In this issue:

  Health care policymakers from Denmark explore emergency medical care during Boston visit

  Dennis Ross-Degnan is fourth to receive Klaus Peter International Teaching Award

  Conference organized by HMI and Hygeia Hospital focuses on preventive medicine

  Exchange program offers students from Taiwan new perspectives on medical practice and instruction

  Tokyo faculty continue curriculum development work at 10-day course in Boston

  Founding members of WHARF faculty attend AIDS conference at Harvard-affiliated hospital

  HMI and Dominican university collaborate on plans for new medical school

Health care policymakers from Denmark explore emergency medical care during Boston visit
A contingent of hospital leaders from the Northern Jutland Regional Healthcare Committee in Denmark participated in a three-day program designed to provide a survey of major challenges involved in developing emergency medical systems. The 17-member group was made up primarily of health care policymakers serving the County of Jutland, which represents about a fifth of the country’s population.

The group’s efforts coincide with significant changes to the structure of government in Denmark. Traditionally, the country has been divided into fourteen counties. This layer of government has been responsible for operating hospitals and providing primary care services. However, in the past decade, the country has been transitioning to a reorganization of the country into five regions, of which Northern Jutland is one. This shrinking of government has resulted in the need to find a way to deliver health care—and particularly emergency medical services—more cost-efficiently.

Dr. Philip Anderson

Philip Anderson, MD, director of international emergency medicine at Beth Israel Deaconess Medical Center (BIDMC) in Boston, directed the program. “Denmark, like most European countries, has a multispecialty care model for emergency medicine, different from the system in the United States where emergency medicine is a recognized medical specialty,” he said. “This group is working to develop strategies that will enable them to improve how patients are evaluated, the accuracy with which they are evaluated, and the timeliness of providing care. These issues run parallel to another major concern going forward: how to develop and enhance the staff to provide emergency medical services.”

The program consisted of interactive discussions held in the morning, followed by afternoon site visits. Anderson provided an overview of pre-hospital and hospital-based emergency medical care delivery in the United States, including underlying assumptions and operational strategies. Other discussions addressed the role of telemedicine in regional health care delivery, helicopter-enabled emergency care delivery, and the pros and cons of centralizing services in pediatric hospitals. The site visits included not only the emergency departments of BIDMC and Children’s Hospital in Boston, but also the Boston MedFlight headquarters at Hanscom Air Force Base, the Boston Emergency Medical Services department, and the “Turret,” Boston’s emergency medical communications hub.

Dennis Ross-Degnan is fourth to receive Klaus Peter International Teaching Award

Dennis Ross-Degnan, ScD has been awarded the Klaus Peter International Teaching Award by HMI in recognition of two decades of helping clinicians in many countries and in many disciplines improve their use of medicines.

As a teacher of medical, nursing, and pharmacy students and clinicians, he has led medical student exchange programs between Harvard Medical School and the University of Tokyo; educated physicians in practice in Brazil on behalf of Harvard Medical International; designed clinical epidemiology and pharmacoepidemiology curricula in Indonesia and Australia; and led or taught in workshops on improving the use of medicines for clinicians and researchers in Bangladesh, China, Egypt, Indonesia, Kenya, Nepal, the Philippines, Thailand, Uganda, Vietnam, and Zimbabwe. Ross-Degnan is an associate professor of ambulatory care and prevention at Harvard Pilgrim Health Care.

Asked to summarize the importance of his international work to his professional career, Ross-Degnan highlighted the rewards of working with international colleagues, as well as the great potential for these kinds of collaborations to yield globally beneficial solutions: “My international teaching, primarily through the International Network for Rational Use of Drugs, has given me the opportunity to share knowledge and experience with health professionals, managers, and policymakers from many different settings, both industrialized and resource poor. The goal in our teaching programs is to create an environment in which the interactions and learning are multidirectional. There are unfortunately no simple solutions to improving use of medicines since the behaviors and motivations are so complex. However, people struggling with the same issues in different settings will often craft unique solutions that can be instructive to everyone. The lessons learned about improving quality of care and changing human behavior are as relevant in Boston as they are in Nairobi or Kathmandu. The interaction with people committed to improving health care, the intellectual stimulation, the long-term friendships, and the chance to make a difference have been the core of my professional life.”

The $1,000 award, established in honor of Prof. Dr. Klaus Peter, dean of the Medical Faculty at Ludwig Maximilians University (LMU) in Munich, Germany, is given annually to an HMS faculty member who has contributed significantly to the field of international medical education, international exchanges, and mentoring of international students, residents, and fellows at HMS. Dean Peter was instrumental in the establishment and in the continuing success of the alliance between LMU and HMS.

Past winners of the award are Andrew Colin, MD (2004); Manuel Guillermo Herrera-Acena, MD (2003); and Timothy Brewer, MD (2002).

Members of the conference’s multi-institutional faculty

Conference organized by HMI and Hygeia Hospital focuses on preventive medicine
HMI and Hygeia Hospital collaborated on a two-day medical conference focused on preventive medicine. For two days in June, a multidisciplinary faculty drawn from both Greek medical institutions and Harvard Medical School presented the latest knowledge on a wide array of diseases for which preventive approaches and diagnostic screening lead to better health outcomes.

Lowell E. Schnipper, MD, professor of medicine at Harvard Medical School and chief of the hematology and oncology division at Beth Israel deaconess Medical Center (BIDMC), led a series of discussions on a disease not often thought of as preventable by the general public: cancer. He cited colorectal cancer as an example of screening’s effectiveness in preventing tumors from developing. “It is not too far fetched to imagine that most deaths from colorectal cancer can be prevented. Numerous lifestyle factors have been identified that contribute to increasing or decreasing one’s risk of developing the disease,” he said.

Joseph Kannam, MD, also of HMS and BIDMC, presented evidence derived from national mortality trends, observational epidemiology, and international studies to show that cardiovascular diseases are preventable. He pointed out that preventive strategies such as the treatment of hypercholesterolemia, hypertension, and smoking cessation programs have contributed to a decline in age-adjusted cardiovascular disease morbidity and mortality in developed nations.

There is great potential to improve our ability to prevent neurological conditions such as stroke as well, according to Galen Henderson, MD, who directs the Cerebrovascular Disease and Neurological Intensive Care Unit at Brigham and Women’s Hospital. He emphasized that evidence-based stroke risk reduction therapies are often underused.

Harvey Makadon, MD, associate professor at Harvard Medical School and vice president of health systems development at HMI, was part of a round table discussion focused on preventing the spread of infectious diseases. Makadon has long been involved with efforts to prevent the spread of HIV, and again emphasized the need to provide education and training to help clinicians become better at addressing HIV in primary practice.

The conference also featured lectures by David Scadden, MD, director of the Harvard Stem Cell Institute, on the potential impact of stem cell research on medical practice; and Robert K. Crone, MD, president and chief executive officer of HMI, on the global burden of disease, in particular the significant impact of often preventable lifestyle diseases.

Exchange program offers students from Taiwan new perspectives on medical practice and instruction
National Taiwan University College of Medicine (NTUCM) has sponsored highly valued medical student exchanges with Harvard Medical School since 1985. Recently students from both institutions had the opportunity to study abroad through clerkships organized by HMI. The students gained insight ranging from the clinical to the cultural, from new medical knowledge to fresh perspectives on the systems and other factors that influence the physician’s role.

Four students from NTUCM completed clerkships at Harvard Medical School. Chia-hung Wu completed courses in advanced neurology and the selection and interpretation of clinical laboratory tests at Massachusetts General Hospital (MGH). His experience provided him with useful insight into not only the relationships that must be forged doctors and patients, but between faculty physicians and medical students. “I appreciated and enjoyed the process, the interaction, and doctor-patient relationship during the observations in outpatient clinics, which gave a good example for clinical physicians to learn how to meet the patient’s and family’s needs and fulfill the duty as a doctor.”

Wu enjoyed the emphasis on problem-based learning at MGH. “Attending doctors usually take students to the bedside, demonstrate the neurological examination, and take the history, instead of just sitting in a conference room and discussing the cases without really seeing the patients. Also, students are encouraged to interact directly with the patients, do the necessary procedures, and discuss with the residents whenever there are questions. This problem-oriented learning is efficient.”

Kuei-yu Lin completed clinical electives in advanced radiology and medical oncology at MGH. He was struck by the differences he observed between the number of patients seen by physicians in the United States during an average day, and the duration of those visits, versus his experiences in Taiwan.

Hsiao-sang Chu completed courses in pediatric ophthalmology (Children’s Hospital) and clinical immunology (Brigham and Women’s Hospital). She noted that she was impressed by the use of real patients in teaching situations at Children’s Hospital.

Hao-Jui Weng completed two clerkships at MGH, including an advanced study of neuropathology and a course in multidisciplinary pain medicine under the tutelage of Dr. Martin Acquadro.

David Hwang, a student at Harvard Medical School, completed a six-week psychiatry rotation at the National Taiwan University College of Medicine. He focused on child psychiatry, working to gain a better undestanding of developmental disorders like autism, Asperger’s syndrome, and mental retardation. Hwang also gained significant exposure to how mental health care is delivered in outpatient and emergency settings. “The value of being a student in the outpatient clinics and the emergency room is that one sees psychiatric illnesses presenting for the first time. I will never forget seeing a 15-year-old boy in the middle of his first psychotic break while in the emergency department or observing a hysterical man in the outpatient department attempt to explain why he was unable to control his own body movements.”

Frank Christ, MD, a member of the faculty of Ludwig Maximilians University, leads a discussion during the TMDU program.

Tokyo faculty continue curriculum development work at 10-day course in Boston
A group of fifteen physician-educators from Tokyo Medical and Dental University (TMDU) gathered in Boston recently for a program aimed at continuing the momentum of the school’s curriculum development efforts. Organized into four teams with specific objectives, the faculty members worked to design clerkships that ultimately can be integrated into TMDU’s medical and dental curricula.

The ten-day course was directed by Robert C. Stanton, MD of Joslin Diabetes Center and Harvard Medical School. Together with Elizabeth Armstrong, PhD, HMI director of education programs, Stanton developed a series of activities designed to introduce the program participants to a wide range of teaching practices and learning environments commonly used in leading medical schools. The program also emphasized the value of input from students, and the importance of assessment.

“The challenge for TMDU is not only to identify and understand different approaches to teaching and learning, but to develop a mixture of approaches that, incorporated in their curriculum, are appropriate for their educational goals,” said Stanton.

The TMDU contingent was divided into four working groups—three focused on developing clerkships in immunology, surgery, and basic science, while the fourth group, through interactions with faculty at the Harvard School of Dental Medicine, focused on dental education.

Jun Tsuruta of TMDU pointed out that this was the first of the three TMDU faculty development programs to include activities focused on dental education, and added, “We were really impressed by the clear structure of education at Harvard Medical School and Harvard School of Dental Medicine.”

“The group was very enthusiastic and focused, and I look forward to seeing how this work translates in Japan,” said Stanton.

Founding members of WHARF faculty attend AIDS conference at Harvard-affiliated hospital
Three physicians from Mumbai, India Menon attended the ninth annual “HIV Update: Contemporary Issues in Management” conference presented by Harvard Medical School and Beth Israel Deaconess Medical Center (BIDMC). While in Boston, Drs. Deepak Batura, Yatin Dholakia, and Shashi Menon also shadowed clinicians who care for HIV-infected patients at BIDMC and other local institutions.

From left to right: Shashi Menon, Deepak Batura, Howard Libman, and Yatin Dholakia. (Photo by Valerie Hope Goldstein, courtesy of Beth Israel Deaconess Medical Center)

The physicians are founding faculty members of the Wockhardt-Harvard Medical International HIV-AIDS Education and Research Foundation (WHARF), a non-governmental organization formed by HMI and Wockhardt, Ltd. Funded in part by a grant from the Horace Goldsmith Foundation, WHARF has developed a comprehensive curriculum for HIV prevention and care aimed at physicians, nurses, and counselors.

Howard Libman, MD, director of the HIV Program in Healthcare Associates, organized the clinical experience for the physicians.

HMI and Dominican university collaborate on plans for new medical school
The Dominican University of Organization & Methods (O&M) is planning to create a new medical school that will serve as the foundation for an integrated health care delivery system for the Dominican Republic. HMI has agreed to provide support in all areas of new school development, from strategic planning and facilities design to curriculum, faculty, and policy development.

O&M, which is based in the Dominican capital of Santo Domingo, was established in 1966 and has grown into the largest private institution of higher learning in the country, with campuses in all of the major cities. The university is well known in the Caribbean for its programs in law, engineering, business administration, and information technology.

Andrew Jeon, MD, MBA, HMI executive vice president and chief operating officer, said, “O&M has a great opportunity to build from the ground up an institution that emphasizes the major attributes of today’s top medical institutions, particularly an active learning-focused curriculum.”

Recently Jeon, along with HMI’s Tom Aretz, MD and Lynn Eckhert, MD, Dr PH, traveled to Santo Domingo to meet with representatives of O&M. Their discussions were aimed at clarifying the university’s objectives, formulating a timeline for the medical school’s development, and identifying the specific facilities, faculty, and educational elements required for the school’s launch. The team also reviewed several potential sites for the new medical school.

The new medical school is part of a long-term strategy that will culminate in the construction of an academic medical center offering clinical care for the people of the Dominican Republic while serving as the teaching hospital for O&M.

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