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The best of times, but a worrisome future

Yale Medicine Magazine, 2011 - Spring


Dean points to recent achievements at the School of Medicine against a backdrop of troubling politics and economics.

“Things have never been better, and we’ve never been more worried about the future,” Dean Robert J. Alpern, M.D., Ensign Professor of Medicine, told alumni gathered for the annual reunion on June 4. With a still recovering economy, a presidential election looming, and possible threats to the NIH budget, Alpern expressed concern over the “crazy things going on in Washington.”

At the medical school, though, Alpern could point with pride to past accomplishments and future endeavors. Incoming students, he said, are arriving with higher GPAs and MCAT scores than ever. The medical school is examining the curriculum with an eye towards greater integration of the basic and clinical sciences. It has also established offices designed to improve teaching. Changes in financial aid are easing students’ debt burden. International research and teaching collaborations send faculty and students around the world to teach and to train. New buildings are under consideration so that researchers can have the space for new projects and the medical school can recruit more scientists. The clinical practice is growing as well, Alpern said, and relations between the medical school and Yale-New Haven Hospital are strong as the two entities work to implement an electronic medical record. And as the school encourages interdepartmental research, the gap between bench and bedside is narrowing.

Noting that the human genome project took 10 years and cost billions of dollars, Alpern said that the sequencing facility at West Campus can sequence an individual’s exome in a week at a cost of $1,000. And that has implications for the practice of medicine. “We are getting DNA samples on patients to make diagnoses,” he said. “We do whole exome sequencing, identifying mutations that are associated with disease, and tell the referring physicians the patient has this disease.”

The school is becoming more engaged internationally, with several collaborations already in place, notably with University College London, the University of Cambridge, and Fudan University in China. Students are traveling across the globe on international rotations, he said. “Many of our students are getting great international experiences. When you go to Africa it is the way medicine used to be practiced before you had MRI or a CT scan. You actually have to use a stethoscope.”

The medical curriculum is also under review, as is how it is taught, he said. “There is no question that there is a science to education,” he said. “We have an educator development office that teaches our faculty to teach, an assessment office that will teach our faculty to assess students, and a technology office that makes certain we are using the best technology in our education programs.”

The curriculum review is examining ways to break out of the traditional paradigm—a year of basic science, a year of clinical science, and two years of clinical education—and increase the integration of the science and clinical years. “Students wonder whether basic science is relevant to clinical experience,” Alpern said. “We believe it is. But we don’t think we send a message that it is.”

The traditional model of having faculty make time for teaching between their research and clinical duties, he said, is broken. “That’s been the model that has worked for American medical schools. The problem is that none of the payers in clinical medicine want to pay for that any more. It makes the cost of practice very expensive in an academic medical center,” he said. “We are focusing on raising endowed professorships and endowed funds for support of teachers.”

In recent years the medical school and the university have invested in such research and teaching facilities as The Anlyan Center, the Amistad Building, 300 George St., and the West Campus. Plans are under way for two new buildings, one abutting The Anlyan Center and the other to be built over the Route 34 Connector.

And the school is growing its clinical practice.

“We were a research-dominated school,” Alpern said. “That is changing. The clinical practice is the fastest growing part of our enterprise. We are becoming a more balanced medical school, where clinical practice receives the same emphasis as the research side. One of the things that has worked really well is that we have established a great relationship with Yale-New Haven Hospital.” The medical school and the hospital recently joined forces to implement an electronic medical record and together have identified a number of service lines in which they will focus efforts to expand the practice.

Alpern also thanked alumni for their support. “Last year was a really good year for philanthropy from the whole community, but especially from our alumni. The alumni fund had the best year it’s ever had,” he said.

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