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NOVEMBER / DECEMBER 2003

BULLETIN

In this issue:

: Immediate impact is focus of Practi-Med Kyoto—and future Practi-Med programs
: Teaching workshops in Germany and the Netherlands support curriculum reform
: AGA Linde, HMI award grants to support gas-enabled medicine
: Curriculum and infrastructure are focus of meetings between HMI and Philippines-based partner

: Medical Education Day highlights evolution of study at Harvard Medical School

A discussion session at Practi-Med Kyoto

Immediate impact is focus of Practi-Med Kyoto—
and future Practi-Med programs
On September 14th, 318 Japanese physicians and other allied health professionals gathered in Kyoto for Japan’s second Practi-Med course. Called “Advances in Medical Diagnosis and Management,” the one-day program was held by HMI in partnership with the New England Journal of Medicine (NEJM).

Dr. Jeffrey Drazen, editor-in-chief, and Dr. Thomas Lee, associate editor, both of the New England Journal of Medicine, joined Dr. Edward O’Rourke, director at HMI, and Dr. Gerald Smetana of Harvard Medical School to present symposia on a range of primary care issues, including asthma, depression, antibiotic use, and cardiovascular disease.

Dr. Shigeaki Hinohara

Dr. Shigeaki Hinohara, honorary president of St. Luke’s International Hospital and chairman of the Board of Trustees at St. Luke’s Life Sciences Institute, was impressed with both the program and the large turnout of physicians from western Japan (notably the Kansai region covering Kyoto, Kobe, and Osaka), which represented 65 percent of the group. At the first Practi-Med program held in Japan in 2002, only 10 percent of the attendees were from this region. Hinohara noted the value for Japanese health care professionals of being exposed to the American ideal of primary care. He added, “Compared with the usual Japanese medical seminars, which consist of lectures and Q&A, the Practi-Med seminar is very unique.”

Several attendees expressed hope that more programs like Practi-Med would be available to them, and that the concepts behind primary care practice would spread across Japan. Many were impressed with the breadth of material presented in a single day. Noted one participant, parts of the program would be “immediately helpful for tomorrow’s practice.”

Dr. Harvey Makadon, HMI director of health systems, built the concept behind Practi-Med. He said, “Primary care physicians in the different regions of Japan have the opportunity to prevent medical problems before they occur, or to diagnose and treat conditions as they arise. We hope that by communicating the latest advances and tools used to deliver quality health care, we can help elevate their daily practice and enhance the prestige of primary care in the region.”

With programs planned for the United Arab Emirates (Dubai, December 2003), India (Chennai, March 2004), and China (Shanghai, May 2004), Practi-Med has the potential to make an immediate impact on a diversity of health care communities facing an array of challenges.

Practi-Med Dubai, a collaboration of HMI and Dubai Healthcare City (DHCC), is the first of a series of lifelong learning programs designed for health care professionals in the United Arab Emirates (UAE). This three-day event will cover a wide range of topics, including the health of children and expectant mothers, the latest medical and surgical conditions, advances in cardiovascular disease, and advances in patient safety and health care management. In addition, Dr. Robert K. Crone, HMI president and CEO; Dr. Joseph B. Martin, dean of Harvard Medical School; and Adel Al Shamsi, CEO of Dubai Healthcare City, will participate with the United States Ambassador to the UAE, Marcelle Wahba, in a panel discussion on the future of health care in Dubai. HMI and DHCC have organized Practi-Med Dubai in conjunction with the New England Journal of Medicine and the Emirates Medical Association.

First offered in Brazil in 2000, Practi-Med was created by HMI as a forum to bring together health care leaders from around the world to discuss local, practical solutions to common health care challenges with practicing physicians and allied health care professionals. In some countries, leaders in primary care have struggled to gain recognition for the discipline of frontline care. For more information about Practi-Med and its upcoming programs, visit the website at www.practi-med.com.

Teaching workshops in Germany and the Netherlands support curriculum reform
Teachers became students in two workshops delivered recently by HMI to partners in Germany and the Netherlands. Both programs focused on understanding and applying learning theory to effective teaching techniques.

In September, Dr. Tom Aretz, HMI director of international education, joined members of the faculty of Ludwig Maximilians University (LMU) for a workshop devoted to learning about new teaching and assessment techniques, and to exploring MeCuM (Medical Curriculum Munich), the newly designed LMU curriculum. Thirty-six educators representing multiple departments used lectures and small group exercises to enhance their knowledge of learning theory, practice new teaching techniques, and develop their case-writing abilities. The participants also had the chance to try their hand at small group instruction. LMU remains at the forefront of sweeping changes in German medical education.

Dr. Elise Sarton, an anesthesiologist, works with the patient simulator during the Rotterdam workshop.

An HMI education workshop at Erasmus Medical Center in Rotterdam provided members of the Dutch “task force” on problem-based learning (PBL) with the necessary tools to move forward with the integration of PBL theory and methodologies into post-graduate training programs. The task force is part of a national effort to reform medical education in the Netherlands.

The 13 participants, who were training directors and coordinators in anesthesiology and orthopedics, were familiarized with PBL as it is used in many medical educational institutions. The three-day workshop focused on tutorials, case writing, curriculum design, and the assessment of knowledge, skills, and competencies by exploring innovative methods of evaluation, such as the OSCE (Objective Structured Clinical Exam) and use of a patient simulator. Participants also evaluated their own bedside teaching abilities by using the patient simulator to teach a clinical skill and undergoing a self and peer evaluation of that session.

Dr. Aretz led the program, along with Dr. Sigrid Adam, anesthesiologist and intensivist at the University Hospital Rotterdam, and Professor Paul O’Neill, associate dean for medical undergraduate studies, University of Manchester (UK). Dr. Adam commented that the workshop participants “were all very enthusiastic about further developing the PBL programs in their home institutions and made concrete plans concerning its implementation next year.”

AGA Linde, HMI award grants to support gas-enabled medicine
Casual observers of medical practice generally define the role of gas in medicine very narrowly. Gas is merely anesthesia—what puts us to sleep sothat the more complicated procedures can be performed. But what if gas itself were the treatment? Today scientists are working to develop applications for nitric oxide, carbon monoxide, xenon, and other “medical tools” that we can’t see with the naked eye.

In a ceremony held October 23rd in Boston, HMI joined AGA Linde Healthcare and the Karolinska Institutet of Sweden to award grants to seven scientists working in the emerging field of gas-enabled medicinal innovations (GEMI). Professor Louis J. Ignarro, the 1998 Nobel Prize Laureate in Physiology or Medicine, was on hand to present the GEMI Fund awards.

The seven awardees are:

Dr. Mark Conradi (Washington University, St. Louis, MO, USA) will study the use of specific gases in connection with magnetic resonance imaging.

Dr. Massimo Ferrigno (Brigham and Women's Hospital, Boston, MA, USA) will study a novel method to induce hypothermia, which is advocated in several clinical conditions to protect vital organs during ischemia and hypoxemia.

Dr. Tadeusz Malinski (Ohio University, Athens, OH, USA) will study the effects of gases on wound healing.

Dr. Danielle Morse (University of Pittsburgh, PA, USA), Dr. Atsunori Nakao (University of Pittsburgh, PA, USA), and Dr. Miguel Che Parreira Soares (Gulbenkian Institute for Science, Oeiras, Portugal) will study various aspects of carbon monoxide in three separate projects.

Dr. Markus Rehm (Ludwig Maximilians University, Munich, Germany) will carry out research on new aspects of inhaled nitric oxide.

To learn more about the GEMI Fund and its first recipients, visit the website.

Curriculum and infrastructure are focus of meetings
between HMI and Philippines-based partner
A delegation from AMA Education System Holdings, a Manila-based organization launching new medical and nursing schools in the Philippines, joined HMI faculty in Boston in October to develop plans and outline a strategy for readying the schools to receive students by June 2004.

Members of the AMA delegation

Dr. Lynn Eckhert, HMI director of academic programs, said that the weeklong interaction was a critical step in aligning the business objectives of AMA with the academic goals of this new initiative. While AMA has excelled at establishing academic and training programs in a range of disciplines, medicine and nursing represent new horizons for the organization.

During the visit, the AMA group, which included the newly appointed deans of both the medical school and nursing school, toured various local facilities. They visited Harvard Medical School, toured the Clinical Skills Assessment Center at the University of Massachusetts Medical School, and participated in a mock Code Blue at the simulation center at the Massachusetts Institute of Technology (MIT). At Northeastern University, they observed the simulation center and distance learning facilities. “AMA saw some programs that they would like to replicate,” said Eckhert. “The tours helped them to think about the best utilization of space, and to explore bringing some of these innovations to the Philippines. ”

Elizabeth Brown, RN, HMI director of clinical services, discusses nursing training with members of the AMA delegation.

Planning discussions began in April 2003 when AMA asked HMI to collaborate on the development of an academic medical center that will eventually comprise a medical school, a nursing school, and clinical facilities. The schools will initially serve 100 nursing students and 100 medical students. It’s an ambitious undertaking, given the timeframe and the resources that must be pulled together, but, as Eckhert pointed out, AMA has recruited some very experienced leaders to drive this project. The dean of the medical school has a solid background leading problem-based learning curricula.

Six AMA faculty members will be among the January class of the Harvard Macy Institute’s Program for Physician-Educators. AMA and HMI will continue to collaborate on the development of the medical and nursing curricula, and design faculty development and assessment programs to support this endeavor.

Medical Education Day highlights evolution of study at Harvard Medical School
The second annual Medical Education Day took place October 28th on the campus of Harvard Medical School (HMS). Sponsored by the Academy at Harvard Medical School and the Program in Medical Education, Medical Education Day brings together the latest innovations in curriculum development, assessment, faculty development, education research, and technology-enabled learning. HMS faculty members contributed presentations on both completed projects and works-in-progress related to medical education. Dr. Malcolm Cox, HMS dean of medical education, delivered a keynote address entitled “Reflections on Medical Education Reform at HMS” that reviewed how recommendations of the HMS Curriculum Reform Task Force are being translated into action.

Harvard Medical International highlighted a number of programs, including the Biosecurity 2003 conference, and the development, by the Harvard Macy Institute’s Program for Physician-Educators, of a teaching toolbox designed to help teach ACGME competencies. Other poster presentations detailed the wide range of HMS student exchange programs sponsored and administered by HMI. HMI also provided information about the recently published Advanced Disaster Medical Response, funding for which was generously provided by the Flatley Company. Dr. Susan Briggs of the HMI Trauma and Disaster Institute authored the manual, which is now available for purchase here.

The Academy, of which HMI medical director of international education Dr. Tom Aretz is a founding member, was established in 2002 to advance the education of future physicians by supporting the endeavors of HMS faculty and helping to drive innovation and scholarship within the medical school. The Program in Medical Education is the organizational structure encompassing all education programs leading to the MD degree at HMS.