| |
 |
Finding a way to do the right
thing
“Healthy people are the
foundation on which we build,” Gates speaker says
At Student Research Day, encouraging
a new cadre of physician-scientists
Integrative medicine: student group
bridges a gap in medical education
Clinical practice suites open in Harkness
Kavita Mariwalla was the banner bearer during the procession to Commencement
on Old Campus.
Zachary Goldberg, Allyson Bloom, Rupali Gandhi and Elizabeth Arleo before
the procession to Old Campus.
Physician and writer Atul Gawande told the graduates that to be a physician
requires “a particular kind of strength.”
Darlene Gabeau was joined at Commencement by her husband, Jean Lacet,
and two of her children, Srina Lacet, 3, and Asha Lacet, 4 months. |
|
Finding a way to
do the right thing
Physicians must go the extra mile for patients, surgeon and writer Atul
Gawande tells the Class of 2004.
By Cathy Shufro
As a medical student on an internal medicine rotation, Atul Gawande, M.D.,
M.P.H., wasn’t particularly worried about the elderly woman with
a low-grade fever who was being watched for signs of pneumonia. She was
one of the last patients he’d cover as a fourth-year student at
Harvard, and his mind was on the surgery residency he’d soon begin.
After rounding in the morning, he decided not to check in again with the
patient after lunch, recalled Gawande, a surgeon and writer for The
New Yorker, speaking at the School of Medicine Commencement in May.
Luckily, the woman’s chief resident was more vigilant. By the time
Gawande stopped in to see her, the patient was gone—gone to the
ICU in the throes of a rapidly progressing fulminant pneumonia.
The lesson, Gawande told the 109 graduates gathered on Harkness Lawn,
is that being a physician requires “a particular kind of strength.
... Doing the right thing is often painful, and yet you find the way to
do it anyway,” said Gawande, whose essay collection, Complications,
was nominated for a 2002 National Book Award. Gawande said that physicians
must go the extra mile for patients, even if doing so is a hassle, even
if it’s humiliating, even though one might make a bad decision and
unintentionally do harm. He urged new graduates to do the right thing
“because you said you would; because it’s what you chose to
do.”
The graduates listening to Gawande’s address had processed into
the tent led by piper Glenn H. Pryor playing “The Athol Highlanders.”
Former opera singer (and 2004 graduate) Nduka M. Amankulor opened the
ceremonies by singing “The Star Spangled Banner” in his bass-baritone.
The Class of 2004 honored Barry J. Wu, M.D., HS ’92, associate clinical
professor of medicine and “the nicest doctor in New Haven,”
with the Francis Gilman Blake Award for outstanding teacher. They gave
the Betsy Winters House Staff Award to Ashwin Balagopal, M.D., chief resident
in medicine, for his “Zen-like brilliance.” The class donated
$1,000 to the School of Medicine’s Society of Distinguished Teachers
to “underscore symbolically our commitment to superlative teaching
at the School of Medicine,” said class co-president Michael Shapiro.
Joseph E. Craft, M.D., HS ’77, professor of medicine (rheumatology),
and Auguste H. Fortin VI, M.D., M.P.H., assistant professor of medicine,
won the Bohmfalk Prizes for teaching. James M. Perlotto, M.D., associate
clinical professor of medicine, won the Leonard Tow Humanism in Medicine
Awards. The Leah M. Lowenstein Award went to Eve R. Colson, M.D. ’89,
assistant professor of pediatrics, and to Rajlakshmi Krishnamurthy, M.D.,
assistant professor of medicine.
Outgoing Interim Dean Dennis D. Spencer, M.D., HS ’77, encouraged
the new graduates to adopt a multidisciplinary approach to medicine that
incorporates the continuum from basic research to patient care. Although
historically scientists have spoken of medicine in militaristic terms—“conquering
disease”—Spencer suggested that the new generation “will
adopt metaphors other than war: metaphors of growth, and exploration and
evolution.”
 |
|
 |
|
Jessica Newman attended Commencement with her daughter, Miko, 3.
|
|
The Class of 2004 donned toy stethoscopes as a symbol of medicine.
|
|
|
|
| |
|
Sharmi Majahan gets a hug from Bonnie Pau (back to camera) at the Commencement
for Epidemiology and Public Health.
Linda Niccolai, an assistant professor of epidemiology, received the
Award for Excellence in Teaching.
Commencement speaker Helene Gayle, director of the HIV, TB and Reproductive
Health Program at the Bill & Melinda Gates Foundation, told graduates
that “we still have unfinished business in our own social and health
agenda.”
| |
“Healthy people are the
foundation on which we build,” Gates speaker says
Helene D. Gayle, M.D., M.P.H., didn’t start out wanting a career
in medicine or public health. She simply went to college to learn how
to change the world.
When she realized that a career in health was an avenue to social change,
she knew she had made the right choice. Formerly director of the National
Center for HIV, STD and TB Prevention at the Centers for Disease Control
and Prevention in Atlanta, Gayle is now director of the HIV, TB and Reproductive
Health Program for the Bill & Melinda Gates Foundation. “The
challenge we all face in our role as public health professionals is finding
a way to use the tools we have to reduce the inequities at home and around
the world,” she told graduates during her Commencement address at
the School of Public Health on May 24.
Events of the last few years have brought an extraordinary pace of change
and challenges to our world and our nation, Gayle said, and have highlighted
public health in unexpected ways. The terrorist attacks on September 11,
2001, the anthrax threat and the SARS outbreak have underscored our connections
to the world community and taught us that we’re not as independent
or as isolated as we once believed. “We can no longer afford to
pretend that actions taken in one part of the world have no impact in
other parts of the world, or that inaction does not have its own dire
consequences,” Gayle told the 123 men and women receiving either
a master’s or a doctoral degree in public health.
While key health indicators such as life expectancy and infant mortality
have long been important measures of societal development, Gayle said
that health is now considered a fundamental component of economic and
societal development, human rights and social justice. “Healthy
people are the foundation on which we build economies, education systems
and, ultimately, a strong and stable civil society,” she said.
Noting that individuals can change society, Gayle also spoke of obstacles
ahead. “We spend more on health than any other nation, but rank
37th in overall health system effectiveness,” she told the crowd,
adding that the disparities in health among different segments of society
are “not-so-gentle reminders that we still have unfinished business
in our own social and health agenda.”
Stephen Vindigni gave the student address, in which he spoke of
the diversity of the Class of 2004 and of the graduates’ shared
desire to improve public health. Citing the variety of internships undertaken
by his fellow students around the world, he said, “What an amazing
contribution this class has made, while simultaneously gaining valuable
experience and giving back to the communities in which we worked.”
Vindigni encouraged his classmates to use what they learned at Yale to
generate interventions in public health that would benefit both individuals
and communities. “Trust your power to influence,” he urged
the graduates. “All of us are capable of initiating change.”
—Jill Max
|
|
|
| |
|
Rachel Willner described her research at Student Research Day in May.
|
|
At Student Research Day, encouraging
a new cadre of physician-scientists
Among the 68 students presenting posters at Student Research Day in May
were three who spent the past year doing research under seemingly ideal
conditions. They each received a $20,000 stipend and a travel budget,
worked under the tutelage of expert mentors and pursued research that
excited them.
“I am basically learning how to do research,” said Sharon
K. Gill, who studied patients with coronary artery disease a year after
their hospitalizations in a project designed to improve clinical decision
making. “If I want to look into a question I am passionate about,
I think I have the tools to do it.”
She was one of seven students at Yale during the last academic year supported
by the Doris Duke Clinical Research Fellowship Program for Medical Students.
The Doris Duke Charitable Foundation (DDCF) started the national program
in the fall of 2001, and Yale has been one of 10 participating universities
since last year. The yearlong program starts in July with three classroom
courses—“Principles of Clinical Reasoning,” “Introduction
to Biostatistics” and “Practical and Ethical Issues in Clinical
Investigation”—before students embark on their own research
projects. According to John N. Forrest Jr., M.D. ’67, HS ’71,
director of student research, there must be a clinical element to the
project and involvement with a patient. “Someone in the research
group touches the patient,” he said. “It can’t be a
mouse model of diabetes.”
Students describe their research goals in presentations at the beginning
of the program and discuss their results at the end. They also attend
three dinners with faculty who describe both personal and professional
aspects of life as a physician-scientist. Encouraging medical students
to pursue careers as physician-scientists is the primary goal of the fellowship.
Students from any medical school may apply to study at any of the 10 participating
schools. During the past two years two students at Yale have gone elsewhere
for research and three students have come to Yale.
Presenting at Student Research Day this year was Paul M. Weinberger, from
the Medical College of Georgia, who worked with Amanda Psyrri, M.D., FW
’02, assistant professor of medicine (medical oncology).
“We are both interested in new molecular therapeutics for
cancer and why some people with cancer die and others don’t,”
Weinberger said. “You look at stage 4 patients, and there are some
who 20 years later have no cancer and they are still alive. Some stage
1 patients are dead a year later. We have no idea why.”
Brian V. Nahed spent his year using a novel approach to identify
the genetic basis of intracranial aneurysms. “This is a perfect
opportunity to contribute to the field I wish to pursue—academic
neurosurgery,” said Nahed.
Echoing the importance of training a new generation of physician-scientists
was the keynote speaker at Student Research Day, Story C. Landis, Ph.D.,
director of the National Institute of Neurological Disorders and Stroke.
“We will only be able to take advantage of the opportunities that
exist if there are physicians, physician-scientists and scientists who
are able to move the field forward,” she said. “We don’t
know what we need to know. Who would have guessed that much of our understanding
of the biochemistry of cell death came out of studies of C. elegans?
Who would have guessed that research funding for coronavirus for 15 years
… turned out to be absolutely critical when the SARS epidemic started
in China?”
—John Curtis
|
|
|
| |
|
|
|
Integrative medicine: student
group bridges a gap in medical education
Medical students have a lot to learn, and not all of it is in today’s
textbooks. One glaring omission in the curriculum, according to second-year
student Rachel Friedman and third-year student Joey Cousin, is exposure
to alternative therapies such as acupuncture, herbal remedies, massage
and homeopathy. As co-organizers of the Yale Integrative Medicine Student
Association (YIMSA), that’s something the two are working to change.
Originally naming the group the Yale Alternative Medicine Student Association,
the handful of students who founded it two years ago soon replaced “alternative”
with “integrative” to reflect their intentions more accurately.
“We’re not exploring alternatives to our profession,”
said Friedman. “What we’re interested in is having one medicine
that is open-minded and that looks at anything that can possibly help
patients.”
Although integrative medicine still has quack status in the minds of some
physicians, the tide is turning. With research programs in major medical
schools across the country investigating treatment efficacy, often with
funding from the National Center for Complementary and Alternative Medicine
at the National Institutes of Health, the field is beginning to gain validity.
But part of the problem, Friedman and Cousin say, is that the definition
of these therapies is still nebulous. “Basically, it’s anything
that isn’t currently taught in medical school,” said Friedman,
which means that acupuncture is lumped together with crystals, psychic
healers and the latest vitamin fad.
Still, patients are turning to such treatments with increasing frequency.
“Outside of whether these therapies work or not,” said Friedman,
“our first goal is to educate students on what’s out there—what
kinds of practitioners we’re going to encounter who are treating
our patients, and what we need to know about those treatments.”
To that end, YIMSA organizes a monthly lecture series at which different
practitioners present not just the backgrounds of their modalities, but
also what a doctor needs to know about them. The idea, said Margaret A.
Drickamer, M.D., associate professor of medicine (geriatrics) and the
group’s faculty advisor, is “not to destroy alternative medicine
or to promote it, but simply to look at it. ... They’re learning
to look at nontraditional medicine, and to see that there are both value
and problems in that.”
The series was well-attended last year, Cousin said, with 20 to
30 students coming to each talk. This year Cousin and Friedman plan to
publicize the talks more widely to encourage broader participation by
students across health disciplines. Other events have been more interactive.
Friedman, who is licensed as a massage practitioner in California, organized
a six-week medical massage course to run concurrently with first-year
gross anatomy, hoping that massaging each other will strengthen students’
memorization of muscle groups. The semester finished with a full day dedicated
to a topic universally known to medical students: stress. Students were
invited to experience massage, Reiki, reflexology and other therapies
during a drop-in health fair. After dinner, YIMSA hosted an expert panel,
the “Science of Stress,” in which doctors and integrative
medicine practitioners offered a healer’s perspective on the biology
and psychology of stress.
Ultimately, YIMSA’s goal is to change the curriculum to incorporate
training in integrative therapies. Progress on this front has been slow,
but Friedman is trying to build a faculty advisory committee to steer
the process. “My sense is that there are many individuals among
the faculty who support change, but there hasn’t been any umbrella”
to unite them, she said.
—Alla Katsnelson
|
|
|
