC. I was immediately intrigued. This intrigue held steady throughout high school and into my Genetics/Cell Biology/ Development degree. Medical school just always seemed to be the right fit that combined my desire to interact with people and be involved with the mystery that is diagnostics and science. — Erica When I was 10, I wanted to work as a medical examiner for the FBI. Then I decided I wanted to help treat living people instead of doing autopsies all day, so thought I should become a psychiatrist and work as a profiler. This kept evolving but stayed in a “physician” realm. However, I was unsuccessful in my application to medical school at the end of college, so I took a job at Regions MetroDoctors
The Journal of the Twin Cities Medical Society
as an OR aide to see if I really wanted to work in health care. During this time frame I took classes part time and eventually pursued a second Bachelor’s degree in Laboratory Science and was then accepted to medical school. — Mallory I came from a family where nobody had received an undergraduate degree, let alone a graduate level education. In that setting it was difficult to find a mentor who could help me with some of the challenges of choosing an academic institution that would make me competitive for medical school. Initially, I was interested in forensic science but could not find a program close to home. So I decided on Duluth since we had taken several vacations there when I was younger. When I got there I was surprised to learn that they had a medical school and the more I learned about it, the more I realized that practicing in rural Minnesota was something that I was very interested in and decided that was where I would go to medical school. — Jesse
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Crafting Medical Physicians Care Organizations of the Future Colleague Interview (Continued from page 7)
Where do you look for mentorship in your medical education? At the University of Minnesota Medical School, we are fortunate to have a great student mentorship program where incoming first year students are matched with second year students. That program has been very beneficial for me. Also, I am yet to run into a faculty member who was not willing to offer advice or to point me in the direction of a good resource. I think that says something about the quality of the staff at the University of Minnesota and its affiliated hospitals. — Dane I am still early in my medical school career so I haven’t really gotten a chance to explore what I want in a mentor. However, all of the faculty has been amazing at providing a kind word of encouragement or bits of wisdom regarding the plan that I, as a student, need to start crafting pretty early into schooling. The administration seems to really want the students to succeed and that mindset lends very well to providing mentorship to the whole student body. — Erica I look for someone I can connect with and who shares common interests. I was lucky enough to be matched with a Faculty Advisor, Dr. Holly Boyer, who has been an amazing mentor for me in the
past four years of school. I also have met a number of residents, particularly in my field of interest (ENT) that have helped me immensely during the past two years. — Mallory The first person I looked to was the 2nd year medical student I was paired with at the start of medical school. My “big sister” was always willing to help me whenever I had questions about things to come. Eventually I started seeing my faculty advisor more and relying on my big sister for advice about the social aspect of medical school. As I entered my clinical years, almost all of my preceptors offered their guidance if ever I had need of them. — Jesse
What do you see as the most important component of your education as a future physician? Even though clinical practice requires a diverse skill set (technical skills, interpersonal skills, exam skills, etc.), doctors would not be doctors without the medical knowledge. Medical knowledge is the gateway to all of those other things. So, I think it is impossible to overemphasize the science component of medical education. — Dane The ability to accept a future of lifelong learning is a component that is vital to the development of a physician. I am not just learning to be a physician practicing five years from now, I am
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learning how to be a physician that will be able to competently practice for the next 30+ years. That will not rest on just what we learn in these short four years, but will rest on my ability to expand my knowledge and keep trying to improve as a doctor of medicine. — Erica There is a wide crevasse to pass when taking memorized knowledge and trying to apply it to clinical practice. For me, learning how to think about patients in a way that connects my experience and education to developing a cohesive, applicable assessment and plan has been the most important component of my education, and one unique to the health sciences. — Mallory The application of knowledge for the appropriate situations. We can memorize all we want but that would make us no better than Wikipedia. Knowing where to apply that knowledge is the most important, and also the most difficult component of medical education. — Jesse
What specific area(s) of medical specialty interest you, and what reasons underlie these aspirations/ preferences (scope of practice, altruism, money, mentor advice, etc.)? My medical interests mostly lie within surgery. I am not sure which surgical specialty yet, but cardiothoracic is one area of particular interest. I am attracted to surgery for a number of reasons. I think working with my hands would fit my tactile learning style. I think I would prefer the fixed end points inherent to operational medicine to management of chronic illness. I also enjoy focusing on one thing versus multitasking and performing surgery would allow me to take one patient at a time. — Dane
not consider ENT until I was on rotation during my third year. I absolutely loved the surgeries, patients, and particularly the residents and attendings on service. There is a huge variety in practice in otolaryngology and lots of opportunity for subspecialization. We can do everything from treating cancer to rebuilding faces after trauma or congenital malformations to allowing someone to hear for the first time. It’s really quite amazing. — Mallory When I started medical school I was very interested in family practice. Three years later, I still believe that is what I want to do. I really enjoy the broad scope of practice and the continuity of patient care. With family practice, I believe that I will still be able to have a life outside of the office to raise a family and live somewhere outside of the metro. I realize that I have not taken some of the core surgery rotations, but I think I will enjoy interacting with patients more than with scrub nurses. — Jesse
How do you see the increased use of technology influencing medical practice? I think technology has the potential to greatly improve the efficiency of health care delivery. The EMR alone does phenomenal things to increase continuity of care and aid communication between providers. However, technology also has the potential (Continued on page 10)
I am currently interested in internal medicine, specifically cardiology. I find the way the heart works fascinating and found myself really connecting with the cardiac material in our various classes thus far. I enjoy what I have heard and seen regarding the practices of internists and hospitalists in terms of scheduling and patient care, so tend to lean that direction naturally. Even though I would be very surprised if I was not entering internal medicine come match day, I am trying to keep an open mind about various aspects of medicine in hopes that I find an area that I truly love. — Erica I am currently applying for residency in otolaryngology. After working at Regions, I knew I was a “surgical personality,” but I did
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Crafting Medical Physicians Care Organizations of the Future Colleague Interview (Continued from page 9)
and set aside time for training with new procedures and equipment. We also need to be aware of the evidence backing the new technologies and critically review it for ourselves. — Mallory
to become a barrier between doctors and patients if doctors give in to the temptation of looking at a screen during an interview instead of at the patient. So, the influence of technology on medical practice may be positive or negative depending on how well the new generation of doctors is able to handle the changes. — Dane Increased technology will become less of a problem as newer generations enter the medical field, especially those that grew up with cell phones, laptops, and tablets. Overall, technology has the ability to greatly improve medicine, especially with things like pacemakers, insulin regulators and all machines used in the NICU. The medical world has consistently been infiltrated with new technology; it is just starting to become the form of computers and centralized charts. We are lucky to be a part of a scientific world that will critically analyze which technology is beneficial and which is not. The medical world adjusted and benefited before, and it will continue to do so. — Erica We will always be creating new materials, developing new techniques. Humans are not satisfied with the now and are always searching for the “what-if.” As physicians we need to be flexible
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With the technical age being somewhat forced on the old guard of physicians, I think there will be a certain grace period where it will hinder practice. However, with the tools available to physicians we are able to be more efficient and precise with our practice of medicine. Instead of a quick referral to a specialist, general practitioners swiftly search up-to-date or other search engines for specialist knowledge and present a more complete picture when and if a referral is necessary. Some still resist change and prefer the “old fashioned ways” but those that embrace technology and use it like the tool it is, are able to be better for their patients and their partners. — Jesse
Do you feel that the medical student body is informed about health care policy? How can students stay informed? On the whole, I feel like my class has a pretty good understanding of health care policy, or as good of an understanding as possible considering all of the changes that are going to take place over the next few years. The best resources at the U for students to
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stay informed on health care are the frequent lunch meetings and lectures put on by student groups, faculty members, and other medical groups. — Dane There is no doubt that the importance of changes in health care policy is being emphasized during medical school coursework. However, it can be difficult to balance the demands of medical school learning and keeping up with politics and policies. The administration of the University of Minnesota Medical School does a great job of giving students resources and speakers to help keep current on health care policy, and the students seem to try to pay attention. It is important to pull information from different sources to make sure opinions can be formed without bias, as well. — Erica Some students make an effort to be very informed. It can be difficult, however, as there are many claims on our time and students are more likely to read their lecture notes or a research article about their patient’s problem than sit down and slog through current legislation. I have been trying to follow the implementation of the insurance exchanges and even that has been trying, as there are many news sources covering the topic, with just as many biases in their reporting. — Mallory Medical school nurtures our ability to quickly find reliable information about pretty much any topic we chose. With that being said I think a lot of my classmates choose to use that skill sparingly when it comes to the topic of health care policy. Some choose to stay up-to-date and involved in the discussions, while others take a backseat and absorb what we can from the media. It is not simply a matter of disseminating the information to the medical students, but making that knowledge a part of a need-to-know aspect of medical school. — Jesse
How is the curriculum designed to address the increasing trend toward utilization of multi-disciplinary teams providing care to patients? Beginning in the first semester of school with the Foundations of Interprofessional Communication & Collaboration (FIPCC) class, we are encouraged to think about medicine from an interdisciplinary perspective. In FIPCC, we are formally introduced to other health care fields and students training in those fields. In small groups, we work together to solve clinical problems. Then, from the second semester of school on, we are in a hospital or clinic on a weekly basis, working with other health professionals to solve real-world problems. — Dane
interacting with other health professional fields. The Medical School does a great job of incorporating interprofessionalism into the curriculum when students are just starting out so positive habits can form. — Erica The FIPCC course is designed to have students work in groups of medical students, veterinary students, mortuary science, laboratory science, public health, and nursing disciplines throughout the year. Many sites that we do clinical rotations at also have midlevel providers and other professionals as part of the team, so we get practical experience working in that setting. This is something that I feel the Medical School can improve upon, and I know they are striving to make each class better than the last. FIPCC should continue to enhance this experience. — Mallory The first year course FIPCC introduced us to this aspect of medical school by teaming us up with students of other health care disciplines. During certain core rotations, internal medicine in particular, we work very closely with practitioners from other areas of the medical field. This is another area of the curriculum that could be more incentivised. — Jesse Jesse Klingelhoets Class of 2015 Undergraduate Program: University of Minnesota Duluth Hometown: Buffalo, Minnesota Email: kling114@d.umn.edu Erica Levine Class of 2017 Undergraduate Program: University of Minnesota Hometown: Owatonna, Minnesota Email: levin278@umn.edu Dane Thompson Class of 2016 Undergraduate Program: Texas Christian University Hometown: Burnsville, Minnesota Email: daneathompson@gmail.com Mallory Yelenich-Huss Class of 2014 Undergraduate Program: University of St. Thomas/ University of Minnesota Hometown: Mountain Iron, Minnesota Email: yelen004@umn.edu
There are two main aspects of the curriculum designed for interprofessional team work. The first is the FIPCC class that put first years with other students from the Academic Health Center. FIPCC is a course specifically designed to encourage cross-discipline teamwork and conversation. The other aspect is how quickly students get into the clinics and actually start
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Crafting Medical Physicians Care Organizations of the Future
Mentors and Dinosaurs
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inding a physician mentor, er multiple mentors, has been the most meaningful and rewarding experience of my entire medical education. And when I think about those who have influenced me, I think about dinosaurs. Well, not literally. Mentors have been such a fundamental component of my medical education that I cognitively organize the eras of my professional life based on the most influential mentor at the time. This may or may not be a holdover from the early years when I memorized the geological timeline based on my favorite dinosaurs. Trilobites were Cambrian, Dimetrodon was Permian, Archaeopteryx was Jurassic, and Triceratops was Cretaceous. (Still got it!) I feel incredibly fortunate to have met these wonderful people and consider them influential figures in my career (regardless of whether they realize it or not). Here is my mentor-ologic timeline, if you will. The Bloomian Era
The first mentor in my medical education was Dr. Stuart Bloom. I’ve known Dr. Bloom since I was five. I went to school with one of his daughters and he was my mom’s oncologist. Prior to becoming a physician, he was an actor and comedian in New York City. So he’s funny, almost intimidatingly funny. As a result, his bedside manner is the best I’ve ever seen. But he was also incredibly kind, patient, and supportive when I was considering applying to medical school. He took the time
By Peter Meyers, MS3
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to let me shadow him during high school. He answered my questions and opened my eyes about forming meaningful connections with patients through end-oflife discussions. Dr. Bloom showed me the powerful impact of a caring, honest physician during those heart-wrenching conversations. Stuart was interviewed on National Public Radio a few years back (about his transition from comedy to medicine) and a quote of his still sticks with me. He said, “Medicine is music. And if you can hear that music, there’s no other melody like it in the world. And if you can’t hear it then you can’t describe it.” More on that in a bit. The Pacalavian Era
This era spans two different family physicians, Dr. Jim Pacala and Dr. Jon Hallberg. Dr. Pacala was my small group leader during the first year of medical school. He is sarcastic, funny, a great teacher, and has an easiness about him that I understand to be
balance. He talked about his kids and his hobbies and I loved it. The idea of being a family physician was easier to envision after having worked with Dr. Pacala. I also met Dr. Jon Hallberg during my first year of medical school. At that time, I was looking for a physician advisor on a summer research project and he was filling in on Dr. Pacala’s discussion group. He was very sharp, witty and approachable. I basically sprained an ankle racing to catch him after class to propose that we become best friends. Dr. Hallberg introduced me to the world of public health through community engagement outside of the exam room. He has an endless variety of interests and skills and has found ways to explore them while maintaining an impressive academic and clinical career. After witnessing Dr. Bloom’s relationship with his patients, I had reservations about achieving a similar career within the overworked and underpaid environment that generally characterizes primary care in the U.S. Both Drs. Pacala and Hallberg erased this fear and renewed my interest in primary care. The Poweronian Era
This era also spans two different family physicians, Dr. David Power and Dr. Shailendra Prasad. Dr. Power is the director of a three-month primary care rotation called Urban Community Ambulatory Medicine (UCAM). I enrolled in UCAM last spring at the United Family Medicine (UFM) clinic in St. Paul. UCAM was transformative for me. The staff at UFM are passionate about community and public health and helped me discover
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my interest in health policy and public health education. As a result, I immediately enrolled in a one-year MPH program so that I could combine these interests in a meaningful way. (This era should also highlight Dr. Tim Rumsey and most of the UFM staff.) Dr. Power was a thoughtful and considerate advisor who offered unwavering support during the tumultuous decision-making process. The experience solidified my interest in family medicine and shifted my entire perspective on the proper execution of primary care. Dr. Prasad is unbelievably passionate about primary care and community health. I honestly think he squeezes a thousand hours out of every day. He’s patient with students, focused, engaged, a wonderful teacher, and has a deep pool of knowledge and experience around the world. He has helped bring some sense of credibility to anything I’ve done in the last two years. During the Pacalavian era, I was searching for the right direction within primary care. I was halfway through my third year of medical school and was starting to worry that I hadn’t found my path. Luckily I had unknowingly entered a new era. The Powernian era opened me up to community engagement and public health, for which I will be eternally grateful. This was the music to which Dr. Bloom was referring. It clicked! Patient care through the lens of public and community health makes sense to me. My experience with physician role models is corroborated by studies that have consistently shown that mentoring is a significant factor when students choose a specialty.1-5 This is particularly important for primary care specialties. As long as I can remember, primary care has suffered from an image problem. Long hours, (relatively) low pay, frustration, burn out…etc. have all become synonymous with primary care in the minds of many medical students. Primary care, more than any other field, needs highly-regarded, empathic physicians to prove that you can lead a healthy, (Continued on page 14) MetroDoctors
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Crafting Medical Physicians Care Organizations of the Future Mentors and Dinosaurs (Continued from page 13)
happy, successful, and balanced career in this field. In fact, Sens. Jack Reed and Roy Blunt introduced a bill last June (S. 1152) designed to increase longitudinal mentoring programs for medical students interested in primary care.6 Given the large income ratio between some subspecialties and primary care, connecting with an inspiring mentor early in medical school might be an important element of increasing the primary care workforce. The questions I keep returning to are, why did it take me so long to find the right role model? And is there a more sophisticated way to find a compatible physician mentor? My method was haphazard. I was in the right place at the right time. An informal poll of my colleagues yielded similar results. Without much planning, mentoring relationships seem to work out
well for most people. But could that process be improved, particularly in primary care? To facilitate the pairing of students with role models, Primary Care Minnesota has made small group mentoring a central goal. Primary Care Minnesota (PCPMN) is a student-run organization at the University of Minnesota Medical School. (We’re a local chapter of a national organization called Primary Care Progress.) Among several other endeavors, PCPMN believes that finding a compatible mentor early in medical school could be an influential factor in decreasing the primary care fatigue in medical school. The process started with student members filling out a simple survey of their interests, academic and extra-curricular. The leaders did their best to match these interests with those of our volunteer mentors (from a variety of primary care specialties). The groups will meet in
informal settings of their choice to have a conversation (e.g. homes, coffee shops, pubs). PCPMN will provide a group leader and material to start the conversation. The frequency of the meetings and topics will be determined by each group. Our hope is that the informal nature of these conversations will promote connections and partnerships for personal and professional development. We also hope they will be complementary to the advising that students currently receive in medical school. The PCPMN small group mentoring program will start this month. We plan to check in with the students regularly about their experiences. So that’s my evolution through the mentor-logic timeline. These physicians have helped shape my path and will undoubtedly continue influencing my future. I feel incredibly fortunate to have found individuals who are as passionate about their patients as their students. For more information about Primary Care Minnesota: primarycareminnesota. wordpress.org. Peter Meyers, Davidson College, Class of 2015 (MD-MPH), Bloomington, MN. He can be reached at: peterjmeyers@gmail.com. References 1) Robert Graham Center (2009). Specialty and Geographic Distribution of the Physician Workforce: What influences medical students and resident choices? Funded by the Josiah Macy, Jr. Foundation. Washington, DC. Accessible: http://www.graham-center.org/online/ etc/medialib/graham/documents/publications/ mongraphs-books/2009/rgcmo-specialtygeographic.Par.0001.File.tmp/Specialty-geography-compressed.pdf. 2) Zerzan JT et al (2009). Making the Most of Mentors: A Guide for Mentees. Acad Med 84 (1). 3) Kashiwagi DT et al (2013). Mentoring programs for physicians in academic medicine: a systematic review. Acad Med 88 (7): 1029-37. 4) Admani S (2013). Understanding the Pediatric Dermatology Workforce Shortage: Mentoring Matters. J Pediatr S0022-3476 (13): 1232-8. 5) Osborn EH (1993). Factors influencing students’ choices of primary care or other specialties. Acad Med 68 (7): 572-4. 6) Building a Health Care Workforce for the Future Act, S. 1152, 113th Congress, 1st session. (2013). Accessible: http://thomas.loc.gov/ cgi-bin/bdquery/z?d113:s.1152:
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The SimPORTAL
Introduction and History
Simulation can be defined as “The technique of imitating the behaviour of some situation or process (whether economic, military, mechanical, etc.) by means of a suitably analogous situation or apparatus, esp. for the purpose of study or personnel training.”1 Using this definition, simulation has been used in medicine for centuries, using pictures and models to teach anatomical structures. Medical simulation as we know it today, however, did not begin until the second half of the twentieth century with the introduction of improved sophistication in simulators.2 Simulation has become an increasingly important and accepted component of medical education, allowing for training and assessment of procedural skills, team training, and interprofessional development outside of the clinical setting. The SimPORTAL (Simulation PeriOperative Resource for Training And Learning) is the simulation center within the University of Minnesota Medical School. It was established in 2005 in order to provide a central resource to meet the simulation training needs of students, residents, physicians and staff. Under the direction of Robert Sweet, M.D., associate professor of urology, the center began to develop and became accredited in 2007 as a Level 1 Comprehensive Education Institute by the American College of Surgeons Program for Accreditation of Education Institutes (ACS-AEI) and at that time had core programs in anesthesiology, emergency medicine, surgery, and urology. In 2006, the research branch of By Lauren Poniatowski, MS2 MetroDoctors
SimPORTAL was founded. Also under the direction of Dr. Sweet, the Center for Research in Education and Simulation Technologies (CREST) is dedicated to simulation research and development. CREST promotes collaboration among members from various backgrounds and areas of expertise including engineering, computer science, manikin design, education and medicine. This group works to create novel training solutions and technologies in the areas of curriculum development, virtual reality (VR) simulator design, tissue analogue model development, human tissue properties characterization, validation research, patient education, and anatomical teaching tools. Additionally, CREST partners with industry leaders to expand and advance research capabilities. The combined creation of SimPORTAL and CREST supported SimPORTAL’s mission “to augment the procedural training and assessment needs of medical professionals through leadership in the use and development of simulation resources.”3 The SimPORTAL was successfully reaccredited by ACS-AEI in 2010 and 2013, continuing to meet the high standards required to become a Level 1 Accredited Education Institute. Additionally, in 2013 the center was the first in the nation to have an ACS-AEI accredited Simulation Fellowship. Simulators and Resources
The SimPORTAL provides resources for medical students, residents, fellows, nurses, faculty and staff. Today, it is primarily used by the University of Minnesota departments of Anesthesiology, Emergency
The Journal of the Twin Cities Medical Society
Medicine, General Surgery, Internal Medicine, Neonatology, and Urology. The SimPORTAL provides high-tech mannequins, VR simulators, synthetic part-task trainers, and hybrid patients. Commercially available simulators as well as novel simulators developed by CREST are utilized for courses and independent practice. Multiple mannequins are available in the SimPORTAL and are utilized by a variety of courses. These simulators give physiologically realistic responses such as eye and eyelid movements, breath sounds, pulses, secretions, bleeding, convulsions, blood pressure, and ECG waveforms. A simulated patient voice allows the mannequin to “react” in real time to decisions made during a scenario. In addition to full body mannequins, part-task trainers are also used in SimPORTAL. These trainers represent a specific part of anatomy or structure that can stand alone, be integrated into a larger simulator, or be temporarily attached to an actor to create a hybrid patient. For example, (Continued on page 16)
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Crafting Medical Physicians Care Organizations of the Future The SimPORTAL (Continued from page 15)
students learn chest tube placement using a task trainer representing the chest wall that is attached to an actor resulting in a “hybrid� patient. Ultrasoundable parttask trainers simulating artery and vein beneath skin and connective tissue are used to practice and assess arterial and central line placement skills using ultrasound. Part-task trainers for training minimally invasive procedures such as arthroscopy, ureteroscopy, and pyeloplasty have been developed. A simulated blood vessel with wall injury represents an emergency situation in which a learner must repair the injury laparoscopically as simulated blood spurts from the injured vessel. All of the above mentioned part-task model examples have been developed by CREST. Virtual reality simulators also allow for training of minimally invasive skills and procedures. These simulators have an interface comparable to a video game, with simulated surgical instruments as the controller and monitors that allow
May 9, 2014:
The Day that Could Change Your Practice The Association of American Physicians and Surgeons (AAPS) and the Minnesota PhysicianPatient Alliance (MPPA) Present: Thrive, Not Just Survive: AAPS Spring Conference May 9, 2014 Marriott - Bloomington
Details at: http://tinyurl.com/aapsmtg Physicians, surgeons, specialists from across the country explain how they built Direct Pay Independent Practice models. Up-to-date reports on the legal, political, and practice trends impacting your career going forward.
Healthcare professionals are looking for answers. This is where you will find them. See event details at: http://tinyurl.com/aapsmtg
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for visualization. This emulates the set up that would be used in the operating room during a minimally invasive procedure. Simulators are available for training procedures such as cranial microsurgery, colonoscopy, photo-selective vaporization of the prostate (developed by CREST), and gastrointestinal endoscopy. Additionally, a simulator is available that utilizes VR to mimic the interface of a console used for robotic surgery. Why Use the SimPORTAL?
The SimPORTAL offers the opportunity for skill acquisition in the simulation environment. In contrast to learning in the clinical setting in which the main focus is on the patient, training in the SimPORTAL is learner-centered. Mistakes can be made without consequence and pose no risk to patient safety. Following a simulated procedure or scenario, feedback is provided to an individual or team and a debriefing allows participants to learn from their mistakes, improve performance, and acquire insight on their own strengths and weaknesses. Through this process, the goal is to improve patient care and safety by preparing health care professionals in the simulation environment prior to or concurrently with clinical responsibilities. Facility
The SimPORTAL facility is located in the Mayo Memorial Building on the University of Minnesota Twin Cities campus. It includes classroom, office, research, and laboratory space. The center includes four main simulation suites as well as conference rooms for meetings and debriefing sessions. The anesthesia/critical care suite emulates the layout of an OR/ICU room with bed, mannequin, anesthesia gas machine, gases, critical care monitoring, difficult airway cart and crash cart. The emergency medicine/trauma skills suite is set up like an emergency room trauma bay with bed, mannequin, crash cart, and defibrillator. The image guided/percutaneous access suite allows for training of fluoroscopy and ultrasound guided procedures. The surgical skills suite has simulators and equipment for training laparoscopic and endoscopic skills.
Who Else Uses the SimPORTAL?
The SimPORTAL also supports the utilization of simulation resources by student interest groups outside of the medical school curriculum. Student groups have the opportunity to apply for funding and design events with specified educational objectives related to clinical skill, interprofessional, team, and/or professional development. Through SimPORTAL hosted events, students acquire skills and work with residents and faculty who volunteer their time to lead events. Additionally, the SimPORTAL participates in community outreach by providing workshops and tours for high school and college students. Students participate in hands-on events where they try out simulators and learn about simulation research and health care. The SimPORTAL also supports Continuing Medical Education (CME) activities as well as workshops and seminars for physicians. What Does the Future Look Like for SimPORTAL?
The SimPORTAL and CREST continue to push the boundaries of simulation technology and curriculum development. The SimPORTAL has become nationally recognized for its simulation work. Highlights include the receipt of the $11.4 million MedSim Combat Casualty Training Consortium, the largest to be awarded for simulation-related research. Overall, SimPORTAL and CREST will continue to strive to remain on the forefront of simulation technology development and work to integrate these advancements into the training of future health care professionals. References 1) OED Online (2013) http://dictionary.oed.com. 2) Bradley P. The history of simulation in medical education and possible future directions. Medical Education. 2006;40(3):254-62. 3) SimPORTAL. http://www.simportal.umn.edu/ about.htm.
Lauren Poniatowski Major: Biomedical Engineering Hometown: Blaine, MN Class of 2016 Email: ponia002@umn.edu
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Medical Student Education at the University of Minnesota: 2014 and Beyond
E
ducating medical students has evolved over the years driven by a number of factors including new scientific discoveries, a more definitive evidence base for clinical medicine, and the transformation of medical practice. Students are coming to medical school with a broader skill set that extends across the sciences and humanities, and with newer methods of learning. The goal of this article is to provide an overview of changes in the medical school curriculum that have occurred as a result of these factors. Curriculum Content
The basic structure for medical education in North America consisting of two years of basic sciences and two years of clinical experience in a teaching hospital was articulated by Abraham Flexner in 1910. Although this structure largely remains in place today, there have been major modifications. Importantly integration of basic science and clinical medicine occurs in all courses and across all four years of medical school. The first two years of medical school consists of decreased classroom time, increased small group time, and more independent learning time to allow students to assimilate and learn the content. A focus on developing skills of life-long learning occurs throughout the curriculum. The first year of medical school is dedicated to learning the scientific foundations of medical practice and the basics of human structure and function. Clinical vignettes are used to reinforce basic science By Kathleen Watson, M.D., and Mark Rosenberg, M.D. MetroDoctors
knowledge whenever possible. Anatomy still involves dissections but is correlated with radiographic anatomy, physical diagnosis and medical procedures. Courses in microbiology, neuroscience, and physiology are also part of the first year. Year two of medical school is focused on pathophysiology of disease with four blocks of courses focused on human disease in different organ systems. Woven throughout the first two years of the curriculum is a course in essentials of clinical medicine that teaches communication and medical interviewing skills, basic physical exam skills, and clinical reasoning. Topics such as ethics, quality improvement, legal aspects of medicine, critical review of the medical literature, are covered in a variety of settings. Teaching of clinical skills progresses to our simulation center where students work with patient educators (standardized patients). In the
The Journal of the Twin Cities Medical Society
last part of the second year students move to three different practice settings — inpatient, long-term care and acute care where clinical skills are further refined. Years three and four of medical school consist of full-time required and elective clerkships where students learn to care for patients by sharing responsibility for patient care. Clinical or research electives are possible locally and elsewhere. Many students spend an additional year or longer in our Flexible M.D. program during which they participate in research, global health, dual degree programs such as M.P.H. or M.B.A., or other enriching academic experiences. Active Learning
Students entering medical school today have grown up with technology and have different expectations and learning (Continued on page 18)
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Crafting Medical Physicians Care Organizations of the Future Medical Student Education at the U of M (Continued from page 17)
methods. In class students often have their computers, tablets, smart phones, or all three, open and connected allowing them to do instant fact checking. This new connected learning style calls for different pedagogy. All lectures are recorded and can be streamed at any time to students. Attendance at lectures is not mandatory and there are many “pajama learners” who view lectures and learn class material at their own speed and convenience. To accommodate this new type of learner and in keeping with modern educational theory we have transitioned to more active ways of learning. Active learning is an umbrella term that focuses the responsibility of learning on learners. Students engage the material they study through reading, writing, talking, listening, and reflecting, with instructors acting as guides. With active learning it is important for students to have an opportunity to clarify, question, apply and consolidate new knowledge. At the University of Minnesota Medical School we have embraced active learning in a number of ways. Almost all courses in first and second year use some form of problem-based learning (PBL) in which students learn about a subject through the experience of problem solving. Students work in groups to identify what they know, what they need to know, and how and where to access new information to solve the problem. The instructor is present to facilitate learning. Other examples of active learning are the use of an audience response system in class in which students can use their smart phones or computers to answer questions posed by the instructor in order to provide instant feedback to both. Some of our faculty has used the “flipped classroom” in which students review the videotaped lecture and reading material before class, and then spend class time solving cases related to the content. Simulation is being increasingly used to teach our students and takes different forms. Patient educators are used to teach principles of history taking and physical examination. 18
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All students participate in a simulated case of a transfusion reaction using a simulated mannequin with programmed physiologic reactions. Simulation is also used to teach ultrasound, anatomy, and basic procedural skills such as gowning, gloving and suturing.
Duluth Campus during which students spend five one-week periods in different rural settings. These and other programs have been successful in attracting students into careers in rural primary care. RPAP is the original longitudinal integrated clerkship (LIC) where medical
A student learning ultrasound and cardiac anatomy in the simulation center.
New Models of Clinical Education
A number of programs have been developed to prepare our students for careers in rural medicine. The longest standing of these programs is the Rural Physician Associate Program (RPAP) in which Year 3 students from either the Duluth or Twin Cites campus spend nine months in rural communities completing core clerkship requirements. The Summer Internship in Medicine program provides an opportunity for students to spend two to eight weeks of their summer between first and second year of medical school working with physicians and other health professionals in rural communities. The goal of this program is to introduce students to rural health systems and rural life. The Rural Family Medicine, Native American, and Minority Medical Scholars Program (RMSP) is a two-year longitudinal program for year one and two students on the
students participate in the comprehensive care of patients over time. A key feature of LICs is the continuing learning relationship with the physicians and other health care providers at the clinical site. LICs allow students to meet the majority of the year’s core clinical competencies across multiple disciplines simultaneously. We have developed a similar LIC at a metro site (MetroPAP) and are in the process of developing an LIC at one of our major teaching sites — the Minneapolis VA Health Care System. Education in Pediatrics Across the Continuum (EPAC) is a new model that will test the feasibility of competencybased education versus the more traditional time-based education model. Second year students interested in careers in pediatrics will be participating in this national pilot program conceived by Deborah Powell, M.D., dean emeritus at the University of Minnesota. The students are guaranteed a
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pediatric residency position and will progress through medical school and residency based on achieving certain pre-defined competencies. Other clerkships provide students with advanced skills in different specialties to make them as competitive as possible for residency. Professional Identity
The process of forming a professional identity as a physician begins at the start of medical school and extends throughout the four years. There are many facets to professionalism with the foundation being a strong faculty advisor program for all students across both campuses and for all four years. Student governance is a key element with a strong student council and many student-driven initiatives. Students are a part of curriculum discussions and their input is sought in many ways. For example we just completed an Innovations Contest in which students were active participants in submitting and voting for ideas to improve education across the medical education continuum. We celebrate many milestones along the path to becoming a physician from a white coat ceremony for matriculating students, to the residency match day for graduating students. We also have a series of Dean’s forums addressing health care issues such as quality improvement, access to health care, and social determinants of health.
in the top 1/3 of the program, and 70 percent were judged to be well-prepared for the residency program. The Association of American Medical Colleges (AAMC) reports on different outcomes in their Missions Management Tool report. The University of Minnesota ranks in the top 10 percent of all medical schools in the number for total medical graduates, the percentage practicing in-state, and the number entering primary care practice. We continue to work on other ways to assess the quality of our curriculum and outcomes of our students that go beyond these traditional evaluations.
to quaternary care medical centers. These diverse sites play an enormous role in providing clinical experiences for our students from the early exposure of first year students to the clinical environment, to more advanced training of fourth year students in primary care or the subspecialties of medicine. The science and practice of medicine continues to expand and evolve, and the Medical School is committed to keep pace with these changes to ensure the future physician work force is prepared to provide good health care for their future patients.
Conclusion
Kathleen Watson, M.D., Senior Associate Dean for Undergraduate Medical Education and Associate Professor of Medicine, University of Minnesota Medical School.
The University of Minnesota has a major role in training the physician work force in Minnesota. Currently 70 percent of actively practicing physicians in the state are graduates of the University’s Medical School, graduate medical education programs, or both. This community of physicians and practices ranges from rural community practices and hospitals,
Mark Rosenberg, M.D., Vice Dean for Education and Professor of Medicine, University of Minnesota Medical School. Dr. Rosenberg can be reached at: (612) 626-9596, or rosen001@umn.edu.
Outcomes
The quality of our curriculum is systematically evaluated throughout the four years of medical school including performance on national examinations. University of Minnesota students score at or above the national average for the three-step examination for medical licensure (United States Medical Licensing Examination Steps 1, 2 and 3). Over the past few years there has been a trend for improved performance on these examinations. Another important assessment is the performance of our graduates once they enter residency programs. Each residency director was asked to evaluate our graduates after completion of their first year of residency. In comparison to the rest of the first year class, 57 percent of our graduates were ranked MetroDoctors
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Crafting Medical Physicians Care Organizations of the Future
A Long, Wonderful, Winding Road— the Path to a “Dual Degree”
I
n the spring of 2002 I received notice that I — along with many colleagues — would be laid off from our positions teaching with the Minneapolis Public Schools. I accepted my pink slip and awkwardly stepped toward life as a “dual degree” student. I transitioned with unfair seamlessness from my brief year in the classroom to several years working as a graduate teaching assistant for the late James Rothenberger, III in the U of M’s School of Public Health. And later I decided to revisit pre-medical coursework — dashed in my undergraduate years by the allure of Latin American Literature and a pre-medical advisor whose words I recall grainily: you’re not a biology major, ergo you’re not pre-med. I finished my training in education and enrolled in the Master of Public Health program. The premedical coursework became interesting, and public health provided a framework giving more than abstract importance to the sciences from which, as a liberal arts undergrad, I had shied away. Thus I found myself with two graduate degrees, applying for my MD. My path was not one for efficiency, but it shaped the physician I’ve become. The road to a dual degree has become increasingly formalized over the years; however, there are now at least six unique pathways for medical students who choose a combined path to the Doctor of Medicine (MD) degree: • Doctor of Philosophy • Master of Business Administration • Master of Science
By Travis Olives, M.D.
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Students emerge as leaders in medical research and experts in their fields. Positions are funded through the completion of their degrees, and are encouraged to apply for competitive outside funding from a diverse base (NIH, AHA). About 25 percent of students secure external funding, according to current MSTP students. Joint Degree Program in Law, Health, & Life Sciences (MD/JD)
• • •
Master of Public Health Master of Health Informatics Juris Doctor Duration, cost, and manner of entry into these programs vary, but all have one thing in common: intense and rigorous curricula that demand dedication in order to complete two degrees on a compressed timeline. Dual Degree Programs Medical Scientist Training Program (MD/PhD)
Each year several applicants with a proven commitment to academic medicine are accepted to a combined position in the University of Minnesota’s Medical Scientist Training Program (MSTP), completing both MD and PhD degrees over sevennine years. Still others are accepted during their first two years of medical school. Curricula are integrated, with medical training punctuated between years two and three by several years of scientific investigation.
Dual degree programs by their nature cater to students with interests beyond the intense and narrow scope of traditional undergraduate medical education. The MD6-year/JD program might be the best example of this. Students are encouraged to explore coursework relevant to their interests despite high demands on both sides of this program, and to tailor their education to fit their professional goals. After completing training in both medicine and law, students may tackle the complex legal and ethical issues coloring the practice of medicine in our changing world. Masters in Health Informatics (MD/MHI)
Most dual degree programs available to University of Minnesota medical students provide training in a field complementary in content to their medical training. The MHI degree is unique in this regard. While the MHI degree certainly delivers core content, it is set apart from other programs for its emphasis on the analysis of the medical delivery system in which we work. Students learn to critically appraise health care systems to solve problems, correct inefficiencies, and improve the health care systems in which they practice. Students who earn an MHI turn a refined and
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critical eye to the multitude of interactions between patients, providers, and medical systems as they improve patient safety, maximize health, and address cost constraints in their health care delivery system. Masters in Business Administration (MD/MBA)
bridging the gap between the delivery of health care and the technology we use to deliver it. By extending their training from four to five years — by taking a leave of absence between years two and three of their medical curriculum — students with an interest in the industry of biomedical
Some physicians in training blur the line between practitioner of medicine and force for change within the health care system. The MD/MBA program is for them. It prepares medical students for leadership positions in industry, health care and government. Particularly as the national framework for the delivery and finance of health care changes, advanced training in the business of medicine gives a leg up to those who take advantage of it. Students complete the same coursework as the MD and MBA programs at equivalent cost, but over a shorter time period, making it particularly rigorous.
with a more developed sense of direction than I had, whose paths appear — at least initially — to lead more directly from point A to point B, opportunity abounds right here in the Twin Cities. Broad skill sets now come in a more streamlined package than I chose, with a wealth of options to
Multiple degrees landed me where I love to be: just inside the emergency department with patients asking for a warm blanket, for a few stitches to make them right, for help at their very worst hour.
Public Health Medicine (MD/MPH)
Medical students whose focus is on population health have a broad palette of options in the School of Public Health. Epidemiologic investigation into diverse emerging health care issues — from diabetes and obesity to infectious disease outbreaks, from barriers to care for the homeless to maternal and child health in developing countries — are the core of the MPH degree. During a 12-month leave from medical school, students enroll fulltime in the School of Public Health and complete coursework, a master’s project, and a field experience to earn their MPH. High quality researchers in the School of Public Health provide the foundation to tailor training to any academic focus. Students leave well-suited to contextualize their practice of medicine in the broader social context of health, always “looking for upstream solutions” in health care. Masters in Biomedical Engineering (MD/MS)
The U of M’s Department of Biomedical Engineering allows up to three currently enrolled or accepted medical students to take advantage of advanced training
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engineering can take advantage of one of only 10 such programs in the United States, drawing from the healthy medical device industry that calls the Twin Cities home. The majority of applicants to this rigorous program come from backgrounds in engineering, but any applicant who excels in math and physics is considered. Combined programs afford flexibility while minimizing the time required to complete two degrees. Some “less traditional” students enter medical school having already completed advanced degrees. Some take still more unconventional paths during or after medical training: many post-residency training programs — international medicine and infectious disease fellowships, for example — incorporate graduate training in public health or community development into their curricula, as do the five residency programs in the Twin Cities metro area with associated international fellowships. For prospective student physicians
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explore. Multiple degrees landed me where I love to be: just inside the emergency department with patients asking for a warm blanket, for a few stitches to make them right, for help at their very worst hour. As more students complement their medical education with additional areas of expertise, we will develop a workforce adept at delivering medical care in the context in which it occurs, and students will find more satisfaction in the care they provide. Consider learning more for yourself at http://med.umn.edu/medical-schoolstudents/combined-degrees/index.htm. Travis Olives, M.D. is a long-displaced New Mexico native and a 5th year combined emergency medicine & internal medicine resident at Hennepin County Medical Center. In addition to his medical degree, he holds a Master of Public Health, epidemiology and a Master of Education, second languages and cultures. He can be reached at: Travis.olives@gmail.com.
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Crafting Medical Physicians Care Organizations of the Future
Applying to Residency: 2013
I
t’s September 15th, and with anticipation and trepidation, medical students around the country click “submit.” The next few days are restlessly anxious, glued to iPhones, androids, or computers, waiting for the emails to arrive. And then, after an initial nail-biting period, the emails from noreply@eraspod.aamc. org come in, one after the other. Within five minutes of receiving an interview offer, an email is shot back as to what days are available. And so the negotiating begins. An original plan to clump interviews geographically can easily be foiled by an offer from a tempting school on the opposite coast, where they only have a single day left to offer you a spot. Because, yes, if you do not hustle, that opportunity could be out the door. Before the week is up, Facebook is full of complaints of having too many interviews. My experience with residency application is fairly similar to that of others in my class, but likely quite different from past generations. The process is introduced in March of third year in a power-point presentation, which is later uploaded to our school’s website. A Google-Plus site was created for our class, where important dates, links and notifications were posted by the administration. I didn’t know what “Google Plus” was before this orientation, but sure enough, I now have an account. I also received quite a few emails with Twitter links that supposedly had useful information, but I am too stubborn to delve into yet another form of social media. By Jessica van Lengerich, MS4
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The actual application, through ERAS, is all electronic. Tab by tab, work experiences, publications, personal statements are entered, along with the names of who will write reference letters. I did print one piece of paper during applications: The request for a UMN transcript had to be faxed. Behind the scenes, our transcripts are uploaded, Dean’s Letters (MSPE Letters) are entered, and letters of recommendation are scanned in or electronically submitted. What I find fascinating about the online application is that I tend not to notice fees assessed. There is a fee to have the USMLE exam scores uploaded, fees for each application sent out after a base fee, and again a cost of registering for the Match through NRMP. Clearly, they can charge whatever they want, since it’s impossible to match without ERAS or NRMP. I enter my credit card number, frustrated at the expenses, but simultaneously indifferent since I can’t change it. After sending my application out to far too many programs (since each just requires checking a few boxes), I wait for emails. Some of my friends received emails inviting them to interview so quickly, that clearly the program gave out invites based on a numerical system rather than reading the entire application. Within a week of submitting applications, I saw many of my classmates struggling to juggle their interview offers. Typically, a program will send a list of available dates — from just one to eight — and ask us to choose the top three that will work. However, if you don’t respond within five minutes, the top
choice dates may already be filled. Sometimes the program coordinator may be unavailable by phone or email due to the high demands. While waiting to establish an interview day at one program, an interview offer from somewhere else may be received that would overlap. Many students find this to be incredibly stressful, as we don’t want to pass up any opportunities to interview, and yet, can’t be in two places at once. The above scenario is what I have seen primarily for internal medicine and pediatrics. Orthopedics is very different — students may wait for weeks without hearing back from any program, while their friends in internal medicine are complaining of having too many interviews. My personal experience with neurology is different, too. I like to think that these programs thoroughly examine the applications before offering interviews. Thus, I
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too was nervous on the sidelines waiting for offers. I would get one offer a week, or even a few weeks apart. I appreciated not being overwhelmed, but it was also nervewracking. I never knew if this would be my last interview offer, or if there would be one more. In late October, the Interview Season began for my classmates and me. Facebook was full of travel pictures and posts “@ MSP, off to interviews 4 thru 6,” or “Phili airport can’t handle snow #stuckatairport.” Words of wisdom on financial planning were put aside when buying $350 flights to Boston. Many threw their suits in their cars and took a two-week road-trip, interviewing around the Midwest. I learned quite a bit about airlines (Spirit runs late and charges for carry on), bus companies (overnight Megabus is exhausting), and airports (Detroit feels like you fell in the rabbit’s hole). Many of us visited old college friends — especially if they had a spare
room and could drive us to the hospital on interview day. Overall, the fourth year of medical school is an exciting time — traveling the country, not knowing your destination for the next few years, and meeting applicants who might become your co-residents. It is also draining — worrying about interviews, finances, and relationships that must sink or swim if you move away. No matter how modernized or expensive the Match becomes, these emotions will remain a fundamental part of the residency application. On March 21st we will still laugh, cry and hug. And yes, I will post where I matched on Facebook. Jessica van Lengerich Class of 2014 Undergraduate Program: University of Minnesota Hometown: Plymouth MN Email: vanl0071@umn.edu
University of Minnesota Continuing Professional Development 2014 CME Spring Activities (All courses in the Twin Cities unless noted)
Fundamentals of Critical Care Support March 17-18, 2014 Advanced Critical Care for Hospitalists March 17-20, 2014 Spring Psychiatry Update: Pursuing Wellness Across the Lifespan April 3-4, 2014 Cardiac Arrhythmias: Interactive Update for Internal Medicine, Family Practice & Pediatrics April 4, 2014 Integrated Behavioral Healthcare Conference: Building a Framework So You Can Grow April 25, 2014
Pediatric Dermatology Progress & Practices April 25, 2014 Annual Surgery Course: Vascular Surgery May 1-2, 2014 Maintenance of Certification in Anesthesiology (MOCA) Training Course May 3, 2014 Live Global Health Training (weekly modules) May 5-30, 2014 Midwest Cardiovascular Forum May 17-18, 2014 Bariatric Education Days: Decade of Bariatric Education May 21-22, 2014 Topics & Advances in Pediatrics May 29-30, 2014
ONLINE COURSES (CME credit available) www.cme.umn.edu/online • Global Health - 7 Modules to include Travel Medicine, Refugee & Immigrant Health - NEW! Family Medicine Specialty • Nitrous Oxide for Pediatric Procedural Sedation
For a full activity listing, go to www.cmecourses.umn.edu
Workshops in Clinical Hypnosis June 5-7, 2014
Office of Continuing Medical Education 612-626-7600 or 1-800-776-8636 • email: cme@umn.edu
Promoting a lifetime of outstanding professional practice
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23
Crafting Medical Physicians Care Organizations of the Future
The Cost of Becoming a Physician
M
atch Day is the time in a medical student’s life when they find out what residency program they will call home for the next three to seven years.1 In 2013, there were a total of 34,355 applicants for the 26,392 available first-year and 2,779 second-year residency positions.2 According to the National Resident Matching Program, 95.1 percent of medical school seniors matched (an all-time high) in 2012, while only 93.7 percent matched in 2013.3 At the end of Match Week in 2013, after students who didn’t originally match had the opportunity to accept offers from programs with unfilled residency slots, there were a total of 528 U.S. medical school graduates who did not match into a residency program.4 These students will have an opportunity to reapply to residency programs during next year’s match. Understanding that applying to residency programs has become competitive, many of the 528 medical students who did not match will spend the next year conducting research, or obtaining additional qualifications (e.g., master’s degree). Medical School
In the U.S. there are two types of medical schools — allopathic (M.D.) and osteopathic (D.O.). Allopathic medicine is defined as “the system of medical practice which treats disease by the use of remedies which produce effects different from those produced by the disease under treatment.”5 Osteopathic medicine “emphasizes prevention of illness and the maintenance of good health.”6 The main difference between these two types of medicine is that those By Juliana Milhofer, J.D.
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training in osteopathic schools receive 200 hours of osteopathic manipulative medicine training. This type of training involves the use of techniques that address the functional and structural issues of the body. Currently, 141 allopathic medical schools7 and 29 osteopathic medical schools8 in the U.S. are accredited. According to the Association of American Medical Colleges, the median four-year cost of attendance at a public medical school in the U.S. was $218,898 (up 5 percent from the previous year).9 For medical students attending private institutions, the median four-year cost of attendance was $286,806 (up 3 percent).10 The rising cost of medical school also comes with high debt loads for many medical students. In 2013, the median medical school debt was $175,000 (for both public and private institutions), a figure up 3 percent from the previous year.11 Graduate Medical Education and the Freeze on Residency Slots
The funding of graduate medical education (“GME”) has a complicated past, present and future. The federal government is the largest funder of graduate medical education, the education that medical graduates receive when they are training in residency programs. Approximately $9.5 billion funds from Medicare, and $2 billion funds from Medicaid, are applied toward supporting graduate medical education here in the U.S.12 Payments that are applied to teaching hospitals are calculated in two separate ways: (1) Direct medical education payments (“DME”– $3 billion) are applied toward paying the
salaries and fringe benefits of residents, the time of their supervising physician, and overhead expenses incurred by the hospital; and (2) Indirect medical education payments (“IME” – $6.5 billion) are applied toward additional hospital expenses that result from the residency programs (e.g., costs associated with more intensive treatments, additional tests used, etc.).13 Therefore, the federal government support is about $100,000 per resident/year and when you add what each state contributes through state Medicaid payments, the cost of training a resident is approximately $500,000.14 In 2012, Minnesota received $40.1 million in Medicaid GME payments, and in 2011 received $165.4 million in Medicare GME payments.15 Discussion of graduate medical education goes hand-in-hand with the limits that were set on residency slots back in the late 90s. In 1997, Congress passed the Balanced Budget Act (BBA), a piece of legislation that brought with it some of the greatest reforms to Medicare-supported
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graduate medical education. Specifically, the BBA placed limits on the number of residents that would be counted for purposes of calculating Medicare payments (both DME and IME) to the number of residents on each hospital’s most recent cost report (number of residents as of December 31, 1996).16 As of October 1, 1997, there has been a freeze (or “cap”) on residency slots, and no additional Medicare funds are given to teaching hospitals as a result. Here in Minnesota, the Medical Education and Research Costs (MERC) program, established by the Minnesota legislature and governor in 1996, assists teaching hospitals and clinics with offsetting a portion of the costs associated with clinical training.17 MERC funds come from (1) revenues stemming from the cigarette tax; (2) a “carve out” of funds for medical education from the Prepaid Medical Assistance Program/Prepaid General Assistance Medical Care program (PMAP/PGAMC); and (3) federal Medicaid matching funds obtained by the Department of Human Services.18 In 2011, funding to MERC was cut by almost 50 percent. Although efforts to restore 2011 cuts were unsuccessful in 2012, the 2013 Minnesota Health and Human Services Budget Bill restored MERC funding to levels in effect prior to the cuts of 2011 (funding was increased by $12.8 million each year). Challenges
Throughout the halls of Congress, funding cuts to graduate medical education have been proposed. In President Obama’s 2014 budget proposal, proposed cuts to graduate medical education funding ($11 billion in cuts over the next decade)19 would have affected not only the training of residents, but the patient care that those residents are able to provide. Two pieces of legislation, Training Tomorrow’s Doctors Today Act, and the Resident Physician Shortage Reduction Act, would fund additional graduate medical education positions over the next five years (15,000 Medicare-supported hospital residency positions). These are two examples of action being proposed in Congress that would help alleviate the
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limited residency slots that currently exist. The proposed cuts to graduate medical education, coupled with an already short supply of residency slots, are both coming at a time when the U.S. is in the midst of a primary care physician shortage. According to the Association of American Medical Colleges (AAMC), shortages in the U.S. are expected to reach 62,900 physicians by 2015, and will exceed 100,000 physicians by 2025.20 Furthermore, AAMC projects a shortage of 45,000 primary care doctors by 2020 and a shortage of 65,000 primary care doctors by 2025.21 Looking at Minnesota, there were approximately 4,215 primary care physicians as of 2010.22 It is estimated that Minnesota will need approximately 1,187 additional primary care physicians by 2030 — a 28 percent increase from 2010 figures.23 Aligning the flow of graduate medical education funding to a state’s workforce needs, or directing the funding to primary care — these are some solutions that have been discussed to address the challenges being presented by the current cap set on residency slots.
3.
Conclusion
15.
Today’s medical students are facing high medical school costs, high debt levels, competition for an already limited number of residency slots, and a changing health care environment. Nevertheless, today’s medical students are eager to take on the challenges facing their profession — after all, isn’t taking on challenges what being a physician is all about. Juliana Milhofer, J.D. is a policy analyst at the Minnesota Medical Association. She received her undergraduate degree from Florida State University and her J.D. from the University of Minnesota Law School. Juliana can be reached at jmilhofer@mnmed.org; (612) 362-3735. (Endnotes) 1. American Association of Medical Colleges, “Match Day Results Show Need to Increase Graduate Medical Education Slots,” April 2013, available at: https://www.aamc.org/newsroom/ reporter/april2013/334068/match.html. 2. National Resident Matching Program (NRMP), Results and Data: 2013 Main Residency Match, available at: http://b83c73bcf0e7ca356c80-e8 560f466940e4ec38ed51af32994bc6.r6.cf1. rackcdn.com/wp-content/uploads/2013/08/ resultsanddata2013.pdf.
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4. 5.
6.
7.
8.
9.
10. 11. 12.
13.
14.
16.
17.
18. 19.
20.
21.
22.
23.
Association of American Medical Colleges, A Word From the President: Taking a Lesson from the 2013 Match, June 2013, available at: https://www.aamc.org/newsroom/reporter/ june2013/346238/word.html. Id. Johns Hopkins University, Allopathic Medicine, available at: http://web.jhu.edu/prepro/health/ allopathic.html. John Hopkins University, Osteopathic Medicine, available at: http://web.jhu.edu/prepro/ health/osteopathic.html. Association of American Medical Colleges, Medical Schools, available at: https://www. aamc.org/about/medicalschools/. American Osteopathic Association, Osteopathic Medical Schools, available at: http:// www.osteopathic.org/inside-aoa/about/affiliates/Pages/osteopathic-medical-schools.aspx. Association of American Medical Colleges, “Medical Student Education: Debt, Costs, and Loan Repayment Fact Card,” October 2013, available at: https://www.aamc.org/download/152968/data. Id. Id. Health Affairs, Health Policy Briefs, “Graduate Medical Education,” August 31, 2012, available at: http://healthaffairs.org/healthpolicybriefs/ brief_pdfs/healthpolicybrief_75.pdf. Id. at 2; see also Council on Graduate Medical Education, “The Effects of the Balanced Budget Act of 1997 on Graduate Medical Education,” March 2000, available at: http://www. hrsa.gov/advisorycommittees/bhpradvisory/ cogme/Publications/budgetact.pdf. Health Affairs, “Graduate Medical Education,” at 2. Commonwealth of Massachusetts, “Report of the Special Commission on Graduate Medical Education,” July 30, 2013, available at: http:// www.mass.gov/eohhs/docs/eohhs/gme-finalreport.pdf. Association of American Medical Colleges, Medicare Resident Limits (“Caps”), available at: https://www.aamc.org/advocacy/ gme/71178/gme_gme0012.html. Minnesota Department of Health, Medical Education and Research Costs, available at: http://www.health.state.mn.us/divs/hpsc/hep/ merc/. Id. American Medical Association, “GME funding remains in critical condition,” available at: http://www.ama-assn.org/resources/doc/ washington/gme-funding-remains-in-criticalcondition.pdf. Association of American Medical Colleges, “Physician Shortages to Worsen Without Increases in Residency Training,” September 30, 2010; https://www.aamc.org/ download/150584/data/physician_shortages_factsheet.pdf. Association of American Medical Colleges, “The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated Projections Through 2025,” June 2010; https://www.aamc.org/download/158076/data/ updated_projections_through_2025.pdf. Robert Graham Center, “Minnesota: Projecting Primary Care Physician Workforce,” September 2013; http://www.graham-center. org/online/etc/medialib/graham/documents/ tools-resources/minnesotapdf.Par.0001.File. dat/Minnesota_final.pdf. Id.
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TCMS Holds 2014 Annual Meeting Lisa Mattson, M.D. Installed as President Executive Committee Appointed Lisa R. Mattson, M.D., a former high school science teacher, was installed as the 2014 president of the Twin Cities Medical Society at its annual meeting held on Tuesday, January 14, 2014. A native of Plymouth, Minnesota, Mattson obtained her medical degree from Mayo Medical School, and completed an obstetrics and gynecology residency at Mayo Graduate School of Medicine, Rochester, MN. Serving OB/GYN patients primarily in the west metro from 1998-2012, she assumed the position of Director of Women’s Clinic at Boynton Health Service, University of Minnesota, in August 2012. (See President’s Message on Page 4 for Dr. Mattson’s comments to the Board.) The following physicians join Dr. Mattson on the 2014 TCMS Executive Committee: • Ken Kephart, M.D. – President Elect • Edwin Bogonko, M.D. – Immediate Past President • Matthew Hunt, M.D. – Treasurer • Carolyn McClain, M.D. – Secretary • Nicholas Meyer, M.D. – At Large Director • Stefan Pomrenke, M.D. – At Large Director Sue Schettle, CEO provided the annual report of the Twin Cities Medical Society. Her comments are captured in the TCMS in Action (Page 5). Jeff Chell, M.D., CEO of National Marrow Donor Program highlighted the work of the organization and Be The Match, noting it is one of the best kept secrets in the Twin Cities. The National Bone Marrow Donor Registry was authorized by Congress in 1987. There currently are 175 transplant centers (35 international) and 101 Apheresis Centers (15 international). Ninety-nine percent of the population can be matched within 24 hours through the NMDP registry or one of the registries worldwide; 50 percent of transplants facilitated by the NMDP have either an international 26
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donor or recipient. Goals for 2014 are to increase availability of donor cells; raise awareness among referring physicians and the public; explore future uses of cellular therapy; and add 500,000 new adult donors to the registry file each year with a focus on younger/more diverse donors. For more information visit www. bethematch.org. Cindy Firkins Smith, M.D., MMA President, brought greetings from the Minnesota Medical Association. She stated that now is the opportunity for change and advocacy, and that working together, TCMS and the MMA can be enormously successful. The First A Physician Award was presented to Sanne Magnan, M.D., Ph.D., CEO of Institute for Clinical Systems Improvement. (See related article on page 27.) Finally, Edwin Bogonko, M.D. was recognized as the outgoing President of TCMS. He concluded his remarks by stating that it is important to preserve what is good about us — the patient/ physician relationship and the desire to do what is right.
New TCMS Board members (from left): Michael Tedford, M.D., Carrie Terrell, M.D., Doug Hanson, MMGMA rep, and Andrea Hillerude, M.D.
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First a Physician Award Presented to Sanne Magnan, M.D., Ph.D.
T
he 2013 First a Physician award was presented to Sanne Magnan, M.D., Ph.D. at the annual meeting of the Twin Cities Medical Society on January 14, 2014. Dr. Magnan is the current President and Chief Executive Officer of the Institute for Clinical Systems Improvement (ICSI). In addition, Dr. Magnan serves as staff physician at the TB Clinic at the St. Paul Ramsey County Department of Health, and as a clinical assistant professor of medicine at the U of M. She is a former vice-president and medical director of consumer health at Blue Cross Blue Shield of Minnesota, was a lead physician at Ramsey Clinic (now Ramsey Hospital), and was a staff physician at Lino Lakes Correctional Facility. In 2008 Dr. Magnan was appointed Commissioner of Health and was responsible for implementation of significant components of Minnesota’s 2008 health reform legislation. She served as commissioner for three years, ending her term in 2011. She was then re-appointed to the position of President and Chief Executive Officer of the Institute for Clinical Systems Improvement where she had previously served as its President in 2006 and 2007. In addition to serving in multiple leadership roles, Dr. Magnan volunteers her time toward many public health initiatives. She served as a spokesperson for smoke-free efforts led by TCMS
at the city and county level, assisted TCMS in writing letters to the editor about various public health topics, and currently is a volunteer Ambassador for TCMS’ Honoring Choices Minnesota program. The First a Physician Award, established in 2007, recognizes a member of the Twin Cities Medical Society who has made a positive impact on organized medicine by selflessly giving of his/her time and energy to improve the public health, enhance the medical community’s ability to practice quality medicine, and/or improve the lives of others in our community. The Award is given annually at the TCMS annual board of director’s dinner.
Glen D. Nelson, M.D. Receives Shotwell Award
T
he 2013 Shotwell Award was presented to Glen D. Nelson, M.D. at the January 7, 2014 meeting of the Abbott Northwestern Medical Staff. Richard D. Schmidt, M.D., chair of the West Metro Medical Foundation of the Twin Cities Medical Society, presented the award. Dr. Nelson’s career as a health care leader spans several decades, serving as chairman, president and CEO of Park Nicollet Medical Center from 1975-1986; initially serving as a director of Medtronic, Inc. in 1980 and then as executive vice president, he subsequently became vice chairman from 1986-2002. Currently, Dr. Nelson is focused on long-term job creation by assisting health care start-up ventures, particularly in Minnesota. Utilizing his experience and networks in health care delivery, insurance and the medical device industry, Dr. Nelson has made many contributions toward improving the performance of our health care delivery system through systems and insurance reforms. In addition, Dr. Nelson is providing scholarships and encouraging the University of Minnesota Medical School to adopt training modules where medical students will learn the human interactive skills needed to improve health outcomes. Presenting the award, Dr. Schmidt stated, “In recognition of MetroDoctors
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his leadership in the evolution of Park Nicollet Medical Center, Medtronic Inc., assisting health care startup ventures, and his interest in bringing business into the training of our medical students, I am honored to present Glen D. Nelson, M.D. with the 2013 Shotwell Award.”
From Left: Richard Schmidt, M.D., Chair, West Metro Medical Foundation; Glen D. Nelson, M.D.; William Parham, M.D., Chief of Staff, Abbott Northwestern Medical Staff.
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New Member Profile:
Meet Kevin Brown, D.O.
A
neurologist specializing in neuromuscular physiology, Dr. Kevin Brown is passionate about finding ways to make accessing health care convenient and enticing, especially for African American males. The prevalence of high blood pressure in African-Americans is the highest in the world, and nearly half of all African-American adults have some form of cardiovascular disease, 49 percent of women and 44 percent of men, according to the American Heart Association’s Heart Disease and Stroke Statistical Update 2014, published in its journal Circulation. Working with the American Health Association, Minnesota Affiliate, the Minnesota Department of Health and the Southside Community Health Services, Dr. Brown hopes to eliminate excuses for not going to the doctor by bringing health screening technology to places of common gathering, e.g. barbershops. Two models of screening are being tested: 1) a kiosk blood pressure and heart rate machine that provides information regarding what to do if your blood pressure is at a certain level; or, 2) an actual person is present to offer blood pressure screenings. “As the barbershop supplies a steady and repeat customer who will come face-to-face with a kiosk
every time they come into the barbershop, this leaves no excuse for getting a check,” says Dr. Brown. Barbers (who have received appropriate training) will be incentivized to engage their clients in discussions about their health and encourage their use of the Blood Pressure Monitoring Screen/onsite blood pressure screener. Several barbershops throughout the metro area are currently piloting this potential life-saving/life-giving screen. Raised in St. Louis, Missouri, Dr. Brown received his osteopathic medicine degree at Des Moines University, Des Moines, IA and completed a neurology residency and clinical neurophysiology fellowship at the University of Minnesota. He is currently the medical director, Neurology and Specialty Clinic at Hennepin County Medical Center with his primary office at the 212 Medical Center in Chaska. He also spends one-half day/week at HCMC teaching medical students and residents.
New Members Yana T. Nagle, M.D. South Lake Pediatrics Pediatrics
Jay D. Sengupta, M.D. Minneapolis Heart Institute Cardiovascular Diseases
Shannon N. Nolan, M.D. Southdale Pediatric Associates, Ltd. Pediatrics
Bradford Sklow, M.D. Colon & Rectal Surgery Associates, Ltd. Colon and Rectal Surgery
Andrea C. Hillerud, M.D. Blue Cross Blue Shield Family Medicine
Matthew M. Palmer, D.O. Oakdale Obstetrics and Gynecology, P.A. Obstetrics and Gynecology
Megan M. Stalpes, M.D. Southdale Pediatric Associates, Ltd. Pediatrics
Leigh B. Koidahl, M.D. Southdale OB/GYN Consultants Obstetrics and Gynecology
Trisha R. Prescott, M.D. St. Paul Radiology Diagnostic Radiology, Breast Imaging
Daniel J. Thompson, M.D. Suburban Radiologic Consultants, Ltd. Radiology, Diagnostic Radiology
Kirsten M. Koos, M.D., MPH HealthPartners Occupational Medicine
Nicholas G. Rhodes, M.D. St. Paul Radiology Diagnostic Radiology, Musculoskeletal
Sarah A. Vogler, M.D. Colon and Rectal Surgery Associates, Ltd. Colon and Rectal Surgery
Erich N. Bryan, M.D. St. Paul Radiology Neurology, Diagnostic Radiology, Neuroradiology
Rachel A. Harris, M.D. Southdale OB/GYN Consultants Obstetrics and Gynecology
Thomas C. Bryson, M.D. St. Paul Radiology Neuroradiology
Katherine J. Hecker, M.D. Pediatric & Young Adult Medicine, P.A. Pediatrics
Pamela G. Chawla, M.D. Midwest Children’s Resource Center Pediatrics Margaret A. Collins, M.D. Dermatology Consultants Family Medicine, Dermatology Elsa V. Fiebiger, D.O. Southdale Pediatric Associates, Ltd. Pediatrics Kathryn B. Grande, M.D. Metropolitan Obstetrics & Gynecology, P.A. Obstetrics and Gynecology Garrett R. Griffin, M.D. Midwest Ear Nose & Throat Specialists Facial Plastic Surgery 28
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Matthew J. Larson, M.D. Dermatology Consultants, P.A. Dermatology Jill S. Melicher Larson, M.D. Minnesota Eye Consultants Ophthalmology
Susan E. Rudolph, M.D. Skin Specialists, Ltd. Dermatology Todd G. Seelhammer, M.D. Dermatology Consultants, P.A. Dermatology
MetroDoctors
The Journal of the Twin Cities Medical Society
ABRAHAM KERN, M.D., passed away at the age of 65 on December 12, 2013. Dr. Kern graduated from Northwestern University Medical School in Chicago. He joined Abbott Northwestern Medical Staff in 1985 and practiced at Metropolitan Urology Clinic. Dr. Kern became a member in 1980. MARY H. PENNINGTON CHRISTENSEN, M.D., passed away at the age of 93 on January 20, 2014. She graduated from the University of Minnesota Medical School and practiced as a pediatric, child and adolescent psychiatrist at Boynton clinic and later in private practice. Dr. Pennington became a member in 1967. EDWARD W. POSEY, M.D., age 86, passed away on January 13, 2014. Dr. Posey graduated from Meharry Medical College in Nashville, TN and completed his general surgery residency at Case Western Reserve University. He went on to complete a psychiatry residency through the University of Minnesota VA program and was founder of the Day Hospital for veterans. Dr. Posey became a member in 1997 and was a featured Luminary of Twin Cities Medicine.
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AINA G. DRAVNIEKS, M.D., age 88, passed away on December 3, 2013. Dr. Dravnieks earned her medical degree from the University of Hamburg in Germany, and practiced pathology in Minnesota beginning in 1956. He became a member in 1958.
see additional Career opportunities on page 30.
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In Memoriam
Career oPPortunItIes
1/23/14 7:05 PM
ROBERT J. SCHULTZ, M.D., passed away at the age of 85 on January 14, 2014. Dr. Schultz graduated from the University of Minnesota Medical School, and practiced internal medicine. Dr. Schultz became a member in 1964. ROBERT L. STURGES, M.D., age 89, passed away November 30, 2013. Dr. Sturges graduated from the University of Minnesota Medical School and practiced family medicine. He became a member in 1948. ROBERT T. VAALER, M.D., age 85, passed away on January 17, 2014. Dr. Vaaler graduated from the University of Minnesota Medical School specializing in anesthesiology. He practiced at Abbott Northwestern and Minneapolis Children’s Hospitals. Dr. Vaaler became a member in 1957. MetroDoctors
The Journal of the Twin Cities Medical Society
March/April 2014
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Career oPPortunItIes
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MetroDoctors
The Journal of the Twin Cities Medical Society
March/April 2014
31
LuMInarIes of Twin Cities Medicine By Marvin S. Segal, M.D.
SuSAn e. CRuTChfieD-MiTSCh, M.D. ChARLeS e. CRuTChfieLD, SR. M.D. LITTLE DID THE THREE SMILING SUBJECTS
pictured on this page dream, 50 years after being photographed, that they would be honored together for their varied and significant accomplishments. Charles Crutchfield Sr. and Susan Crutchfield both earned BA, BS and MD degrees — graduating together from the U of M Medical School when Charles Crutchfield III was only three years old. Since then, pathways for all three have taken varied directions in interesting and engaging ways. Dr. Susan, the first African American female to graduate from the U of M Medical School and a diplomat of the American Board of Family Medicine, practiced privately in the Twin Cities and as a college student health service director. The major portion of her professional career was spent in 20 successful years of Occupational Medicine practice as a Vice President/Medical Director for the Prudential Insurance Company. Dr. Charles, Sr. moved from Alabama to Minnesota at age 15. He states, “I went from shining shoes and picking cotton to saving lives — in just nine years.” After being chosen Intern of the Year at Ancker Hospital (now Regions), his residency was completed at the U of M — and soon thereafter became the first obstetrician/gynecologist of color in Minnesota. His 40+ years of private practice was marked by nearly 10,000 deliveries, Fellowship in the American College of Ob/Gyn and decades of clinical faculty teaching at his alma mater. Both Susan and Charles Sr. have earned numerous academic and professional awards and have served in a variety of leadership positions for their hospitals and professional organizations. She was Chairman of the Minneapolis Children’s Hospital Board and he was Chief of Ob/ Gyn multiple times at United Hospital. The Dr. Charles and Susan Crutchfield Dermatology Lectureship at the U of M was recently established by Dr. Charles III, that cute tyke in the photo. Susan and Charles Sr. speak respectively of their most gratifying professional endeavors — hers of improving the health of children — with whom she dearly loves to work; his, of playing a major role in increasing the standards of care for minority women. However, along with their many 32
March/April 2014
professional and family accomplishments, standing out in bold relief and probably defining their legacy is their dedicated and energetic service to our community. Susan has volunteered her time and talents to many organizations including the Southside Clinic — where she stressed the importance of improving communication with patients in helping them to achieve greater understanding of their health status. In addition to a multitude of volunteer activities, Charles Sr. continues to consult regularly at the Open Cities Health Clinic where he occasionally purchases needed medications and bus or cab fare for especially needy patients. Perhaps as important as the many achievements along the lengthy pathways of the good doctors Crutchfield, is the superb guidance and support given to their son, Charles III — who is among the most successfully recognizable physicians in our community. He has embraced and followed their “leading by example” philosophy of giving back to one’s community. The apple did not fall far from those strong and venerable trees. Charles Sr. and Susan, each independently state that the driving force behind their many special pursuits has been the goal of repaying our community for all it has provided them these many years. Our Luminaries have easily exceeded that target — for which we thank and honor them.
This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.
MetroDoctors
The Journal of the Twin Cities Medical Society
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Optimal Diabetes Care
A
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