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