State of the School 2016

Jeffrey S. Akman, M.D.

Between tours of the labs at the Science and Engineering Hall and the Fifth Annual Frank N. Miller Lecture during this year’s Alumni Reunion Weekend, Jeffrey S. Akman, M.D. ’81, RESD ’85, vice president for health affairs, Walter A. Bloedorn Professor of Administrative Medicine, and dean, and several key members of his senior staff, discussed the latest developments in GW’s School of Medicine and Health Sciences (SMHS), particularly in the M.D. program, at the dean’s annual State of the School Address.

In his opening remarks, Akman updated M.D. program alumni from 1966, 1976, 1981, 1986, 1996, and 2006 on the elements of the school’s strategic plan, such as leadership, education, discovery, community, and clinical excellence.

The dean also focused on a side of the school many of those in attendance were not familiar with, the “HS” in SMHS: Health Sciences.

“Our Health Sciences programs are really a crucial part of who we are,” Akman explained. “The health sciences represent a major area of growth at the school, and they are an important part of our strategic plan and our strategic vision.”

Over the past several years, Health Sciences programs have grown to include 57 degree or certificate programs, from mainstays like physician assistant studies and physical therapy to new offerings in bioinformatics and a doctoral program in Translational Health Sciences. Undergraduate admissions grew by 20 percent over 2015, and graduate online enrollments are currently 42.8 percent higher than this time last year.

“We now have linkage programs with community colleges in Maryland and Virginia to improve access and increase the pipeline into the health professions for kids who initially might not be able to afford a four-year education,” Akman said. He added that if the students hit specific academic targets, they can gain automatic admission into any of a number of health science bachelor’s degree programs.

Akman also highlighted the school’s significant research accomplishments this year. Following increased research faculty recruitment and significant improvements in research infrastructure in recent years, SMHS nearly doubled the number of new awards in the past academic year, despite a shift in emphasis to fewer, yet more strategic and higher quality, grant proposals.

Akman called attention to a few of the most significant new grant awards, including the renewal and expansion of the Clinical and Translational Science Award given to GW and Children’s National Health System in 2010 to establish the Clinical and Translational Science Institute at Children’s National; the $6.2 million Program Project Grant from The Eunice Kennedy Shriver National Institute of Child Health and Human Development to solve pediatric dysphagia; and the five-year, $28 million Martin Delaney Collaboratory grant from the National Institutes of Health to apply immunotherapy advances to create a novel HIV cure strategy.

Acclaim for Accreditation

Following Akman’s remarks, Richard Simons, M.D., senior associate dean for M.D. programs, took center stage to announce the school’s recent full, eight-year accreditation by the Liaison Committee on Medical Education (LCME), the U.S. Department of Education-recognized body charged with accrediting the country’s M.D. programs. The decision, Simons said, came on the heels of a grueling 18-month self-study process that began in 2014 and culminated with a  site visit in February 2016.

“We just came through a major self-study accreditation process,” said Simons, adding that typically LCME accreditation teams provide little feedback beyond areas they’ve identified for improvement.

“They actually complimented the school on the attention to detail and the quality of the materials we submitted. They were extremely pleased by our librarians’ role in teaching evidence-based medicine,” he told the alumni. “They also commented about the enthusiasm and quality of our medical students.”

Simons discussed developments in the clinical curriculum of the M.D program, particularly a longitudinal primary care clerkship, as well.

Next on the horizon in medical education, he added, are Entrustable Professional Activities, 13 clinical practice activities (e.g. performing a history and physical, writing admission orders and prescriptions, presenting a patient in oral and written form, transitioning patient care by performing a “hand-off” to another covering physician) the Association of American Medical Colleges (AAMC) believes medical students should be able to do, with indirect supervision, by the time they start residency.

“This is an initiative that was pushed by the AAMC, and we are embarking on this competency-based initiative,” Simons said. “It’s not yet required by the accreditation bodies, but I believe in another five years it will be.”

Recapping the Revised Curriculum

Matthew L. Mintz, M.D. ’94, RESD ’97, FACP, assistant dean for pre-clinical education and associate professor of medicine, followed Simons, presenting an update on the progress and success of the school’s recently revised pre-clinical M.D. program curriculum.

Mintz reminded the audience that little has changed since 1910, when the Carnegie Foundation for the Advancement of Teaching’s Flexner Report ushered in a series of national programmatic changes that standardized medical education. Despite significant advancement in terms of scientific knowledge and technology in the century to follow, the report’s recommendation for two years of basic science preclinical education followed by two years of hands-on clinical clerkships has remained relatively constant.

“Whether you were a member of the Class of ’66 or 2006, your medical education experience at GW was pretty much the same as mine,” said Mintz, who earned his M.D. from SMHS in 1994 as well as his internal medicine residency training in 1997. “That served us well, but a lot in medicine, especially in the last decade, has changed so much.”

The programmatic modifications, he explained, were guided by those changes in the health care landscape and informed by research into how medical students learn best.

A key element of the revision, he added, was the decision to shorten the pre-clinical curriculum from two years to a year and a half. “Students finish their pre-clinical curriculum before winter break and then study for the boards starting their clinical rotations early in the spring.”

The other big change, he said, was the decision to move from a discipline-based curriculum to an integrated curriculum. Following a foundational course, students now take organ system-based block courses.

“Rather than have a separate anatomy course, when students have the cardio/pulmonary/renal block, they learn about clinical cardiology, pathophysiology, pharmacology, and anatomy of the heart within that block,” he said. “There is some good research available that shows that when you integrate material like that you tend to learn it better.”

The members of the Class of 2018, the first SMHS class to study under the revised curriculum, are now halfway through their clinical rotations. In September, Mintz led a preliminary review of the curriculum, looking at written and clinical exam scores as well as board results. So far, he said, the outcomes appear good.

“Whether you looked at examinations, physical exams and interviewing, all of those numbers were the same or better than classes under the previous curriculum. Board scores were also similar.

“Most importantly,” he continued, “when you ask the clerkship directors and the faculty on the wards, they tell you this is new group of students; they are thinking better, and they are better prepared. That makes me very happy.”

Anniversary Celebration

Wrapping up the lineup of speakers at this year’s State of the School event was Christina Puchalski, M.D. ’94, FACP, FAAHPM, founding director of the George Washington University Institute for Spirituality and Health (GWish) and Professor of Medicine and Health Sciences. Her remarks centered on the accomplishments of GWish as SMHS celebrates the institute’s 15th anniversary.

The institute, established in 2001 to promote whole-person care by integrating spiritual care into health care, education and policy marked a milestone this year: its 15th anniversary. To commemorate the occasion, GWish welcomed members of the community, including political and academic luminaries, to a special dinner.

Among the goals of GWish, explained Puchalski, is to change the way health care is taught. “As health care advances in ways that are more technological, we want to ensure that the art of medicine and the respect for the whole person is integrated as well.

“Many people think spirituality equals only religion,” Puchalski said. “It is broader than that.”

GWish, along with colleagues in the US and representatives from more than 30 countries, established a functioning definition of spirituality as it relates to health: spirituality is about meaning, purpose, and connectedness to the significant or sacred, however people see it.

“You can see in this definition, that spirituality is a way that we seek, and our patients seek, ultimate meaning and purpose and transcendence; how we experience relationship to self, family, others, community, society, and nature; and the significant or sacred,” Puchalski said.

Thanks to Puchalski’s efforts, spirituality is now recognized as a vital contributor to a new field within health care — Spirituality and Health — that is being taught in medical schools and public health schools across the country and around the world. It has also led to the development of a Global Network for Spirituality and Health which now has over 400 members and is actively involved in developing educational programs, research and guidelines on integrating spiritual care into care in diverse global health settings.

Among the most significant achievements for GWish has been the development and widespread adoption of the FICA Spiritual History Tool. Rather than a checklist, the FICA card offers physicians and health care professionals a guide to aid and open the discussion to spiritual issues with their patients.

FICA stands for: Faith, Belief, and Meaning, asking patients about their spirituality however they understand that; Importance, assessing the role that patients’ spirituality has in their health and wellbeing; Community, determining whether a patient is part of a spiritual or religious community that might serve as support system; and Addressing/Assessment in Care, assessing for and treating spiritual distress and supporting patients’ spiritual resources of strength or meaning.

“This is not just about disease and palliative care, it’s about whole health,” Puchalski explained, recalling the words of former U.S. Surgeon General Regina Benjamin: “We should fight for health, not fight against disease.” Puchalski added that “health is that broader part of the whole person. It’s not just physical health it’s also psychological, social, and spiritual health as well.”