Document from the collections of the AAMC Not to be reproduced without permission conclusions This to Meeting. been point information informal, document of providing The from which so note contains some perfection -

the taking may STIE of paper be NOTES, OCTOBER NEW the beneficial. and summaries, MEETING may from ORLEANS Courtesy is SOME at sessions organization to 1986 not SUMMARIES /' give exist of Hope everyone excerpts, at the in the of ya'll Southern all this an National enjoy areas. opportunity ideas paper Region it... and OSR The has Informal Notes/Outline 24, 1986 on the GeneraL Session - Friday, October

Dr. Leon Eisenberg, Chairman Policy Department of Social and Health

Dr. Dr. Leon Eisenberg spoke following his wife, about the Carola Eisenberg, who presented ideas Dr. "Light at the End of the Medical School Tunnel." in the Leon Eisenberg then talked about the Trains his tunnel. I have taken the liberty to reorganize talk to an outline form. ,1 ia-dittAzn 7iet 71_4.4

-NottetcOlthe-coriitiuttitiorWRAiorettcalicribbftWand. tabwAsWmorkMicin-. 19.giVOleattlm1 4SW1.- r-40%. "INC FAP 90( GALLERY 2 Prf CARY-OIRSON Ntif IN PAPERBACK. DALE :21 THE TRAINS

MALPRACTICE CRISIS COST OF EDUCATION

Problem Possible Solution Problem Possible Solution insurance I. Less than 302 of collected I. No-fault the edit 1. Change the time allowed for -1. Trend is that funds, from a law suit go to repayment of loans. when trivalent will increase the "injured party." 2. Fees charged cases are brought to court from 2. Have a surcharge (of the 2. Applicants will come fear increases the debt) based on Income Tax 2. Cost and *families with higher use of defensive medicine incomes Figures 3. Mistrust erodes the doctor- • 3. Forgiveness of debt if 3. What about minorities? relationship student has selected a field patient needed area 4. Debt may restrict a in a student's choice of career

THE TRAINS

of CLINICAL Preservation INCOME QUALITY FREEDOM EQUITY AND (decreasing) sel. Possible Solution Problem Possible Solution Problem

THOUGHT: "If we go down, let's go Restriction by. I. This same ter . MAIN 1. Probably.affects- I. Physiciam's:•:- patients' rights and not strictiorr will down fighting for pool. salaries. will: health care applicant many doctor*. rights..." probably remain organisations, help avoid your unnecessary 2. Remember: • higher than most will, affect prescriptions and Incomes have of societies. decitionipabot. surgeries. been increasing, tests, etc. rapidly since "PRACTICE BY 2.. This "protocol" WWII. Doctors purrocoo-, can help.you..keep- have not alway, your standard of had, such high, care "up to: snuff." incomes., A. leveling, off- is 3. We.still,nevd, to expected. when. fight for INDIVID- viewed over e UAL CARE, because_ longer period of cheaper is. not the time-rel.erence way to determine health. THE HEART AND SOUL OF MEDICINE EVERYDAY ETHICS Betsy Garrett, M.D. New Orleans 10/25/86 things we as Caring is still one of the most important physicians can hope to do... questions. This is a We are in the midst of a time of many of the basics - from how time of great energy and rethinking physicians should best be medicine should be practiced to how for change... trained. This is a time of great opportunity needs to be to teach An essential goal in medicine today raised above the level of a .students in such a way that they are and raised to the level of a technician and fighter,. of independent learning... healer who is prepared for a life-time our wisdom in its The power of our technology outweighs application... and illness, and between The ,distinctions between disease heart and soul of medicine. caring and curing are crucial to the as much as we value We must value a person's function disease. Healing is the preservation of life and freedom from even when there is no chance caring and comforting of a person for cure or effective treatment...

Obstacles to our becoming caring physicians: government and insurance •(1) Society. Ever-changing some traditional doctor-patient regulations have interfered with relationships and decision making. are told to memorize facts. (2) Medical education. Students for analysis or synthesis. There seems to be little opportunity are trained with "specialized" In the clinical years, students There is a lack of ambulatory patients in tertiary care centers. exposure to community hospitals. training; there is not enough are often neglected by medical Students' needs as individuals become cynical and lose their education. Students can easily idealism. to recognize our own feelings (3) Ourselves. We must learn best. As students, we to be able to help our patients in order patient, -we feel our roles in the care of the often underevaluate diadnosis or anything significant to the that we. will, not add are badly. But because we treatment. . For this we feel because we are not yet caught idealistic and a little naive, and and the technology, we up in all of the jargon of disease the patient than the doctor. naturally identify more closely with to the patients experience We will have a more special closeness now than we ever will again. • between "hard" subjects Medical training tends to be divided and "soft" subjects (psychology, (science, facts,.' numbers, etc.) philosophy of , medicine). The patient-doctor relationships, changes With time. The "soft" "hard" is a key foundation, but it Too often the "hard" is subjects have greater longevity. the "soft". • A balance is emphasized at the e4ense of necessary... It takes deep inner sLrength. emotional highs to confront and lows, and the demands, medical self-discovery that training. We must are all part of individuals... q,ind time for our own special needs as We must never allow relationships knowledge to get . . with- in the way of our patients. . Ultimately our for the human soul q. it is our that determines the respect worth of our science...

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Not Courses a Clinical In the seminar "Giving Human Value the benefits Reverend Skeel and Dr. Thomasma stressed Focus," clinical years teaching ethical decision making during the of are: 1) that of medical education. Among these benefits 2) that students students take ethics courses more seriously, in the second more' out of such courses than those taught 'get of ethical year, and 3) that students see the application decision making. that some kind Reverend Skeel and Dr. Thomasma suggested the first year and of ethical decision making be taught during the third and fourth then again in the clinical setting during faculty, she conducts year. At MCO, where Reverend Skeel is on surgical patient is 'ethics rounds' where a medical or surrounding the presented with discussion of the ethical issues ethics rounds (and patient's case. Reverend Skeel reports that success. She adds that adjunct conferences) have been a big years of instruction students who "blew off" ethics during the sorry they did so after in the basic sciences tell her they are experiencing ethics in the clinical years. following signs of Reverend Skeel also mentioned the improved integration progress, many of which stem directly from years, including: of human values courses in the clinical

group teaching o Expanded use of interactional, small programs by basic o Better acceptance of human values science faculty everyone to raise o Greater willingness on the part of values questions giving hospital o Human values program faculty regularly committees conferences and serving on institutional engaged in human o Greater number of clinical faculty values teaching components and basic science o Improved coordination of clinical curricula

at schools which have Moreover, curriculum-building is evident a number of years and nurtured their human values programs over third- and fourth- at schools with newer programs where, during laid during pre- year courses, faculty can assume a foundation clinical years. the observations possible from an examination of Among the and above and other information obtained from surveys interviews are: humanities continue to o Programs based in the medical relevance to the goal of grow and to demonstrate their improving students' clinical skills. patient contact need to experience significant o Students examine their _first year, encouragement to during their the basic and own values, and exercises which integrate clinical sciences. in any department values components can originate o Human when they combine but appear to have the most success the strengths of more than once discipline. values programs need o In order to be effective, human Using clinical cases in problem- practical orientation. by and small group discussions led, solving exercises in faculty can ground- their programs clinicians, a,s developing students' immediate emotional experiences the clinical realities health care professional and in they will face. this Project, please, more information or to discuss For Programs (202/828- Janet Bickel, Division of Student contact: at this Exhibit Booth to 0575). Please sign a sheet available when it becomes available. receive a full report of the Project faculty characteristics and (Yther discussion headings are barriers to progress, evaluating faculty development efforts, values teaching programs for human values teaching, and human resiklents.

Dan Shapiro -- Preventive Medicine Seminar --

The purpose of the seminar in preventive medicine was to present information on the state of this "stepchild" of modern allopathic practice today. A panel of enthusiastic speakers involved in teaching and working in the field offered their views about preventive medicine. Dr. Kevin Patrick, Director of the Preventive Medicine Residency Program at the University of California-San Diego, spoke about the four areas involved in permission permission a preventive health residency program: occupational health,

aerospace medicine, public health and general preventive without without medicine. Common to training in most preventive medicine residencies is a clinical period of at least one year, an year to obtain an MPH or equivalent, and a practicum

reproduced reproduced academic

be year. Areas of study include biostatistics, epidemiology, to to

planning, administration and health care organization. Dr. Not Not James Carter, Assistant Professor in the Department of Family

Medicine at Morehouse School of Medicine, spoke of the need to AAMC AAMC

counsel patients not only about their acute illness or the the of of suboptimal health, but also about plans of action for long term optimal health. He advised physicians to stress to the

patients self-responsibility for their own health; nutrition; collections collections

physical fitness; stress management; social, economic and the the

political factors; and their spiritual development. Dr. from from Sapenfield, an Epidemic Intelligence Service Officer from the CDC, spoke about the development of EIS and the exciting experience with the Document Document possibilities of a career or short time CDC. Each of the presenters was positive and encouraging about the possibility of meaningful careers in preventive medicine. The highlight of the afternoon's seminar wasa presentation by Dr. Andrew Weil, from the Division of Social Perspectives at the University of Arizona School of Medicine, entitled "Alternatives to High Tech Health Care." Expressing mild disagreement with the panelists over the meaning of preventive medicine - "more than sanitation and jogging" - a painstaking Dr. Weil made the centerpiece of his lecture the audience. Dr. history which he took from a volunteer in what the patient Weil explained that in a thorough history Unless does, in -effect, is diagnose his own illness. for - surgical allopathic measures are clearly called like - what procedures, disease-specific antibiotics, and the the history has Dr. Weil prefers to do with his patients - once the natural pinpointed the nature of the problem - is encourage the use of a healing powers of the mind and body through in some cases, variety of non-invasive therapies, including, remedies, diet cranial-sacral manipulation, the use of herbal and is and exercise. Dr. Weil is quite convinced- beliefs - that extraordinarily convincing in presenting his the mind as a modern allopathic medicine has failed to consider process. As an significant and powerful force in the healing is by no means alternative to high tech medicine, which he may rely too opposed to but which he feels the modern physician - when called heavily upon, he posits humanistic alternatives compliance of the for - which enrist more fully the willing patient.

Michelle Greenway-Birdseye Mercer University School of. Medicine Document from the collections of the AAMC Not to be reproduced without permission (second Staying differs here. session, style General of Alternatives Andrew many this change find system. not medicine, cult I first tioners health system blinds diet, many etc. student to paying localized directly rationale a apparently next question by am referral his First, Andrew Second, offer. Thirdly, The The available Jim is of very task those of newsletter interventions stress clumsy There Weil, In philosophy patients' care as attention us second remainder Healthy from half) occasionally Seesion ushave that from them Stout, which Over or that began general, his for homeopathy, thankful having to back became Andrew alternative In to had than is Andrew indirectly M.D. to how he factors, those during two the emphasis the by him our phase an stuck I been nothing nothing pain Pediatric High the speech feels for (not will we I our nothing hour to audience. osteopathic apparent of of uses is credential years there for) knew alternative emphasizes -Tech session are exposed that my such of not the in the health paid present to summarize. to offers herbalism, relationships, historys Saturday is what magical practitioners introductory taught the to my taught he wade existed, we associated conclusion session are mention could worthwhile items Health Resident on lip later do mind has tend discussion with care. -and can to The avoiding three certain system. through with physician service the to to play good accumulated as about techniques and was: night only to patient in was a Care our oseteopathy, including license leave history practice major the discussion main These treat physicals. with the of a education to clinical spent own) be types the that exercise, his by in disease part Andrew was problem, the offer. out interview. in areas -oriented described childhood presented trauma. Andrew points our quacks those much questions. unhealthy have that an case. the on medicine, in of a naturopathy, of --that medical network has interview course, questions in that methods preventing etc. health more our patients' from something Unfortunately, work. Most use although and were and which studied Many as system events, work with was of than The I is, behavior. charlatans Certainly outside of addressed that schools, an of care In struggling won't and -ups. body, of a Andrew's with these a interview and diet eclectic alternative traditional fact, we occasionally hometown. capsule illness. (which more uniquely complaint Andrew's he strategies to birth are answers. go our type a covered and his questions I varieties the I this medical into during in used approach doubt I dominant history, recall through summary other patients of ended Although referral most might beneficial order questions prejudice of Tune detail practi- Chinese occupation, to, in to the The the that well life- diffi- I using with this of add, to in those was - Staying Healthy (cont'd) page 2

Q) How can we find time to learn about these alternative methods when there isn't even enough time to learn abouth allopathic medicine?

A) Obviously, there's no real answer to this one, although Andrew pointed out that to at least be conversant in these different techniques will give you a competitive advantage as patients become increasingly interested in pursuing options and being more responsible for their care.

All in all, it was a good, stimulating session and led to a lively

discussion afterwards.

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from from Document Document COMMUNITY ORIENTED PRIMARY CARE

H. Jack Geiger, M.D. Arthur Kaufman, M.D.

..0 - The main concept is first to get a solid epidemiological grasp on u a defined area's population, then to design a sD, the health problems of primary care preventive medical approach to provide solutions to that '50 community's problems. - One of the early long-term projects with a well developed data -0 base involves a string of community health centers operated by the u University of Natal in South Africa. While this approach lends itself -0 of .0 well to chronically underserved third world conditions, plenty sD, exist in the United .u regional health care needs and opportunities u areas, as well as urban ,0 States. Smaller communities and rural In this ..,0 neighborhoods and ethnic enclaves, make well suited models. .., O country a collection of approximately 20 group practices with a Z developed data base and uniform record keeping procedures has Central published relevant information under the name of the American Welfare Practice Network. The United States Health, Education, and has Department (possibly through the Office of Economic Opportunity) been involved in projects along these lines as well. O In actual operation, a group of health professionals, mostly for a defined O involved in primary care, are given responsibility community. The health situation of the area, from actual disease to the occurrence to environmental, economic and life-style factors condition of the local health care system is assessed using cost epidemiological and statistical tools. Considerations of habits effectiveness and the practical aspects of changing health O One key allow tailoring of a long-term preventive medicine program. life statistical concept used in evaluation is the years of productive on the lost because of a health problem. Also one of the limitations of residents O use of urban areas is their generally higher turnover effectiveness of 121 which hinders the follow-up necessary for judging the the programs. New Dr. Kaufman referred to the film Learning Medicine: The in medical Mexico Experiment to show how this concept can be exercised for education. He also pointed out how mall scale pilot projects such as medical students work well when based on a captive population more classes of school children. This makes tracking patients much because of simple. Students also get excited about it at this level the tangible results in prevention of such obvious problems as teen pregnancy, cigarette smoking, and other areas. Dr. Geiger described a nine-week elective program he is involved with in New York. Teams of three students are assigned an urban information neighborhood. Using census data and previously gathered construct a from a variety of governmental and academic sources, they community profile. This includes data on housing, employment, and mortality, recreation, education level, health resources, mobidity are etc. Then the prevention points are targeted and programs designed. university Discussion brought out the following points. Tufts resource stresses learning descriptions of and access to the various of Connecticut agencies and organizations in their area. University in their students have a prepared list of organizations and services holds a very area. University of Massachusetts periodically various groups can • successful fair so representatives from.all the present information to local physicians and students. 0 and Additional contacts for funding and design of projects electives: sD, Residency Program in Social Medicine O 3412 Bainbridge Avenue Bronx, NY 10467 (212) 920-5521 -c7s Smith-Kline Beckman -c7s O National Fund for Medical Education 1 Marla J. Driscol (203) 278-5070 Deadline March .0 O American Medical Student Association Foundation Prevention Project O Health Promotion and Disease Kathie Westpheling (703) 620-6600 1890 Preston White Drive Reston, VA 22091 Funding still pending for '87-89 Deadline March

O H. Jack Geiger, M.D. of Community Medicine 0 Professor 130 8th Street at Covenant Avenue New York, New York 10031

Arthur Kaufman, M.D. Director of Family Medicine 0 University of New Mexico Albuquerque, New Mexico 87131

0

Clayto allantine Problem-Based Learning 10/26 review Shragge began this session with a historical Dr. William educators based learning (PBL) which began when of problem of the realized a dichotomy existed between the process/content clinical years. Basic Sciences and the skills needed for the PBL: (1) The He listed three fundamental premises behind for his/her own student is a mature individual, responsible continuum of education; (2) Medicine entails a "lifelong defined core of self-directed knowledge"; (3) No real As time passed, knowledge exists for the mastery of medicine. a learning model evolved: The student is presented with problems that are integrated, "non-clean". Learning is then based on skills of solving with those problems in a small group faculty as FACILITATORS only. a Emphasis is on the problems serving as jumping off point for learning ... and then the the process evolves into a solution of problems. "learning skills at The thrust of PBL, according to Shragge, is ask yourself is, "Are problem management." And the question to filled?" you dynamic and active, or a little pot being learning, the large To demonstrate an example of problem based with a faculty then divided into small groups, each group we began We were all given a case (included) and facilitator. was a Family generating hypotheses. My group facilitator "Tutor" for their Medicine M.D. from New Mexico who is a group and he listed some program. He spends eight weeks with a Everyone at some of the dynamics of the small group: (1) reasoning process point will stop knowing the answers, (2) The what you know or is crucial, (3) The point is to identify students to become don't know, and (4) The small group helps more comfortable with saying, "I don't know." the group that the Kim Dunn of Houston, now chair-elect, told student centered. AAMC has taken PBL as a project that will be (goal is 1987/ The project involves developing a workshop showcase PBL. She summer) for Deans, faculty and students to challenged us to: about 1) Start educating sympathetic faculty/Deans PBL -- that it exists and that you are interested in it and this workshop. send 2) Write down any ideas you have about PBL and them to Janet Bickel, c/o Association of American ; Medical Colleges; One Dupont Circle, N.W. Washington, D.C. 20036.

Jill Hankins, M-4 University of Arkansas rrobicm - wsea Learn ni J CA4a-107 THE JAUNDICED MAN

The Jaundiced Man

Jason LaMark, a 32-year- old married computer programmer, presents to your office with a 2-day history of jaundice.

Reader's Tasks

of write down a list of possible causes Take out a piece of paper and jaundice (hypotheses). in qac hypothesized cauSe WOould result Explain the mechanisms by which h jaundice.

rTh • French jaune, The word j2.9ndist derives from the L',:tarO, which means yellow. The Grek worn, for'aundicy also means yellow and is -another wori (i.e., icterus).

• ;1

NEW MEXICO - uNIVERSITY OF PRIMARY CARE CU,RR.I.C..uLum

09/0906 2.4 SUMMARY OF SOUTHERN SURVEY CONCERNING NATIONAL MEETING AT NEW ORLEANS

was Perhaps the most overwhelming consensus of the group meeting, that New Orleans was an excellent location for the despite the expense. you In response to the first survey question, "What have enjoyed most ... ?", the chance to interact with other medical OSR students was the most frequently mentioned item. Several members commented that they enjoyed discovering that other students were concerned about medical education and that they were concerned about many of the same issues. The Problem Of Based Learning session was the second most mentioned item. the speakers, Andrew Weil and the Eisenbergs (General Session) of the were enjoyed most. Other items enjoyed: the diversity topics, becoming aware of issues, efficiency of business ethics meetings, bulletin board for information exchange, sessions and, of course, Bourbon Street. was Specific information found to be the most useful Based (listed in decreasing order of frequency): (1) Problem Mexico Learning session; ( 2) Ethics session; ( 3) New medicine; Experiment; (4) Financial aid update; (5) Preventive included and (6) Minority affairs issues.. Others listed systems, National Boards update, emerging health care delivery the Spring community health projects, and "getting info on meeting."

Constructive criticism on . .

1) Program Content a. Needed to present more information on the New Mexico Experiment (more specifically, how to implement). b. Too much repetition in some cases. * c. Needed to be presented with more specific and concrete ideas to take home "that students in my school can use now." d. Needed more information about legislation, malpractice insurance, and how to implement problem based learning.

2) Small Group Sessions a. Would like to see repeated sessions to offer more chances to see different programs. b. Bandouts would add "teeth" to sessions. c. "The Emerging Health Care Delivery Systems" needed a more basic overview of mechanics of "Health Care Delivery" (definitions, etc.) d. Need more organized small groups. Small Group Sessions (continued) 2) and more e. Need more "problem solving" sessions interaction about problems. f. More emphasis on networking. g. Make minutes of meetings available.

3) Organization of Activities and Time time. a. Meetings should attempt to start and end on b. Not enough time spent on items important to GSA/AAMC. c. Needed another day - or more time. d. Needed more free time during the day. e. Too structured.

Jill Hankins Southern Chairperson University of Arkansas