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Winter 2011

Musings on the Welch--And Grand Rounds

Date: February 18, 2011

Musings on the Welch—and Grand Rounds

As I anticipate my 50th reunion after graduating from Johns Hopkins in 1960, I have many times thought about the 17 years spent in Baltimore as a medical student, Osler resident, cardiology fellow, Osler chief resident, and faculty. In your fall issue, two articles revived my memories of good things that happened while I was at Hopkins.

The first was the article written by Simeon “Moan” Margolis relating to the Welch Medical Library (“Lost in the Stacks No More,” p. 14). I recollect that during my first and second years at Hopkins, I spent practically every night in the Welch Medical Library trying to keep up with what I learned from my instructors. In addition, it also provided an opportunity to discuss a lot of things, medical and non-medical, with friends in my own class and other friends senior to me in medical school. As Moan has pointed out, there is no question that we studied differently than medical students do today. In fact, since I still attend on the inpatient cardiology service, I cannot recall seeing a textbook of anything, let alone cardiology on the wards or in the offices assigned to the house staff.  I have found that if I ask a question that a student or house officer can’t answer, they say, “Just a minute, Dr. Conti, I’ll look it up on Google or Up-To-Date.” And, of course, the answers are generally there, including pictures, pathology, images, you name it. The only thing that concerns me about this method of learning is that there is a tendency for little reading after the day’s work is done.

Moan also pointed out something that goes on routinely when lectures are given to students and house staff— i.e., handouts of copies of the slides used in the presentation. I don’t like doing this, but I suspect that if we didn’t give these handouts to the listeners, the amount of information that would come across from PowerPoint slides would be so much that it would overwhelm the student or house staff member. I still like to write and draw things on a blackboard and give the listener a little more time to absorb what I am trying to get across.

The second thing I’d like to comment on is the Saturday morning Grand Rounds in Hurd Hall (“High Point of the Week,” p. 44). I can recall as a resident presenting many patients in Hurd Hall. We were given five minutes for a presentation with the patient and a nurse there. The discussant was given approximately 10 minutes with five minutes for questions. This format worked out beautifully. To this day, I am a firm believer that the case presentation method of teaching clinical medicine is still the best way to do it.

Unfortunately, Grand Rounds have morphed over the years into a one-hour lecture often related to a specific area of research that only those who work in the lecturer’s laboratory have a complete understanding. I have no objection to having research worked in with the clinical presentation, but it needs to be aimed at the level of the internist, or third-year medical resident, not the lecturer’s laboratory workers.

At any rate, I really look forward to returning to Baltimore in June. Perhaps I'll even be able to attend a Grand Rounds and visit the Welch Library.

C. Richard Conti ’60, MACC
Emeritus Professor of Medicine & Eminent Scholar (Cardiology)
University of Florida College of Medicine

[I just finished] the article written by my friend and colleague, Dr. Simeon “Moan” Margolis, be-moaning (pun intended) the understandable loss of books from the wonderful Welch Medical Library. I share both his sense of loss and his understanding of the need for this move. During both my own pediatric house staff training and my time as a PhD student I spent endless intellectually stimulating hours ensconced in the Welch Medical Library in my own tiny and austere (read: monastic) carrel. Occasionally I could emerge into the wonderful and handsome reading room where all the new journals that had arrived that day (or the day before) were displayed and where I could leaf through whichever ones I fancied. I could also go into the repository room for the Index Medicus (the Google of yesteryear) where I could try to find past publications on a topic of my choice. In the past 12 years, I doubt that I have entered the Welch Medical Library more than six times.

Perhaps also relevant is an aphorism that I first heard from another friend and colleague, Dr. Donald Coffey, who claimed (during the first or second of the three curriculum revisions that have occurred in the 51 years that I’ve been at Hopkins) that the curriculum really didn’t matter very much for an excellent education. All you needed for an excellent education were excellent teachers, excellent students, and a key to the library. I guess the modern version would be excellent teachers, excellent students, and a computer. Could it be that in the post-modern era we could do away with the excellent teachers, and perhaps even the excellent students? Then maybe we could have one central national online curriculum and one central national computer that could communicate with the students’ computers and we could call that education.

Paul S. Lietman, MD, PhD
Professor Emeritus
Departments of Medicine, Pharmacology and Molecular Sciences, and Pediatrics