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Annual Meeting Speakers Connect Lessons of the Past With Hopes for the Future
In celebration of the AAMC's 125th anniversary, the Leadership Forum of this year's Annual Meeting began with a procession of the banners and flags of the 22 founding colleges of the AAMC. The representatives of these colleges met in Philadelphia on June 2, 1876, to establish a society dedicated to medical education reform. Continuing in the spirit of the AAMC's founding fathers' commitment to quality medical education, AAMC President Jordan J. Cohen, M.D., advocated reforms in medical college admissions and acculturation to medical practice in his address to the 112th Annual Meeting. Dr. Cohen opened his speech by recognizing the innumerable health professionals who lent their skills to the rescue efforts that aided the many victims of the Sept. 11 terrorist attacks. Seeing images of these heroic physicians, nurses, and emergency responders, said Dr. Cohen, "resonated with most peoples' deep-seated image of medicine as a moral enterprise." However, Dr. Cohen continued, this traditional image of medicine is increasingly suffering under recent media-driven critiques of the medical profession, tarnishing the reputation of the field and perhaps contributing to the continued decline in the number of medical school applicants. To entice the best and the brightest students in the nation to consider a career in medicine, Dr. Cohen offered a plan to alter the way medical schools currently choose their incoming classes - a way that, according to Dr. Cohen, over-emphasizes test scores and under-emphasizes personal characteristics. He suggested that this approach to the admissions process "does not project to prospective applicants the degree to which we value, in addition to GPAs and MCAT scores, those other essential attributes we prize: altruism, fervor for social justice, leadership, commitment to self-sacrifice, empathy for those in pain." Dr. Cohen suggested - to the sound of warm audience applause - that schools begin student screening with an assessment of personal characteristics, use standardized test scores only as threshold measures, and use past experiences to improve their ability to identify promising students. "As a general rule, it doesn't take long for a consensus to emerge among faculty and staff about who among each entering class of students are destined to be the best, most caring, most compassionate physicians," Dr. Cohen declared. "Why don't we look back at those students' credentials at the time of admission and see if we can find some common characteristics that might be helpful in sharpening our ability to identify such stars among future applicants?" Dr. Cohen also asked the medical education community to examine carefully the manner in which it acculturates students and residents to medical practice. Noting that many idealistic students turn cynical by the time they finish their residencies, he encouraged his audience to model the professed values of the medical profession in their actions as well as their words. "No matter how successful we are in attracting idealistic, properly motivated students to medicine now or in the future," said Dr. Cohen, "we have little hope of delivering the same number of idealistic, properly motivated doctors to society unless we can close the gap between rhetoric and reality." To assist schools in fulfilling this task, Dr. Cohen distributed a draft of a "Compact Between Teachers and Learners of Medicine," a list of guiding principles and norms of conduct to which faculty members, residents, and students could aspire as a reminder of their motivation to become compassionate healers. Such a contract, concluded Dr. Cohen, "can exert more self-discipline and, in the process, prepare our students and residents to face the future with confidence that the profession they inherit will be a true calling, and not just another beleaguered occupation." Great Expectations Outgoing AAMC Chair George F. Sheldon, M.D., Zack D. Owens Distinguished Professor of Surgery and former chair of surgery at the University of North Carolina, Chapel Hill, began his address to conference attendees by reviewing the tremendous contributions physicians and scientists have made to medicine since the first AAMC members met in 1876. "The greatest decline in mortality in the history of the world occurred during the last one hundred years," he declared. "This is a tribute, in large part, to the success of the academic health center system of this country. It also has raised great expectations for the work force we produce for the future." After reviewing the profound exponential growth of improvements in health care delivery and technology throughout the 19th and 20th centuries, Dr. Sheldon voiced his concerns that the current health care work force is not sufficient to implement rapidly advancing technology and meet an aging population's demand for specialized services. Recognizing past flaws in attempts to predict national physician supply, Dr. Sheldon made a case for his opinion that in order for tomorrow's health care needs to be met, the current number of annual medical school graduates - 16,000 plus - must be increased and greater importance must be placed on graduate medical education in current and evolving specialty areas. Noting the growth of non-physician practitioners and the overlap of the services they offer with those traditionally provided by generalist physicians, Dr. Sheldon drew the conclusion that the current profusion of primary care providers is unmatched by the number of physicians capable of providing specialty services. He thus called for a concentrated effort on the part of medical educators to develop a larger specialty work force. "While some services are economically and qualitatively better provided by non-physician clinicians," Dr. Sheldon concluded, "the complexity of translational modern science requires a highly specialized, scientifically oriented physician as the key health professional for the 21st century." Learning From History In her keynote address to a packed auditorium, noted historian and Pulitzer Prize-winning author Doris Kearns Goodwin concluded the Leadership Forum by recounting stories about the four American presidents she has studied and shared moments from her own personal history. Goodwin recalled stories about her friendship with Lyndon B. Johnson, a relationship that began with an internship in the White House and ended in conversations with the former president during his final days spent at his Texas ranch. She went on to explain her fascination with the Kennedys and the Roosevelts, whose histories, along with Johnson's, she has chronicled in her writings. Goodwin wove throughout her comments comparisons of how America's leaders and citizens have responded to difficult times in the past - such as the Depression, World War II, and the civil rights movement - with today's significant international and domestic challenges. Goodwin ended her address the way she began it, attributing her love of history to her parents' influences on her as a girl and a young woman. She recalled how she learned to love both baseball and story-telling by recounting Dodgers games, play-by-play, to her working father, and how her invalid mother read an endless number of books to her when she was a child. Listening to her words, Goodwin's applauding audience was left with a sense that each of our histories is both of our own making and defined by the times in which we live.
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