Volume 4 | January 2014
The Student Newsletter of the Icahn School of Medicine at Mount Sinai
Dr. Neil Calman: A Champion of the Underserved and Leader in Medicine By Alexa M. Mieses, MS2
Dr. Neil Calman is a Board Certified family medicine physician and leader in advocacy for the underserved. As the founding President and CEO of the Institute for Family Health, he has been serving underserved populations throughout New York since 1983. Dr. Calman is also Professor and Chairman of the Department of Family Medicine and Community Health in the Mount Sinai Health Care System. Dr. Calman has won numerous regional and national awards for his work including the Robert Wood Johnson Foundation’s Community Health Leadership Award, the American Academy of Family Physicians Public Health Award, and the Pew Charitable Trusts’ Primary Care
Achievement Award. He is also the Project Director for Bronx Health REACH, an effort funded by the Centers for Disease Control and Prevention to eliminate racial and ethnic health disparities in the Bronx. Alexa Mieses, Editor-in-Chief of the Rossi, recently spoke with Dr. Calman about how he became interested in medicine and a leader in his field, and about his hopes for the Department SEE CALMAN, PAGE 7
COURTESY OF WWW.NEILCALMANMD.COM Dr. Neil Calman is now the CEO of the Institute for Family Health.
Sinai’s CEYE Connects Students to Health Sciences By Sanders Chang, MS1
Sinai Establishes Two New Scholarships . . . Page 2 SINAInnovations Talks Team Science . . . Page 2 Social Media: A Space for Work or Play? . . . Page 3 Doctors Rethink Cultural Competency . . . Page 4 Alumnus Profile: Dr. Herbert Chase . . . Page 10
In 1975, educational advocate, Dr. Lloyd Sherman, EdD, established Secondary Education Through Health (SETH). SETH was later formalized as the Center for Excellence in Youth Education (CEYE) under the Center for Multicultural & Community Affairs (CMCA) at the Icahn School of Medicine at Mount Sinai. His vision was to provide educational opportunities in the health sciences to students of diverse backgrounds, primarily economically disadvantaged students and students from groups historically underrepre-
sented in science and medicine. Since its creation, the Center has offered academic programs and internships to more than 10,000 New York City students, many of whom have ended up pursuing higher level education and diverse professions in medicine, nursing, allied health, social work, and research. CEYE offers an array of interactive programs that are accessible to students in middle school up to those in their college years. Students in the 7th and 8th grades can get their hands dirty in the “Day-With-A-Scientist” program. For a full day of activities, SEE CEYE, PAGE 6
Sinai Establishes New Scholarships for LGBT Health and Diversity By Jeanne Bernard, Department of Medical Education An important part of the mission of the Mount Sinai Health System is to provide quality health care to all, and particularly to those who have been traditionally underserved by the medical community. A crucial path to achieving this is to ensure that healthcare providers stem from diverse groups and experiences. Icahn School of Medicine at Mount Sinai works pro-actively to increase the representation of women and individuals who are members of groups underrepresented in medicine among our students. Recently, the Medical School established two new scholarship opportunities specifically aimed at increasing diversity among our students: The Excellence in Lesbian, Gay, Bisexual, and Transgender (LGBT) Health and Advocacy Scholarship and the Weir Family Scholarship. These targeted awards are part of a continued effort to increase the availability of scholarship aid and reduce SEE SCHOLARSHIPS, PAGE 5
Diversity in the health professions and science benefits every aspect of health, healthcare, and biomedical research. — GARY BUTTS, MD, ASSOCIATE DEAN FOR DIVERSITY PROGRAMS, POLICY, AND COMMUNITY AFFAIRS
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COURTESY OF WWW.BLOG.MOUNTSINAI.ORG The 2013 SINAInnovations conference brought together a diverse group of speakers and panelists.
SINAInnovations Celebrates Team Science By Christopher Hernandez, MS1 On November 18th and 19th, the Icahn School of Medicine at Mount Sinai hosted its second annual SINAInnovations conference. The focus this year was on team science: what is it, why is it important, and how can it be encouraged? The event consisted of an impressive series of speakers, panels, and breakout sessions, as well as a networking event. Distinguished speakers included former Yankees manager Joe Torre, state Commissioner of Health Nirav Shah, Rear Admiral Scott P. Moore, and many, many others from all walks of life: authors; engineers; researchers; administrators; entrepreneurs. The bulk of the event took place in the Stern Auditorium, where a large screen displayed a live Twitter feed with real-time reactions and questions from the audience. Opening remarks were given by Dean Dennis Charney. “Why did we think it was so important to attract leaders from all
walks of life?” he asked. “Because in many cases, unexpected findings come from unexpected places.” This would be one of the conference’s main themes — that it is vitally important to break down the barriers between disciplines, and to disrupt bureaucracy wherever it rears its ugly head, in order to encourage the development of ideas. Commissioner Shah was the conference’s first speaker, and he cited an old study that showed that it took 17 years, on average, for a clinical application of research to make its way into practice. “Even in this Twitter age,” he said, gesturing to the screen behind him, “it can still take as long as ten years — far too long.” This, too, would be a theme: speed; what can an institution like Mount Sinai do to stay agile? Shah suggested encouraging the creation of multidisciplinary teams — bringing physicians, researchers, social workers, and patients together — as a major step in the right direction. He cited social-media-facilitated SEE SINAI, PAGE 5
New Study Looks At Social Media’s Role in the Medical Field By Caroline Eden, MS1
Summary: Social media (SM) has become a prominent aspect of today’s culture; yet, appropriate professional conduct with respect to social media is somewhat unclear, especially in the medical field. According to Muhlen and Ohno-Machado, “Posting of unprofessional content and breaches of patient confidentiality, especially by students, are not uncommon and have prompted calls for social media guidelines.” Hatch et al. attempted to address this issue through an interprofessional educational intervention that introduced questions about appropriate SM use. Year 1 students from various medical programs rotated through stations, one of which included an activity where teams where given SM-related scenarios to discuss and then asked to record their responses on a graffiti wall, simulating an online post. In assessing student’s perceptions of this activity, the researchers found that overall, students thought the
exercise was effective, and the majority thought that practical tools, including a wallet card regarding professional use of SM, would be useful in the future. However, some students reported that they had learned about SM adequately in school COURTESY OF WWW.SOCIALMEDIACLUB.ORG and that the mate- Using social media can lead to breaches of patient confidentiality. rial was “common sense.” Regardless, the authors argue presence, both medical students and that SM-related misconduct is ubiquiprofessionals walk a fine line betous, and that these principles should tween representing the medical field be revisited throughout the various and maintaining an online identity medical program curricula. separate from our professional lives. Today, it is instinctive for many of Discussion: us to post images, random musings, Indeed, equipping both medical or quotations on social media sites; students and professionals with some however, we need to take a step back specific guidelines about appropriate before clicking that “post”, “upload”, social media use would be helpful in or “add friend” button, not only to maintaining both a professional protect ourselves but also our colonline identity and patient confidenleagues and patients. tiality. With respect to our online As the medical community’s presence continues to move beyond the physical confines of the hospital or office, we will need more education in navigating our changing roles in this virtual space.
Sources: Hatch, T., Bates, H., Khera, S., and Walton, J (2013). Professionalism and social media: an interprofessional learning activity. Medical Education, 47(11): 1137-7.
COURTESY OF WWW.FACEBOOK.COM/MOUNTSINAINYC Social media can be a useful tool for medical students and professionals to represent the medical field.
Von Muhlen, Marcio, and Lucila Ohno-Machado (2012). Reviewing Social Media Use by Clinicians. Journal of the American Medical Informatics Association: BMJ, 19:777-781.
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Physicians Rethink Cultural Competency Training Approaches New strategies in cultural competence training focus on case-based experiences By Brian De, MS1
Summary: With the globalization of health care evolving rapidly, many residency programs have begun to emphasize cultural competence as a prized and crucial skill of their trainees. However, recent studies suggest that trainees often feel discouraged and frustrated by such programs, which many think focus too strongly on stereotypes and generalizations and often ignore deeper, more meaningful cultural understanding. In an attempt to encourage greater acceptance of these programs, the investigators (Dr. Neil K. Aggarwal and Dr. Ravi DeSilva) of this study devised a new cultural competence approach that occurs earlier in training, includes casebased experiences, and “anticipates trainee resistance.” The study included psychiatry residents (n=12) at Columbia University. These residents took a course based on the Cultural Formulation Interview (CFI), a survey that psychiatrists use to gather information about the impact of culture on patient care. The course included five weeks of discussion related to social science theories and the CFI, and seven weeks of practicing the CFI with patients and reflecting with instructors on how culture affects patient care. Trainees appreciated the CFI’s individual approach to culture, which does not rely on stereotypes and generalizations. They were more likely to participate in discussions about
COURTESY OF WWW.FLATCLASSROOMPROJECT.ORG Residency programs have begun to reconsider how they train residents in cultural competence. “their own acculturation within . . . medicine and psychiatry,” about cross -cultural miscommunication with patients despite using “hospital cultural and linguistic brokers,” and about “the relevance of cultural competence” in shaping patient care decisions. Trainees were least likely to participate in discussions that asked them to reflect on their own backgrounds in relation to individual patients.
plores an alternative method by which the concept of cultural competence can be emphasized and fostered by physicians. Though many physicians have had related training in medical school, the findings of this study strongly suggest that reflective learning in the context of real patient care is far more likely to resonate with trainees than didactic lessons and unfocused self-criticism. Future studies may expand upon the approach taken by the authors of this study by exploring whether these strategies can be successfully implemented across specialties, and by identifying other factors likely to correlate with self-directed interest in cultural competence.
Discussion:
Sources:
Although this study is limited in its generalizability given that it evaluated only one specialty and a small number of trainees within a single program, it successfully ex-
Aggarwal NK and DeSilva R (2013).
Many think [cultural competence] programs focus too strongly on stereotypes and generalizations.
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Developing cultural competence in health care professionals: a fresh approach. Medical Education, 47 (11):1143-4.
Sinai Raises Funds for Two New Scholarships SCHOLARSHIPS, FROM PAGE 2 the debt burden for Icahn graduates. The Excellence in LGBT Health and Advocacy Scholarship will be awarded to outstanding candidates who demonstrate a commitment to LGBT health, and who exhibit exceptional promise for leading this movement on a national scale. Ongoing fundraising for this scholarship is being conducted through the Mount Sinai Development Office. The Weir Family Scholarship is designated for students from backgrounds historically underrepresented in medicine. This scholarship is the result of a generous donation through the Estate of David M. Weir, a friend of Andrew Heineman, late member of the Mount Sinai Board of Trustees and the Center for Multicultural and Community Affairs Advisory Board. “Interacting with diverse peer groups enhances the learning experiences of all students, trainees, and postdoctoral fellows to effectively impact culturally diverse populations and to achieve health equity and improve health outcomes,” says Gary Butts, MD, Senior Associate Dean for Diversity Programs, Policy and Community Affairs and Director for the Center for Multicultural and Community Affairs. “Ultimately, diversity in the health professions and science benefits every aspect of health, healthcare and biomedical research.”
To learn more about these or other scholarship opportunities, please contact MacLean Pilsbury, Associate Director of Development, Medical Education, Mount Sinai Development Office, 212-731-7487, maclean.pilsbury@mountsinai.org or Lisa Harper Kennedy, Esq., Director of Development and Alumni Relations, Medical Education, Mount Sinai Development Office, 212-7317492, lisa.kennedy@mountsinai.org.
Joe Torre Speaks at SINAInnovations job as manager, when he was first introducing himself to his players, he told them that he didn’t want to “just” win a World Series — he wanted to win three in a row. His reasoning was that he didn’t want his team to feel like they were making one quick grab for the gold; he wanted to transform the attitude of the team at a basic level, to have them adopt a long-term view, to craft them into a winning machine. Needless to say, these principles can be applied equally well to the process of obtaining a medical education. As medical students, we shouldn’t think of ourselves as just, say, cramming for two years in order to do well on the boards; instead, we should be training ourselves to continuously synthesize new scientific information, in preparation for a long, impactful career in medicine; we should be focused on laying the intellectual foundation that will allow us to better serve our patients in the long-term. This idea also gets at the heart of what Mount Sinai is trying to do with a conference like SINAInnovations. Many different speakers pointed out that the keys to success in team science are to pick out clear and distinct objectives, and to doggedly pursue those objectives with a long-term mentality. An event like SINAInnovations is designed to adjust the whole spirit of the institution to think along such lines: to think less about what quick and easy project is most likely to get the next grant approval, and more about what major scientific milestones can be achieved in a ten-, COURTESY OF WWW.MOUNTSINAI.ORG twenty-, thirtySINAInnovations held a panel discussion highlighting Team Science. year time frame. SINAI, FROM PAGE 2 reactions to the devastation of Hurricane Sandy as good examples of people working together who normally do not: strangers preparing kosher meals for those who needed them; doctors emerging to make simple signs about how to avoid infection. When Joe Torre took the stage, the conversation became less about team science and more about baseball — and yet, it wasn’t difficult to see the parallels between the two. What he discussed, in essence, was the nature of leadership itself: that the trick is to make sure each member of the team feels recognized and appreciated for the value that he or she contributes; that the trick is to never grow complacent (“once you admire what you’re doing, you stop doing it,” he said). “My job was about communication,” Mr. Torre said, “and trying to put people in a position to succeed . . . The only thing magical I had was being honest and believing in my players. If people felt like I had their back, they’d give me their all.” Under Torre’s leadership, of course, the Yankees had an amazingly successful run, including four World Series titles. The Yankee fans in the audience (Dean Charney among them) made their immense love and respect for Torre known. One interesting comment Torre made was that on the first day of his
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CEYE Inspires Students to Pursue Research and Health Sciences CEYE, FROM PAGE 1 students engage in animal dissections and presentations to learn about the physiology and diseases of the heart, brain, eye, and other organ systems. Max Sobrero, a medical student volunteer, recounts the enthusiasm the students bring to one of the dissections, “My favorite moment was when I showed the students how they could use the lens of the cow’s eye to magnify the letters on their worksheets. They spent the remainder of that class sharing with each other what they could magnify and hypothesizing how the lens worked.” For high school students, CEYE offers exciting summer internships to shadow clinicians and participate in research within Mount Sinai. In the Hospital Placement course, students can explore a hospital department and see behind the lines of health care. “After participating in the Hospital Placement Program, my career plan of becoming a doctor became stronger,” says Estephania Macias, a senior at Central Park East High School. “My favorite experience was learning about cultural competency. I would see so many patients with cultures and beliefs that the doctors had to respect.” Through a special partnership with the High School for Math, Science, and Engineering, high school juniors can enroll in the two-year Biotechnology & Medical Research Course. This intensive course allows students to engage in a full year of acquiring research skills in genetics and technology, followed by a full year of rotations in clinical departments and laboratories throughout Mount Sinai. Roscoe Wasserburg, a senior in high school, comments on his shadowing experiences at the Plastic and Reconstructive Surgery Clinic. “Scrubbing in for the first time was slightly frightening but also an edu-
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cational experience. I found myself surrounded by compassionate doctors that I hope to be like one day.” At the collegiate level, CEYE offers the North Regional Alliance (NERA) MedPrep program, led in conjunction with the Columbia University College of Physicians and Surgeons and New Jersey Medical School. Over the course of three summers, college students prepare themselves through biomedical research experiences and clinical rotations for eventual application to medical school and other health care professions. Digna Nosike, a NERA MedPrep graduate, remarks on the barriers for pursuing her goals in medicine. “I have always wanted to be a doctor coming to college. But as the first in my family to attend college, I did not have the foresight for how applying to medical schools would work and whether I would be ready for it.” However, after joining NERA in her sophomore year, Digna found a support system that helped her build confidence in her studies and herself. “NERA is remarkable in that I found many mentors, teachers, and professionals, at my side who I could speak to and network with. I remember meeting with Dr. Sherman, and hearing him emphasize the importance of contributing to the diversity of the workforce. This strengthened my resolve to stay in the field,” she said. The successes of CEYE students are reflected in their achievements beyond the program. CEYE high school students have presented their research projects in the New York City Science and Engineering Fair (NYCsef), a competitive city-wide research fair sponsored by the New York City Department of Education and the City University of New York. For 2012-2013, out of 700 participants, six CEYE students were selected as semi-finalists, four as finalists, and three were placed first in their individual categories.
COURTESY OF CEYE ISMMS students led dissections to teach middle school students about physiology and anatomy. CEYE high school students who graduated in 2013 have gone on to study at colleges including Villanova, Southwestern, Amherst, NYU, Hunter College, Cornell, Brown, and University of Pittsburgh. Since the inception of the 3-level summer NERA Program in 2008, 120 students have graduated the program with 365 currently in the pipeline. Approximately 55 of the graduates have applied to medical or graduate school, with 34 having been accepted to medical school and 7 to other health professions programs. “Working with our students is extremely rewarding,” Alyson Davis comments. “We are able to watch them grow, mature, and build confidence after working in a professional academic environment like the Mount Sinai Health System.” On the personal impact that the students have on her work, Davis remarks, “The zeal, inquisitiveness, and dedication that they bring to these programs is truly infectious. They keep me grounded in this work and remind me that we have so much to be excited about and still so much to learn.”
Students interested in applying or volunteering can contact Alyson Davis at alyson.davis@mssm.edu. Additional information can also be found on the Facebook page, www.facebook.com/ceye.cmca.
Dr. Neil Calman Speaks About Advocacy in Medical Careers CALMAN, FROM PAGE 1
and field of family medicine. How did you first become interested in medicine? I’ve been interested in medicine since I was a little guy. I came from a family of oral surgeons. My great uncle was a general practitioner but everyone else in my family were oral surgeons — my father, my grandfather, my uncles. I was always interested in medicine until one day my dad brought me into his oral surgery office and split a tooth with a hammer and blood went squirting all over the place and I said, “You know, I don’t think this oral surgery thing is really for me. I think I’ll go to medical school.” So I became a doctor.
Medical School in New Jersey, which was my state school. At the time, Rutgers was a two-year school so after two years, I transferred to Rush Medical College. Then I came back to New York (where my family and friends lived) to do my residency at Montefiore in the Family Medicine/ Social Medicine program.
Did you put your activities on your application and the medical schools didn’t look upon them favorably? Well, actually the story is a little more intense than that. I was actually suspended from college for six months, and that was on my college transcript. What I did during those six months was I went back and worked in a hematology and leukemia research laboratory in Washington Heights where I had worked So what was medical school like for every summer throughout high you? school. During that time, I produced It was not so easy for me to get an experiment which got published in the Journal of the National Cancer into medical school. I had been involved in a lot of anti-war activities Institute. I really made good with the during the Vietnam War, and was time I wasn’t in school. involved with an anti-war and stuThen I went back [to college] and dent-power demonstration in college graduated with my class because I took extra courses. So I made it up but at the University of Chicago. So for there were over 100 people who were me, medical school admission was a challenge. suspended or expelled for the sit-in in I applied to fifteen schools and 1969 at the University of Chicago. got in off the wait-list at Rutgers So I never regretted what I had done not just because it turned out to be good career-wise in terms of doing the research, but also because until this day I also believe it’s really important to stand up for what you believe in. When I let issues I feel strongly about go by unaddressed, and when I haven’t stood up for important things that COURTESY OF WWW.NEILCALMANMD.COM matter to me, I alDr. Neil Calman cites his grandfather as an inspiration to activism. ways regret it. But I
have never regretted the kind of outspoken activism that I learned from my grandfather. It sounds like you were a great advocate even before you became a physician. Can you talk about how you integrated advocacy into your career in medicine? Let me go back and say a few words about my grandfather. So my grandfather, Maurice Samuel Calman, was a socialist alderman in Harlem, right here in New York. When he first immigrated to this country from Romania he went to a commune in southern New Jersey, which was a place where a lot of Jewish immigrants went to be trained as agriculturalists. He literally became a farmer and got a degree in agriculture. But I guess he had an activist spirit within him and he couldn’t stand being in a rural area so he moved to New York City. First he went to dental school and became a dentist, practiced oral surgery, and then went to law school and became an attorney. He was then elected as an Alderman in New York where he fought for and started the first pediatric dental care program for school children in New York City with his brother, also an oral surgeon. My grandfather lived close to us as I was growing up and spent the last years of his life living with us in our home in Glen Rock, New Jersey. He became my role model. He was someone who had passionate beliefs about everything that was going on around him, and he acted on those beliefs; first, as an alderman long before I was born but then all throughout his life through the kinds of organizations and activities he was involved in. He was always brave about speaking out for the things he thought were important whether in the dental society or for school programs for CONTINUED ON NEXT PAGE
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CONTINUED FROM PREVIOUS PAGE kids. And so I think that was probably my most formative family connection. My dad, on the other hand, who followed in my grandfather’s footsteps into oral surgery never got into any activist activities. When I asked my dad about it later in his life he said, “You know my dad was out every evening, and I swore I would be home with my kids.” So the balance I’ve had to learn to achieve in my life is how to be home with my kids and be a social activist. You’d have to ask my boys but I think I’m doing a pretty good job at both. Can you tell me more about your advocacy work and what it was like to be elected by the Obama Administration to take part in really meaningful conversation about health care? I am an appointed representative for vulnerable populations to the Health Information Technology Policy Committee. My role is to think about what the needs are for populations of people who might otherwise get left out of the technology revolution and who now need special attention to ensure they can avail themselves of all the improvements in care that are going to come from electronic health records and health information exchange. Working inside government is not a huge advocacy opportunity because everything is so structured, the agendas are set and the topics for your meetings are set ahead of time. But the recognition that the appointment to the policy committee brought me has created lots of other opportunities for me to advocate for issues of social justice and equity in health care.
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What are some examples of advocacy opportunities and what can medical students do to be advocates? One of the most important things that happened to me is when I was at Rutgers I connected with a few other students who were very much social
activists. They actually had a lot we were bringing from the student more experience in a broader range group. of activist activities than I did so I We put on a program that talked learned a lot from them. about the influence of the pharmaWe formed a study group and read ceutical industry on how doctors articles that we discussed together make decisions. Remember this was which looked at medicine in a the early 1970’s and nobody was talkbroader social context. We would ing about that stuff. In those days read in the literature about the health you couldn’t walk 5 feet in the hospicare system and tal without being talk about what accosted by drug was going on and reps. what type of We also develchange was oped a program needed to make that looked at sure that poor how the hospitals people got access we were training to all the health in were delivering care they needed. different types of — NEIL CALMAN, MD, care to different So I started to work for the stuCEO OF THE INSTITUTE classes of people. dent-run clinic We developed a FOR FAMILY HEALTH called the “Nabe” program when a which was short researcher who for Neighborhood House. It was run had done a lot of unethical research by a pediatrician. That experience, on developmentally disabled children being in the basement of a church was scheduled to be brought to the once a week and seeing children and hospital to speak at Grand Rounds. families who had been shut out of We actually preempted the Grand the rest of the health care system, Rounds a month beforehand by putwas incredible to me. ting on a program about human exActually, looking back on it, it perimentation and using the unethihelped me formulate my goal of cal researcher as an example of what wanting to be in primary care, on the not to do. He ended up canceling his front lines of health care delivery. trip to Chicago having gotten the But the connection with these other news that we outted him before he students was the most important was able to come and speak. thing. Two of us went and finished All of those things were ways to our medical school at Rush together. raise the consciousness of the people At Rush we developed a much, were working with without being much larger group of advocate studisruptive. More importantly, it dents — probably twenty or thirty. helped us sustain those values we We called ourselves, “Concerned brought to medical school during an Rush Students.” Not exactly a brileducational process that can be very liant name, but we used to put on dehumanizing. programs for the hospital to give a More importantly things were different spin on the things everyone happening during medical school was experiencing. that were horrific and I started writWe formed a very close collaboraing about them. Some of those essays tion with a few faculty members who have been published. But it was really appreciated and supported really difficult to confront some of what we were doing. But also with the ethical and moral questions that the hospital clergy who just concome up when you’re in medical nected with the message of social school observing what goes on in the CONTINUED ON NEXT PAGE justice and equity in health care that
You can’t just sit around and be part of a system that doesn’t do the right thing.
CONTINUED FROM PREVIOUS PAGE health care delivery system without the power to change anything. My outlet was to journal everything. I started to talk to people in our reading group about my experiences. Some of those experiences became quite outrageous and forced me into action. One of the things we looked at were the nursing schedules on the private versus public OB floors which were separate at that time. There were twice as many nurses on every shift for weeks and weeks at a time [for the private patients compared to the public floor]. We brought that to the attention of the administration who shrugged it off and basically said, “Well, of course there are. These are privately insured patients.” It brought home the difference in how the hospital administration felt about equity in care and how we felt about the rights of everyone to be treated the same in the health care system. You can’t just sit around and be part of a system that doesn’t do the right thing. You have to basically address those injustices as you move through life. Otherwise, what accomplishments are you really making? You’ll just become another cog in a dysfunctional wheel that has yet to figure out how to care for everyone the same and provide good healthcare access to all. What is your favorite thing about family medicine? I was just finishing my third year of medical school. I was one of those people who loved everything. I almost became a psychiatrist, I almost became a cardiac surgeon, and I almost became a pediatrician. I loved every clinical rotation. I was in a quandary. I had participated in activist things in medical school, and I needed to find a way to couple what I believed in and what I wanted to do in some field of medicine. There was no Family Medicine at Rush Medical College at the time. I
was looking through the back of the New England Journal of Medicine to get a sense of jobs that were available in medicine. There was an ad for a visiting doctor to come and work in a clinic, in the Central Valley in California, which treated farmworkers and was part of the United Farm Worker’s (UFW) Health Union. At the time the UFW was leading a national boycott of Gallo wine, California grapes and lettuce coming out of the Central Valley because the workers were trying to unionize. Since this was a union-run clinic I thought “great opportunity to combine social activism with medical care.” I took a leave from medical school for two months and went out and worked with the United Farm Workers’ health clinic. I worked with a general practitioner who wasn’t even residency trained but he had been there for years. The clinic had two beds in the back and we were taking care of people who had no health insurance. Basically, they got care from us or they got no care. Nobody else would see them. We were more than half an hour from the nearest real hospital which was in Bakersfield. We were in a little town called Delano. We did everything. We had a library of books and a lot of them were like cookbooks. People talk about cookbook medicine; this was like, “how to set a Colles fracture and how to cast it.” He would pull the book down from the shelf if something new came up. We had an X-ray machine. We did all the lab work in-house. I learned how to count red cells and white cells with a little clicker. I learned how to do X-ray procedures. I worked as the X-ray tech for a while. The doctor and his staff who were all volunteers took good care of all of these patients. We took really good care of people. He had developed a whole group of specialists who he consulted with over the phone. They would see some of these patients for free if they really needed specialty care.
WWW. INSTITUTE2000.ORG Founded in 1983, the Institute for Family Health now serves 80,000 patients a year. So I went back to medical school and I said that’s what I want to do. I want to do family medicine. I want to be like a generalist. I want to take care of the things that are wrong with people. I want to be able to understand medicine really broadly. I wasn’t focused in one little area. I wanted to be able to go out into communities and think about what the communities needed; actually work in those communities with that kind of breadth of knowledge, realizing that you need specialists and surgeons and other people. The front end of the health care system should be exactly like what we were doing there. I went back to medical school to talk to the dean about going into family medicine. They really had no idea what family medicine was. I said I needed an advisor, someone who knows something about this. He assigned me to a psychiatrist who had been a general practitioner in southern Illinois, seeing sixty patients a day. He did that for a number of years and just burnt out and went back and did his residency in psychiatry. That was the closest [my school] could come to find someone who knew what it meant to go into family medicine. If you want something bad enough, you figure out how to do it. So I figured out all the programs that were in urban family medicine because I knew that I wanted to be in a city. CONTINUED ON NEXT PAGE
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CONTINUED FROM PREVIOUS PAGE There were only three programs at the time. I interviewed at all three and went to the one that I really liked the best which was at Montefiore in the Social Medicine program.
students come and see what we do, that medical students are enthralled by our faculty and what they do and see that as potential careers for themselves. And if not, when they go into [medical] specialties that they have an increased appreciation for what their primary care colleagues do and that they will help support them by taking some of their patients that might not be able to pay as much — or pay at all.
Can you talk about the creation of the family medicine department at Mount Sinai and what your hopes are for the program in the future? My expectation is that we will provide places where medical students can see what health care should look What skills do you think are neceslike on the front lines. Not what it does look like but what it should look sary to be a leader in medicine and like — with absolutely no disparities how can medical students develop or differentiation in care between the these skills while still in medical poorest folk school? The most importhat we treat in tant thing that our eight homeless centers and medical students the people who need to do is to come in with connect with one great insurance. another to find people who are of like We see both types of people mind, to work toat our centers, gether, read toin fantastic fa— NEIL CALMAN, MD, gether, meet tocilities with gether, study toCEO OF THE INSTITUTE gether the issues state-of-the-art FOR FAMILY HEALTH that are related to equipment. We bring to lowwhat is happening income comin the health care munities the kind of care that everydelivery system, to talk about their body should have and deserves acexperiences in medical school and throughout residency. It’s by doing cess to. So I think if we model that and that that people actually begin to show medical students here that that open their eyes and take leadership type of practice is possible, I think a in making change. Anybody can take lot more people will choose careers leadership in making change. in primary care. A lot of people are I love the saying that you see in the subways now, “if you see someconvinced that it is impossible to do well for yourself and your family thing, say something.” That should financially and still provide equal be the motto for medical students access to care for all people. They are too. If you see something, say somewrong. It is possible to actually make thing. If you just see something that you think is not right and you don’t a good living and do well by your say something then it just happens family and still provide great public service and make that a hallmark of again. And that should apply to evewhat you want to do with your prorything that people do. fessional career. Another favorite saying of mine, So I’m hoping that first and foreand I don’t even remember where I heard this, is that leadership is somemost we continue to provide incredible services to people — that medical thing taken not given. You don’t wait
If you’re interested in primary care or family medicine, there is no better time than now.
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until someone says, “Oh, you’re the President of this.” You take leadership by action. The best way to learn how to be a leader is to take action and then you learn what it means to bring other people around you and work with you on the things that you find important. Do you have any advice for medical students who are specifically interested in primary care? If you’re interested in primary care or family medicine, there is no better time than now. The country has awakened to the brilliant discovery that taking good care of people and teaching people how to take good care of themselves is actually the best way to reduce health care costs. When you think about where we need to go and what we need to do in primary care, the high-hanging fruit (the stuff that is really tough), is not just to improve primary care but to do so in a way so that it is accessible to everybody. The thing that medical students need to know about primary care is that it is more intellectually challenging than anything anybody could imagine in relationship to medicine. You’re dealing with people who come in with undifferentiated symptoms. That is the most challenging part of medicine. With electronic medical records there are new research opportunities for family physicians who are trying to find out what really is best to do for people who come in with common ailments. No better time to go into family medicine than now. Great field., Never spent one minute of my life regretting my career choice. That’s what I hear from my colleagues in family medicine, too. You don’t find family docs running around lamenting about horrible it is now to be a doctor or how they wish it were like the good old days in medicine. These are the good days for people who are interested in primary care.
Alumnus Profile: Dr. Herbert Chase By Jeanne Bernard, Department of Medical Education
Each issue of the Rossi features a successful alumnus or alumna and invites readers to submit questions about their education and career. The questions and answers will appear in the following issue.
tronic health record (EHR) to improve medical practice. Projects include developing automated methods to detect chronic kidney disease in its earliest stages; using machine-learning to predict the future natural history of chronic illnesses; implementing strategies for pharmacovigilance operating through the EHR; and creation of a patient record summary in the EHR. Dr. Chase served as a medical advisor to the IBM team that developed the medical version of Watson and is currently a member of the Watson Healthcare Advisory Board. He continues to develop new educational programs at Columbia where he is currently implementing two four-year curricular threads, one in Biomedical Informatics and the other in Medical Decision-Making.
This issue profiles Herbert Chase, MD, MA, a graduate of Icahn School of Medicine at Mount Sinai’s 1974 class. Dr. Chase has taught clinical medicine and basic science at the College of Physicians and Surgeons of Columbia University for over thirty years. He is a board certified Internist and Nephrologist who spent the early part of his career as a basic scientist. After shifting his interest from research to education, he participated in, developed, and directed several To submit a question to Dr. Chase, major medical school courses. In email TheRossiNewslet2000 he was appointed the first Depter@gmail.com by February 28, 2014. uty Dean for Education at Yale School of Medicine where he introduced several major programmatic changes. In 2006 he returned to Columbia to enter the Masters program in Biomedical Informatics as a Post Doctoral Fellow. He completed his Masters in 2006 and joined the Department of Biomedical Informatics. Dr. Chase has been recognized for his outstanding teaching with many awards including the Presidential Teaching Award of Columbia University. Dr. Chase is currently a Professor of Clinical Medicine (in Biomedical Informatics) and involved in several research projects that explore the development and potenCOURTESY OF HERBERT CHASE tial integration of artificial Dr. Herbert Chase is an alumnus of ISMMS and is now intelligence into the elec- a Professor of Clinical Medicine at Columbia University.
EDITOR-IN-CHIEF
Alexa M. Mieses ASSOCIATE EDITORS
Kamini Doobay Dipal Savla Alison Thaler LAYOUT EDITOR
Ann Wang EDITOR-AT-LARGE
Daniel Caplivski, MD WRITERS
Jeanne Bernard Sanders Chang Brian De Caroline Eden Christopher Hernandez Alexa Mieses SOCIAL MEDIA MANAGER
Marielle Young The Rossi was founded by students at the Icahn School of Medicine at Mount Sinai in 2012 and is published quarterly at http://icahn.mssm.edu/ education/institute-for-medical -education/medical-studentquarterly-report. Do you have questions? Comments? Story ideas? Email TheRossiNewsletter@gmail.com Check out The Rossi on Facebook: https:// www.facebook.com/ sinai.rossi Follow The Rossi on Twitter @SinaiRossi
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