Hopkins Medicine Magazine - go home
Current Issue Past Issues Talk to Us About the Magazine Search
an online version of the magazine Fall 2005
Circling the Dome
Hugh, a multitalented fellow, spurts blood, duplicates abnormal heart rhythms or breath sounds, and undergoes intubations.
WHAT A DUMMY
Hugh, a multitalented fellow, spurts blood, duplicates abnormal heart rhythms or breath sounds, and undergoes intubations.
   ARTICLES IN THIS SECTION:

 
 
 

What a Dummy

One lesson Betsy Hunt learned as a fledgling lifeguard has stuck with her: Told to dial 911 during a mock emergency, she heard the dispatcher on the other end ask for the pool's address and drew a blank. In one tongue-tied moment, she discovered that life-saving minutes can be eaten away by “things you don't have time to mess up on.”

Today, Hunt is a pediatric critical care specialist who has earned wide recognition for pinpointing equally mundane lapses that can occur amid desperate situations in hospitals—take the rare times when a child's heart suddenly stops beating. She's found, for example, that the first part of standard CPR–getting air into the lungs–is often done furiously. Meanwhile, checking for a pulse and starting chest compressions—if there's no heartbeat—appear as afterthoughts.

“Instead of using basic life support,” Hunt says, “people go for the defibrillator. But the hook-up takes time, and if no one's doing chest compressions, oxygen isn't getting into the blood. At six minutes, you're approaching irreversible brain damage.”

To help residents and nurses here sidestep such pitfalls, for the last two years Hunt has been staging monthly pediatric “codes.” Assisting her in these simulated emergency situations is Hugh, a multitalented fellow who spurts blood, duplicates any abnormal heart rhythm or breath sounds and undergoes intubations. He even flatlines in the same way a real patient might when his heart suddenly stops functioning. Hugh—aka SimMan—can perform these feats because he's a computerized medical mannequin.

Though a handful of academic medical centers have long embraced interacting with stand-ins like Hugh, at Hopkins this kind of simulation training has typically been viewed as time stolen from real patients. After meeting the mannequin man, though, doctors-in-training here now admit there's no question but that Hugh builds confidence.

“When I was an intern at real pediatrics codes,” says critical care fellow Nicole Shilkowski, “I'd think, How are you supposed to learn to deal with emergencies like this? But Hugh is so lifelike he can actually retch if your ventilations put air into his stomach instead of his lungs. You don't forget that.”

Hunt's work with Hugh has also made believers of patient safety expert Peter Pronovost and Vice Dean for Education David Nichols, and she's been tapped to head a new simulation center here slated to open next summer. The center, however, will be more than a place to hone skills. The point isn't to catch people doing things wrong, Hunt says, but “to figure out where everybody's falling down so we can improve our teaching.”

Mary Ann Ayd




The Changing Hood

Relocated East Baltimore resident Pat Tracey in her new digs.
> Relocated East Baltimore resident Pat Tracey in her new digs.

For 23 years, Pat Tracey lived in a little house on Rutland Ave. , just north of her job at Hopkins . The neighborhood was seriously drug-ravaged, but Tracey had learned to roll with the punches. If friends stopped by, she simply stepped outside and asked the dealers to cease business until her guests left. They always complied. For Tracey, this was home.

Then, a year ago, along with her daughter and two grandchildren, Pat Tracey became part of the first wave of 365 households to move out of the neighborhood to make way for a massive, $800 million redevelopment that will transform the area. Today, she lives several miles away in an end-of-group, three-bedroom town home with a front porch, landscaped yard and off-street parking. She has an eat-in kitchen with faux granite countertops, a bath on every floor and a third-floor master suite. And drug deals don't even appear on her radar screen.

Still, despite such grander surroundings, all residents of the decaying East Baltimore neighborhood haven't been delighted to have to leave their homes. “We were anxious and afraid,” admits Ava Warren, an EKG tech at Hopkins Hospital and Tracey's neighbor on Rutland . “We were being asked to do something we didn't want to do.” What residents say brought them around was the way staff at East Baltimore Development Inc. dealt with their upheavals. “They let us talk about our concerns and really listened.”

Arlene Conn, the agency's senior director of acquisition and relocation, believes also that many residents may not have understood their unusual benefits package: replacement housing equal to or better than what they'd come from and—for those who remained within Baltimore City—a $1,000 resettlement benefit for an appraisal and home inspection, plus a subsidy to help with the adjustment to higher property taxes. “We don't know of another place in the country where this is being done,” Conn says.

Warren, who is about to follow her neighbors into a townhouse community, now is doubt-free. “People who have lived on Rutland all their lives are sitting on porches in detached homes,” she says. “It's given hope to those of us still here.”

Meanwhile, as the old neighborhood empties out, demolition of hundreds of abandoned buildings around Hopkins is under way, and construction of new residential units and the first of five life sciences buildings has begun. By the end of the decade, medical students and residents arriving on campus should find themselves surrounded by a community chockablock with attractive housing, high-tech businesses, interesting shops and plenty of green space.


Anne Bennett Swingle


Classroom Gigs for Doctors

Classroom gigs

As the American Board of Medical Specialties gets set to institute new competency requirements for physicians, Todd Dorman, the School of Medicine 's associate dean for continuing medical education, is revving up.

Not that continuing education here isn't already thriving, mind you. Over the past 30 years, Johns Hopkins has achieved something of a reputation as a national leader in teaching physicians the latest techniques in diagnosing and treating patients. Between 55,000 and 75,000 doctors in a plethora of specialties, in fact, now sign on annually for one of these 600 “activity opportunities” (as Dorman calls them).

Physicians take these refresher courses in a variety of not unpleasant locations—upscale hotels at vacation spots, lecture halls on campus and even aboard cruise ships. But it's brand loyalty, Dorman says, that keeps them coming back to Johns Hopkins year after year for the updates they bring home to their practices.

Still, all this could be just the tip of the iceberg. The new national guidelines will require physicians in 24 approved medical specialties to show “evidence of a commitment to lifelong learning and involvement in a periodic self-assessment process.” For Dorman, that's reason to come up with more teaching venues. Current and past lectures, he says, can be put onto PDAs or the Web and he's also eyeing potential growth overseas, where most nations are just now implementing continuing-education standards. That, he says, is a huge potential market he intends to tap with help from Johns Hopkins International.

But there are some formats that Dorman still isn't ready to consider for teaching new material: self-directed learning, for instance, or web-based, activities. Those who see physicians refresher courses moving in this direction, he says, don't know human nature.

“Not many doctors want to take courses on the Web at night after working all day in the office and hospital. As long as physicians can combine educational opportunities with vacations, traditional CMEs will flourish.”

Barry Rascovar

 


Osler's Chair Goes Home

Last spring, as Mike Klag packed up his director's office in the Johns Hopkins Precursors Study to become dean of the Bloomberg School of Public Health, he came on one item he wouldn't be taking with him—a library chair that once belonged to William Osler, the School of Medicine's first chairman of Medicine and arguably the most famous physician of the 20th century. Klag is passing the piece on to a small collection here honoring the great physician.

It's a fitting last stop in a travelogue that began in 1905, when Osler moved to Oxford University and dispersed many belongings to a group of young doctors known as the latch-keyers—because they held keys to his Franklin Street home. Henry Thomas, the latch-keyer who would go on to become Hopkins ' first neurologist, got the chair.

In a phone conversation, Henry Thomas III, SOM '61, a retired pulmonologist in Hastings , N.Y. , and the grandson of that original Thomas, remembered the chair well. It passed to his father and then his mother, Caroline Bedell Thomas, who in 1946 launched the Precursors Study, the long-term analysis of the health of Hopkins med students that Klag most recently directed. Bedell Thomas willed the chair to the Study library.

But now, concerned that people are forgetting Osler, Henry III believes the chair should be used instead to “solidify the memory of a remarkable person who embodied the hospital and the medical school.”

And so, on June 1, almost 100 years to the day after Osler left Baltimore , his chair was carried across to the Hospital. There, in a room beneath the dome, it will become part of the Osler Textbook Room, the site where the great physician penned his most famous work, The Principles and Practice of Medicine.

Anne Bennett Swingle

 


Of Human Bondage

Man running a hamster wheel

A lot of basic science trainees wonder when they'll finally have a lab of their own.

 

In a glorious moment at the White House last spring, neuroscientist Solomon Snyder came to the podium to receive the National Medal of Science and proceeded to applaud a group often forgotten in such triumphant moments. “I am grateful that the work of my graduate students over the past 40 years has received recognition,” Snyder said in his thank you speech. “During that time, the importance of the dynamic interaction of teacher and student in scientific discovery has become more and more apparent to me.”

Snyder's acknowledgment of the critical role played by the scores of young men and women he's prepared for careers in the neurosciences must cheer not only his own charges, but also the hundreds of other basic-science trainees who toil in Hopkins laboratories year after year. Though the principal investigator on most research grants is the laboratory chief, most of the work here, according to Stephen Desiderio, director of the School of Medicine's Institute for Basic Biomedical Sciences, is done by grad students who are working toward their Ph.D.'s, and postdocs—who already hold the Ph.D. but are spending additional years working under a senior researcher. The long apprenticeship is requisite for an academic career. It's not unusual, in fact, for these young scientists to spend 60 to 80 hours a week in the lab. But as the academic job market tightens and the age of reaching scientific maturity—when you claim an independent lab, academic appointment and grants—creeps steadily upward, some wonder whether the system needs tweaking.

“By the time you begin your own research, you may be 36 or 37 years old,” says Abebe Tesfaye, the president of the Johns Hopkins Postdoctoral Association and a postdoc in Hematology. “You may be 40 before you get your first grant. It's very difficult to transition to an independent position when you've spent the past five years working 10 or 12 hours a day on your PI's project.”

This same conclusion was reached by the National Research Council. The newest report, commissioned by NIH director Elias Zerhouni and just out, cites the average age for landing the first NIH grant as 42. It suggests that the long number of years spent in postdoctoral positions “stymies the development of the most promising young researchers and the novel ideas they could contribute to science.”

As a remedy, the report recommends the creation of “career transition grants” to help postdocs become independent researchers—an idea that “sounds good but may be quite difficult to implement,” says Levi Watkins, associate dean for postdoctoral affairs. Watkins points out that in today's tight funding environment, money for such grants would need to be diverted from other sources. Moreover, he says, “most of our postdocs make the transition and do quite well.”

Still, postdocs feel anxious. “There is enormous concern about professional and career issues,” says Wendy Sanders, director of the Professional Development Office, which provides career assistance to junior faculty, fellows and students. “There aren't as many academic research positions as previously,” she says, “and that, combined with a greater than usual number of grad students and postdocs, makes the competition for [academic] jobs intense.”

Acknowledging that “the leap from being a postdoc to attaining that first position is enormous,” Sanders says Hopkins provides more assistance than most institutions. In addition to classes in writing grants and research papers and delivering research talks—free to postdocs and students—her office sponsors two to three career-related events a month. Recognizing that nearly half of the School of Medicine 's postdocs move into nonacademic careers after leaving, it also convenes 10 to 12 panels a year on alternative job options, including positions in industry. “Biotech and pharmaceuticals are probably the biggest draw for our graduates,” Sanders says.

Some faculty advisers are aware of the competitive pressure students and postdocs feel and are troubled by it. “They are under an enormous amount of stress,” says molecular biologist Randall Reed. “They think that if you don't have three publications in three high-profile journals, you won't be successful. That may be a misperception. I wish the emphasis were more on what you publish and not where.”

Still, things have changed a great deal for postdocs since 1992, say Sanders and Watkins, when the first postdoctoral association in the country formed at Hopkins . Surveys carried out then showed that variability in stipends and poor health and dental benefits were the major concerns of Hopkins postdocs at that time. Those issues have been addressed, says Watkins, with minimum standards for stipends and full medical and dental coverage now provided for all. “We also put a limit of six years on how long you could train here as a postdoc,” he explains. “Both preceptor and postdoc now know that you can't be here making $30,000 a year indefinitely. ”

And despite concerns about issues like jobs and parking, Tesfaye acknowledges that the most recent PDA survey in May showed that “the majority of our postdocs are quite satisfied” with their experience here. They view it as “a privilege and an honor” to be part of a scientific community where such first-rate work is going on. And most of them consider that to be the most critical aspect of their training.

Deborah Rudacille



Sixty-Year-Long Love Affair

Richard Ross
> Richard Ross

During the decade and a half since Richard Ross ended his 15-year run as dean of the medical faculty, if he ever speculated that he'd simply become a name on a campus research building, April 27 dispelled such notions. Late that afternoon, as the 81-year-old took the podium in Turner Concourse to accept the President's Medal—an honor the University reserves for people of great and distinguished achievement—he faced an ovation from more than 300 well-wishers who'd left their labs, clinics and offices to celebrate with him. Months later, Ross's voice still caught describing the event. “I was amazed,” he said, taking a deep breath, “at the number of people who appeared at the end of a busy day to attend the reception.”

That Ross was so touched by this outpouring on what's been his home turf for almost 60 years is in many ways a testament to his unflagging dedication to the place. No stranger to accolades, he was nearing the end of his term as president of the American Heart Association in 1974 when the National Heart and Lung Institute asked him to be its director—an offer he declined because it would pull him away from patients and his research. Even as dean, overseeing an enterprise that went from seventh to first in NIH research funding and from $20 million to more than $100 million in clinical income, he always set aside one morning a week to see patients and talk with students and house staff.

Never one to put his feet up, Ross still spends several half-days a week on campus, often working behind the scenes to promote the institution he fell in love with in 1947, when, fresh out of Harvard Medical School, he arrived for what he thought would be a one-year internship. “I am,” he says, “still here.”

Mary Ann Ayd

 

 
 
 
 
Features
 Catch Up Time
 To Outrun the Mouse
 Heavy Science in Asia Lite
 
Departments
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
 
Opinions
 Learning Curve
 Post-Op
 
Johns Hopkins Medicine

© The Johns Hopkins University 2005