School of Medicine: Message from the Dean

International Experience Shapes Perspectives on American Health Care

2009-09-10T15:36:00Z

Back in the U.S., Sikka is now training in the Department of Emergency Medicine residency program.

When Veronica Sikka, M.D., returned from a month's rotation in Chandigarh, India, she told me that she had a new appreciation for how the South Asian country had learned to practice very sophisticated medicine with minimal resources. During the spring of her fourth year in medical school, Sikka traveled to the world’s second-most populous country under the auspices of VCU’s partnership with the Post Graduate Institute of Medical Education and Research. The Institute is located in Chandigarh, a northern city that boasts the highest per capita income in the country and some of the brightest clinical minds in India. Nevertheless, Sikka found limited beds and staffing and strained financial resources at the Institute, which serves as the city’s Level I Trauma Center. In her experience however, those limitations did not translate into diminished health care quality. Assigned to the emergency department, Sikka worked long hours, seeing patients and discussing their differential diagnoses and treatment plans with attending physicians. In the midst of her experience, she was reminded of a 2006 Institute of Medicine report that emphasized that U.S. emergency physicians work in a fragmented system of emergency care with limited interhospital and out-of-hospital care coordination, too few on-call specialists, minimal disaster readiness, strained inpatient resources and inadequate pediatric emergency services. “If we could take the efficiency India has achieved with their access to modern technology but increased emphasis on basic clinical exam skills,” wrote Sikka, “and combine it with American’s current health care resources that are far more abundant than what is available in India, we have awesome potential to address many of the problems highlighted in the IOM’s recent report.” She offers this as an example: “Rather than immediately resorting to imaging and labs, the physicians there are great clinicians first and foremost—using their clinical skills and acumen to guide patient management as opposed to a lab value or image. Sometimes we get so dependent on tests and imaging here that we forget that perhaps the best judge of a patient’s disposition is not necessarily a blood value or an x-ray but the clinician’s sixth sense of what he or she feels is going on with the patient.” Our medical school established its partnership with the Institute in 2006 to foster just this kind of experience. Already yielding faculty collaboration in the fields of psychiatry, genetics and internal medicine, it is one of 15 partnerships that VCU has established with international universities and one of three international agreements forged by the medical school. Psychiatry Professor Ananda Pandurangi, M.D., is director of our partnership with the Institute. He says that it’s a great learning place for our students and residents in various disciplines because of three unique qualities. “They are a top-ranked academic medical center in India, a tertiary care hospital with 64 different medical-surgical specialties and yet they also see a significant number of patients receiving care for the first time from two surrounding states.” With a bachelor’s, two master’s, a Ph.D., and M.D. to her credit, Sikka’s connection to VCU now spans more than a decade and is ongoing. She is now training in the Department of Emergency Medicine residency program. “VCU is one of a kind in its strong commitment to ensuring students and residents are given access to ample opportunities that will enrich their education and training. I had many opportunities to transfer to other institutions throughout my educational and residency training, but VCU is difficult to match.” She says that this experience was a wonderful opportunity to “gain a unique insight into how healthcare is delivered in countries that were once third world nations and today are on the cutting edge of medical technology. As we enter a historical era in our country where we are starting to question our healthcare system and determine what we can do to make it better, it is helpful to have an international perspective to inform our national debate.” Wanting to eventually pursue a career that combines both academic emergency medicine and health policy, Sikka believes global perspectives such as the one gained in India will position her well for the coming years.

Roll Call

2009-08-14T18:00:00Z

On Monday at Roll Call, their names were read one-by-one. And one-by-one, they stood to take their place in the Class of 2013. As the week progressed, I watched them get to know one another and get to know the MCV Campus, and was struck by the thought that these students will be agents for change. They will be the ones to transform American health care into whatever form it takes in the coming years. Although the future course for American healthcare is yet to be defined, I remain optimistic that meaningful change can occur. I’m from Chicago. And I’m a Cubs fan. So I’m well equipped with the necessary patience, passion and hope. And I am confident that our school serves as an outstanding training ground in that regard. On the one hand, our students participate in our nationally recognized Project HEART program that nurtures their spirit and their commitment to empathetic care. On the other hand, they will work with our health care information technology system that is ranked as one of the best in the country. The juxtaposition of these programs is particularly interesting to me. They offer fundamentally different views on medicine, but without each other, they are useless. Our Health System’s innovative approach to medical homes for the under-served is touted as a national model. So as our students celebrated the first official milestone in their medical careers, I reminded them that medicine is a science. Doctoring is a profession. Health care is a business. By the time they finish their four years here on the MCV Campus, I know that they will be equipped with the wisdom to reconcile these perspectives as their careers progress.

A Magician Leads Peds

2009-07-06T15:59:53Z

No doubt about it. One of the first things to catch your attention when you look over Bruce Rubin’s CV is his affinity for all things magical. Not only does he work it into his patient exams, he teaches it to students, to residents and even to practicing pediatricians at CME conferences around the world. He maintains that physicians are natural magicians, with our special costumes, magical potions and incantations. We've even got X-ray vision, to his way of thinking. But Dr. Rubin’s magician’s props are tongue depressors and ear specula, with the occasional rubber band or sponge ball thrown in. And his goal is communication. “It gets the kids interested, listening and engaged. And it makes me more human and less intimidating,” he says.

Dr. Bruce Rubin, the new department chair for pediatrics, works with an impromptu magician’s assistant on a recent afternoon at the Children’s Medical Center.

Or maybe the first thing to catch your attention was his amazing record of professional accomplishment. He says that he’s known as the mucus guy. But I say he’s known for developing effective and appropriate aerosol therapy for children with lung diseases. And for advocating the antibiotic drug azithromycin for cystic fibrosis. He’s also known for setting the traditional understanding of CF on its head by discovering that, contrary to conventional wisdom, it’s not that there’s too much mucus in the CF airway. Instead CF patients’ lungs fill up with pus. And that, of course, leads to a very different treatment approach. Patients around the world know him for his mucus clearance clinic, which is the only like it in North America. And others know him for his study and treatment of plastic bronchitis, a deadly disease that takes its name from the way the mucus forms a fibrous cast that—when pulled from the lungs—clearly mirrors the branching of the bronchial tree. Dr. Rubin maintains the international registry for patients with this rare condition, and he’s working to develop disease models so that he can better understand and treat it. Here on the MCV Campus, he’ll continue his patient care and his research. But interestingly, he thinks that of all the different jobs you can have at a hospital, being chair of pediatrics is the best. He says that pediatricians are genetically programmed to be nice and nurturing. “Even the most difficult pediatrician is still a pediatrician, and that's what makes this so much fun.”

Goodbyes are Bittersweet

2009-05-11T17:05:26Z

Graduation Speaker Enrique Gerszten, M.D., it has been said, perhaps more than any other faculty member, helps students to understand and appreciate the honor and responsibility of being a physician.

At this time of year, we’re accustomed to saying goodbye to the students who have trained with us for the past four years. It’s bittersweet, as we salute their accomplishments and share a few parting words of advice. On Friday, that responsibility will fall in part to Enrique Gerszten, M.D., who will serve as the medical school’s convocation speaker.

This year Dr. Gerszten, too, is marking a milestone, as he transitions from full-time responsibilities to the role of Professor Emeritus.

We all—myself included—remember our first interaction with him. For some, the relationship began at their admissions interview when they discover they’ve drawn Dr. Gerszten. Others met him for the first time during the second-year Pathogenesis course that he has directed for more than three decades. In his address to the Class of 2009, he’ll be speaking to an audience he knows well.

The Class of 2009 and I joined the MCV Campus at about the same time. Their White Coat Ceremony was one of my first responsibilities after being appointed as Dean. In the time since, I have enjoyed getting to know and admire this remarkable class, whose members include:

Kyle Eliason

Kyle Eliason is headed to the University of Iowa for his internal medicine residency.

Kyle Eliason, who says he learned what medicine was all about before he even arrived on campus. It was December 1, 2004, when he underwent a living donor liver transplant, donating 55 percent of his liver to his brother and best friend, Eric. Kyle’s four-year Aesculapian Scholarship was made possible by the medical school’s Annual Fund; now he’s headed to the University of Iowa for his internal medicine residency.

Jemilat Badamas

Jemilat Badamas will train in internal medicine at Johns Hopkins-Bayview.

Growing up in Ibadan, Nigeria, Jemilat Badamas, always knew she was bound to study in America. At 18, she moved to the U.S. to pursue her dream of becoming a doctor, first as an undergraduate in Baltimore and then here at our School of Medicine. Her four years have been distinguished by her coursework—in her third-year she was inducted into Alpha Omega Alpha, the national medical honor society—as well as for her commitment to the community. Volunteering at Richmond homeless and remote-area clinics and mentoring high-school students interested in medical careers are just some of the things she has made time to do.

David Buxton

David Buxton at the medical school's Aloha-themed Match Day celebration.

David Buxton, too, has always believed in the value of volunteer service. That dedication led to his being named as the first recipient of the Harry and Zackia Shaia Scholarship that offers four-year support to a student with a demonstrated commitment to the community.

Next year, he will have responsibilities over and above those that come with his Brown University psychiatry residency. David has been selected by the Journal of the American Medical Association as one of 12 students who will serve as next year's editors of “Virtual Mentor.” The online publication encourages medical students to discuss bioethics topics, and David has already claimed a theme for his issue: pediatric palliative care. It’s a topic that reflects David’s plans for his own career. He has regularly spent time shadowing Dr. Bob Archuletta, a local physician who was among the first to become board-certified in pediatric palliative care. And David, in fact, already has a publication credit in the field: his account of grappling emotionally and spiritually with a patient’s death appeared in the Journal of Palliative Medicine last year.

Branden Engorn

Branden Engorn was singled out by the pediatrics department for the Elizabeth Joanne Harbison Memorial Award. He will train in pediatrics at Johns Hopkins Hospital.

The list of Branden Engorn’s service to his class and to his school is a long one that includes his presidency of the Medical Student Government Association, Admissions Committee member and third-year clerkship group leader. His commitment to leadership extends outside of the medical campus through community service and even lobbying city and state officials on health concerns of not only medical students but the community in general. On top of all this, Branden ranks in the top of his class.

His four-year record of remarkable accomplishments was recently recognized by the Joseph Collins Foundation. Established by the late Dr. Collins to assist “ambitious and determined” students in their study of medicine, the foundation selected just four students in the nation for its Beverly Chaney Award that carries a cash prize of $10,000.

These are four of our 174 students who will earn their medical degree this month, each with a unique success story. Together they created a phenomenal class, who have made us proud, and project a bright future for American medicine.

Goodbyes are bittersweet.

Opening a new Door to Discovery

2009-04-20T15:06:32Z

Some say that good things come to those who wait. I’m glad to be able to say that—in this instance—we didn’t have to. As it happens, the Molecular Medicine Research Building is opening ahead of the original schedule set forth in the School of Medicine’s Strategic Research Initiative.

8:30 – 11:30 a.m. — Scientific Symposium, Kontos Medical Sciences Building
12 noon — Building Dedication, Molecular Medicine Research Building

On each of MMRB’s eight floors, you can find the power to transform our understanding of illness and disease and to ultimately uncover new therapies and cures. The cohort of researchers who will occupy the building are outstanding scientists and having them in this wonderful new environment should bring out the best in their creativity. In fact, one of my favorite things about the new building is its open labs that will encourage interaction among these researchers—even among those of different disciplines. To mark the building’s opening, we have asked two exceptional scientists to come to the MCV Campus and challenge us to think about biomedical problems in new ways. Joining us for a scientific symposium on April 24, in the Hermes A. Kontos Medical Sciences Building Auditorium, are:

J. Silvio Gutkind , Ph.D., who is chief of the Oral and Pharyngeal Cancer Branch of the National Institute of Dental and Craniofacial Research. He is an internationally acclaimed researcher in cell signaling networks and cancer, topics which will be the focus of his presentation on Friday.
Charles Stevens , M.D., Ph.D., a world-renowned professor of molecular neurobiology at the Salk Institute for Biological Studies in San Diego. A National Academy of Sciences member since 1982, he has a particular interest in synaptic vesicles and synaptic transmission. His talk is titled “Darwin and Huxley Revisited: On the Origin of Allometry.”

The symposium will culminate the noon-time dedication of the Molecular Medicine Research Building. Brief remarks will be followed by the chance to tour one of the building’s labs. Please join us for the symposium, the dedication or both, as we commit the facility to a new era of discovery and ourselves to the pursuit of science that demonstrably improves health and patient care.

The Sholley Trolley Departs

2009-04-09T17:19:15Z

Have you ever heard of the Sholley Trolley? If, at some point in the past 33 years, you have studied for your medical degree on the MCV Campus, then you know exactly what I’m talking about. Professor of Anatomy and Neurobiology Milton Sholley, Ph.D., has an extensive knowledge of gross anatomy, a mental catalog of pertinent clinical applications and the legendary ability to connect the dots between the two. That combination makes watching him in the Gross Anatomy Lab a little like seeing the Pied Piper at work. When he points out an unusual anatomical finding, students flock to his side—or climb onto a nearby countertop to get a better vantage point. And then follow him on to the next specimen, and thus the Sholley Trolley is formed. But now, Dr. Sholley has announced his retirement. So last Friday, while Dr. Sholley and his wife were quietly packing his office, the students conspired with Anatomy Course Director Richard Krieg, Ph.D., to surprise Dr. Sholley with a heartfelt thank you for those trolley rides. With a fabricated plea for input on a video project, Dr. Krieg led Dr. Sholley and his wife Peg to the Egyptian Building. And as Dr. Sholley walked down the sloping aisle of the Baruch Auditorium, the students welcomed him with a standing ovation. Invited to the podium to make some remarks, the surprised Dr. Sholley paused and listened to a call from the back of the auditorium: “We want some knowledge!” “Well, I forgot my PowerPoints,” Dr. Sholley began. He went on to say how much he has enjoyed teaching the different classes over the years, not just from behind the podium, but especially in the gross lab where “we really do the work.” He also shared with them his hopes that they would use what he’d taught them throughout their careers. And before he stepped away from the podium for a final time, he concluded: “Next slide please.”

Match Day 2009!

2009-03-20T14:33:41Z

One of my favorite milestones in the academic calendar is the day that our fourth-year students learn their residency destinations. The excitement is palpable—and the room’s noise level is nearly so!—when students gather with family and friends to learn where they will spend the next several years of their lives.

Fourth-year student Kevin Lee slowly opens his envelope and then celebrates with classmates. He’s going to his first-choice residency destination: VCU’s Fairfax Family Medicine Residency.

As it happens, this year’s Match Day brought exceptionally good news for our medical school. Ninety-six percent of our students matched to their choice of residency program. That’s compared to a 93 percent national rate. Of our 170 students who participated in the Match, I was pleased to see that 56 elected to pursue primary care specialties like family medicine, pediatrics and internal medicine. As we work to reverse the forecasted physician shortage, particularly in the primary care fields, I applaud the choice that these students have made. It's one that is vital to the future of our nation’s health. And I was equally impressed to see how many matched into this year’s most competitive residencies like dermatology and orthopaedic surgery. These well-prepared students will carry our name out to medical centers across the country, including Johns Hopkins, UC San Francisco, Yale and Brown. I am confident that the compassion and skill they demonstrate will continue to build the solid reputation our school enjoys. It’s that reputation that opened doors for these students. They’ll do their part to open the door wider for the next class. But Match Day is a two-way street and even as we say goodbye to one group of students, we’re welcoming another. The medical center had remarkable news as well: all our training programs were fully filled with our program directors’ top choices! This is virtually unheard of and it’s the first time in at least 16 years that it’s happened for us. Normally, the days leading up to match are spent on the phone, talking to colleagues at other schools to find qualified students to fill a few remaining slots. But this year, I believe we were better positioned that ever before to attract an exceptional group. Our program directors have earned a reputation for very strong leadership and are known to expend a great deal of time and effort in providing the best education possible for our residents. The opening of our Critical Care Hospital was also very important to our prospective trainees. As a result, in July, we’ll welcome 165 students from 47 medical schools in 25 states. That includes 46 of our own medical students who will stay on for their training, either here on the MCV Campus or at one of our family medicine residency programs located around the state. Match Day is a great day. And it was particularly so this year. I salute our students and their accomplishments. And I thank their families and friends whose support has been a vital ingredient for their success.

COWs in Hospital Hallways

2008-12-02T18:39:22Z

It’s the largest construction project ever undertaken at the VCU Medical Center. The new Critical Care Hospital has 15 floors, each nearly half the size of a football field. But it’s the little things that catch my attention.

Behind Dean Jerry Strauss, a nurse enters patient information at a “COW”–short-hand lingo for a Computer On Wheels. Because of the Critical Care Hospital’s unparalleled wireless network, physicians and nurses can access and enter patient information on the fly. At the patient’s bedside or pushed down a hallway, there is no spot in the facility where the signal is weak or in danger of losing connectivity. It’s the key to making Electronic Medical Records function as they should.

Those details tell the story of the thought and planning that went into our state’s only hospital devoted solely to critical care. I notice the lack of noise in the Newborn ICU. Families are welcome in the rooms of even the sickest patients in the Burn Center. And COWs are free to roam down hallways and around corners. Let me tell you more about that last item. “COWs” is short-hand lingo for Computers On Wheels. They are the key to making Electronic Medical Records function as they should, because they make it possible for physicians and nurses to access and enter information right at the patient’s bedside. Not down the hall at the nurses’ station where, too often in the past, you had to wait in line to get access to a computer. And because the facility has an unparalleled wireless network, you can wheel those COWs anywhere you need them to go. There is no spot where the signal is weak and threatening to lose connectivity. That wireless quality supports other communications as well: telemetry, cell phones, two-way radios and paging systems. When you tie it all in together, you get real power. A patient’s bedside monitor feeds critical messages on fluctuating vital signs directly to wireless phones that our nurses carry at their waists. Each unit’s sheer size means that nurses do not always have a direct line of sight to all patient rooms—so this kind of reliable, two-way contact was essential. And what makes the NICU so quiet? Rubber floor tiles, an acoustical ceiling and privacy curtains on plastic tracks and rollers. Based on years of research into the needs of premature and critically ill newborns, these are important ingredients for the development of each tiny patient. As is the size of their private rooms—yes, even these smallest patients get their own space to encourage the family’s involvement from the very beginning. That family engagement is important in the Evans-Haynes Burn Center, too. Our nation’s first civilian burn unit made a name for itself by pioneering advances in burn care, but its space constraints meant that sometimes family had to be asked to leave the unit. In fact, even patients sometimes had to leave when their wounds required a trip to an operating room. Now, the center has a large procedure room down the hall equipped with high-intensity lighting and special water purification devices that will help prevent infection in some of the most susceptible patients. Patient safety was the overarching goal in the design and construction of the $184-million hospital. But their comfort—and their family’s—was a close second.

Step I Board Scores Bring Good News to Medical School

2008-10-03T12:18:29Z

A major milestone for our students has brought some outstanding news to our school. The National Board scores are rolling in for the Class of 2010. And it is shaping up to be our best year ever on the crucial exam that is officially known as Step I of the USMLE.

To prepare for Step I of the USMLE, students must master the over 10,000 pages of syllabus that represent the first two years of medical school. Linda Costanzo, Ph.D., is their coach and cheerleader as she leads an intensive board review that starts with weekly sessions in January and offers to meet individually with students to construct detailed study schedules based on their strengths, weaknesses and concerns.

The Class of 2010 took Step 1 In June. Now, three months later, with all but two of the scores in hand, the average score for the class was 223.2—our highest ever! The students achieved a 95.7% pass rate, with 42% of the class scoring 230 or above, and 13 students scoring above 250. These statistics will surely exceed national averages, which will be published later in the year.

Physiology Course Director Linda Costanzo, Ph.D., may well be our students’ secret weapon. Her enthusiastic teaching has been recognized nationally with the Alpha Omega Alpha medical honor society’s coveted teaching award. And her best-selling textbook Physiology and her physiology review book for the Board Review Series have been overwhelmingly adopted by medical students throughout the country. But it’s our own students who benefit from her offers to meet individually to construct detailed Step I study schedules based on their strengths, weaknesses, and concerns.

Since 1991, Dr. Costanzo has been their coach and cheerleader as they seek to master the over 10,000 pages of syllabus that represent the first two years of medical school. She leads an intensive board review that starts with weekly sessions in January. That schedule ratchets up dramatically in May, when she gives them a jump-start into their own personal study plans with an eight-hour marathon physiology review.

It is that sort of commitment to our students’ education and training that she will bring to her newest role—that of Assistant Dean for Medical Education. Together with Isaac Wood, M.D., Senior Associate Dean for Medical Education and Student Affairs, and Alan Dow, M.D., M.H.A., another recent appointment to the role of Assistant Dean for Medical Education, Dr. Costanzo will be instrumental in designing a new curriculum and developing the programming for the new School of Medicine Building that will open in 2013.

I look forward to this creative and committed team setting a new standard for what medical education will look like in our school and, no doubt, across the country.

School Receives Good News from LCME

2008-07-02T14:29:10Z

This summer our medical school received good news in the form of an official notification from the Liaison Committee on Medical Education that the school has received an eight-year accreditation, which is the maximum amount of time that can be awarded.

The accreditation followed an 18-month self-study process during which the School of Medicine evaluated all aspects of its educational program. The LCME praised our school for its leadership, educational support and responsiveness to students. In addition, the school’s separate clinical program at the Inova Fairfax Hospital for 48 students was also praised for the richness and diversity of its learning environment and a new education building that opened earlier this year. The next accreditation cycle will occur in 2016.

We are very pleased with the results of the accreditation process, and I offer my thanks to all of the faulty, students and staff who participated.

Announcing the Dean’s Blog

2008-06-30T12:56:06Z

One of the best things about being Dean is that I get to learn of the accomplishments – both big and small – of our students, faculty and alumni. These bragging points don’t always make the headlines and may go unnoticed by many in our community. But in this blog I’ll bring them to your attention so that you can applaud with me the creativity, compassion and contributions that our colleagues demonstrate every day.

After the School of Medicine’s convocation ceremony, Georgia Ferrell stopped for a quick picture with me. Georgia spent a year working with me and OB/GYN Associate Professor Catherine Matthews on the genetics of pelvic organ prolapse. She has just started her residency in OB/GYN at Vanderbilt with her husband, Benjamin, a fellow M’08, who is training in Internal Medicine.

In future postings, I will also share updates and announcements that affect our school. I may even occasionally comment on health-related issues in the news. But for this first entry, I’m wondering if you’ve heard about the déjà vu that the Department of Pathology is experiencing?

The American Society of Cytopathology has recently announced its highest award will go this fall to Dr. Celeste Powers. The award bears the name of George Papanicolaou, the father of cytology, who you may remember as the originator of the Pap test that has proven to be one of our most effective screening tests for cervical cancer and for saving women’s lives.

This may sound familiar to those who’ve been on campus a while. Precisely 25 years ago, Dr. William Frable was honored in the same way by the ASC. I am aware of only two other institutions who can claim a pair of Papanicolaou Award winners: Johns Hopkins and Memorial Sloan Kettering Cancer Center.

This outstanding accomplishment is a testament to the tradition of excellence in cytopathology that was established by Dr. Saul Kay, who was recruited to the medical center in 1950 and was one of the first area pathologists to encourage cervical cancer screening. He led the Division of Surgical Pathology for three decades and, along the way, trained Dr. Frable, who in turn trained Dr. Powers. Both of these trainees would go on to be named to the presidency of the ASC. They even wrote a book together, the authoritative text on fine-needle aspiration of the head and neck, published by Butterworth-Heinermann in 1996.

Apparently, Dr. Frable made an unwise bet with Dr. Powers as she was completing her fellowship here in Surgical and Cytopathology in 1990. He wondered whether she could follow his path to the ACS presidency and the Papanicolaou Award within 25 years. He owes her a bottle of champagne.

Cheers!