Two years ago, clinical immunologist Sarbjit (Romy) Saini leafed through a copy of the Department of Medicine’s faculty guidebook he’d received at a retreat. With each page he read, Saini felt a veil lifting. For the first time, he had a sense of how to map out his career and get promoted. The book “exposed the secrets of charting a future in academic medicine and blasted the myths that surround the promotion process,” Saini says. “This stuff used to be passed down only by word of mouth. Suddenly, it was all there—what was meant by a national reputation, how you record your publications. It really was a defining moment.”
Developed several years ago by Associate Professor Susan MacDonald for the Department of Medicine’s Task Force on Women, the handbook was originally conceived as a way to help female faculty battle their way through a system with gender prejudices and few role models and mentors. But Saini says the rules and guideposts it presents aren’t gender-specific. “We all need preparation for the evolution from junior to senior faculty.”
Now, the guide has been adapted for use throughout the School of Medicine for beginning faculty. Called the Promotions and Career Development Guide, it is full of useful facts like:
Finally, the handbook includes a special section instructing faculty on how to document scholarship in teaching. “This is a very important piece,” says Janice Clements, vice dean for faculty affairs, “because we need to place more emphasis on teaching. But how do you measure someone’s worth as a teacher? This is something faculty have a lot of trouble figuring out.”
As for Saini, he was an instructor when he first came upon the manual. Today, he’s an assistant professor.
With its paths, ponds and gardens, the Johns Hopkins Bayview campus has become an unlikely oasis. Last fall, a spiral walking course known as “the labyrinth” was added to the mix, a first in a health care setting on the East Coast.
The idea for the labyrinth, based on a 5,000-year-old pattern, was to create a peaceful, healing space for patients, visitors, employees and the community. There are no dead-ends or false turns. Instead, you’ll find benches on which to rest and reflect.
Located on the lawn between the Francis Scott Key Pavilion and the Johns Hopkins Geriatrics Center, the 20-minute course has already become a popular way for employees to take a break. It’s also become a favorite part of the activity program for Geriatrics Center patients, even those in wheelchairs.
Mary Ann Ayd
Life can be lonely business for the spouse of a resident. Now, a group where everyone's in the same boat is filling the void.
Match Day 1999 was a bittersweet moment for Avery Cameron. Her husband had been awarded his top choice—Johns Hopkins—for his pediatrics residency. But for Cameron, it meant leaving behind the network of “friends in the same boat” she’d made through the medical auxiliary of the University of North Carolina while her husband was in medical school there. She had come to rely on the group and its get-togethers to fill the hours when she was alone with her new baby. Now she’d be moving to a strange city, connected to a hospital with no such support network, while her husband, Scott, plunged into the unforgiving schedule of hospital internship.
For years, Hopkins had a housestaff-wives organization, but getting together was easier a generation ago when residents with families lived side-by-side in housing provided for them. Sometime in the early ’80s the group simply faded away.
“I knew before we got up here I had a big job ahead of me,” says Cameron. “I couldn’t live here and not have any friends.” The former elementary school teacher wasted no time in contacting spouses in other departments to find out if they shared her interest. Then, she presented the House Staff Council with a nine-page proposal, to establish the Medical Auxiliary of The Johns Hopkins Hospital, and received $1,000 to get it off the ground.
Since last September, when about two dozen spouses showed up at the first meeting, membership has doubled. For Melissa Meininger, who grew up near Baltimore and has friends and family nearby, the Medical Auxiliary is still “the only place you can go and find people who understand what you’re going through, what it’s like to have a husband who does this. I feel like I’m a single parent, even though I’m not. It’s real hard.”
On a Monday a few months ago, the topic was money. “That’s a big stress point for everyone,” says Meininger, whose husband, Glen, is a third-year resident in internal medicine. “You’re living on one salary that’s not very high. Everyone worries about bills. But there was one woman, whose husband is almost finished, who was telling us how her life would change in June, how she’d see more of her husband, and they’d finally be making more money than they spend.”
For the families of residents and fellows who will arrive at Hopkins come July 1, the group has prepared 250 “welcome packs” complete with an invitation to a picnic where the spouse will be the focal point, and a housing booklet listing houses and apartments that current residents will be giving up. (This last piece was critical to Avery Cameron, who was stumped about choosing a neighborhood to live in and bought her house sight unseen.)
“Last year, if I’d received a packet in the mail that said, Here’s this group, come to a picnic, I would just have felt so much more welcome,” says Cameron. “Because this is not just about my spouse and his job. It’s about an entire family uprooting and joining a new place.”
Mary Ellen Miller
Medications have gotten so complex that pharmacists now visit patients right alongside physicians. It's paying off.
With new drugs hitting the market daily, keeping up with the capabilities and hazards of each can be daunting—even for M.D.s. Add to this the fact that caring for critically ill patients, who often suffer multiple secondary complications in addition to their main problem, can require a physician to be conversant with 10 to 15 complex medications at a time.
Faced with such challenges, physicians in the Pediatric Intensive Care Unit here are relying on a new member of their patient-care team to advise them on details about today’s high-tech pharmaceuticals. Every day, when the team makes rounds to check patients, it looks to Mike Veltri, the only member of the crowd not wearing a white coat, for information about the most effective uses of medications. Veltri is one of a handful of a new breed of pharmacists called clinical pharmacists who have begun working on selected medical units at The Johns Hopkins Hospital since last year. The service has proved so successful, it’s now expanding to nine more clinical units.
“None of us are experts when it comes to knowing the precise dose levels of a drug that can be used safely in combination with another drug or how a dosage should be adjusted to meet changes in a patient’s condition,” remarks Ivor Berkowitz, the associate professor of anesthesiology/critical care medicine who was serving as the attending physician in the PICU on this day. “Having a clinical pharmacist with us has proved indispensable.”
Now, as Berkowitz and his group of residents, medical students and nurses make morning rounds to the accompaniment of the pings and beeps of equipment, the hushed voices of staff and an occasional cry for mommy, they come to a stop beside the bed of a heavily sedated teenage oncology patient who had been rushed to the PICU days earlier when his kidneys shut down.
A resident reviews the medical events of the previous night, which prompts a discussion on whether to change the patient’s antifungal medication. Until today, this youngster had been on a new drug that had presented no possibility of affectinghis kidneys adversely. But this costs $1,300 a day.
Now that the patient’s kidneys are again functioning properly, the team wants to know if there is any reason not to go back to a more standard and much less expensive drug. The dilemma poses both clinical and ethical questions, but Veltri quickly assures the group the change in medication won’t have a deleterious effect.
“This is exactly the kind of knowledge we rely on Mikto give us,” Berkowitz says. Several studies—one by the Harvard University School of Public Health, another by the federal Health Care Financing Administration—bear out Berkowitz’s assertion that medical practice improves when a pharmacist works with physicians. The Harvard study showed that nationally, having pharmacists on intensive-care units cut the rate of prescribing errors 66 percent—from 10.4 to 3.5 per 1,000 patients.
“Clinical directors also say they expect cost information from a pharmacist when they prescribe drugs,” notes Daniel Ashby, the Hospital’s director of pharmacy services. “By assigning these clinical pharmacy specialists to hospital units, we’ve got everyone singing from the same hymnal.”
By definition, the young patients who stay at the building known as Children’s House on the edge of campus are seriously ill. They’re all under treatment at Johns Hopkins, and can count on being there for a lot more than just an in-and-out visit.
But the dogs who drop in on these kids twice a month don’t seem to notice that the boy from Kenya is in a wheelchair, or that he’s blind and can’t speak. And they’re not fazed either by the full-leg casts on the little girl with Down syndrome. These furry, four-legged visitors are here to provide a floppy ear to yank on and a wagging tail to grab. They’re therapy dogs, who along with their owners are part of National Capital Therapy Dogs (NCTD), a nonprofit Washington-based organization that offers regular visits by man’s best friends to area hospitals and health care facilities.
Predictably, this canine contingent contains its fair share of amiable labs and retrievers. But on a recent evening at the Children’s House, some two dozen children and adults gathered in the company of Bailey, a stately Great Dane who dutifully followed the lead of a pint-sized walker. Two perky beagles, Daisy and Annabel, kept a watchful eye on the goings-on, as a tribe of toddlers got up close to coo and pet.
The dogs and their handlers are evaluated periodically for obedience—dogs must respond to commands like sit, stay, down and come—and pleasant dispositions. Before each visit, they are bathed, groomed and outfitted with official tags. Dogs must be free of parasites, infection and disease and have all their inoculations up to date. According to NCTD, in all the years of pet-assisted therapy in hospitals, not one case of infection has been shown to be caused by a dog.
Some 2,000 animals nationwide provide documented psychological benefits for the sick and disturbed and visit more than 350,000 patients each year. Here at the Children’s House, where kids often stay for long periods or return again and again, no documentation is required. There simply is nothing like a dog when it comes to lavishing unconditional love and helping a child forget.
Anne Bennett Swingle
When the health system's newest outpatient center opened at White Marsh just north of the city in Baltimore County on July 10, so many calls pummeled the switchboard on the first day from people seeking appointments that administrators speedily had to add more phone lines and staff. They attribute the response to the center's high visibility location across from IKEA and the White Marsh Mall, past which 40,000 cars drive each day. A large menu of medical services under one roof doesn't hurt either. The center features Hopkins physicians practicing all the common specialties plus a dozen family practitioners, internists, pediatricians and dermatologists. Plans are already in the works for White Marsh II.
Launched in 1959, the Year I Program hand selected bright undergraduates who were interested in research and gave them the chance to earn both a B.A. and an M.D. in seven years.
"Slim to none,” was how Richard Goldstein’s pre-med adviser described his chances of getting into medical school back in the early 1970s when he was a student at City College of New York and aspiring doctors were in huge supply. Then Goldstein heard about a special program at Hopkins. He could apply when he was just a sophomore and, if accepted, would know at once that he’d be able to go to the School of Medicine. He dashed off an application, enclosed a $10 bill and dropped it in the mail.
Goldstein (B.A ’74, M.D. ’77) had applied to Hopkins’ Year I Program in which undergraduates who had completed at least two years of college transferred to JHU (if they weren’t already enrolled there), took one year of joint study at the School of Arts and Sciences and the School of Medicine and then four years of medical school. They would receive their B.A. after their second year in the program, and their M.D. In seven years instead of eight.
Launched in 1959, the Year I Program started off with a group of hand-selected kids, remembers Registrar Mary Foy. “We were trying to attract bright students interested in research and fast-track them.” The program took about 20 students a year but can count a fair share of luminaries among its graduates. In the Class of 1966 alone, for example, were Marty Abeloff, now director of oncology at Hopkins, Lenox Baker, a key Hopkins trustee; and Frances Watt Baker, a member of the advisory board for this magazine.
In 1978, to provide a better transition between undergraduate and medical studies, a second joint year was added, following which students entered the second year of the M.D. curriculum. “Pre-meds often had been afraid to take non-science courses for fear of getting a poor grade,” says Hopkins endocrinologist and biochemist Simeon Margolis, who ran that later version of Year I. “With this program, they could take anything they wanted because they had already been accepted into medical school.”
Still, by then the concept of accelerated medical education was losing its luster. “We had to market it constantly,” Foy says. “Colleges didn’t want to give up their brightest students, not to mention two-years’ worth of tuition.” What’s more, there were always nagging worries about accepting students when they were too young, several faculty members from the era recall. The program ceased in the early 1980s.
Visiting colleges with his high-school-senior son Randy, the oldest of his 11 children, Goldstein, now a colorectal surgeon in private practice in Bucks County, Pa., returned to Hopkins last fall. On the tour, the two heard from premed adviser Ron Fishbein, who ironically had been dean of admissions at the School of Medicine in Goldstein’s day. The usual question—how easily can you get into the School of Medicine if you’re a Hopkins undergrad?—elicited Fishbein’s dim views of any form of guaranteed, or accelerated, medical education.
“Some 20 or 30 medical schools today have some sort of accelerated programs, but they’re counterproductive,” Fishbein asserts. “They lock students into decisions made prematurely, and offer no assurance that the guaranteed admission will inspire the recipient to test new waters or to explore other fields of endeavor.”
The elder Goldstein certainly didn’t bother to test new waters when he was a student. He tore through college and medical school, earning his M.D. when he was just 23. “I have always had mixed feelings about missing out on the experience of junior and senior years in college,” he now says. “Twenty-eight years later, I wonder: what was the hurry?”
Choosing a new department head at the School of Medicine, says Dean Edward Miller, is the most important thing he does. And because it’s critical to find just the right person for the job, the search process sometimes has been drawn out for years. No more. As of this fall, Miller has fast-tracked chairman searches.
Instead of expecting a search committee of busy faculty members to handle the background work before candidates can be interviewed, a pre-search group from the dean’s office now will take care of time-consuming jobs like eliciting a list of luminaries in the field from around the country and collecting their CVs. The search committee then can begin immediately to bring candidates to campus for interviews.
What’s more, says the dean, “If people we want to interview can’t meet our timetable, we’ll move on to the next name(s).”
Miller says times are moving too quickly to allow chairmanships to remain vacant. “Faculty become demoralized when there’s no permanent person in place to act for their department.” To ease that problem, he’s made clear he wants interim department heads to act as more than placeholders. “They’ll make decisions for the department for the time they’re in the job.”
In light of the departure or pending retirement of a series of chairpersons, Hopkins suddenly finds itself with several top-echelon vacancies. Medicine, Pathology, Psychiatry, Dermatology and History of Medicine all currently are searching. With the streamlined system, “we’ll have new department heads in place in less than a year,” Miller states. And, in fact, just two months after Edward Benz announced last fall that he’d be stepping down as head of the Department of Medicine (and the William Osler Professorship) to become president of the Dana Farber Cancer Institute in Boston, the dean reported the groundwork had been laid to identify his replacement. “Resumes are already coming in the door,” Miller said.
In a new approach to medical discovery, eight biomedical departments and several hundred scientists will soon operate under one umbrella, thanks to what is being called the largest single initiative for the basic sciences here in the last 50 years: the School of Medicine’s new $125 million Institute for Basic Biomedical Sciences.
The new institute, with its shared administration and facilities, links the departments of Biological Chemistry, Biomedical Engineering, Biophysics and Biophysical Chemistry, Molecular Biology and Genetics, Molecular Cell Biology, Neuroscience, Pharmacology and Molecular Sciences, and Physiology. For researchers in these areas, the initiative will mean increased efficiency and collaboration in research focused on fundamental scientific discoveries.
Already jump-started with a $30 million gift from an anonymous benefactor long-associated with the medical school, the institute will spend $125 million in the next few years to train young scientists, support endowed professorships, recruit top new researchers and construct a $40 million building.
“The new venture is a response to the growing demand for scientific research that will advance medicine, “ Elias Zerhouni, the medical school’s executive vice dean, told the Washington Post. “In the past, we never had to deal with the amount of data we are now facing, nor with the complexity of the questions we now have to ask.”
The basic science faculty has chosen Tom Kelly, chairman of Molecular Biology and Genetics, as the institute’s first director.
The School of Medicine has hired James Owiny, a veterinarian, to assist scientists in following regulations pertaining to the use of animals in research. Owiny is building a training program on the Web on the proper handling of animals and a final test that scientists will have to pass.
Currently, 342 principal investigators throughout the University are engaged in research that uses 48,000 subjects, ranging from birds and mice to primates and sheep. With such controls in place, animal-based research would appear to be fairly problem free. It’s not. Animal-rights groups now are trying to extend the Animal Welfare Act to mice, rats and birds with the goal of preventing scientists from using these species to gain new medical understandings.
“We wish to assure you that Johns Hopkins will be an active participant in the fight to humanely use mice, rats and birds in biomedical research,” Estelle Fishbein, general counsel for the University, told the faculty in a memorandum.