| Women in Medicine |
| University of Pennsylvania Principal Investigator: Jerry A. Jacobs, Ph.D. The last comprehensive assessment of the impact of women physicians on American medicine was made at a 1976 Macy Conference on Women in Medicine. Since that time, little has been written about the topic. This study addresses that gap, using a number of existing databases to examine the impact of the growing numbers of women physicians on the practice of medicine over the past 30 years. The study is examining a number of specific questions, including why women enter medicine; the course of their professional development during medical school and their choice of specialty; whether women practice differently from men; where women practice and the impact of managed care on that choice. Data to answer these questions is being drawn from many sources, including national surveys of the career plans of college students; data collected over the past three decades by the Association of American Medical Colleges, from interviews with students before, during and after medical school; and data from Medicare that link provider characteristics with patient case files. Findings will be published in peer-reviewed publications and/or a book. |
| Increasing Diversity Among Health Care Professions |
| University of California-San Francisco Principal Investigator: Philip R. Lee, M.D. This grant supports an assessment of the impact of federal, state and institutional policies on the goal of increasing the representation of minorities in medicine, an issue the principal investigator has been involved in throughout the 40-year period proposed for the study. Dr. Philip Lee first served as Assistant Secretary for Health in the Johnson Administration and then, 25 years later, in the Clinton Administration. In the intervening years, Dr. Lee created and headed the Institute for Health Policy Studies at University of California at San Francisco, an organization that has focused on health policy and its impacts on human health and illness. He is now Professor of Social Medicine Emeritus at the Institute. Under Dr. Lee's direction, the assessment team is looking at the impact of policies on the actual matriculation and graduation of minority medical students, beginning with case studies from Stanford and UCSF for which extensive data are available. The team is now extending the study to Texas, Florida, New York, Maryland, and the District of Columbia. In addition to available data, the study relies upon an extensive literature review; federal, state and university archival research; oral history interviews with administrators and faculty, graduates and students; document analysis; and the collection and analysis of secondary data on medical school applicants, admissions and graduates. At the project's conclusion, the team will give briefing reports to a number of audiences and prepare oral histories and articles for peer-reviewed journals. |
| Women's Health in Medical Curricula |
| Yale University School of Medicine Principal Investigator: Janet B. Henrich, M.D. Recognizing that gender specific issues are essential to the quality of health care provided for women, a number of academic medical institutions established centers for women's health and attempted to identify gender specific material which should be included in medical curricula. Despite these efforts, though, issues affecting health care for women have not been well-represented in either medical education or medical research. In 1995, "Women's Health in the Medical School Curriculum: Report of a Survey and Recommendations," based on findings from a study conducted by the Council on Graduate Medical Education, which was the most comprehensive assessment of the subject to date, provides the basis of comparison for results of this current study. Dr. Henrich, Associate Professor of Medicine and Obstetrics/Gynecology at the Yale University School of Medicine, was the author of the 1995 report and is the principal investigator for this grant. For this current study, Dr. Henrich is analyzing data from a medical curriculum database called CurrMIT, a restricted website developed by the AAMC, to determine how many schools now teach some or all of the gender-specific topics identified in the earlier survey. Findings will help policy makers, professional organizations and individual institutions assess the progress that has been made in integrating the key elements of women's health into the medical curriculum, and also pinpoint areas where efforts are needed. |
| A Grant to Extend Funding for a New York Post-Baccalaureate Program |
| Associated Medical Schools of New York Principal Investigators: Marc Nivet, M.S. A number of states have experimented with the concept of a post-baccalaureate program to increase the numbers of underrepresented minorities in the medical profession. In this program, participating medical schools have identified promising minority applicants who did not quite make the cut in the admissions cycle and then worked with them to strengthen areas of weakness through appropriate academic programs and special summer instruction to prepare them to join the next entering medical class. Students who complete the post-baccalaureate program successfully are assured of admission into the New York State medical school to which they had almost gained admission the previous year. Now in its thirteenth year, this post-baccalaureate program conducted by eight members of the Associated Medical Schools of New York is considered to be one of the best in the country. For the first six years of the program, 20 slots per year were funded by the Federal Health Careers Opportunity Program. Since funding from that program had a strict six-year limit, the Macy Foundation Board approved a grant to support 12 students for each of the next three years in 1998. A supplemental grant from the State of New York paid for eight additional students, bringing the total for each to 20. 182 students have graduated from the post-baccalaureate program and 177 have completed medical school. Two transitional years were supported by the Macy Board in 2001 to allow for transition to a New York State medical school-based source of durable funding. The performance of these students in medical school has been at least acceptable in the preclinical years and indistinguishable from their peers in the clinical years and beyond. Preliminary data suggests that many are choosing careers in primary care. In addition, first year minority enrollment in participating New York State medical schools has increased from 11 percent in 1998 to 14 percent in 2002, an increase the Associated Medical Schools attributes to this post-baccalaureate program and the support of the Macy Foundation. The post-baccalaureate program has now been institutionalized at the SUNY-Buffalo campus. Based on the results of this program, the New York State Department of Health is providing three additional years of funding. |
| Neurology Fellowships for Minority Physicians |
| Beth Israel Medical Center and St. Luke's/Roosevelt Hospital Center,
New York City Principal Investigator: Susan Bressman, M.D. Even though stroke is a major cause of disability in African-American, Latino and Asian-American populations, minority physicians are underrepresented in the practice of neurology and the treatment of stroke patients. Beth Israel and St. Luke's/Roosevelt have increased efforts to attract minority physicians to their programs through this training fellowship. New Yorkers are given preference since a stated goal of the program is to increase effective specialty care for stroke patients in targeted minority communities within New York City. Now in its final year, the program also aims to increase minority participation in stroke prevention and treatment programs. |
| A Blueprint for Pediatric Residency |
| Ambulatory Pediatric Association, Greensboro, NC Project Directors: Kenneth B. Roberts, M.D. The 1996 guidelines for residency training in general pediatrics are currently used by 80 percent of the pediatric residency training programs in the country. Since those guidelines were adopted, though, the Accreditation Council on Graduate Medical Education has moved from process-based criteria to outcomes-based criteria for residency programs. This grant supports the revision of current guidelines to reflect that change and place emphasis on communication skills and self-directed learning assessment. The Ambulatory Pediatric Association is an organization of general pediatric faculty at academic pediatric residency programs, and was designated by the Federation of Pediatric Organizations to take the lead in developing the revised guidelines. Authors have been selected as section editors for each component of the new guidelines and new content has been mounted on the association's website and field-tested by selected pediatric residency programs. The revised and final form of the guidelines will be available on the Internet and will be disseminated throughout the nation. The Federation of Pediatric Organizations will evaluate the revised guidelines for two additional years. |
| Improved Clinical Training for Medical Students |
| New York Academy of Medicine and Association of American Medical Colleges
Principal Investigator: Jeremiah Barondess, M.D. Over the past decades, the actual clinical, or bedside, training of medical students has become increasingly fragmented, due both to the growing dominance of fact-driven biomedical science and the simple reality that senior clinicians no longer have sufficient time to teach clinical acumen and interpersonal techniques to medical students. This is not a new problem. A strongly worded report in the mid-1980s called clinical clerkship an unstructured, haphazard apprenticeship that often failed to contribute to the overall educational objectives established for the medical student education program. Unfortunately this report had little impact. Instead, the situation continued to deteriorate. In most medical schools the third- and fourth-year clinical clerkships, which are the core of clinical education, are designed and conducted by faculty in clinical departments and no attempt is made to coordinate programs or provide any central oversight. In addition, shorter lengths of hospital stay and changes in the delivery of care have exacerbated the situation. Jeremiah Barondess, M.D., President of the New York Academy of Medicine (NYAM), created an advisory group of academic physicians for this grant, all with considerable experience in medical education but currently in positions that permit them to take a broad look at the fundamental problems in clinical training. Building on earlier work of the Association of American Medical Colleges, the group identified changes in both medical education and health care that have contributed to the growing deficiency in clinical education. This advisory group identified new objectives for the content of clinical education for medical students and recommended support of innovative models for the education of future physicians in the clinical transition. During an invitational conference, leaders in medical education developed a number of principles and recommendations for restructuring clinical medical education. Based on that guidance, the investigators requested proposals for new models of innovative teaching, including strategies for both long- and short-term evaluation. The advisory group is now conducting site visits to the medical schools that submitted proposals and will select four sites. This grant provides $75,000 per site to carry out the proposed innovative model of clinical education. During the period of this grant, the group will continue to serve as an advisory committee, meeting with investigators, conducting site visits, and overseeing evaluation. Funding at the end of the grant will support final evaluation, publication, and dissemination of results. |
| A Fourth-Year Medical School Curriculum |
| University of California-Los Angeles School of Medicine Principal Investigator: Gerald S. Levey, M.D. Over the past several decades, the fourth year of medical school has become increasingly flexible to give students a head start in their chosen specialty. Often this flexibility has been expanded through the introduction of audition electives, which permit senior students to opt for elective clerkships in their hoped-for field and improve their chances for being selected for choice residencies. Indeed, this trend to flexibility has become so extreme that in some institutions the fourth year is now entirely elective. This grant supports an effort to restructure the fourth year of the medical school curriculum at the UCLA School of Medicine with a stated goal of recovering the fourth year of medical school in order to better prepare medical students for the challenges of providing care and conducting research in the fast-changing world of health care. The UCLA effort includes all fourth-year students and has been designed to serve as a national model. A core group of faculty leaders has developed a five-colleges program for fourth-year students. In this program students belong to the college most closely suited to his or her anticipated career paths and will spend half of their time within the chosen college, with the remaining half available for electives. The five colleges are 1) primary care, including general internal medicine, pediatrics, family medicine, obstetrics/gynecology, and psychiatry; 2) acute care, including emergency medicine and intensive care; 3) applied anatomy, including surgical specialties, radiology, radiation oncology, pathology and related areas; 4) medical science, designed for students interested in academic careers in research and/or teaching; and 5) underserved communities. Each college offers a college-specific curriculum block of three to four weeks at the beginning of the fourth year. Students participate in a year-long advisor/mentor program and evening seminars related to the focus of the college, and also acquire experience in pertinent patient care or research, as well as required clinical core rotations and electives. In addition they have an opportunity to pursue individual projects. Three classes of fourth-year medical students will participate in the revised curriculum. Each class will be evaluated and, if the model proves successful, it will be disseminated to other schools. |
| Alcoholism and Drug Addiction Core Curriculum |
| Mt. Sinai School of Medicine Principal Investigator: Mary Foley, Ed.D. Building on their experience with a 15-hour didactic course on the subject, faculty members at Mount Sinai School of Medicine developed a core curriculum in treating alcoholism and other drug dependencies for primary care resident physicians. The goal is to improve knowledge and clinical skills in screening, early diagnosis and management of alcohol and other drug abuse. The program is available to residents from the departments of internal medicine, emergency medicine, and adolescent medicine. Ten residents participated in each of the three years of the grant. After completing the course, residents chose an elective in either the Narcotic Rehabilitation Center or the Adolescent Health Center based in the hospital community. Faculty include Dr. Mary Foley, an Assistant Professor of Community Medicine, and Elizabeth J. Garland, M.D., an Assistant Professor in both Community Medicine and Prevention and in Pediatrics. Barry Stimmel, M.D., Dean for Graduate Education at Mount Sinai and Editor of the Journal of Addictive Diseases, provided oversight for the program. |
| Fast Track for Academic Nursing |
| University of Michigan School of Nursing Principal Investigator: Ada Sue Hinshaw, Ph.D., R.N. This project addresses the "graying" of nursing faculties, a problem which has become especially acute in academic nursing where the average assistant professor is nearly 50 years of age. A typical academic nursing career pattern includes completion of the R.N. or B.S.N., a number of years in practice, and, possibly, time out for a family before beginning an academic career. Many academic nurses have such a late start that by the time they complete doctoral programs their faculty careers are frequently limited to less than 15 years. This program provides academic nursing with a faster track, one that is analogous to medicine's M.D./Ph.D. programs. The initial pilot-project identified promising nursing undergraduates, then provided career counseling and incentives to encourage them to progress directly from a baccalaureate or master's program to a five-year program that would lead to a Ph.D. in Nursing. The Macy grant supports three cohorts of five students for a period of five years, while the nursing school assumes full responsibility for the final two years of the scheduled seven-year program. |
| Macy Scholars Program |
| State Mailman School of Public Health, Columbia University Principal Investigator: Allan Rosenfield, M.D. The Macy Scholars Program at the Columbia School of Public Health permits medical students from New York medical schools to take a cost-neutral year between the third and fourth years of medical school to obtain an M.P.H. as well as an M.D. at the end of five years. Initiated in 1999, the program is now in its fourth year. As this program has grown in both visibility and popularity, it has received more applicants than it can accept. Fewer than half of the applicants for the third cohort could be accommodated. In addition, a number of other medical schools have inquired about the program. As designed, no more than half of each cohort can be from Columbia's medical school; the rest come from other New York City medical schools. The need for cost-neutrality of this additional year has been reinforced by the fact that almost all unsuccessful applicants have not been able to pursue the dual degree because they had already reached their debt limit and could not afford tuition for the additional M.P.H. year. In its 3 years, the Macy Scholars Program funded 37 medical students from six medical schools who have enrolled in almost all tracks at the school: Population and Family Health (13), General Public Health (9), Biostatistics (1), Health Policy and Management (6), Epidemiology (4) and Sociomedical Sciences (4). Minority students comprise about half of the current cohort. Since the first graduates are only now in their residency training, the direct impact of the program on their careers, and on the practices and communities in which they will work, cannot be assessed. However, the need for individuals who can bridge the gap between medicine and public health is extremely important in light of the continuing deficiencies in the public health infrastructure. This grant provides funding for two additional cohorts of 12 students per year, bringing the total to 61. The program is being evaluated to compare MD/MPH graduates of the Macy Program with other formats that lead to the two degrees, both at Columbia and at other institutions. The focus in the final year will be on evaluation of the effectiveness of the training in meeting the primary goal of enhancing collaboration between medicine and public health, and on determining the impact of public health training on the practice of traditional medicine by graduates of the program. |
| An Inter-professional Curriculum |
| University of Washington School of Nursing Principal Investigator: Pamela H. Mitchell, Ph.D., R.N. Many recent activities of the Macy Foundation have identified inter-professional teaching of students as an essential step towards developing greater teamwork among health care professionals. Though several pilot studies have examined how inter-professional teaching might be accomplished, further work is needed to explore both the concept and the feasibility. This grant will help meet that need. With six health sciences schools — Dentistry, Medicine, Nursing, Pharmacy, Public Health and Community Medicine, and Social Work, — and an Information Technology School which already have a record of working together, the University of Washington provided an ideal setting for this effort. The grant supports a project — formally titled The Inter-professional Bridges Program: Classroom and Clinical Linkages in the Health Sciences Curricula — to extend classroom and clinical inter-professional education into the required curricula of the seven schools. A Center for Health Sciences Inter-professional Education, housed in the School of Nursing, has been created by deans of the collaborating schools to support the program. The program will reach 350 students each year in the professional schools. If the project is successful, it will provide guidance for other institutions interested in implementing inter-professional teaching. |
| Your Genes/Your Health (YGYH) |
| Cold Spring Harbor Laboratory DNA Learning Center Principal Investigator: David Micklos, Director, DNA Learning Center This grant continues work begun in 1997 when the Macy Foundation supported the development by the DNA Learning Center at Cold Spring Harbor, New York, of an interactive website to teach the fundamentals of molecular biology and genetics to interested users from middle school age through adulthood. That website, DNA from the Beginning, offers an animated primer on the basics of DNA, genes and heredity and was developed by a team with expertise in biological sciences, computer science, art and publishing. In the second phase, the same team and the same interactive website format was further developed to look at the disease consequences of some known variations in the human genome. The diseases included in this new site, Your Genes/Your Health (YGYH), are cystic fibrosis, fragile X syndrome, hemophilia, Marfan's syndrome, Duchenne/Becker muscular dystrophy, phenylketonuria, Huntington's disease, neurofibromatosis, sickle cell disease, hemochromatosis, beta-thalassemia, Tay-Sachs disease, Down syndrome, Alzheimer's and polycystic kidney disease. Since its release in 2001, YGYH has logged over 960,000 visitors averaging more than 10 minutes. Using materials from the related genetic disease foundations and support groups, the website now includes basic information about the disease, clinical symptoms, epidemiology and frequency of the disorder, and the underlying genetics, as well as providing users with a sense of what it is like to have the disease. Once developed, the laboratory will keep the websites current, providing an up-to-date source of reliable information for health providers and patients. |
| Leadership Training for Safety Net Hospitals |
| The National Association of Public Hospitals and the Robert F. Wagner School of Public Service of New York University Principal Investigator: : Betsy Carrier, Vice President for Education and Operations, NAPH Many medical institutions are now led by individuals with extensive management and leadership training, often putting the nation's safety net hospitals at a disadvantage if their physician leaders lack these skills. In 1999, the Macy Foundation awarded a grant to the Wagner School at New York University (NYU) and the National Association of Public Hospitals (NAPH) to develop a program that would help public hospital physician-leaders gain this needed expertise. That effort was remarkably successful, with 137 participants involved in 12 meetings. Those participants represented 49 hospitals and 38 medical schools in 22 states and included representatives from 63 percent of NAPH member hospitals. This renewed project builds upon the success of that initial effort and makes it possible for the group to continue its work, with a goal of involving 100 additional medical directors and department chiefs, potentially reaching all of the safety net institutions. In addition, at the request of past participants, the group has a new session on implementing quality improvements in large safety net institutions. The NYU/NAPH is establishing a database, posting instructional materials on the Web, and developing a resource guide for safety net hospital physician leaders. This project also is producing a peer network of trained leaders committed to maintaining and strengthening the nation's public hospital system. |
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