Eyeing ‘a higher level of doctor’

The course is called “Doctoring,” and along with the foundations of anatomy, cell biology, physiology, genetics and other core medical sciences, it is one of the first building blocks of every Brown University medical student’s education.
It teaches how to conduct a physical examination, gather a medical history, talk with a patient and clearly explain a procedure, a diagnosis or a treatment plan. And it offers a first glimpse at the “big picture” of the health care system – how it’s financed, how the pieces fit together, how public health, private systems and communities interact with one another.
It is students’ first exposure to real-life medicine. Their teachers are practicing physicians, and for half a day every week, they shadow a mentor, watching the doctor be a doctor and getting a chance to interact with patients two full years before their clinical clerkships.
If you want to know where The Warren Alpert Medical School is headed, this is a good indicator, because it embodies key principles guiding the school’s ongoing transformation.
Like the two-year Doctoring series, the whole school’s curriculum is increasingly shaped and taught by working doctors – so even the basic science is more closely connected, from day one, to hands-on medicine. And students are surrounded by potential role models.
Like the Doctoring course, the whole school is increasingly looking at medicine in a broader context, encouraging tomorrow’s doctors to think about their place in the whole system.
And while Doctoring in particular has a clinical focus – with a lot of attention to primary care – its emphasis on hands-on experience is also emblematic of the new Warren Alpert Medical School. More and more, students are being encouraged to delve into community health projects, public service, and clinical and basic-science research.
The goal, say faculty members and administrators, is to produce a new breed of doctors who are sophisticated, socially aware, capable of working across disciplines, and able to help advance health care on multiple levels, from the lab to the public-policy sphere.
“We want leaders in public health, in primary care, in research … in the areas where we can make the biggest impact,” said Dr. Edward J. Wing, who this summer took over as dean of medicine and biological sciences.
With seven teaching hospital partners – Rhode Island Hospital and Hasbro Children’s Hospital, The Miriam Hospital, Memorial Hospital of Rhode Island, Women & Infants Hospital, Butler Hospital, Bradley Hospital and the U.S. Department of Veterans Affairs’ Providence VA Medical Center – and numerous affiliated private medical practices, the Medical School at Brown is a critical part of the state’s health care system.
Its more than 750 faculty members include the doctors who save trauma patients in the ER.
Its residency programs not only provide crucial manpower to local hospitals, but they’ve also trained hundreds of physicians who now serve Rhode Island’s communities, including more than 350 family doctors alone.
Its physical presence is enormous; the school occupies numerous buildings in Providence, on College Hill and in the Jewelry District, with a signature new medical school building to be erected in the coming years as well.
And the medical school’s research enterprise, which has grown dramatically in the last decade, is not only doing cutting-edge work in many fields, but it’s also bringing those scientific advances into the hospitals and pumping millions of dollars into the economy – $158 million alone in grants last year, including awards for hospital-based projects.
“If you’re doing cutting-edge research, you’re providing the newest and the best care for patients,” Wing said. “You’re also attracting the best doctors. … And technological advances in research, which are very exciting at Brown, will translate into economic development, from the university and from tech firms, the growth of biotech companies.”
Although Brown University’s involvement in teaching medicine goes back to the early 19th century, the med school itself was only set up in the early 1970s, and its limited enrollment, with 70 students admitted per year until recently, vs. more than twice as many at Harvard Medical School, made it almost boutique-like.
But Brown’s medical school has been growing its enrollment, to 96 students in this year’s entering class,Wing said. Primary care remains a priority for the school, but increasingly, graduates are going into other areas instead, reflecting a national trend.
But the most dramatic change has been the explosion of new research. In just over five years, the Division of Biology and Medicine has doubled its external funding, to $200 million per year. Often in partnership with the hospitals, it has opened numerous high-tech clinical and research facilities, including several Center of Biomedical Research Excellence (COBRE) sites that are using genomics, computer science and other new technologies to unveil the molecular processes behind cancer, for example, and develop new therapies.
Dr. James F. Padbury, a veteran professor of pediatrics, pediatrician-in-chief at Women & Infants, and director of the Brown-Women & Infants COBRE for Perinatal Biology, said the university has stood out in promoting interdisciplinary and inter-institutional research, collaborating not only with the hospitals but with the University of Rhode Island and others.
For the school itself – ranked No. 31 in the nation for research by U.S. News & World Report, and No. 23 for primary care – shining in research is crucial because “research is the driver for quality in medical schools,” Wing said.
For students, the growth of the research enterprise translates into opportunities to participate in projects involving everything from the latest in brain science, to smoking cessation.
In the Class of ’07, a whopping 85 percent of graduates had completed a research project with a faculty member, vs. 59 percent nationally, and 63 percent were co-authors on a paper submitted for publication.
But will this all come at the expense of Brown’s primary care focus?
Wing said it will not, though he and others interviewed for this article said they worry about primary care in general, because the low pay and harried work schedules are real turnoffs for medical school graduates, especially given their enormous school-loan debt (an average of $132,858 for the Class of ’07).
Dr. Jeffrey Borkan, chairman of the Department of Family Medicine and physician-in-chief of family medicine at Memorial Hospital, said he sees Brown “moving from a primary care-focused school to a multi-focused school” with primary care as one of its pillars.
“I think at Brown we’re developing a higher level of doctor,” he said. “We are going to create physicians who look beyond their narrow specialties and at broader medicine and community health.” •