Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

Page 18 text:

10415 Q2 8 1050 Q7 3 1955 Q9 0.3 1960 811 16 lt was against this background that a very important meeting occurred in November of 1961 in Dr. Handlers office. ln addition to Dr. Handler: Dr. Eugene Stead, Chairman of the Department of Medicine: Dr. Thomas Kinney, Chairman of the Department of Pathology: and of Pediatrics were present. Certain criti- cisms won unanimous agreement: ffl The curriculum was much too inflexible. Even though medicine offered a diversity of specialities, a student could not vary hisfher curricular content to coincide with hisfher in- terests. Similarly, a student was precluded from exploring one particular field of interest in depth. 121 instead of promoting creativity or original research, the curriculum inhibited it. The stu- dent leamed basic sciences during the first two years when hefshe could not appreciate their clinical pertinence. Rather than a sense of appreciation and interest, a feeling of frustra- tion and a sense of distaste for these subjects developed. Only after the clinical skills have been mastered does a physician realize the importance of a sound background in the basic sciences, but then the rigors of practice make it too late for the average physician to pursue these areas of importance. l3J Students were not exposed to clinical areas until late in the curriculum, thereby dis- couraging early career decisions. By delaying such decisions, a student could not construct a curricular program in accord with hisfher ca- reer plans. With this conceptual basis a unique curricu- tum slowly took shape. The first year would pro- vide a student with the core material needed to understand the clinical experiences hefshe would encounter on the wards during the sec- ond year. The third and fourth years would be entirely elective, with approximately one half of the student's time being devoted to basic science studies and one half in clinical rota- tions. Thus, students would be encouraged to design their own elective experiences. These aims were articulately stated in a grant proposal to the Commonwealth Foun- dation for financial assistance in instituting this curricular format: fit to provide a strong academic basis fora lifetime of growth within the profession of medicine, with the development of techni- cal competency, proficiency, and the proper attitudes perculiar to the practice of medicine as well as appreciation of the broader social and service responsibilities: T21 to establish for the first year a basic scien- ce program which will fulfill the purposes of the increasingly heterogeneous student body: l3J to offer both clinical and basic 111 4 science education simultaneously: lrll to permit the student to explore his personal intellectual preferences and capabilities: L51 to allow study in depth in selected areas, either basic science or clinical: lol to pro- vide greater freedom of course selection, and thus to encourage earlier career de- cision: l7J to achieve better integration of the medical school curriculum with residen- cy training and the practice of medicine. The Commonwealth Foundation unanimously approved the Duke request, and entering class of 1966 became the first class of the New Curriculum. Dr. Ewald Busse For the new curriculum to be successful, the general approach to each year had to be reassessed. Furthermore, each department had to review its own approach to the different years. This required an enormous amount of time, energy, and willingness to compromise. Departmental autonomy has a strong tradition at Duke and for the new curriculum to function effectively, it required support and commit- ment from all the departments. This was most obviously seen in the revision of the first year. The goal was simple: to trim down two years of basic science material to a core of information to be crammed into eight months of the first

Page 17 text:

Dr. Eugene Stead being one of the most efficient units. Although the war was a very unsettling expe- rience for the medical center, the postwar years were remarkable forthe expansion ofthe center's facilities and its recognition as one of the top academic institutions in the United States. The clinical departments at the Medical Center were launched into the forefront of ac- ademic medicine thanks to the active leader- ship of a younger generation of men who ar- rived at Duke some years after the establish- ment of Duke as a tertiary regional center. These men were relieved of the responsibility of establishing Duke's reputation as a referral center and could dedicate their time to the promotion of research and academic com- petitiveness within their departments. Dr. Eugene Stead was brought to Duke from Emory in 1947 to succeed Dr. Hanes after his sudden death in 1946. Dr. Stead is known for his tremendous working capacity and is responsi- ble for leading Duke into the arena of aca- demic excellence. His unyielding pursuit of ex- cellence, his dedication. and above all his love for medicine and patient care have won him a national reputation as one of the best clinicians of all times. The Department of Surgery was led for many years by Dr. Clarence Gardner who was among the first surgical residents trained at Duke by Dr. Hart. His contributions were sub- stantial and the surgery department soon rose to national recognition under his leadership. Dr. Gardner was also instrumental the founda- tion of the Durham Cerebral Palsy Hospital. The Department of Pediatrics was headed by Dr. Jerome Harris from 1954 to 1968. Psychiatry was headed by Dr. Richard Lyman from 1940 to 1951, then by Dr. Lowenbach until 1953 when Dr. Ewald Busse. who later became Dean, was invited from Colorado to occupy the chair. In 1937, Dr. Deryl Hart recruited a very talented young man trained at Harvard and Johns Hopkins as chairman of the department of neurosurgery: Dr. Barnes Woodhall. Dr. Woodhall had a remarkable ability as an organizer. After getting the neurosurgery de- partment on its feet, he became involved with the administrative aspects of the medical cen- ter where his foresight was considerable and his contributions many. Woodhall became the second Dean of the Medical School in 1960 after Davison's retirement and he held sequen- tially the offices of vice provost of health affairs, 1960-67, associate provost, 1967-68, and chancellor pro team from 1969-70. One time he remarked facetiously that it was always dif- ficult for him to keep the same job. Among his contributions are the construction of the Barnes Woodhall building lor Red Zonej connecting the Gerontology and Diagnostic and Treat- ment Building with the rest of the hospital, the implemention of the new curriculum, the long range plans for the expansion of the medical center including the Research Drive building, and the conceptualization of Duke Hospital North. During the mid-1960's a number of depart- mental chairmen reached retirement age, opening their positions to generation of men. Dr. David Sabiston, Jr., was invited from Johns Hopkins in 1964 to replace Dr. Clarence Gard- ner. Dr. James B. Wyngaarden replaced Dr. Stead in 1967, Dr. Roy T. Parker became chair- man of Obstetrics and Gynecology in 1964, and Dr. Samuel Katz of Pediatrics in 1968. Dr. Joseph A.C. Wadsworth was invited back to his alma mater in 1965 to replace Dr. William B. Anderson inthe Department of Ophthalmolo- gy. Dr. Wadsworth is well-known for his fine work in the field of ocular pathology and ocu- lar surgery. His presence at Duke culminated in the creation of the Duke Eye Center which stands out for its beauty and for its excellent delivery of patient care. Dr. William Anlyan, a thoracic surgeon by training, also became a member ofthe execu- tive committee formed by the younger faculty members of the 1960's. Dr. Anlyan was identi- fied early on by Dr. Woodhall for his brilliance and leadership capabilities. He was appointed Vice President of Health Affairs in 1969 when Woodhall became Chancellor of the University. Dr. William Anlyan desenfes credit for his active role in the promotion of academic excellence inthe institution and for his arduous and relentless participation in the planning and construction of Duke Hospital North. The late Dr. Thomas D. Kinney also came to Duke in 1960 to replace Dr. Wiley D. Forbus as chairman of the Department of Pathology. Dr. Kinney was well known to students for his love of teaching. His talents as an educator led to his appointment as Dean of the Medical and Allied Health Education Program. Dr. Kinney came from Case Western Reserve, an institu- tion unique at that time for departing from the traditional curriculum taught at Johns Hopkins. instead of having different departments teach the same subjects. Case Western organized its basic science material into organ systems. In this manner, the anatomy, physiology, and biochemistry of each organ could be taught in unison rather than independently and without cohesiveness. Dr. Kinney, together with Drs. Stead, Harris, Handler, and Sieker, was in- strumental in organizing and implementing the new Duke Curriculum, one of the major de- velopments within the medical school in the 1960s. ln its early years the Duke Curriculum allowed nearty half i46O!oJ of the students stud- ies to be in elective courses. Unfortunately, as medical knowledge burgeoned over the next three decades, the faculty instituted more re- quired time at the cost of the elective time. The zenith of this trend was reached in 1955 when, of the 5,148 teaching hours over the four years, only 17 were elective time! The chart below depicts this progression of declining elective time: YEAR PERCENTAGE OF PERCENTAGE OF HOURS IN HOURS IN REQUIRED COURSES ELECTIVE COURSES 1930 54 46 1935 72 28 1940 83 17 DI. BGFIIES Woodhall 14 13

Page 19 text:

year. The real difficulty arose in trying to decide what to include and where. Each department had to justify the number of hours it was allo- cated. To appreciate The dimensions of this burden, a comparison of the number of hours assigned tothe departments in The respective curricula is helpful: DEPARTMENT OLD NEW CURRICULUM CURRICULUM Anatomy igross, micro. and neuroj 531 252 Biochemistry 208 117 Physiology 358 150 Microbiology and immunology 164 160 Pharmacology 110 121 Pathology 348 214 Introduction to Clinical Medicine 364 96 The most conspicuous cutbacks were in The time allotted to Gross Anatomy and to Physical Diagnosis. Despite The obvious shortcomings ot The system, however, iT has been The consensus of most students over The past 18 years that The sacrifices and constraints of years one and two are well-compensated by The immense free- dom of The elective curriculum of years Three and four. Although The new curriculum weathered almost 15 years without major revi- sions, The 1980s brought a few major changes. By original design, the second year was composed of five required clinical rotations each of Two months duration: lntemal Medi- cine, Surgery, Pediatrics, Ob-Gyn, and Psychi- atry. However, tothe surprise land constema- tion of somel of The class of 1984, a sixth re- quired rotation - Family Medicine - was added effective September of 1981. Although the rotation has generally been a popular one, the12-month duration ofthe second year has been a source of dissatisfaction to many stu- dents. The most recent chapter in the evolution of the curriculum was written in January of 1984 when MEDSAC lthe Medical School Advisory Committeej, after months of deliberation by various committees, announced major curric- ulum changes to take effect with the entering class of 1984. The changes included: 111 mov- ing Introduction to Clinical Medicine to the early part ofthe second year, 121 utilizing the six weeks thus vacated to decompress the first year - not by increasing the number of lec- tures, but by setting aside Tuesday and Thurs- day afternoons throughout the first year for study, and 131 allowing second year students the choice of five ofthe currently required six rotations, with the option of taking the omitted rotation as an elective during the fourth year. Thus, the second year was restored to its origi- nal 10 months in duration. There were no changes made in the elective curriculum. lf the unfolding of the new curriculum dominated the middle and late 1960s, the de- velopment of Duke North was foremost in the decade ofthe 1970s. The history of the development of Duke Hos- pital North TDHNJ began on November 22, 1970 with a decision made by the Medical Center Administration and supproted by its clin- ical departments to proceed with the plan- ning of new hospital facilities. The decision re- sulted in the authorization of a hospital plan- ning staff, the Hospital Planning Studies Office, To coordinate all planning activities associ- ated with new hospital facilities. The members ofthe HPSO were Dr. Jane Elchlepp, Associate Vice President of Health Affairs who, in The words ofthe Vice President of Health Affairs, Dr. William Anlyan, orchestrated the develop- ment of Duke North, Wallace E. Jarboe. Larry D. Nelson, and Robert G. Winfree. This office established liaison with planning agencies and area hospitals, collected patient statisti- cal data, and involved clinical faculty and staff and administration in developing other plan- ning data. Inpatient and outpatient data was gathered from as far back as 1964 and was analyzed with respect to patient loads, origins, etc., in order to obsenfe trends in the patient population. One of the more important observations, noted Dr. Elchlepp, was that pa- tients were coming from farther and farther away - Duke was becoming a tertiary care hospital. The data generated also showed that inpatient services were grossly overloaded. For example, occupancy studies showed that surgery frequently ran in excess of 100070 ca- pacity. a feat made possible bythe existency of a recovery room. When the inpatient func- tional unit analyses were compared with Unit- ed States Public Health data, Duke Hospital was found to be severely lacking in both pa- tient space and support space. The HPSO data documented the need for expansion. The HPSO went on to identify consultants necessary to develop programs for hospital modemization. On January 14, 1972, the Execu- tive Committee ofthe Board of Trustees autho- rized acceptance of a proposal submitted in November, 1971, by American Health Facilities TAHFJ, lnc., To Develop the Conceptual Mas- ter Plan, Project Budget and Economic Feasi- Dr. Roy T. Parker X 1 15