continued
Education
Radical changes in American medicine forced radical changes in medical education
in the 1990s, and the volume of emerging scientific information compounded
the need for reforms.
Didactic classroom settings needed to be supplemented by small group interactive
settings. The separation of basic and clinical sciences was outdated. Information
technology had revolutionized teaching.
The school responded by introducing a dramatically revised curriculum in 1994
after two years of collaborative planning by faculty members, senior administrators,
and students. Today, we stimulate University of Maryland medical students’
appetite for knowledge with faculty mentors, laptop computers, and the ability
to find answers independently.
“We tell students that medicine is a lifelong commitment to learning and show
them how to access information and how to solve problems,” says Frank M. Calia,
MD. He facilitated the curriculum development process, which he characterizes
as democratic and participatory. “If students and faculty wanted to be on
a committee, all they had to do was say so,” Calia explains. “They were empowered
and vocal.”
Committees explored an integrated approach to basic sciences and clinical
medicine. In the clinical years, a new emphasis was placed on ambulatory education.
“We needed to revaluate faculty rewards in order to entice faculty members
to spend additional hours in medical education when there were more demands
placed on them for patient care and research,” says Calia. “By-laws needed
to be changed to reflect the importance of teaching for promotion and tenure.
We also wanted to assess the impact of information technology on curriculum.”
The school invested in training to teach the faculty to adapt to the new curriculum.
They learned to mentor students in small groups and at the bedside and to
use technology to present information. Students attend a boot camp on informatics
to increase their comfort with technology.
The changes began when the class of 1998 arrived. Students now spend two hours
a day in lecture, rather than eight. Learning time is presented in “blocks”
of varying lengths. Basic science blocks are multidisciplinary, with emphasis
on their clinical relevance.
Each basic science block has a clinical and basic science director. Teaching
is done by lecture, in small groups, and with laboratory experiences. During
the clinical years a stronger emphasis is placed on education in an ambulatory
setting, and family medicine is now a required clinical clerkship.
Calia says there
is a new emphasis on women’s health, geriatrics, nutrition, bioethics, substance
abuse, and non-traditional medicine.
Alliances are stronger with the other professional schools on campus, particularly
nursing and pharmacy. Faculty members from the schools of medicine and nursing
teach physical diagnosis together in the school of nursing simulated patient
laboratory. Videotapes record students as they take histories and physicals
and come to diagnoses. “This technique allows us to be objective in evaluating
clinical skills,” Calia explains.
Howard Hall renovations provided the infrastructure for change, with computer
labs configured into four clusters, each with four pods. Each pod accommodates
13 students. Clusters and pods are used individually, simultaneously, or in
combination; so faculty members can reach as many as 180 students at one time.
Students plug laptops into the lab’s PCs to get course syllabi, assignments,
and slides. With the completion of a significantly expanded health sciences
and human services library in 1998, nearly 2,000 data ports became available
at the site two blocks from the school.
“This always will be a work in progress. We are presenting and publishing
our experiences with the new curriculum and faculty reward programs, and we
welcome the inquiries we receive from other schools,” Calia says.
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2001 The number of underrepresented minority faculty is double what it was a decade ago. 2000 Liaison Committee for Medical Education grants full re-accreditation for seven years and lists 18 institutional strengths. 1999 57 percent of first-year students are women, making this the fourth year since 1992 that women are in the majority in the first-year class. 1998 For the fourth year in a row, more than half of this year’s graduates select a primary care specialty. 1997 School is a national leader in diversity, averaging 18 percent in underrepresented minorities in entering medical school class. 1996 School is one of the first in the nation to require all entering students to have lap-top computers. 1995 Department of physical therapy graduates students in its first all master’s degree program; the department of medical and research technology introduces a master’s degree track. 1994 School is one of the first in the nation to make informatics part of the required curriculum. 1993 Preparations are finalized for launching the revised curriculum, based on the realities of managed care, holistic treatment, and information technology. 1992 University of Maryland School of Medicine has state’s only family medicine program. |
Research
Howard B. Dickler, MD, does not have the time or the inclination to be timid.
He oversees a $201 million research enterprise that accounts for 48 percent
of the school’s revenue. Since his arrival in 1999 after a decade as director
of a National Institutes of Health branch that supports clinical immunology
programs, the number of institutional review boards (IRBs) has gone from two
to four. That translates to one IRB meeting a week for 48 weeks of the year.
And that translates to a three-fold increase in support staff, paperless processes,
and training on protocol procedures that all researchers must pass. “It is
absolutely essential that we do everything we can to maximize the protection
of people who participate in research,” Dickler says.
His conversations about the school are peppered with phrases like terrific
growth, more rigorous accounting and making things happen.
“Not all medical schools understand the need for institutional leadership
for research,” Dickler explains. “Science is becoming ‘big’ science. It demands
interaction among multiple disciplines with leaders and participants who think
and plan together rather than individually.”
In the last 11 years, the school’s external research support has more than
tripled. Says Dickler, “It increased across all sources of funding, from the
NIH, from other federal agencies and from industry.” About 50 percent of the
basic science faculty, 34 percent of the clinical faculty, and 42 percent
of the allied health faculty are principal investigators on externally funded
awards.
The success came from increased productivity rather than additional faculty
members, he says. “We focus our resources where they will benefit the maximum
number of faculty members.” And then he ticks off a few of the successes:
“The world’s leading academic-based vaccine effort, a schizophrenia resource
no one else can touch, and a model infectious diseases program.”
He cites the center for clinical trials (CCT) as an example of the new emphasis
on collaboration. Based in the school of medicine, the CCT opened in July
2000 and provides the infrastructure and financial expertise to increase opportunities
for industry-sponsored clinical trials at the university’s dental, medicine,
nursing, and pharmacy schools. It brings together sponsors and researchers
to negotiate contracts, conduct the trials, and report results. Dickler estimates
the center has access to a participant base of five million people and to
1,500 university researchers. “Our clear mandate is to do the research as
safely and efficiently as possible,” he adds.
The CCT also fosters relationships between basic and clinical scientists and
enhances in-house development of intellectual property.
Another outcome of the school’s “big” science approach is the sharing of facilities,
such as genomics, transgenic animal, and nuclear magnetic resonance cores.
They are available to all faculty members.
By the end of 2002, the school will have expanded laboratory space through
the construction of an additional research building, complemented by renovations
of Howard Hall, site of some of the benchmark work throughout the school’s
history. The new space will help recruit and retain top faculty members and
students and enhance its ability to compete for research funding.
The school and its primary partner, the University of Maryland Medical Center,
completed extensive preparations early in 2001 and competed successfully to
become an NIH-funded general clinical research center.
Plans for the school’s 2007 bicentennial originally included a goal of $200
million in research funding that year. The goal was met six years early. Setting
a new number is part of Dickler’s job, and he is characteristically upbeat.
“This school understands,” he says.
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2001 The Bill & Melinda Gates Foundation awards $20.4 million over five years to the center for vaccine development. The goal is to develop a safe and effective measles vaccine for children in developing nations. Myron M. Levine, MD, PhD, DTPH, is the center’s director. 2000 Construction begins on Health Sciences Facility II, a $78 million, 186,000 square foot structure that wil house basic science labs. Thirty percent of the space will be allocated to the school of pharmacy, enhancing collaborative studies. Opening is set for 2002. 1999 The Maryland Psychiatric Research Center receives the largest grant in the school’s history. The $24 million over six years from Novartis Pharma AG will help develop treatments for schizophrenia. The Center’s director is William T. Carpenter, Jr., MD. 1998 The center for research on aging opens to coordinate research and training in multiple areas of gerontology among all of the university’s professional schools and the nearby University of Maryland, Baltimore County. 1997 A seven-year study analyzes the safety and effectiveness of lung volume reduction surgery as a treatment for emphysema. 1996 Researchers Gary Plotnick, MD, and Mary Coretti, MD, show that blood vessels do not dilate normally after a person eats a high-fat meal. However, a high dose of vitamins C and E before the meal may prevent the phenomenon. 1995 Health Sciences Facility I opens, bringing the school’s total research space to 324,609 square feet. 1994 The National Institutes of Health awards the school more than $13 million to evaluate vaccines for cholera, malaria, typhoid fever, and other infectious diseases. 1992 A research collaboration led by Kenneth Johnson, MD, finds that beta interferon delays attacks in multiple sclerosis patients and reduces damage. |