ASCI Presidential Address Mentoring and Teaching Clinical Investigation
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ASCI Presidential Address Mentoring and teaching clinical investigation Kenneth Kaushansky J Clin Invest. 2004;114(8):1165-1168. https://doi.org/10.1172/JCI23462. ASCI Presidential Address Supplement A man walking along a road comes across three bricklayers. When asked what he is doing, the first bricklayer replies, “I am laying bricks.” When asked the same question, the second bricklayer answers, “I am making my living.” When asked what he is doing, the third bricklayer steps back, looks around, and responds, “I am building a cathedral.” It is my great privilege and pleasure to address the ninety-sixth annual meeting of the American Society for Clinical Investigation. I will begin with many thanks: to the council members who provide sage advice and a critical eye; to our staff, who provide dedicated direction and a keen sense of corporate memory; to the members of the ASCI in 2001, who felt it appropriate that I serve on the ASCI Council; and to the Presidents who have come before for providing the insights and precepts that have helped shape our Society into an organization of extremely dedicated men and women that continues as the leading advocate for scholarship in medicine. I will also try to follow the advice of the seventeenth-century Catalan philosopher Baltasar Gracian, who stated, “What is good, is doubly so if it be short; and in like manner, what is bad, is less so if there be little of it.” Most recent Presidential Addresses have begun with a palpable […] Find the latest version: https://jci.me/23462/pdf Supplement ASCI Presidential Address Mentoring and teaching clinical investigation Kenneth Kaushansky, M.D. A man walking along a road comes across three Seldins. We have a distinguished history often, and teach widely. And we must teach bricklayers. When asked what he is doing, the first and an outstanding cause, and I applaud the grand landscape — the larger context of bricklayer replies, “I am laying bricks.” When asked the members of the ASCI. clinical investigation — to demonstrate to the same question, the second bricklayer answers, In reading over prior Addresses, I was each of these groups how the act of asking “I am making my living.” When asked what he is struck by the many recurring themes that scientific questions with a clinician’s intu- doing, the third bricklayer steps back, looks around, our past presidents chose to highlight: the ition can build “cathedrals.” and responds, “I am building a cathedral.” spirit of science, the imbalance between MD and PhD biomedical researchers, financial Teaching medical students and It is my great privilege and pleasure to support for clinical investigation and the residents the power of clinical address the ninety-sixth annual meeting of favorable economics of investing in bio- investigation the American Society for Clinical Investiga- medical research, and diversity in the ranks The US Public Health Service initiative tion. I will begin with many thanks: to the of American academic medicine. But of all Healthy People 2010 lists the major national council members who provide sage advice the challenges facing us as a Society within health concerns: tobacco use, substance and a critical eye; to our staff, who provide our broader society, I am most concerned abuse, cancer, osteoporosis, diabetes, cardio- dedicated direction and a keen sense of cor- about our ability to mentor and teach our vascular disease, immunization and infec- porate memory; to the members of the ASCI learners, and am frequently reminded of tions, blood pressure, nutrition, sexually in 2001, who felt it appropriate that I serve the pure joy that endeavor can bring to the transmitted diseases and many others (1). on the ASCI Council; and to the Presidents physician-scientist. The theme of the program argues that all who have come before for providing the Rather than being intimidated by the citizens should have a better understanding insights and precepts that have helped shape prospect of having my remarks compared to of those factors that affect personal health. our Society into an organization of extremely those of Presidents past — such as Joe Gold- I would argue that to achieve this goal we dedicated men and women that continues as stein’s insightful 1986 talk formulating the need both a citizenry that understands the the leading advocate for scholarship in medi- malady of insufficient technical training and processes of science and medicine, as well as cine. I will also try to follow the advice of the consequent lack of courage in junior faculty high-quality students selecting a career in seventeenth-century Catalan philosopher which I paraphrased to a group of junior fac- the science of medicine to do today’s work. Baltasar Gracian, who stated, “What is good, ulty members just last week, or Tom Stossel’s Of the plethora of enjoyable tasks of is doubly so if it be short; and in like manner, witty and wise apocalyptic fable in 1987’s being a Chair of a Department of Medicine, what is bad, is less so if there be little of it.” Brave New Medicine, or Ed Benz’s 1992 cel- one of the most enjoyable is speaking with Most recent Presidential Addresses have ebratory Presidential remarks — I relish the fourth-year students while preparing their begun with a palpable angst, prompted chance to convince you that perhaps our letters of recommendation. While basking by one of the major challenges of ASCI greatest challenge as advocates for the physi- in their enthusiasm for the upcoming years leadership — preparation of the Address cian-scientist is the issue of teaching. of residency, I always manage to inquire itself. Although I cannot speak for others, We must teach, teach often, and teach whether they appreciate the connections my apprehension was due to the sense of widely. We must teach medical students the between their first two years of basic sci- awe that developed while carrying out the rewards of marrying scientific inquiry and ence curriculum and their third and fourth unwritten oath of office requiring each clinical medicine; we must teach residents years of clinical rotations. Although an President to read the prior Addresses in that the singular discovery of new knowledge occasional student sees the relationship, the months prior to the annual meeting. can sometimes impact tens of thousands of most do not. Rather, they usually express The angst of writing the Address comes patients; we must nurture our fellows and great joy in shedding the shackles of class- from considering the accomplishments junior faculty members, providing them the room work for “real medicine” — interview- and panache of the individuals who have tools of the trade and instilling in them the ing and examining patients, formulating a previously held the ASCI gavel and used tremendous excitement that comes from differential diagnosis, doing scut work, this pulpit to espouse acute wisdom and solving the mystery of an idiopathic disor- and watching their patient rise from the uncommon insight and to create new pro- der or bringing effective therapy to patients. near dead and walk out of the hospital. fessional diagnoses and level outstanding And because teaching can impact these con- They often miss, for example, the integral wit — the Clem Finches, Joe Goldsteins, stituencies, we must teach the public about significance of the immunology they stud- Holly Smiths, Gene Braunwalds, and Don the values and processes and power of bio- ied in their second year to the survival of medical science, replacing the fear of things their patients’ renal allografts, or how the This article is adapted from a presentation at the unknown with a renewed enthusiasm for molecular biology they labored over makes ASCI/AAP Joint Meeting, April 16–18, 2004, in Chicago, Illinois, USA. the reward and potential made possible by the diagnosis of tuberculosis or AIDS so Citation for this article: J. Clin. Invest. 114:1165–1168 strong support for clinical investigation. To much quicker and easier, or how the signal (2004). doi:10.1172/JCI200423462. reiterate: it is clear that we must teach, teach transduction studies they slept through The Journal of Clinical Investigation http://www.jci.org Volume 114 Number 8 October 2004 1165 supplement in cell biology yielded the development of a remarkable new drug for patients with Table 1 chronic myelogenous leukemia. Many just Examples of resident research blocks, 2002–2003, University of California San Diego don’t get the connection — they do not see the cathedral — and we must fix this N-glycolylneuramic acid, a common mammalian sialic acid no longer endogenously situation. We must offer bench-to-bedside produced by man opportunities to illustrate — some might p38 MAPK activation in human tissues: Modulation by insulin, obesity and type II diabetes say indoctrinate — the power of transla- mellitus tional medicine throughout the four-year Cardiomyopathy associated with methamphetamine abuse medical school curriculum. Academic medicine is just beginning Assessment of coronary flow reserve using myocardial contrast echo to pay attention to this issue. Three years Purification of surfactant protein D and development of an ELISA for measuring levels in ago, the Mount Sinai School of Medicine BAL fluid introduced a full-time three-week course for first-year students that emphasizes the techniques, and enhanced their ability to One strategy our residency program and link between basic science concepts intro- critically evaluate a medical or scientific others have used to address this trend has duced at the bench and the clinical care of manuscript. Perhaps most importantly, been to implement a research elective block. patients. The goal of the course was to reen- 85% responded that the project impacted It appears such programs are quite popular ergize students’ career choices by allowing their careers in medicine.