Achieving Excellence In Medical Education

Achieving Excellence in Medical Education

Richard B. Gunderman

Achieving Excellence in Medical Education

Richard B. Gunderman, MD, PhD, MPH Associate Professor, Radiology, Pediatrics, Medical Education, Philosophy, Philanthropy, and Liberal Arts Indiana University Schools of Medicine and Liberal Arts Indianapolis, IN 46202-5200 USA rbgunder@iupui.edu

British Library Cataloguing inPublication Data A catalogue record for this book is available from the British Library Library of Congress Control Number: 2005936716 ISBN: 978-1-84628-813-5 Printed on acid-free paper © Springer-Verlag London Limited 2006 First published 2006 in hardcover as ISBN 978-1-84628-296-9 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted underthe Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to thepublishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case therespective user must check its accuracy by consulting other pharmaceutical literature. 9 8 7 6 5 4 3 2 1 Springer Science+Business Media springer.com e-ISBN: 978-1-84628-317-8

Foreword, by Thomas Inui

Excellence in Medical Education: Looking Beyond “See One. Do One. Teach One.”

Carry Me Back
Philip Tumulty was Johns Hopkins Hospital’s “doctor’s doctor”.Whitehaired, red-cheeked andvigorous, he seemed to know more medicine than almost anyone else at Hopkins and he put this knowledge to use in the care of patients. Unlike some of the other major figures at the school, he was predominantly an active clinician with a busy consultative and primary care practice. As students, we first saw Dr. Tumulty at Clinical Pathology Conferences (CPCs), where he always “wowed” us with his eruditecomprehensiveness and (in the end) uncanny capacity for being correct about what disease process was at work in the case under review. I loved the moments at which Phil’s discussions would finish the elaboration of an incredibly long differential diagnosis, an exhaustive list of what the mystery patient might have had, and take on a new tempo—like a horse rounding the last turn in the track—suddenlypicking up speed,gathering himself,and racing for the finish line, arriving at the final diagnosis in a rush and lathered up. The times I most enjoyed learning from Phil, however, were not in the CPC but in his end-of-afternoon “case discussions” in the Thayer classroom. These discussions usually centered on a patient Phil had in the hospital. Phil and one of his patients would sit in the front ofthe classroom and talk as he “took” the history, in a somewhat casual and discursive manner, and inevitably learned something more. I particularly remember his conversation with a retired judge from Virginia, who was to be discussed as a case of possible granulomatous arteritis. Probably wanting to learn more about fatigue and waning vitality, Phil asked the judge “what he liked to do.” A wholeworld of country life in the rolling hills of Virginia opened to our sensibilities. We were going to the kennel in the autumn to let the eager dogs out—then rambling across the blue hills behind the dogs on the pretense of “hunting pheasants” but actually wanting just to breathe the air and be in the fields, shotgun unloaded, broken over the arm, strolling under the azure sky. What space; what...