Celebrating excellence at home during a time of global uncertainty

Dr. David Guzick, M.D., Ph.D.

October 14, 2008

“A tournament, a tournament, a tournament of lies.
Offer me solutions, offer me alternatives, and I decline.
It's the end of the world as we know it and I feel fine.”
It's the end of the world as we know it (and I feel fine)
R.E.M., 1987

After the historic and cataclysmic changes that have occurred in world-wide financial markets since my last newsletter, I must open this essay by stating that the University of Rochester, along with its Medical Center and School of Medicine and Dentistry, is fundamentally sound. Higher education is in a better position to weather this storm than many other workplaces, and this University and Medical Center in particular can address these challenges from a position of strength.

We must also be realistic, thoughtful and prudent. Taking some liberty in an interpretation of R.E.M.'s lyrics that they didn't intend, we have lived through the “tournaments” of collateralized debt obligations played by investment bankers, through the “lies” of asset risk assessment, and through Herculean “solutions” that the markets have declined to accept thus far. We are about to try to thaw the frozen credit market by using government funds to buy illiquid assets and partially nationalize the banking industry. It is, indeed, the end of the financial world as we've known it. I'm not sure how “fine” we all feel, but in terms of the medical school and medical center, we will have to adjust to an array of significant financial pressures from a variety of sources.

In the meantime, our hospital, ambulatory practices, research laboratories, clinical research offices and classrooms are all full. We have a job to do. And we continue to excel. In this newsletter, I will highlight two major honors for which our faculty have been recognized in the past month: First, on September 10, it was announced that the winners of the 2008 competition for the British Medical Association's Book of the Year Award went to Philip Rubin, M.D., Professor Emeritus of Radiation Oncology and John Hansen, Ph.D., Professor of Neurobiology and Anatomy and Dean for Admissions, for their volume entitled “TNM Staging Atlas.” Second, the Accreditation Council of Graduate Medical Education (ACGME) recognized Diane Hartmann, M.D., Professor of Obstetrics and Gynecology and Dean for Graduate Medical Education, as one of three individuals nationally to receive Courage to Lead Award.

British Medical Association's Book of the Year Award

Author Richard Dawkins, Simonyi Professor for the Public Understanding of Science at the University of Oxford, presented 20 top awards at the annual British Medical Association (BMA) Medical Book Competition ceremony in London on September 9, 2008. According to the BMA, “competition was fierce, with 640 entrants competing across a variety of medical disciplines and categories.”

John T. Hansen, Ph.D.

The result? Drs. Rubin and Hansen's uniquely illustrated text depicting the different stages of cancer development, TNM Staging Atlas (Lippincott Williams & Wilkins 2007), not only won the award for best book in Oncology but also the top prize (“Book of the Year”) in the overall competition.

If you're wondering how an illustrated text – an atlas – can win the award for best medical book among all of the books published in the course of a year, all you have to do is pick it up, and read the text in conjunction with the magnificent illustrations. Not only do the text and illustrations constitute a beautiful work of art, but the presentation of the material represents a philosophy that has evolved over a 20-year time frame of teaching and clinical practice at the University of Rochester School of Medicine and Dentistry.

Beginning with the idea that the study of “neoplasm” can provide “new life” to cadaver dissection learning, Drs. Rubin and Hansen developed the concepts described in the TNM Staging Atlas and oversaw their evolution over many years. These concepts came to life during a preclinical elective course for first year medical students between 1988 and 1999 entitled “oncoanatomy.” Students were introduced to 3D/3-planar anatomy (superior/inferior, medial/lateral, and anterior/posterior) of cancer spread. The anatomic surgical dissection of cadavers was reinforced by viewing the anatomy on CT and MRI planar views. In 1998, Drs. Hansen and Rubin wrote a paper in the journal Clinical Anatomy (11:95-99) describing this course, which was the forerunner for many of the educational paradigms described in the Atlas.

The overarching principle underlying this approach is that oncoanatomy becomes the paradigm for oncotaxonomy. That is, the anatomic extent of cancer spread is the basis for cancer classification and staging. Put differently, oncoanatomy refers to the normal tissue organization of a specific anatomic site that determines the clinical behavior of the cancer that originates there and its pattern of spread.

Dr. Rubin was Chief of the Division of Radiation Therapy of the Department of Radiology from 1957-1984, at which time this Division became the Department of Radiation Oncology. He was the founding Chair of this Department and remained in that role until 1995. His interest in the staging and classification of cancers dates back to the first edition (1977) of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual. He was co-editor of this volume, which was the first compilation of all primary cancer sites staged to that time. Through the years, he and Dr. Hansen were involved in the evolution of this manual to numerous editions of Clinical Oncology and Oncoimaging, and then to Clinical Oncology for Medical Students and Physicians, which was sponsored and printed by the American Cancer Society.

Prior to his role as medical school admissions dean, Dr. Hansen served as the Kilian J. and Caroline F. Schmitt Professor and Chair of the Department of Neurobiology and Anatomy from 1992 to1995. He is the recipient of numerous teaching awards and in 1999, he was the recipient of The Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Award given annually by the Association of American Medical Colleges to nationally recognized medical educators. Before embarking on his “second career” in education, Dr. Hansen's work on the peripheral and central dopaminergic systems, neural plasticity and neural inflammation encompassed a 25-year span of extramurally funded research. In addition to about 100 research publications, and his co-authorship of the TNM Staging Atlas, he also is coauthor of Netter's Atlas of Human Physiology, consulting editor of the Atlas of Human Anatomy, author of the Essential Anatomy Dissector, author of the Netter Anatomy Flash Cards, a consultant on the CD-ROM Netter Presenter Human Anatomy Collection, and coauthor of Netter's Clinical Anatomy textbook for first-year medical students.

Top oncology book! Best of breed! Best book overall! Best of show! As the authors state in their introduction, “A picture is worth a thousand words; a well designed illustration is worth even more.” To get a first-hand look, visit the Miner library, where a copy of the TNM Staging Atlas is at the main information desk. It is well worth the trip.

ACGME Courage to Lead Award

Dr. Hartmann's Courage to Lead Award from ACGME is well deserved and, to those familiar with her contributions to Graduate Medical Education, comes as no surprise. To put the matter succinctly, Dr. Hartmann is an extraordinary physician and educator who, because of her deep commitment to graduate medical education and her leadership skills, has been able to galvanize a loose confederation of 70 residency and fellowship programs into an integrated, powerful GME program for the institution as a whole.

Diane Marie Hartmann, M.D.

As Dean, I would like to think that we have been successful in graduate medical education in part because of the support that the medical center provides to GME. The truth is that while we provide Dr. Hartmann modest resources, it is her inspiring leadership that has been the critical factor in bringing together the diverse medical specialties, personalities, and varying departmental agendas into a cohesive, fine-tuned GME enterprise with shared values and goals. Under her guidance, the University was honored this year to be one of the four institutions nationwide that was selected and visited by the ACGME's Committee on lnnovation in the Learning Environment (CILE).

I first met Diane in 1995 when I was finding my way as the new Chair of the Department of Obstetrics and Gynecology. Diane was Associate Director of the Ob-Gyn residency program, and needed another year from her residency to be eligible for a Program Director position. So I became the Program Director and Diane remained as Associate Director. We met every week, and I learned a great deal from Diane about how to run a residency program. But I also learned a great deal about Diane and her commitment to our residency: she not only orchestrated the formal, RRC-required components of the residency, but also cared enough to find out about the hopes and dreams of the residents, and about all pertinent family matters involving spouses and children. She also monitored the occasional flare-ups between residents, between residents and faculty, and between residents and staff, which she handled immediately and with sensitivity. Above all, it was abundantly clear to the entire department that Diane was about excellence – in the education of our residents, and by extension in our faculty and our institution.

Diane's transition to Program Director was seamless; she did such a great job that in 2001 she was appointed by then Dean Hundert to become Dean for Graduate Medical Education. Since then, she has transformed GME at Rochester. How so? Here are a few of the many statements that were made on Diane's behalf as part of her nomination for the Courage to Lead Award:

Chairs

“When I assumed the position of Chair, our Department had a residency program on probation and in disarray. We confronted many challenges that threatened to derail our teaching program, including a paucity of qualified candidates; poor or failing written boards; a disenfranchised and disillusioned resident staff; confusion as to how to approach the 80-hour work week; and an outdated educational program. Six years later, we successfully recruit our top residency candidates, residents are publishing clinical and basic research articles at an unprecedented rate, and our resident conference schedule, outpatient clinics and research opportunities are among the best available anywhere. None of this would have been possible without the leadership and vision of Dr. Hartmann.”

“Dr. Hartmann provides a wonderful balance of empathy for faculty and residents in leading to an optimal outcome for the resident. She also knows when the issue at hand demands a definitive action. She is able to provide advice clearly that will lead to the right action for patient safety and care, and for the institution and our profession. Her principles do not waiver and her behavior always brings calm and decisive action.”

“Dr. Hartmann, in overseeing but assisting programs, takes the practical but high road, which does not compromise resident education for service. She is very sensitive to this “stress” and assists programs in finding ways to accomplish both ends.”

Program Directors

“The support that she and her staff provide to help programs prepare for internal reviews and RRC site visits is truly amazing. Although she is often put in the position of highlighting a program's deficiencies, she always does so with thoughtfulness and grace and an insight that can only come from having been a program director herself. As Chair of the Graduate Medical Education Committee, she listens carefully to all points of view and is highly skilled at bringing a diverse group to consensus. She deserves much of the credit for the long RRC cycle lengths that many of our programs currently enjoy and deserves virtually all the credit for our institution's unprecedented six year accreditation awarded by the ACGME at the time of our last institutional site visit. Her leadership was also instrumental regarding the University of Rochester's selection by the ACGME's Committee on the Innovation in the Learning Environment as one of the four institutions nationwide to be “studied” by them in 2007.”

“Dr. Hartmann has been extremely creative in her efforts to develop new local faculty development programs for program directors and clinical educators to help all of us do our jobs better. She travels widely and listens carefully for new opportunities to improve our programs and regularly brings back these “tricks of the trade” to GME Committee meetings. She also makes herself available to program directors whenever ‘crises' arise in their program. I have had my share of such crises since Diane became Dean for GME and have found her advice and support invaluable.”

“When I took over our residency program, it had been suffering from many problems: poor recruitment, dissatisfied residents, faculty apathy, and little dissemination of knowledge about the new ACGME competencies. To complicate matters, my program coordinator quit that week, and I had a site visit coming up in eight months. My initial panic was channeled to productive efforts with Diane's help. Her knowledge of residency program operations was evident as she advised me on what I should concentrate on fixing first and how to do it. During this time I also had to dismiss two residents and deal with other complex residency personnel issues. It was obvious that Diane's skills are not just in the knowledge she brings, but in her sense of timing, compassion, and professionalism in helping with these troubled individuals. Our program is now operating very well, the residents are much happier, and we have had three very successful recruitment years.”

Program coordinators and residents

Diane has also actively reached out to the unsung heroes of GME, the residency program coordinators. Because she understands the critical importance of these individuals to the success of our programs, she meets with them regularly to be sure that they are well-informed and receive the support they need to get their jobs done. Here is one comment from a Program Coordinator that capsulizes what many Coordinators conveyed:

“For as long as she has been in her position, Dr. Hartmann has held monthly Program Coordinator meetings and has spent countless hours researching the guidelines and requirements and passing the information on to us in an easy to comprehend format. Last fall I attended a national meeting for Program Directors and Coordinators. Because I had attended Dr. Hartmann's very informative and helpful sessions, I felt like I was already miles ahead of everyone else. It was then that I realized how lucky I was to have such a valuable resource right here and available when I need it.”

Finally, Diane stays in close direct communication with her most important constituency, the residents themselves. She meets regularly with residents from each program to hear directly how their experience is going and to solicit their advice regarding areas in need of improvement. She takes their suggestions extremely seriously and aggressively advocates on their behalf with departmental and/or institutional leadership whenever legitimate concerns are identified.

Diane's exceptional abilities as educator and leader of educational programs have brought her well-deserved national recognition and stature. Included among her more prominent national positions:

Board of Directors of the American Board of Obstetrics and Gynecology
Chair, Council on Resident Education in Obstetrics and Gynecology
Steering Committee, Group on Resident Affairs, American Association of Medical Colleges
Residency Review Committee for Obstetrics and Gynecology of the Accreditation Council for Graduate Medical Education

Dr. Hartmann has been an impassioned advocate for graduate medical education, yet also a measured and thoughtful guiding hand. Over the seven years in her position as GME dean, she has created a vision for GME that our faculty members have embraced, and has methodically put into place a series of tools, methods, and programs with which we have been able to realize a substantial part of the vision. She indeed had the courage to lead a highly disparate group of residency and fellowship program directors into the uncharted territory of core competencies, and emerged with a cohesive team focused on the common goal of superb, comprehensive graduate medical education and quality health care.

Meliora,

David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry
University of Rochester

Dean's Newsletter

Posted May 28, 2009:
A Fond Farewell to the University of Rochester

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