Outlook Magazine, Fall 1985

Washington University School of Medicine Digital Commons@Becker Outlook Magazine Washington University Publications 1985 Outlook Magazine, Fall 1985 Follow this and additional works at: http://digitalcommons.wustl.edu/outlook Part of the Medicine and Health Sciences Commons Recommended Citation Outlook Magazine, Fall 1985. Central Administration, Medical Public Affairs. Bernard Becker Medical Library Archives. Washington University School of Medicine, Saint Louis, Missouri. http://digitalcommons.wustl.edu/outlook/75 This Article is brought to you for free and open access by the Washington University Publications at Digital Commons@Becker. It has been accepted for inclusion in Outlook Magazine by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. " I • I 1 Color-enhanced brain images generated by computer in the Laboratory ofNeuro- Imaging can be rotated to display any angle andplane. All images are derived from computer cOllverted autoradiograms ofbrain slices. See story beginning page 12. (Photos courtesy Arthur Toga) v,;:QN3 ~ Volum e XX 1[ , Nlllllber 3 l'all 1985 In the Beginning ... 2 Director, Medical Public Relations A physic ian-historian, Kenneth Ludmerer has Glenda King Wiman conducted nearly a decade of research to reveal the genesis of modern medical education. In the process, he has exposed the mythical underpinnings of some Executive Editor widely believed traditional dogmas. Don Clayton Editor Medical Mal'kejshal'e 6 Su zanne Ha gan Medical center hospitals, eager to retain and expand their marketshare, seek new ways to provide Design improved medical care. Academic hospitals can John Howze compete in every arena with their non-academic counterparts and , in many cases, have led the way in Photography developing new programs and marketing strategies. ~ Cheryl Ungar Window jo j/1e Brain 12 or Circulation Researchers from inside and outside the School of Barbara Hebrank Medicine can view the brain from a unique vantage point: the Laboratory of Neuro-Imaging. Using software written by LON! director ArthurToga, scientists can achieve high-resolution images in order • On The COWl": to understand how neurological diseases originate. A three-dimensional im age of the brain, enhanced by false color, ca n be rotated Profiles and Predict ions 18 to show any perspecti ve, and electron Using specifi c information about a woman - her age '/ icall y "sectioned" to di splay an y plane, and data from her medical history, for example that a re searcher in the Laboratory of researchers can more closely predict her vulnerability j~ Neuro-lmaging desires to examine. to breast cancer. How? By using computer programs -~- Fall 1985 developed from a collaboration between a medical Volul11e XXII , Number 3 scientist and mathematicians. .. Outlook Magazine (ISSNOI95-0487) is published quarterly by the Ernie Simllls: Against the Odds 22 Washington University School of Medicine at 660 S. Eu clid , A black man without a college degree earned a S1. Louis MO 63110. Second-cl ass tenured facult y position at the School of Medic ine. postage paid at S1. Loui s, MO . But Ernie Simms, a member of Arthur Kornberg's Nobel Prize-winning team, earned more than kudos POSTMASTER: Send address changes for his scientific re search, as his former students and to Circulation, Outlook Magaz ine, colleagues attest. Box 8065, 660 S. Euclid , S1. Loui s, M063110. Sludenlslag-e: Hot Docs 10 © Washington University School of Medicine Newsbriefs 28 Permission is granted to reproduce The Alumni Hcport :15 materials contained herein , provided OUllook, the Magazine ofWashinglOn Class Noles :38 University School of Medicine, is credited. ~ I i 'I ... ". --r . ~ BY SUZANNE HAGAN odern medical education isn't mate educational institutions with which students graduated without ever having really modern. Although it's been universities desired to affiliate. And until had the chance to follow, and care for, ; 1'" ;, called many things, it's actually well-prepared students desired admittance patients who were hospitalized. "Section a century-old product of an historic union to medical schools , the calibre of medical teaching - the forerunner of clinical among three entities: medical schools, education was by definition low. Only clerkship - was widely implemented, as universities and teaching hospitals. As with the strengthening of all levels was dispensary teaching - the outpatient with all mergers, the partners underwent of education - primary, secondary and clinics of the day. These innovations were changes that were molded and influenced beyond - did modern medical education in themselves a great advance compared by external factors - they had to reach become a possibility. to 1870 and 1880, when clinical instruc maturity before they were ready for Another necessary ingredient was tion was by lecture alone. But it was not each other. money. American philanthropy made pos as significant a change as was the labora Most people regard the Flexner Report, sible the maturation of university-based tory in scientific teaching, and that was written by Carnegie Foundation research medical schools and of teaching hospi what was needed. er Abraham Flexner and published in tals. With an endowment, medical schools "But the nineteenth century hospital 1910, as the beginning of a new era in and hospitals could perform research, a was much different from the hospital we medical education. But the truth of the vital component of good education. Once know today," continues Ludmerer. "At matter, says Kenneth M. Ludmerer, M.D., all the components were ready - the that time, very little medical care was is that modern medical education had its restructuring of the entire school system delivered in hospitals - it was still done beginnings earlier: "In 1910, when the (including medical schools), the infusion at home. Middle- or upper-class women 1 Flexner Report was issued, the overall of philanthropy that strengthened floun would del iver children at home, physi ~ ,,~ - condition of medical teaching in this dering educational institutions and hospi cians would do operations at home. A hos country was very good. In fact, it was at tals, and the rise of academic medicine pital was more a domicile for the deserv the highest point it had ever been. Indeed, - could modern medical education take ing poor. Most hospital admissions were medical educators were glowing with place in America. But before this could for chronic conditions, and duration of satisfaction as to how much things had happen, a change in the role of the hospi hospital stay was long. " oj progressed in the preceding 20 or 25 tal had to take place. Thus, medical care delivery was not years. Modern medical education in the By 1910, when the Flexner Report was a function of hospitals, but moral uplift U.S. had already arrived." first issued, many of the worst medical was. Says Ludmerer: "Perhaps the best The inflated importance of the Flexner schools of the era - the proprietary description characterizing nineteenth Report is only one of the myths exposed schools, run for profit by private prac century hospitals is paternalistic. In one in Ludmerer's new book, Learning to titioners - were already dying out. In sense that's good, because the patient is 1. Heal: The Development o/America/"l Medical deed, at the time, they comprised only considered to be more than just a liver dis J' Education. * Ludmerer, who carries a joint about a fourth of the schools in existence. ease or a heart disease. But there arc nega r.- ...., appointment in two departments - medi "In the five years preceding the Flexner tive implications - who wants someone II cine and history - has spent nine years Report," points out Ludmerer, "30 pro to tell you how to run your life, or what poring over archival records, traveling prietary schools had died. By 1910, they you should believe, especially at a time across the U.S. and recording his represented the bottom tier, with univer when you're most vulnerable'?" findings, in order to discover the roots of sity-based schools at the top. But the fact However, with advances in scientific "modern" American medical education. that Flexner focused on proprietary knowledge as the basis for medical prac He has traced medical education's true schools, and was so startling in his prose tice, this role of the hospital began to lineage and found that it was derived from and his description, caused people to change. 'The 1880s was the decade of an ever-widening circle of sociological think that his comments characterized all transition ," says Ludmerer. "The germ changes that began after the Civil War. of medical education in America." theory of disease was formulated, and sur Until medical schools created full-time In real ity, says Ludmerer, medical gery became safer. " Hospitals became faculty positions in pre-clinical and clini schools had already come a long way by less a social service agency, and began to cal departments , they were not the legiti- 1910. The scientific, or pre-clinical, com adopt their present-day role as factories to ponent of medical education had already deliver medical care. As this happened, Abraham Flexner was a Carnegie Foun progressed to the point where students hospital trustees also changed roles. dation researcher whose 1910 report on "learned by doing": laboratory learning "A modern hospital's trustees meet the state ofmedical education in the U.S. occurred side-by-side with lectures. And periodically to approve policy, and created quite a stir. (Frontispiece of many proprietary schools had succeeded they're involved in fund-raising. But in Flexller's autobiography, I Remember, in becoming part of the university system. the nineteenth century, trustees would Simoll & Schuster, New York: 1940) But it was the clinical part of a student's visit the hospital daily," discloses Lud training that was anemic. Many medical merer. 'They would be involved in the "Basic Books, New York: 1985 ".

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