Episode 11 (.mp3) [ 39:10 ] Download (5301)

Dr. Holly Humphrey, Dean of the Pritzker School of Medicine and Professor of Medicine, and Joni Huff, a Director of Admissions & Financial Aid, join us to talk about some new initiatives sweeping across Pritzker in the near future.

If you have questions for us, please send them to pritzkerquestions@gmail.com.

Embedded Links:
Dr. Humphrey’s Physician Profile

Episode 11 Transcript

Ben Ferguson: Hello everybody. Welcome to another episode of the Pritzker Podcast. We have a very interesting episode today. I’m pretty excited about it. Unfortunately, Mary won’t be able to join us today as she is now a third-year medical student and is as such busy doing third-year medical student things and doesn’t have time to podcast all that often. So, Mary, if you’re listening, we know where your loyalties lie now. That’s okay. But like I said, this is an interesting episode. We are joined once again by Joni Huff who is becoming a regular on the show. She is one of the Directors of Admissions & Financial Aid at the Pritzker School of Medicine. Hey Joni.

Joni Huff: Hey Ben, hey everybody.

BF: Thanks for being on the show again. We also are very elated to say we have Dr. Holly Humphrey joining the show as well. We’ve been trying to get Dr. Humphrey on the show for quite a while and deans can be pretty busy people. But Dr. Humphrey is, again, the Dean of the Pritzker School of Medicine. She also happens to be a graduate of the University of Chicago for medical school as well as our Internal Medicine Residency Program and Pulmonary and Critical Care Fellowship. So she’s been here for quite a while. She’s also a Professor of Medicine. And obviously, she has an intimate knowledge of the workings of Pritzker so we’re excited to have her on the show to talk to her about a few things. So Dr. Humphrey, welcome to the Pritzker Podcast.

Holly Humphrey: Thanks Ben. I am sorry that it’s taken me so long to join you because it looks to me like this is the funnest show on earth so I thought I can be a part of it.

BF: It is the most fun I can imagine.

HH: Okay!

§ “Overview of New Initiatives”

BF: So like I alluded to before, we’ll be talking about some changes that are going on with Pritzker, some new initiatives, and Dr. Humphrey knows a lot about that sort of thing so we’ll be asking her a lot of questions about that. And Joni’s just going to chip in to talk a little bit about how that’s going to affect some admissions things, essentially. So why don’t we begin at the beginning. I think Dr. Madara, who is the Dean of the Biological Sciences Division, talked to the medical students several weeks ago about some of the new initiatives that Pritzker is starting up, and one of the most obvious ones, and one of the most palpable ones, I guess, was the change in class size. Typically, Pritzker has been somewhere around 100 students, 104; last year was 112. And we are now going down to an 88-person class. And so, Dr. Humphrey, we are wondering if you could talk a little bit about why that change came about and why 88 specifically? Was it a particular interest in even numbers or palindromic numbers or something or was it something else?

HH: There was a lot of thought that went in to this decision to decrease the class size to 88 as you correctly point out. We have been a medical school with a class size of right around a hundred for several decades. And actually, for most of those decades, we were a class size of about 104. And in the last two years, we’ve gone up believing that we were doing the right thing in the interest of the country and the call to increase the number of physicians at a time when we have had just really terrific applicants. I mean, such terrific applicants, I think we could have had a class of 200. But when we really started to think in a rigorous way about how a school should determine their class size, a number of important points came to the forefront of that discussion. And the first is that we want every student who we admit to this medical school to be successful in the broadest sense of those terms. And as we are implementing a brand new curriculum, one of the new requirements for that curriculum is a requirement that each student, at the time they graduate from our medical school, will have a product demonstrating their curricular experience in Scholarship and Discovery.

Now, it’s not a big change for us since in any given year, 80 to 90% of our students already participate in some type of scholarly activity. But because we’re now “curricularizing” this in a formal way and requiring that every student meet the set of requirements, we want to be absolutely sure that every student can do that at the highest possible level and not extend the time that they’re in medical school if they do not wish to be in medical school for longer than the four-year experience. So, several schools who have introduced this requirement have done so and then as an unintended consequence have found that their medical school experience gets lengthened to some time longer than four years. So we are being very intentional about wanting to make sure that everyone can meet these bar for scholarship discovery within the four-year timeframe. And I am personally very excited about the curriculum that we have in place for the students who will be entering in 2009 to participate in this new curriculum.

Now, the second feature that went into deciding what size class we should have is that we’re operating from a principle that we want a well-resourced student body. And that means excellent resources in terms of exposure to and experience with faculty mentors. So each student who does the Scholarship and Discovery will have a mentor of their choice, and that faculty person will be the person who oversees their progress on the Scholarship and Discovery curriculum. The second piece of a well-resourced student body is to have a wide variety of intense mentorship experiences in the acquisition of clinical skills. And what I mean by that is that in most medical schools in this country, students are assigned to a wide variety of different types of clinical services with different types of residents and faculty supervisors, and usually in a wide variety of different types of hospitals. And we want to be absolutely sure that our students have the very best and most intense kind of robust mentoring in each of their clinical experiences. And to do that, we are going to be focusing on the fundamentals of history-taking, physical examination, clinical reasoning, developing a differential diagnosis, developing therapeutic and treatment plan. And as I say those things, you would be correct if you said, “Well, that doesn’t sound new. That actually sounds exactly like what my father did when he was in medical school. “And you would be right. But the thing that’s different in 2008 is that the pace of medical care on our hospital wards and in our outpatient clinics has changed in a pretty dramatic way. And it’s not uncommon for students to be literally on the sidelines and no longer at the center of the patient care experience. And we are trying to, in many ways, return to the fundamentals so that it’s the student with the patient at the center of that clinical experience. And in order to do that well, we want to see how we do that with a smaller class size. If we see that we can do that as well as we have done that historically even with the new environment that exists in the 21st century, then we are certainly prepared to increase our class size over time. But we don’t want to enter into that with the false assumption that business is as usual because, in fact, taking care of patients today is much, much different than it was even a decade ago.

The third reason that we are really excited about this smaller class size is that it’s going to allow us to take our current level of scholarship funding, which is substantial, and spread it over a smaller number of people. And that basically is going to allow us to shift the total amount of debt that students graduate with to a much lower level. So we will decrease the average student debt by just taking the current total dollars and applying them to a smaller number of students. We will decrease that debt by a significant degree, going from actually about an average of $150,000 to just about $100,000; so $50,000 on average less debt at the time of graduation.

So when we think a well-resourced student body, we’re thinking primarily of the intense exposure to mentors for Scholarship and Discovery, the intense exposure to patients and faculty supervisors in a busy clinical environment with the patient and the student at the center of that experience, and we’re thinking about how can we most dramatically impact the student debt that they have at the time of graduation.

Now, at the same time that we are decreasing the class with those three principles in mind, we are also going–we have just launched this new program called Repayment for Education to Alumni in Community Health. And what that is going to allow for the very first time in our experience is an opportunity for graduates of our medical school, who choose at the end of their residency and/or fellowship training, to apply for positions in our primary service area working in federally-qualified health centers or other types of community-based medical centers. And if they’re chosen for a position in one of those centers, they can apply to us for a $40,000-per-year stipend on top of the income that they would be earning in their position, and should they be selected for this program, have the opportunity to receive that stipend for up to four years to do exactly what it’s described as, our REACH Program (Repayment for Education to Alumni in Community Health), trying to really address the issue of the maldistribution of physicians at the same time that we are providing an opportunity for our graduates to return to the community where they received their medical education and invest in that community that we care deeply about.

BF: Right. Does that go for residents as well or is that only post-residency?

HH: It’s for any graduate of our medical school who has completed training. So if they are going to stay in a general field, such as general internal medicine or general pediatrics or family medicine, then they could apply at the end of residency. But we’re also very interested in sub-specialists. So somebody who’s finished a cardiology fellowship or orthopedic surgery or rheumatology, this program is not specifically for primary care physicians but for a broad range of graduates of our medical school.

BF: Sure, sure. Just to return briefly to the change in class size. You mentioned a little bit about how the clinical education will change a little bit in terms of being a bit more hands-on that it already is. Is that the major change you foresee in terms of curricular change, or are there going to be changes also associated with the pre-clinical education here?

HH: Yes.

BF: I mean, in addition to the Pritzker Initiative, do you see that the global structure of the curriculum will change as a result of the different class size?

HH: Well, the global structure of the curriculum will be organized a bit differently but the things that will remain the same are that this is still going to be a four-year curriculum. This is still going to be a curriculum that has the summer between the first and second years open. We expect that many students will choose to use that summer to participate in our Summer Research Program but that is not a requirement. And so students will still have the option to spend that summer in ways that are consistent with their own personal and professional goals. But the organization of the curriculum will be more interdisciplinary and it will feature more opportunities for the basic sciences to be presented throughout all four years of the curriculum, as well as for the clinical sciences to be presented throughout all four years of the curriculum. And this kind of interdisciplinary framework is the way in which the National Boards are changing so the USMLE exams in their revised format, which will happen over the course of the next several years, will be organized in this interdisciplinary format as well.

§ “How Will Admissions Be Affected?”

BF: Joni, if I could ask you, being an admissions person and someone who oversees that whole process, do you think that having less people in the class will make the application at Pritzker a lot more competitive? Do you think more people will end up applying at Pritzker or do you think actually less will because it might scare off some people who think that it, indeed, may become more competitive?

JH: Yeah, I think you’re raising a really good point. And to be honest, I’m not sure which way it’s going to be fall out. I think there are probably many applicants who feel as though, “Oh, my gosh. Now, there are fewer seats. I don’t know if I want to risk an application there. Maybe there’s fewer likelihood that I’ll get in.” But at the same time, I think I would really encourage people to think about whether our class size is the kind of overall structure that would allow them to have the best fit in terms of their medical school experience. We said the same thing when our class size was around 100. If you’re a person who likes to anonymous and who likes to kind of hang out in the back of a room and not really have a lot of interaction with your classmates or your faculty, this really isn’t a good medical school for you to explore. And certainly having an even smaller class size will just emphasize that point a little bit more greatly. So I think for those students who really want to have a medical school experience where they know their classmates, they know their faculty, they have the opportunity to be mentored in a really strong way, and to really be known by the entire Pritzker School of Medicine throughout their four-year experience, I think this is a school that those applicants definitely want to apply to.

Clearly, with fewer slots, a lot of people are curious about whether our admission standards are going to change. And to a great extent, they’re really not. As it is, we don’t have computer pre-screen cutoffs for GPA or MCAT score. We read every single application that comes to us and we’ll certainly continue to do that. So what I would encourage students to do is to really pay attention to the application and, in particular, the supplemental application where we ask them to tell us directly why they want to be a part of this medical school. And those essays which I know can be very time-consuming to write, especially as you have 15 or 16 or more secondary applications coming to you all at one time, we really read those applications very, very carefully. And what we are always trying to do is to create a student body that really is a very diverse and cohesive and collaborative group of people who will wind up not only contributing in individual ways to this experience, but also as a collective, because they do have so much interaction with each other, to actually grow beyond the individual commitments and individual contributions of every single member of the class.

So in terms of our overall standards and what we’re looking for in an application, that hasn’t changed. The best advice that I can give to applicants is if you read through our mission statement and that speaks to you, that really is what we’re all about. If you listen to our podcasts or join online chats, and the personality of the school seems like a good fit for you, then definitely, absolutely apply to Pritzker and we certainly read every application very carefully. So just tell us why you want to be a part of this institution.

BF: Sure.

§ “Is This…Allowed?”

BF: Dr. Humphrey, you touched on the fact that there’s been increasing initiative just across the country to increase medical school class sizes, and we happen to obviously be going down in class sizes. Is that something that might be looked down upon among the general medical education community or the federal higher-ups, I guess? I don’t know how much leeway we have in sort of deciding on our own that we want to go smaller instead of larger.

HH: Well, the good news is that the faculty of the medical school do have the ability to make the decision about how large or how small their school should be. There was a period of time in this country, the 1960s and early 70s, when there was a major incentive program from the federal government where schools were incentivized in the form of actual dollars that came from the federal government to increase your class size. That is certainly not the case right now. The call for the increased number of physicians interestingly is a call that has come not from the public sector, but it’s a call that has come from the organization of medical schools called the Association of American Medical Colleges (or the AAMC) and from the Council of Teaching Hospitals, COTH. Those two groups, many might say, have a vested interested in wanting to increase the number of doctors. And so, I think if you look at this superficially, it could be seen as going against the federal mandate.

But I would just invite us to think about that very rigorously. Where is the federal mandate coming from and what is the data on which it is based? And there is equally good data, and in some cases, many might call it better data, that indicates as a country we do not have a shortage of physicians, but what we have is a serious maldistribution of physicians. And that data comes from the Dartmouth Health Studies Group and what they have shown repeatedly in several published articles, including articles published in the New England Journal of Medicine and the Health Affairs Journal, is that because we have a serious maldistribution of physicians in this country, it’s one of the most important drivers of the high health care costs in this country. So if you look at the regions of the country where there are high concentrations of physicians, it turns out those are the same regions where there is an escalation of health care cost per individual patient. And many who interpret that data say that there’s overuse of tests and technology in those areas of the country. So in other words, where you have a lot of doctors, you’re going to get a lot of medical care whether you need it or not. And where you have a region of the country where you don’t have any doctors, people are not going to get medical care.

Now, neither one of those extremes are good places to be at. And I think as a country, the real answer is not yet pristinely clear about what the numbers should actually be. But I think what is clear is that we have a serious issue of maldistribution. And so as a medical school, we have decided that we are going to first focus on our own students because we think the best way that we can improve health care for our country is to graduate the finest physicians in the country, and then secondly, to do our own part in trying to address the maldistribution problem by incentivizing our own graduates to return to practice in our primary community through our REACH Program.

BF: Right.

HH: And as I said earlier in the conversation, if it turns out that we can meet all of our goals in terms of having a well-resourced student body with the mentoring and the scholarship support and so forth, we’re certainly prepared to increase our class size over time if that’s what our experience teaches us. And so we’re eager to learn from that but we don’t want to make those estimates on the high side and have our students end up caught in the middle of that.

BF: Sure.

§ “Diversity”

BF: Let’s see. Joni, you included this question on diversity. Did you want to touch on that specifically at all or…?

JH: Yeah, I included that question because it was one that came up when Dr. Humphrey and Dean Madara gave this talk originally. Somebody asked about the overall diversity of the student body and if we are going to try to maintain that diversity.

BF: Sure.

JH: And I think it might be just worth raising partly to just re-emphasize the point that we don’t have set criteria for anything. We don’t take 25 science majors and 25 non-science majors or anything like that just to say that overall, we’re still looking to bring in a really diverse class with a lot of unique and interesting backgrounds and contributions that they can make. So I don’t know. What do you think? Dr. Humphrey, do you think that we should talk about it?

HH: Well, the question has been raised by our own students so it makes me think that it’s likely to be in the minds of at least some members, and maybe a significant number of members, of our applicant pool. And there is a concern, I think, that by having a smaller class size, there will simply be a smaller number of students from diverse backgrounds and potentially, specifically, from underrepresented minority backgrounds and a concern that there will not be a critical mass of those students on campus. My commitment is that we are as committed as ever to having a diverse class, as Joni just pointed out, that is the core of our mission statement, is diversity of all kinds from underrepresented minority students to the nontraditional student, to diversity that comes from the various paths in life that an applicant has already traveled. And the good news about the diversity that we have achieved over many decades at this medical school is that if you look at diversity measured in a number of different ways, we are, in almost every category that we can think to measure, above the national average.

So, in most years and the last ten, we have had more students with nontraditional backgrounds than many of our peer institutions. And in all but two of the last 15 years, we have had a significantly higher percentage of underrepresented minority students than the national average. So year after year after year, we are above the national average for the overall percent of members of our class who are a underrepresented minority. And that is something that we certainly intend to continue. And the last thing we would want as an unintended consequence of a smaller class size is to destroy what is core to the medical school, which is a celebration of diversity of all kinds.

BF: Sure.

§ “Scholarship & Discovery”

BF: Dr. Humphrey, you talked a bit in your first answer about the new Scholarship and Discovery initiative to the curriculum. And we’ve talked about this a little bit in the podcast before. But can you talk a little bit about exactly what that entails? You said most people will still graduate in four years, if not all, unless they decide to take off a year for themselves. But, again, can you talk about what that involves and whether that will require any additional requirements to complete the degree?

HH: Yeah, I’d be happy to. There are lots of exciting components to this in many ways it could occupy an entire podcast or two, but let me try to summarize it very briefly. First is that we have excellent directorship and leadership for this program. Dr. Gene Chang and Dr. Vinny Arora are co-chairing it. And we intend to have a curriculum in Scholarship and Discovery that’s present through all four years of the curriculum starting with the first year with pretty basic things, like how to search the medical literature, how to generate a good hypothesis, how to do good hypothesis-driven research, and building on those very basic building blocks over the course of the first year, so that by the time you get to your spring quarter, you’re actually fully exploring which pathway in Scholarship and Discovery you might like to explore. And right now, we have four pathways that have been laid out by the planning committee. It could be that these might be revised a bit by next fall, but they’ve been this same four for the last year. So I don’t expect them to change dramatically.

But the four pathways within Scholarship and Discovery are somebody could choose to do traditional basic science research. And we have campus filled with laboratories and investigators and research teams to engage in basic science research. And so I expect that will be a popular pathway chosen by several students.

A second pathway is probably not as commonly present in a formal way in other medical schools and that’s a pathway called Quality Improvement. And quality improvement is a very, very critical piece of clinical education and of residency education where doctors are taught the science and the methodology of how to evaluate their clinical care and their clinical practice with the overall goal of improving that clinical care and that clinical practice. And so we have a number of faculty here who have done extensive work in quality improvement and that might be an area that a student would choose to focus their own research in Scholarship and Discovery in a project related to quality improvement.

A third path within Scholarship and Discovery is a student could make the choice to focus on medical education. So we are a medical school that has long been known as the teacher of teachers. In fact, our whole university is known as the teacher of teachers. We are a school that takes teaching and medical education very seriously and we also would like to much more rigorously incorporate the scholarship of teaching, the scholarship of medical education, asking pretty basic questions like how do doctors learn, what interventions make the most difference in a doctor’s clinical practice, how can we more effectively teach, and, as I said, how can doctors more effectively and efficiently learn. So we will have this third pathway in Scholarship and Discovery in Medical Education.

And then the fourth pathway is a pathway that intersects very closely with one of the major initiatives of our medical school and of the Biological Sciences Division and that is our Urban Health Initiative. And so the pathway for the medical students is Scholarship and Discovery in Community Health. And so, this pathway will allow our student to develop a project in a community-based setting or certainly involving a community population right here in our local community, or in some other part of the world, or if a student wishes to incorporate an international perspective to their work. But the whole idea is to examine health and health outcomes and medical interventions in a community of people without any real restrictions on how that community is going to be defined or where that community actually is. But the idea is a community-based project.

So those are the four areas: Traditional Basic Science, Quality Improvement, Medical Education, and Community Health/Community-Based Medical Care. So, as I said, I’m sure that this will evolve with time but I hope that it gives you the sense that there will be a lot of different paths that a student might choose.

BF: Yeah, I just have to say that that sounds amazing. It makes me really jealous to have completed the first two years already because that’s something that we didn’t have when I was doing my first two years. And I can tell you that most people coming into medical school, unless you’ve done a whole lot of research, don’t really have a good grasp of what hypothesis-driven research is. So I think the basic science aspect to that is extremely useful. And in terms of the Urban Health Initiative in particular, I know the health disparities course that was just started, what, two or three years ago now has been wildly popular, so I think that will really cater to a lot of incoming students’ interests as well. So it really sounds fantastic.

HH: Yeah. Well, if you want to come back and participate in any session, Ben, you’re always welcome.

BF: Sure. I’ll just extend my education a little bit more.

HH: Well, we don’t want you to pay any more tuition, so just let me know and we’ll get you in those sessions.

BF: Awesome, awesome.

§ “Update on Construction”

BF: Dr. Humphrey, do you want to just talk really briefly because we’re sort of running out of time about the new buildings that are being built on campus. I know there’s the Center for Biomedical Discovery, the Knapp Center, that’s going up directly adjacent to the Biological Sciences Learning Center, which is the building that houses the medical school essentially. And there’s also the new hospital pavilion going in, just breaking ground here pretty soon. Can you talk about the time table for when those will be done and, sort of, how that will affect future medical students?

HH: Yeah. As you implied, Ben, this is a really exciting series of developments on our campus which the students who come here to interview will have a chance to see firsthand. But the new Center for Biomedical Discovery will provide brand new research base for physician-investigators, and that is scheduled to actually open next summer, either late spring or summer, of 2009. So it will happen almost as the new class is arriving. So it will literally be a building that’s opening in synchrony with the arrival of the class arriving in 2009.

At the same time that that building is opening, we will be breaking ground for the new hospital pavilion. And the new hospital pavilion, we’ve already cleared all the ground for. There’s signage up all over campus so you really can’t miss it. And when you see it, you’d get some idea of the enormity, of the scale of this building. And the new hospital pavilion will be, as its name implies, the new hospital, the new state-of-the-art, high-tech, high complex care platform hospital that if we’re able to stay on schedule–and I have to say all of our building projects to date have actually been on schedule or ahead of schedule, so with that in our favor, this building is scheduled to open in 2013. So it seems to me that the class who enters in 2009 will have a chance to actually take care of patients in that building before they graduate from this medical school. So that should be a great treat for all of us but specially for the inaugural class who will help us break that building in.

BF: Sure, sure.

§ “New Partnership With ENH”

BF: And then not only are we expanding on campus but we’re also expanding to additional hospitals as well. In fact, this news came out just yesterday about our new partnership with Evanston Northwestern Health Care, I believe it is, correct?

HH: Right.

BF: And so, that will obviously change some of the clinical curriculum for future students as well, is that right?

HH: Yeah. This actually ties in very nicely with that principle of having a well-resourced student body and returning to the fundamentals with their clinical experiences. And I think it’s really important for our applicants and our current students to understand that the vast majority of their clinical experience will still take place on this campus, the campus of the University of Chicago. But with the affiliation with Evanston Hospital, it gives our students and our residents and our fellows the opportunity to experience very high quality medical care in a setting that is dramatically different than the one we have on our campus. And reason it’s dramatically different is that it is not physically located in Hyde Park on the south side of Chicago but in fact is located in Evanston in a suburban community north of the city of Chicago. So geographically, these are very different patient populations.

And the good news for us educationally is that the quality of the medical staff at Evanston Hospital is of the highest order. They are clearly among the very best of physician medical staffs in a community in the entire country. And there are many different ways that gets measured. And every parameter that I look at in terms of the quality of this medical staff is that they literally are in the top group when you compare them not only against every community hospital in Chicago but with every community hospital across the country. So this gives our students and our residents the opportunity to return to the fundamentals of clinical medicine under the tutelage and supervision of a very high quality physician staff in a community setting that’s much different than the one we have on campus. So it seems to me like a big win-win.

BF: Yeah. Again, it sounds really exciting and I personally am looking forward to going up there to do some of my training as well.

§

BF: Well, I think we’ve run out of time. I want to thank you both for joining us on the Pritzker podcast and thanks again.

JH: Thanks Ben. And thanks, Dr. Humphrey.

HH: Okay. Thanks a lot, Ben.

BF: It’s okay.

HH: Okay, bye-bye.

JH: Bye.

BF: Bye.

BF: So thanks again for listening to the Pritzker podcast. To hear more, visit iTunes or pritzkerpodcast.libsyn.com. We want to thank Dr. Humphrey and Joni for joining us on this episode and lending some expertise. We also hope that this is an informative resource for you. And if it is, we’d love for you to send us an email to tell us about it.

You can contact us at pritzkerquestions@gmail.com and also you can comment on our podcast paged directly in iTunes telling us how we’re doing. We’d also love for you to submit questions of your own so that we can address them on the air for all of our listeners. Chances are there are many people out there with the same question.

In fact the next episode we’re planning, Episode 12, will be one dedicated to answering questions from our audience so we’re trying to solicit as many questions as possible to discuss on the show. Also, if you want to hear more about a certain in-depth for the future, don’t hesitate to write in. Take care.