GrandRounds

Fall 09 Saint Louis University School of Medicine

Raising Expectations

curricular reforms emphasize critical thinking and finding ones passions

2009 White Coat Ceremony

A Little Spit and Polish Goes a Long Way

Forward Thinking

From the Dean | As our nation struggles with health care

reform, there are many challenges for medical education, health care delivery, health care finance and a myriad of related issues. The current spectrum of possibilities ranges from minor incremental adjustments to what could be a socio-political health care revolution. This follows on the heels of the biological revolution that occurred just a few years ago when the human genome was sequenced. As a result, the possibility exists that in the near future individualized medical therapy will be based on a persons unique genome. This utopian vision, however, is likely to be realized only at a substantial cost. Yet, reducing the cost of health care is one of the driving imperatives of the current health care reform movement. How are students to be educated in the midst of such apparent contradictions? How will American health care look and work in 5 or 10 years, and what meaning does that have for todays medical school curriculum? Obviously, we dont have all the answers, but neither does anyone else. Accordingly, we are sharing our ideas with regional and national leaders, with our faculty, with our students and with you. The latest edition of our new on-line alumni newsletter Dialogue with the Dean begins to explore these health care reform contradictions and controversies and to seek your ideas. Newspaper headlines each day promise that the legislative controversies may be resolved in the weeks or months ahead. Even so, the implementation controversies likely will be with us for many years. Were doing our best to prepare our students for these unique challenges using new approaches, some which are detailed in the current issues article about the curriculum. There are ways that you can help, too. Get engaged with Dialogue, come to the Medical Reunion events or just visit the campus at your convenience. Youll find many new programs, great new ideas and an enthusiasm for the future. SLU is preparing for change, participating in that change and hoping to set an example for the future. We hope that youll join us.

Grand Rounds is published biannually by Saint Louis University Medical Center Development and Alumni Relations. Grand Rounds is mailed to alumni and friends of the School of Medicine. Philip O. Alderson, M.D. Dean | Saint Louis University School of Medicine Vice President | Health Sciences Schwitalla Hall M268 1402 S. Grand Blvd. St. Louis, MO 63104-1028
GrAnd roundS EditoriAL BoArd

On the cover

Stuart S. Slavin, M.D., gets input from students as he reforms the medical schools curriculum. From left to right: David Wilson, Kristen Brandt, Claire Schultz, Sean Cavanaugh, Thomas Loh, Lindsey Enoch. Right: Jesse Whitfield and Nick DAngelo pick pole beans in the student garden as part of the School of Medicines wellness initiative.

Terence A. Joiner, M.D. 82 Philip O. Alderson, M.D. Edward J. OBrien Jr., M.D. 67 Thomas J. Olsen, M.D. 79
CoordinAtor And writEr

Marie Dilg | SW 94

dESiGnEr

Dana Hinterleitner Laura Geiser | A&S 90 | Grad 92 Nancy Solomon Carrie Bebermeyer | Grad 06 Sara Savat | Grad 04 Steve Dolan | cover, 8-11, 14-18 Kevin Lowder | 19
Photo CrEditS ContriButorS

GrandRounds
Fall 09
Vol. 7 No. 2 Saint Louis University School of Medicine
Curricular reforms emphasize formation of the whole person. | page 6

2009, Saint Louis University All rights reserved For more information about the magazine or to submit story suggestions, please contact 314 | 977-8335 or grandrounds@slu.edu.

Raising Expectations

Forward Thinking

Philip o. Alderson, M.d. Dean | Saint Louis University School of Medicine Vice President | Health Sciences

SLUCare maps out its strategic plan. | page 14

2009 White Coat Ceremony What a day!

Poised for Discovery

Dr. Belshe explores new vaccines and novel ways to deliver them. | page 18
page 18

What an opportunity! The Class of 2013 is encouraged to surpass patient expectations. | page 10

page 3

A Little Spit and Polish Goes a Long Way Dr. C. Rollins Hanlon

Vital Signs |

page 2

Alumni Pulse Living the Mission

continues working to improve surgical care. | page 12

| page 20

Profile of Philanthropy |
page 4

back cover

standing outside the Doisy Research Center

VitalSigns
Unlocking the Mysteries of the Brain: Investigators Search for Answers About Injuries, PTSD
In the first study of its kind, researchers at the School of Medicine are recruiting patients for a clinical trial that will use cutting-edge imaging equipment to map the brain injuries of combat veterans and civilians. Funded Bucholz by a $5.3 million grant from the U.S. Department of Defense, researchers will use three types of imaging equipment combined to produce better data and a more complete taxonomy of brain injuries. This is an extraordinarily significant study, said Richard Bucholz, M.D., lead investigator of the study and director of the division of neurosurgery. Its an opportunity to get a better handle on the problem, to see what actually constitutes head injury as opposed to relying on a vague description of someone who is having problems after a blow to the head. In the United States, approximately 1.4 million people suffer traumatic brain injuries each year. Of these, 230,000 are hospitalized and survive, while another 50,000 die. At the same time, combat veterans, now equipped with better body armor and armored vehicles, are thought to be surviving injuries that were once lethal.

As imaging technology and knowledge of the brain continue to advance, researchers believe that they can best leverage these developments by combining several types of imaging techniques: 3 Tesla MRI, 64 Slice PET/CT, and magnetoencephalography (MEG). The 3 Tesla MRI and PET/CT provide structural images, while MEG produces functional imaging. The aim of the study is to try to understand situations where patients with moderate head injury have anatomically normal brains but significant neurological impairment, Bucholz said. Weve noticed soldiers coming out of the Iraqi conflict whose MRI and CT images look structurally normal, but who nevertheless have significant neurological deficits. Scientists once believed that an injured brain was irreversibly damaged and that its function could not be recovered after being lost. It now appears, however, that the brain has the remarkable ability to rewire itself. Researchers anticipate that this study may aid them in identifying specific areas of the brain that can be rewired, as opposed to those that, once damaged, cannot be redirected. Between 120 and 150 participants will be enrolled in the SLU study, which will last approximately four years. Participants will include veterans and civilians with traumatic brain injury, as well as healthy civilians who have not suffered injury.

international, multi-center research study, School of Medicine researchers will examine teriflunomide, an investigational oral drug for multiple sclerosis (MS). They will test whether the medication may prevent or delay MS in patients who show symptoms suggestive of MS, while offering an alternative to currently approved medications which are injections. No oral medications are approved currently for multiple sclerosis. While various medications slow or modify disease progression, all must be injected into the skin, muscle or veins, making the search for an oral medication a top priority. We know that patients dont always take their medications as prescribed, said Florian Thomas, M.D., Ph.D., professor of neurology and lead researcher of the study. Many patients have a real adversity to injections. A clinical diagnosis of MS can be reached in a person who has had two neurological events separated by time and space, such as vision problems and, later, a spinal cord condition. However, there is mounting evidence that it may be beneficial to begin treatment soon after the first event in people at high risk for developing MS. For this reason, the study conducted at the School of Medicine seeks to enroll people who are at high risk for MS in this case patients who have had a single neurological event and an MRI that shows characteristics signaling the possibility of MS to evaluate the benefits of the drug to prevent or delay MS.

Multiple Sclerosis Pill Treats Illness Early | As part of an

Early, smaller studies of teriflunomide suggest that this is an effective drug for relapsing forms of MS. A medication in the form of a tablet may make it easier for patients to take it as prescribed and not miss doses, Thomas said.

a better treatment for the autoimmune disease myasthenia gravis, researchers have found that a protein in tick saliva shows promise in limiting the severity of the disease in an animal model. The findings were published in the Annals of Neurology. This disease can leave patients weak and on breathing machines, and conventional treatments can be toxic, said Henry Kaminski, M.D., chairman of the department of neurology and psychiatry and one of the nations leading experts on myasthenia gravis. There is a real need for better treatments. While drugs Kaminski like prednisone, a corticosteroid, can be effective in treating the disorder, they also can carry a host of severe side effects, including pronounced weight gain, osteoporosis, glaucoma and diabetes. Other treatments, intravenous immunoglobulin and plasmapheresis, which involve blood plasma, are expensive and can have rare but serious side-effects such as infections, heart attacks and stroke.

Tick Saliva Protein Studied as Treatment for Myasthenia Gravis | Looking for

Doctors believe that myasthenia gravis is caused by an overreaction of the complement system, a component of the immune system that specifically defends against parasites, bacteria and other pathogens. To impede the complement systems misplaced response, researchers hope a new class of drugs, called complement inhibitors, may stop the bodys defense system from attacking itself. Other researchers discovered that rEV576, a protein found in tick saliva, works as a complement inhibitor, allowing ticks to avoid setting off an immune response in their human host. SLU researchers, in collaboration with Varleigh Limited, tested the protein on two groups of rats with mild and severe models of myasthenia gravis. The health of rats that were given the complement inhibitor rEV576 improved, with reduced weakness and weight loss. Researchers hope rEV576 could have therapeutic value in human myasthenia gravis. And, because ticks apply themselves to people without causing a reaction, researchers are optimistic that rEV576 will not cause allergic reactions or other negative side effects. Complement inhibitors are a completely new class of drugs, Kaminski said. This one will probably prove to be superior to what weve seen. Since complement is activated in many diseases such as Alzheimers, stroke and rheumatoid arthritis, our studies may be important for other diseases.

Can the Bodys Defense System Treat Arthritis? |

A School of Medicine researcher is studying whether a group of immune system cells that is capable of preventing rheumatoid arthritis from developing also can be used to treat the disease. Using a grant from the Arthritis National Research Foundation, Richard DiPaolo, Ph.D., assistant professor in the department of molecular microbiology and immunology, is exploring

whether cells in the immune system known as regulatory T cells are an effective treatment for rheumatoid arthritis. DiPaolo, an Arthritis National Research Foundation Scholar, has invested the last seven years exploring how regulatory T cells work. We have shown that regulatory T cells can prevent the development of rheumatoid arthritis when given before the disease process has begun. We now will investigate whether they can be used as an effective

treatment when given after the disease is already in progress, he said. We also will investigate how regulatory T cells suppress diPaolo inflammation in joints. These studies will provide valuable insight into the potential to use regulatory T cells, or drugs that mimic their activity, to treat rheumatoid arthritis and potentially other autoimmune diseases.

Making Strides School of Medicine Students Form Charitable Organization

Tyler W. Rusts, M.D. (09) joy over the arrival of his first child in 2007 quickly turned to panic. Ashton developed a massive brain hemorrhage at birth that required immediate surgery. Surgeons had to remove a quarter of his brain to stop the bleed. Months of extensive medical care followed. Today, Ashtons mother, Holly Rust, said her blond-haired 2-year-old son is perfect. Ashton is developing right on target and, except for the scar on his scalp, no one can tell what he or his family has been through. Hes a miracle, Holly Rust said. We were fortunate to have the family and finances to get Ashton the care he needed, but the experience made me and Tyler think. What about families that cant afford the medical help their children need? What happens to them? This thinking led the Rusts to establish Strides 4 Kids, an organization comprised of medical students and friends of the School of Medicine who want to help children who need but cant afford lifesaving medical treatments. Its one thing to donate money. Its another thing to get involved, Tyler Rust said. When you get involved on a personal level, you learn something about yourself. When you serve, you gain. Strides 4 Kids teamed with the Leukemia and Lymphoma Society to sponsor the groups first 5K run at Tower Grove Park in the fall of 2008. More than 100 runners participated, and Strides 4 Kids raised $3,200. Ashton was at the race with us, and he had his own little Strides 4 Kids T-shirt, Holly Rust said. It was very emotional for me. At the end of the race I could pick him up and hold him and feel so blessed. I wanted so badly for other parents who are emotionally vulnerable to be able to feel the hope we were able to feel. Although the Rusts now live in San Antonio where Tyler is performing his surgical residency at the San Antonio Military Medical Center, Strides 4 Kids did not leave St. Louis with them. The Rusts and their team designed the organization so that its mission and annual 5K could pass seamlessly from class to class. Third-year medical student Jeremy P. Timm chaired this years event. We all got involved in medicine to help other people, and this is one way we can do that and have fun at the same time, Timm said. At the September 2009 5K run, Timm said more than 140 runners participated and the event raised more than $4,000 for the Leukemia and Lymphoma Society. For more information about the group, go to strides4kids.org

Grand Rounds Saint Louis University School of Medicine

researchers are taking part in a national study to explore whether drugs used to regulate nerves in the brain may also be able to help patients with functional dyspepsia. Saint Louis University is one of only six medical centers to participate in the NIH-funded study. Typically, a patient with persistent symptoms of functional Prather dyspepsia will have an endoscopy to rule out another condition, such as an ulcer, or have an ultrasound to exclude gallstones. Current treatment for dyspepsia includes dietary changes and acid suppression, but these approaches have had limited success for many people. It can be very frustrating for patients to be unable to pinpoint a clear explanation for the stomach pain, said principal investigator Charlene Prather, M.D., associate professor of internal medicine. Everyone has to eat, but when these folks do, theyre in pain. People with functional dyspepsia may have misfiring or misregulation of nerves going to the stomach, Prather said. We have as many nerves in our gut as in our spinal cord, she said. And we think one way to correct the problem may be to use medications that will soothe the nerves, potentially relaxing the stomach and allowing food to be processed correctly.

Study Aims to Gut Persistent Stomach Pain | School of Medicine

Volunteers in the SLU study will take one of two drugs: amitriptyline, an antidepressant thats also used for treating irritable bowel syndrome (IBS), diabetes, migraines and other illnesses; or escitalopram, an antidepressant commonly known as Lexapro; or a placebo.

NIH-funded study published in a June issue of Archives of Internal Medicine, researchers examined risk factors for pancreatitis, looking specifically at the connection to alcohol and tobacco use. Investigators, including a School of Medicine professor

Link Between Pancreatitis and Alcohol Not as Strong as Expected | In an

These pathology slides compare the severe fibrosis and glandular destruction in patients with chronic pancreatitis to patients with normal pancreas.

of internal medicine, were surprised that the relationship between alcohol consumption and pancreatitis was far less than expected. These research findings dispute the notion that alcohol use accounts for around 80 percent of pancreatitis cases, as previously believed, said Frank Burton, M.D., professor of internal medicine and one of the study authors. In fact, alcohols contribution to pancreatitis appears to be much lower. One thousand patients with pancreatitis were enrolled in the study along with 695 healthy patients, who served as a control group. Researchers found that only 38.4 percent of men and 11 percent of women with chronic pancreatitis were very heavy drinkers, a level much lower than anticipated. Smoking, however, was found to be a significant risk factor for pancreatitis, as was very heavy drinking, defined as five or more drinks a day. The study also demonstrated that the combination of smoking and alcohol is a risk factor for the condition. Interestingly, this study suggested that other causes, such as environmental or genetic factors, contributed to developing chronic pancreatitis in the large group who did not have a history of heavy alcohol use, said Burton. This offers a great deal of hope for the future that with continued studies we will be able to identify other potentially treatable causes of chronic pancreatitis.

LEADERSHIP NEWS
Di Bisceglie, M.D., has been selected to lead the department of internal medicine, a position he had assumed on an interim basis since July 2006. Di Bisceglie came to SLU in 1994 as a professor of internal medicine. Previously, he had been chief of the hepatitis studies and liver diseases sections of the National Institute of Diabetes and Digestive and Kidney Diseases. An internationally recognized expert in the field of liver disease, Di Bisceglies research interests are the treatment and natural history of viral hepatitis and the link between chronic hepatitis and hepatocellular carcinoma. Di Bisceglie received his medical degree from the University of Witwatersrand in Johannesburg, South Africa, and his gastroenterology training at Baragwanath Hospital in Johannesburg, South Africa, and at the National Institutes of Health in Bethesda, Md. He has served on many international and national committees, including those sponsored by the NIH and the Food and Drug Administration, and on many editorial boards for medical journals. He is an

DI BISCEGLIE to Chair Internal Medicine | Adrian

ad hoc grant reviewer for the Department of Veterans Affairs, the Merit Review Board and several sections of the NIH. Di Bisceglie is the co-editor of Hepatocellular Carcinoma in North America, Liver Disease: Diagnosis and Management and Comprehensive Clinical Hepatology (second edition). In addition, he has published more than 200 peer-reviewed publications, books and chapters and has received numerous honors and awards.

EISSENBERG Appointed Associate Dean for Research

Joel Eissenberg, Ph.D., professor of biochemistry and molecular biology, has been named associate dean for research at the School of Medicine, a position he had held on an interim basis since February. Eissenberg will work closely with the vice provost for research, help with the management of grants and contracts for medical school research and serve as a liaison between researchers and University administrators. Dr. Eissenberg is a strong leader and committed researcher. He is well respected by his peers, who recognize his passion for scholarship and his drive to bring together scientists in different departments to collaborate on projects of shared interest, said Philip O.

Alderson, M.D., dean of the School of Medicine. Eissenberg said he plans to lead the School of Medicine in capitalizing on the strengths of its core areas of research the Cancer Center, Liver Center, Center for Neurosciences, Center for Vaccine Development and Center for Cardiovascular Research in seeking grants for program projects that cross many disciplines. The idea of having a center is to bring together investigators from many departments who share a common interest in a problem, Eissenberg said. Funders want to support projects that reflect collaboration between researchers from different disciplines who work together to investigate a problem. Our goal is to bridge the boundaries between basic scientists and clinical researchers to create teams of investigators who bring their unique perspectives to a single project. Eissenberg joined the faculty of Saint Louis University in 1987 as an assistant professor of biochemistry and molecular biology, and he has an appointment as an adjunct professor of pediatrics.

M.D.(67), a urologist with 42 years of experience treating patients, mentoring medical students and serving

CHEHVAL to Lead Division of Urology | Micheal Chehval,

as a leader for the medical community, has been named chief of urology. We are absolutely ecstatic about Dr. Chehvals decision to return to Saint Louis University as chief of urology. He has been intimately involved with the program for decades as he directed our urology residents during their rotations at St. Johns Mercy Medical Center, said Robert Johnson, M.D., chairman of the department of surgery. He has long been cited by the residents as a great mentor and role model for them. After graduating from the School of Medicine, Chehval performed his residency at University of Iowa Hospitals and completed a fellowship at the American Cancer Society. He also has a masters degree in health service management from Webster University. In addition to directing SLU residents at St. Johns Mercy Medical Center, Chehval previously served at St. Johns as chief of staff, chairman of the department of surgery and chairman of the division of genitourinary surgery. Among other leadership roles, he served as president of both the Missouri Society of Urology and the St. Louis Urological Society. His research includes work in male infertility and prostate cancer. Im so pleased to be at SLU in a full-time capacity with the opportunity to guide the future direction of the program. My aim is to continue SLUs tradition of excellence as a leader in urologic care, especially in pediatric urology, Chehval said. In addition, I hope to expand our outstanding cancer treatment program.

SCALzO Appointed Medical Director of Clinical Simulation Center |

Anthony J. Scalzo, M.D. (79), professor of pediatrics and internal medicine at the School of Medicine, has been named medical director of SLUs Clinical Simulation Center. The facility uses computerized technology and high fidelity patient mannequins to teach medical school students, residents, faculty and health professionals in the community. Through the C-STARS program, U.S. Air Force medical military personnel also use the Emergency Medicine Trauma Simulation Lab, which is located in the center, to learn to treat the kinds of battlefield injuries theyre likely to see in a war zone. Scalzo is board-certified in pediatrics, emergency medicine and medical toxicology. He has served as medical director of the Missouri Regional Poison Center since 1986 and is director of the School of Medicines division of toxicology. Scalzo also has been an emergency medicine physician at SSM Cardinal Glennon Childrens Medical Center for 27 years. A fellow of the American College of Medical Toxicology and the American Academy of Pediatrics, Scalzo recently completed two three-year terms on the board of trustees for the American Academy of Clinical Toxicology, where he also is a fellow.

Saint Louis University School of Medicine Grand Rounds 4

VitalSigns

Slavin discussing new elective opportunities with a group of second-year medical students. From left to right: David Wilson, Sean Cavanaugh, Lindsey Enoch and Thomas Loh.

Slavin, however, made the case for change by citing research showing no significant variation between students in schools with grading systems and pass/fail systems. One study by researchers at the University of Virginia School of Medicine compared students from that schools class of 2006 the last class under its interval grading system, with the class of 2007 the first class under its pass/fail grading system. In the May 2009 issue of Academic Medicine, the researchers reported no statistical difference between the two classes in terms of academic performance. Performance in clinical clerkships did not differ between the graded and pass/fail classes, and the pass/fail class performed as well as the graded class on the USMLE Step 1 and USMLE Step 2CK (clinical knowledge). The study also found that residency directors did not give preference to students from either graded or pass/fail schools. Literature shows that residency directors dont give much weight to grades in the first two years of medical school, Slavin said. They consistently rate these lowest on their scale of whats important when evaluating a student for residency. They dont consider preclinical grades, in and of themselves, great measurements of excellence, and in my opinion, neither should we.

In for the Long Haul

ExpEctations
Stress Relief
Curricular reforms emphasize critical thinking and finding ones passion.
It could be seen as a clear case of foreshadowing. When Stuart J. Slavin, M.D. (83), M.Ed., was in his second year of medical school, he became interested in how physicians are educated. A self-described student activist, Slavin and a few of his classmates initiated the first formal program evaluation to rate their classes and organized a student/faculty forum to discuss the findings. Flash forward about 25 years. Slavin has returned to the medical school, this time as associate dean for curriculum and professor of pediatrics. He is again meeting with students and faculty to evaluate classes, but he is doing more than discussing. He is implementing the School of Medicines first major curriculum reform in more than a decade reforms he believes will allow students to develop critical thinking skills and to feel and live the Jesuit mission much more than they have in the past. We looked at our mission statement and goals and asked ourselves whether our learning environment matched our objectives and whether it embraced the Jesuit tradition of educating the whole person, he said. While we were doing well, we felt we could do better. The class of 2013 will be the first to feel the impact of the curriculum reforms, which have three integrated components: creation of longitudinal electives for first- and second-year students, reduction of classroom sessions during the first two years and revision of the grading system during the first two years to pass/fail for all courses. More importantly, Slavin said, the Virginia study and others demonstrated that the change to pass/fail was accompanied by a statistically significant improvement in psychological factors related to anxiety, depression, positive well-being, self control, vitality and the general physical health of students in the early semesters of medical school. A study by the University of Michigan found pass/fail grading eased anxiety, reduced competition and encouraged student cooperation. Grades are a major source of stress and social isolation, Slavin said. Some first-year students have told me that at some points during the year the only time theyre not studying is when theyre in the shower or sleeping. Medical school is tough. But when statistics indicate that, nationwide, 25 percent of first-year students are depressed and 11 percent experience suicidal ideation, we have to ask ourselves whether curriculum has something to do with it. As associate professor of molecular microbiology and immunology, and assistant dean of student affairs, James E. Swierkosz, Ph.D., knows about student stress. Students come to his office when they are in trouble academically and personally. He is a member of the Curriculum Management Committee, and he supported the change. It stands to reason that if you have someone who is burned out, depressed and anxious, theres a significant drop in compassion, he said. Its unrealistic to expect someone to be caring and altruistic when theyre in a compromised mental state.

Swierkosz said he believes the switch to pass/fail succeeded because the change is coupled with other reforms to the curriculum. The class of 2013 will be the first to engage in longitudinal electives designed to provide students with more rewarding learning experiences. Previously, first- and second-year students were allotted one half-day per week over seven weeks during the spring for their electives. Longitudinal electives will now extend across the majority of Year One and the first semester in Year Two, with one full day of elective time every two weeks. Every other Wednesday students have no required lectures and no labs just time to become fully engaged in research, community service and clinical experiences. The first two years of medical school are characterized too much by sitting in classrooms and reading in the library, Slavin said. It can be a depersonalizing experience. Our hope is that through these longitudinal electives, we can focus less on absorption of knowledge and more on educating the whole person and helping them find their passion. Slavin also noted that the longitudinal electives help faculty get a sense of how students are doing in terms of reliability, communication skills, integrity and ability to work with others. Under the old system, for example, the only outcome to measure the performance of students who spent their electives in research labs would be to see whether they presented at a meeting or published a paper. Now, every six months or at the end of the year, faculty members are expected to evaluate the students based on their overall performance. This evaluation can be included in deans letters sent to residency directors. They will get a much richer assessment of what our students are capable of and what theyre like as people, Slavin said.

We changed our grading standards and increased our elective hours to better align with the very outcomes that we espouse in our goals.
Community Support

| Slavin

Making the Grade

About 40 of the nations 125 medical schools, including Stanford, Washington University and Johns Hopkins, have adopted pass/fail grading systems for the preclinical years. SLUs School of Medicine had debated the merits of moving from the schools traditional system of honors/near honors/pass/fail to strict pass/fail several times before, but the idea never gained enough traction with students and faculty. They feared a pass/ fail system would result in a decline in academic performance, a drop in United States Medical Licensing Examination (USMLE) Step 1 scores and reduced success in residency placement.

Most longitudinal electives required only the extension of current electives. But new electives were created and will continue to be created through the School of Medicines learning communities another aspect of curriculum renewal. Learning communities are virtual communities that link students and faculty members who share a common interest in a certain area that extends beyond the classroom and often transcends traditional medical specialties. With the help of faculty liaisons, students organize the communities, which are divided into five groups: global health, medical education, research, service, and advocacy and wellness. Membership in any community is voluntary, and students can belong to one community while participating in the activities of another.

Grand Rounds

One of the reasons Megan Jacobs chose SLUs medical school was because service to others is important to her. Within a few months of arriving from Seattle, she and a few of her classmates began developing a childhood obesity prevention program called Empowering Youth Today (EYT). They partnered with the nationally recognized Wyman Center to develop a nutrition and physical fitness curriculum for teens between the ages of 12 and 14. The idea is to empower teens by giving them the tools they need to make healthy choices, said Jacobs, a second-year student. If theyre going to get something from a vending machine, for example, well give them the information they need to make a good choice. Well teach them how to read food labels and how exercise can fit into their lives. EYTs pilot project begins this fall in St. Louis City schools, and if it is successful, the program

could become an elective within the service and advocacy learning community. The learning community puts us in touch with other medical students interested in the same thing we are so we dont have to spend so much time looking for people. Instead we can use that time to brainstorm new ideas, Jacobs said. Jacobs also said the learning community assures her that the program will continue when she and her classmates move into their busier clinical years. What I like about the learning community is that if you have a passion for something, you can find a place for it, she said. Im still going to work hard in medical school, but I also want to do something with my life that I enjoy and that promotes wellness. And Im convinced that by promoting wellness in others, our emotional and physical health will improve as well.

While the learning communities start with this years class, they are open to all students, thereby allowing first-, second-, third- and fourth-year students to mingle freely within the groups. Many of our students have had great community service or research experiences outside the classroom, and until now, they had to leave it at the door, Swierkosz said. There was little opportunity for them to share or mentor others. The learning communities help create an informal but important learning environment. During this initial year of implementation, students and faculty will establish the goals and infrastructure of each community, including ideas for electives and non-credit initiatives such as social projects and outreach opportunities. Students interested in global health might invite a faculty member or alumnus to speak to community members about a recent mission trip to Ghana. They may work with that physician to take students on the next mission trip for elective credit. Members of the research community could hold a forum on clinical research internships and develop an elective that introduces students to topics such as research design and research ethics. Wellness community members might take an elective in gardening and nutrition (see sidebar) or attend weekly yoga classes.

How Does Your Garden Grow?

As a second-year student, Jessie Whitfield missed out on the curriculum reforms by a year. She does not have time built into her schedule for a longitudinal elective, but she was so excited by the potential of the learning communities that she is helping to develop an elective within the wellness group. Initially, the community will promote medical student wellness and eventually expand into outreach with the general public. Under the wellness umbrella, Whitfield and Nick DAngelo, also a second-year student, are cultivating a gardening elective. The elective will include volunteer opportunities for students with the City Seeds Urban Farm an organization that teaches homeless individuals how to grow and distribute food. The elective also will include lectures on healthy eating, sessions with master gardeners and classes on growing crops on campus. The department of nutrition and dietetics in Saint Louis Universitys Doisy College of Health Sciences has given the medical school plots of land on which several students already have planted seeds. Whitfields cherry tomatoes and Hungarian wax peppers are not doing well, but she said the basil and cilantro in the herb garden are going bonkers, and the pumpkin patch is showing promise. Whitfield said the students tend to their plants between or after classes as a way of getting back in touch with nature. A gardening elective may seem unrelated to medicine, but it teaches students how to have balance in their lives, Whitfield said. When I go down to the garden and see my plants, I cant help but be caring. I water them, watch them grow. They are endearing. It reminds me that things take time, that each tomato I eat from the cafeteria or each cucumber I buy at the grocery store took time to grow. It creates a mindfulness that I hope I can keep through my life as a physician.

Making Room

Healthy Choices

Service is a core value in the School of Medicine, and the community service learning community puts all student-run initiatives under one umbrella. Students interested in service projects will have more time to participate in tutoring programs, the Health Resource Center in north city, the HIV Prevention Task Force, the Child Abuse Prevention program and the Empowering Youth Today project (see sidebar). In the past, the model the student groups had for community service was more of an episodic drop-in experience, Slavin said. Students would go to schools or community centers and talk about disease prevention for a couple of hours and leave. Every little bit helps, but its not clear whether this drop-in model has a big impact. We dont want to eliminate anything the students are doing. We just want them to be able to engage more fully over a longer period of time.

Reaching Out

To free students to participate in the more robust elective system, something had to give. The third facet of curriculum reform required faculty to reduce classroom hours and change content an ongoing process. Some compare the first two years of medical school to drinking from a fire hose, Slavin said. Ultimately the information overload crowds out all of other things we want to see students develop, such as critical thinking skills and problemsolving skills. To help faculty modernize content, Slavin said faculty development sessions will focus on teaching strategies that enhance retention of information. Teaching of isolated facts will be discouraged in favor of teaching a more integrated curriculum that leads to a better understanding of how the human body maintains homeostasis, how diseases disturb homeostasis and how therapy restores homeostasis. Regardless of the other changes were making to our curriculum, review of content and teaching constitutes a healthy part of curriculum renewal and improvement, he said.

All Aboard

Modernizing content, going to pass/fail and increasing elective hours are significant changes to the School of Medicines curriculum, but Slavin proudly notes that the proposals were enthusiastically accepted. The Curriculum Management Committee, the Curriculum Oversight Committee and the Executive Committee of the faculty which includes all department chairs voted unanimously in favor of the reforms. Its easy to paint the reforms as lowering expectations, but I argued, and faculty agreed, that the current system of rewarding simple acquisition of knowledge as the only metric of excellence in the first two years doesnt seem to be very forward thinking, he said. We changed our grading standards and increased our elective hours to better align with the very outcomes that we espouse in our goals and to promote the acquisition of a whole different set of skills in our students. In many ways, weve raised expectations.

Above Megan Jacobs encourages 14-year-old Jonathan Pulphus to make smart food choices at a student-sponsored health fair in north city in August. right Farhoud Faraji listens intently as a fellow second-year student presents an article on a novel approach to HIV vaccine development during a journal club meeting for first- and secondyear students. Next to Faraji is John E. Tavis, PhD., associate professor of molecular microbiology and immunology, who helped facilitate discussion and answer questions. Far right Jessie whitfield and nick dAngelo pick fresh basil and cilantro from the medical student garden.

Practice Makes Perfect

As a member of the leadership team developing the research learning community, second-year student Farhoud Faraji is almost constantly in brainstorm mode. Research is the mechanism by which the medical field expands, and although conducting research may not be necessary to becoming a physician, I think it is necessary to understand the literature and to be able to analyze it critically, he said. I think this is especially pertinent as we continue the pursuit of evidence-based medicine in health care.

During his first year of medical school, Faraji organized a journal club where other first-year students could discuss research findings and practice presenting papers. The research community will allow the journal club to expand to the incoming first years as well as subsequent classes. Faraji also would like to see the community develop a Web site where students can learn about research projects on campus, faculty who have a record of

accepting medical students for research positions and speakers who are in town. Often there are posters in the Doisy Research Center about prominent researchers coming to lecture at SLU or Washington University, but there are no posters in the medical school or in the Learning Resource Center where we spend most of our time, he said. A Web site would get the word out. Faraji also appreciates learning communities for their ability to bring together like-minded students.

If you have an idea, you can take it to the communitys faculty sponsor, and it will be given a serious look, he said. The community provides us with an infrastructure for implementing ideas that we believe will make us better at what we do.

Grand Rounds

2013

CLASS OF

Az 1

CA 44

CO 1

FL 1

GA 1

IA 2

IL 20

IN 5

KS 5

MD 2

MI 3

MN 8

MO 49

MT 1

NC 2

NE 5

NY 2

OH 4

OR 1

PA 1

TN 1

TX 3

UT 3

WA 1

WI 7

Canada 2

Trinidad 1

Tobago 1

25 states and three countries representedw 74 Universities Represented Including

2013

CLASS OF

2009 WhitE coat cErEmony What a day

2013
112 Males
CLASS OF

63 Females

My roommates and I went out and bought white coats and came back to our apartment and took pictures. That was our white coat ceremony. It was a big deal to put it on. You felt like all of your hard work had finally paid off. It was a sense of relief and accomplishment.
Kent L. Snowden, M.d.79 OB-GYN, St. Louis Associates

What an opportunity
2013
11 Masters Degrees
CLASS OF

In his address to students at the annual White Coat Ceremony in St. Francis Xavier College Church this August, Robert J. Blaskiewicz, M.D. (75), told members of the Class of 2013 to get ready for the adventure of a lifetime.The medical care system will change dramatically during the course of your career, but your actual practice of medicine will stay the same, said Blaskiewicz, professor and director of the division of general gynecology, obstetrics and womens health. It always will be one on one one caring person to a person in need. It will begin with a question of What can I do for you? and should end with Is there anything else that you need? Between those boundaries you will be given access to a persons most private thoughts and concerns. Your patients expectations are high. You should aspire to surpass them.

When I was in medical school there was no White Coat Ceremony, so its an honor for me to be a part of this. I think the ceremony reminds students of how much theyve achieved but also how much they still have to achieve. I know I felt a little bit frightened when I put on my white coat for the first time, and I imagine theyre feeling the same right now.

2 Doctorate

Catherine Beal, M.d.82

Neuroradiologist, St. Anthonys Medical Center

What expectations
2013
3.73 GPA
CLASS OF

32.56 MCAT

I was looking forward to cloaking Jordan because I wasnt able to cloak my oldest son, who also went into medicine. Im very proud, and its a privilege to have this opportunity. I think the coat distinguishes us. Its the mantle of our profession.
James A. nepute, M.d. (res 80-81) Interventional Radiologist, St. Johns Mercy Medical Center

University of Illinois Champaign/Urbana

Rockhurst University University of Missouri-Columbia

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Washington University

30 University of California School System

47 Saint Louis University

Dr. C. Rollins Hanlon continues working to improve surgical care

A Little Spit and Polish Goes a Long Way

In the Do You Remember? section of the Fall 2008 issue of Grand Rounds we asked you to send us your memories of two of the School of Medicines most outstanding educators: C. Rollins Hanlon, M.D., and Vallee L. Willman, M.D. (51). Due to Dr. Willmans passing, we ran only those letters pertaining to Dr. Willman in the spring issue of the magazine and held your stories about Dr. Hanlon until now. Thank you for your patience.

Hanlons lessons still resonate with alumni as we discovered when we asked readers: Do You Remember Dr. Hanlon?
The year was 1968. I was a second-year medical student in a surgical classroom session with Dr. Hanlon. Unfortunately, all of us were so young and inexperienced that we had no idea of the great privilege we had of sharing an hour with such a prestigious individual. He called on a student and asked, How large is this room? The student replied, What do you mean? He responded, I mean the total volume of this room. The student answered, Dr. Hanlon, I have no idea how big it is. He went on, Is it bigger than, for example, two cubic yards? The answer: Certainly its bigger than that. He asked, Well then is it as large as a million cubic yards? The response: I dont think its anywhere near that large. He said, Youve just established that you do have an opinion. Its bigger than two cubic yards but not as large as a million cubic yards. The problem is not that you are lacking an opinion, rather you are fearful of committing yourself and making a mistake. He went on to state that using the knowledge we learned in the first two years of medical school to make a diagnosis after a history and physical exam was an exercise in committing ourselves. This was the basic skill we needed to develop to transition from being a student to a physician. This was an insightful lesson from a remarkable teacher that spun off a simple question. Omaha, Neb. Michael Gross, M.d. 70

Tom Dooley was a classmate of mine. He was well connected to St. Louis society in those days. Tom was a brilliant student whose social life often interfered with the demands of medical school. One night when Tom was on the surgical rotation and scheduled to be on-call, he made arrangements for a classmate to cover. It was the night of the Veiled Prophet Ball, the season opener for the socially connected in St. Louis. The next morning at surgery rounds Dr. Hanlon said to Tom, Last night I came in to see a couple of your patients, but I couldnt find you. Tom replied, I was feeling ill last night so I signed out to a classmate. Dr. Hanlon took the morning paper from his coat pocket, and on the front page was a large picture of Tom escorting the Veiled Prophet Princess to the dance floor. Dr. Hanlon said, Tom, you do not look ill in this picture. Tom repeated that year. robert w. Glein M.d. 53 Marysville, Wash.

Dr. Hanlon always referred to the medical students as Mister or Miss. Shortly after graduation in 1956, I had to return to Desloge Hospital to pick up something I had forgotten and ran into Dr. Hanlon coming out the back door. He looked up and said, Good morning, doctor. He was the first person outside of family to call me doctor, and I can tell you it was the biggest thrill of my life up to that time. John d. Moroney, M.d. 56 Tampa, Fla.

Long before he was an esteemed professor at the School of Medicine, C. Rollins Hanlon, M.D., was an eager student. While an undergraduate at Loyola College in Baltimore he spent his Saturdays observing operations at the Johns Hopkins Hospital. Mentors showed him how to gown, how to conduct himself professionally and how to make sense of what he was seeing. Hanlon knew then he wanted to be a surgeon and a teacher. After earning his medical degree from Johns Hopkins and serving in the Navy during World War II, Hanlon joined the faculty in the surgery department at Johns Hopkins. He worked closely with Alfred Blalock, M.D., and together they developed the Blalockhanlon Hanlon procedure as a primary procedure for simple transposition of the great arteries. Hanlon was well established as a nationally prominent surgeon when Saint Louis University President Paul Reinert, S.J., and School of Medicine Dean Melvin Casberg, M.D., lured him to St. Louis in 1950. It didnt take Hanlon long to establish the surgery department as a regional research and clinical center for the study and treatment of cardiac conditions. His teaching program set an example throughout the University and won wide respect throughout the nation.

Perhaps Hanlon is best known in St. Louis for bringing open-heart surgery to the area. In 1956 he led a 12-person team in the first open-heart surgery performed in the lower Midwest region, and in 1972 he conducted the research that led to the areas first human heart transplant. Hanlon remained chairman of the department until 1969 when he passed the baton to Vallee L. Willman, M.D. (51) and accepted the directorship of the American College of Surgeons. Hanlon led the ACS for 17 years and continues to serve as an executive consultant. He also continues to serve on the boards of several other professional organizations and is an honorary fellow of five English-speaking surgical colleges. Gifts from friends, students, patients and colleagues helped established the C. Rollins Hanlon Endowed Chair at the School of Medicine, which is held by Robert G. Johnson, M.D., professor and chairman of the department of surgery. When it came to teaching, Hanlon preferred the Socratic Method as the best way to develop thinking surgeons. He also believed, and still does, in a bit of spit and polish. Making rounds in polo shirts is unacceptable. Hanlon believes professional garb a jacket and tie instills patients with confidence in their physicians.

Pithy, pertinent and profound at least most of the time were the professors words but one evening on rounds I overheard an exception. As we entered a patients double room, the professor nodded to the youngster swathed in burn bandages in the adjoining bed and said, Good evening, young man, and how are you today? Im smoking less and enjoying it more, was the youngsters flippant response. Taken aback by this glib reply from a painfully burned patient, Dr. Hanlon was, for the moment, uncharacteristically at a loss for words. Pausing for a moment he replied, Yes, I would agree, as we moved on. reilly Maginn, M.d. 60 Daphne, Ala.

It was March 1954, and I was on Dr. Hanlons senior surgery service. My wife just delivered our son at 6 a.m. after a 12-hour labor, and I was exhausted! So, at 8 a.m. as I appeared for the day, I asked Dr. Hanlon if I could take part of the day off to rest and go back to see my wife and child. He replied, I guess you can have only one baby on surgery service, so take the day off! C. John Stechschulte, M.d. 55 Ocala, Fla.

Dr. Hanlon recruited me as the cardiac fellow in 1965, and I subsequently joined the faculty. His accomplishments at Hopkins were well known and impressive to me. I was particularly inspired by his quest for excellence in all endeavors and his effort to inculcate this quality in trainees and associates. In 1969, he announced his decision to accept the position of director of the American College of Surgeons. Initially I was devastated and felt abandoned by my chief, whose guidance I still desired and likely needed. My reaction was quickly recognized as selfish. Practicing surgeons would frequently ask me if I thought he was making a bad choice and would he not be lost without a surgical practice? I would suggest to them that his decision was sound for many reasons. His leadership qualities were evident to all who knew him. His riveting presence on the podium or as an engaging conversationalist reflect language skills, a literary bent, quick wit and a delivery style that is envied by many and not easily imitated. How fortunate we and the University are to have benefited from this surgical giant. hendrick Barner, M.d. Cardiac fellow 1965-66 St. Louis

Dr. Hanlon was a great teacher and lecturer but held in awe and somewhat feared by members of my class who considered him a most formidable living legend. He called upon my classmate, Art Brickel, in a professors rounds to estimate the chances of a patient, who had been treated for two or three previous malignancies, getting another. Art answered, Well, Dr. Hanlon, its like a 54 Ford. If its gone this far itll go another thousand miles. I remember the class seemed shocked and speechless at what seemed an attempt at levity that very few of us would have felt comfortable doing around Dr. Hanlon. Gerard M. Gerling M.d. 66 St. Augustine, Fla.

In the next issue of Grand Rounds, Do You Remember? will focus on our pediatrics faculty. Share your stories about Dennis OConnor, M.D.67, professor of pediatrics, and the late Richard Barry, M.D. 71, at grandrounds@slu.edu.

When I started medical school in 1954, my plans were to become a hematologist, but as soon as I met Dr. Hanlon my plans changed. Inspired by his leadership, the way he treated students and the way he handled his patients, I soon decided to become a surgeon. I never have regretted my decision. I am his only disciple in Puerto Rico. Years later when Dr. Hanlon came to Puerto Rico as director of the American College of Surgeons, my wife and I had the privilege of having him as the guest of honor at a party in our home. It was an evening that we never will forget. Felix Vilella Suau, M.d.58 Rio Piedras, Puerto Rico

I first encountered Dr. Hanlon in 1963 when I was a sophomore medical student. Dr. Hanlons stature and reputation was well known to us, as was Dr. Willmans. Most of us had only heard of the two men and had never seen them. We all waited with mixed emotions and some apprehension for the chairmans arrival. Suddenly the door opened, and in walked Dr. Hanlon, followed closely by Dr. Willman. I dont remember any of the lecture itself, but two things stuck with me that day. First, Dr. Hanlon arrived in a lab coat that looked like cardboard. There was nary a wrinkle or crease that could be seen. I thought this guy either just put the coat on as he stepped in the room or was able to move about without moving any body parts. The second thing I remember was his delivery. He looked around the room as he lectured but always looked over our heads, never in our eyes. This just reinforced our already-held feeling that Dr. Hanlon lived and functioned at a level we were not on at that time and would have to work long and hard to achieve. During the rest of my time as a student and then an intern at the University, Dr. Hanlon remained almost a mythical figure. Dr. Willman, on the other hand, always left me in wonderment on how he could be everywhere and do so much yet always have time to talk to the students and residents. They both left a positive and lasting impression on me. Im still not sure if I became an internist/endocrinologist because of interest or thinking it would be pretty hard to live up to the examples of Dr. Hanlon and Dr. Willman. dale E. Lehmann, M.d. 65 Pensacola, Fla.

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SLUCares strategic plan calls for enhancing community relationships and empowering patients.

GR: To what do you give credit for last years impressive performance? KB: I think its a combination of factors. We havent increased

FORWARD THINKING
Last fiscal year was a good one for the University Medical Group (UMG). SLUCare (as the UMG is known) physicians handled more than 480,000 ambulatory visits at the practices six locations. This represents almost a four percent increase over fiscal-year 2008. It also represents the highest number of visits since Saint Louis University sold the hospital to Tenet in 1998 and began tracking ambulatory care as a separate number.

the number of faculty very much, but I think weve become more efficient in aligning how we take care of people. Hepatology is a good example. Dr. (Bruce) Bacon sees a tremendous number of patients in clinic every day. He is committed to getting patients in when they need to be seen and getting them through as efficiently as possible. I think other people are stepping up more to that model of care. I also think the community is increasingly aware of what we have to offer. SLUCare is 80 to 85 percent specialists and subspecialists. We have primary care, family medicine and general internal medicine, but theyre not the largest part of our clinical enterprise. Our primary focus is providing unique and specialized levels of care that cant be found just anywhere.

Glennon Childrens Medical Center and Tenet at Saint Louis University Hospital, and were trying to build on those relationships as we look to a broader region of outreach. When you have a specialty, and particularly a sub-specialty practice, you have to cast a wide net for patients. We also have to look for niche opportunities. St. Anthonys in south St. Louis County is a good example of where this could happen. St. Anthonys may not have a need for a broad-based relationship with us, but if some of the hospitals patients need a special type of care, such as vascular surgery or neurosurgery, we provide that care.

GR: What did the consulting firm find when reviewing your numbers and the strategic plan? KB: A couple of important things emerged. The firm identified as our key strength the quality of care delivered by our specialists and sub-specialists. The firm believes that we need to encourage delivery of that message to the community of physicians. SLUCare physicians are well known, but we can always improve on that. Because were a specialty practice, patients most often come to us through other physicians. They dont come because they looked us up in the Yellow Pages and found our name. They come because a physician referred them. In particular, we need to emphasize to our referring physicians that if they send patients to us for a specialized level of care, were happy to accept those patients, deliver that care and return those patients to their physicians so they can follow them in whatever specialty they were seeing them. Thats a really important message. A lot of physicians are concerned that if they send a patient to a physician for a particular procedure or advanced level of care that theyve lost that patient to that specialist group or system. We want community physicians to know that they have control and that we will get their patients back to them.

Building on and enhancing that volume is Kathleen (Kate) R. Beckers charge. After five years as associate general counsel for the Medical Center, she was named chief executive officer of the UMG in February. Becker oversees operations, planning and budget for the practice. She took the job as the UMG began mapping out its five-year strategic plan. This fall, she presented details of that plan and findings from a consulting firm hired to do a deep dive into the UMGs data. In the following conversation with Grand Rounds, Becker discusses the report and what the results could mean for SLUCares 360 physicians, staff and their patients.

GR: What were some of the key components of the UMGs strategic plan? KB: Access is a big issue for us. Over time, the practice has

evolved into letting physicians find their way in through certain people. A physician will say I know the chair of such and such department, so Ill get my patient in that way. It works, its been functional, but its not ideal if you want to add more patient volume to the system. So, over the next couple of years well be working hard to improve the ability of both patients to get in and of external physicians to make referrals. Well identify and remove potential barriers to access. Is there a situation where you have multiple phone numbers that you need to call before getting to the physician you want? Is there a situation where you need to staff up the call center so that patients are on hold for a shorter period of time? Is there a situation where maybe a particular specialty needs to add a half day of clinic or offer later hours? Access is critical.

GR: What other goal has the practice set in its strategic plan? KB: Another important goal for us is strengthening our partnerships with affiliate hospitals. We clearly have very strong relationships with SSM at St. Marys Health Center, Cardinal

GR: You mentioned there were a couple of important findings in the consultants report. KB: The other important finding concerns our patient volume.
We really want to grow, and one of the potential challenges to that is the facility we have at Grand Boulevard and Vista Avenue. Nearly 70 percent of our patient volume comes through our offices at the Medical Center, whether its at Cardinal Glennon for pediatrics, the

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Patient-Load by Location
Doctors Office Building (DOB) for GI or primary care, or the Anheuser-Busch Institute (ABI) for dermatology or ophthalmology. The DOB, our primary site, has been a very serviceable, workhorse of a facility. It has fulfilled our basic needs. Weve been working to keep it as modern as we can, but the consulting firm strengthened our conviction: weve reached the point where there is a limit to how much more we can grow in that facility. We need a more modern facility on campus. the patient care physicians deliver now?

GR: What is the medical home concept of care and how does it differ from KB: Creating a medical home is a priority for us. Medical home,

GR: What would a new facility offer that the DOB doesnt? KB: One thing would be improvement of our electronic health record (EHR) system. We started implementing the system about a year ago on a rolling basis. Weve been going department by department and site by site to bring it online. We should be finished by 2012. This is a big investment for the practice, and its very important in terms of managing patient care across specialties. Theres a much better exchange of information, and its a huge improvement in patient safety because you arent waiting for someone to get a paper chart from one building to another. A new facility enables us to hardwire a building with the capacity for that electronic record keeping. Instead of trying to figure out how to drop lines in an older building, such as the DOB or ABI, a new building gives us a chance to design from the ground up a truly electronic-friendly patient care environment. A new building also would give us efficiency of space. As we look forward, were envisioning a much more flexible model that will enable us to build on the medical home concept of care.

or PCMH (patient-centered medical home), is a model of care that encourages preventive care and patient wellness. Patients would have a primary care physician, and that physician is supported by an increased number of physician extenders and care managers. A physician extender could be a physician assistant, a nurse practitioner or some other mid-level care provider who follows more closely patients who have chronic conditions. A patient with diabetes would be very well suited for SLUCare has 360 full-time the medical home model of care. The patient would faculty physicians (462 if you include part-time) who practice have a care manager calling to say, OK. Its been 30 days since you had your hemoglobin test so you need in 14 clinical departments. to come in and get that done, and by the way, are you checking your sugar levels at home? How have they Anesthesiology been? Because diet and exercise are critical for patients and Critical care 6% with diabetes, theyd also have a physical therapist and a nutritionist from allied health to give support. Then Dermatology 2% patients have their physician, the quarterback for the Family and Community Medicine 4% whole team, who might say, Youre been working really Internal Medicine 21% * hard on managing your sugars, but youre having some kidney problems. Im sending you to nephrology for a Neurology 8% look. OB-GYN and Womens Health 6% The medical home model provides patients with a variety of levels of care in one universe. Youre not Ophthalmology 3% waiting for a crisis. A new building would give us space Orthopaedic Surgery 4% for these extra providers and their follow-up work. Otolaryngology/Head and Neck Surgery 2% GR: I understand the practice is going to run a pilot program of this care model next year. Pathology 5% Pediatrics Radiation Oncology Radiology Surgery 23% ** 1% 4% 11% *

Thats a huge issue across the country right now in terms St. Marys 11% of comparative effectiveness research. If you really do Des Peres 6% help people stay well, do you Family Health 4% drive down the cost of health care? Health care accounts for University Club Tower 3% about one fifth of the GNP. Other 10% Thats huge so when you look at how you manage that cost item, you have to look hard. Theres not a lot of data out there right now because that hasnt been the reimbursement model. SLUCare Midtown 66%

GR: Does anything change with the practices academic mission? KB: No, our plans just further strengthen our mission. In any

academic medical center, the clinical practice is a support for the education component. We are providing clinical care because we want to teach other people how to do it. The question is how to maximize that educational experience. You think about the educational experiences for residents and students and it brings us right back to a new building. How do we design a building so that we can provide the best possible educational and patient experience?

GR: What would you say is the practices greatest strength as it looks forward? KB: The number one thing is the dedication of the clinical
faculty. That dedication comes through in all of our discussions. No matter whats on the table, they always ask, Whats the best thing to do for the patient? Faculty members are proud of their support from the University and their support of the University. We not only financially contribute to the support of the University, we also provide enormous support for the Universitys mission. We provide quality care for the uninsured and underinsured. Thats an important component of the clinical practice, and its something that makes us different than somebody out in the community. Faculty members come here because they want to teach. They want to conduct research, and they want to care for patients in the compassionate, mission-oriented environment that we provide.

KB: Were looking at working with human resources to

* all divisions ** all pediatric department divisions but not pediatric specialists in other departments

roll out a pilot project for SLU employees. Through a lottery system, wed enroll a number of employees and their family members in a patient-centered model of care. That gives us a chance to figure out how its going to work without overburdening our space, and well spend the next year or two tweaking the system to figure out what works. The pilot project also provides us with a great opportunity from a research and education perspective. Well track what preventive care really does. When we provide that level of patient-centered care for chronic conditions and wellness, do we see a difference in outcomes?

Our primary focus is providing unique and specialized levels of care that cant be found just anywhere.
Becker

GR: As the health care reform debate continues, what issues are you watching more closely? KB: Health care reform is focused on three main elements:
access, quality and cost. We are watching developments closely in all three areas. We feel comfortable that we will be compliant with any quality measures, and already participate in several national quality improvement projects. Given the mission of the UMG, we currently treat a number of uninsured patients, and an increase in access may give those patients coverage, which would be a positive for the UMG. Increase in access, however, looks likely to be tied to decrease in cost, that is, in payments to providers, which could mean decreased reimbursement for the UMG. We need to be flexible in our planning and prepared for a variety of outcomes.

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When a new vaccine is given this fall to protect U.S. residents from the pandemic H1N1 influenza, it will bare the fingerprint of researchers at Saint Louis Universitys Center for Vaccine Development. The centers director is Robert Belshe, M.D., an internationally respected researcher who has invested his career in fighting infectious diseases.

Vaccine SLUs Center foramong eight Development is elite research institutions that are funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, to study new and improved vaccines and novel ways of delivering them. In the midst of a public health emergency when traditional seasonal influenza is expected to collide with the H1N1 influenza, Belshe is a leader in the charge to keep us safe from disease. In terms of public health importance, the current H1N1 vaccine research is among the most significant projects that the vaccine center has done, Belshe said. Belshe is a member of the NIH research team that this summer launched a series of clinical trials involving thousands of volunteers in testing vaccines to protect against H1N1 influenza.

SLUs Center for Vaccine Development is the lead site on two of the early national research studies, and Sharon Frey, M.D., professor of infectious diseases and one of Belshes colleagues, is lead investigator. So far, most of the infections are relatively mild, Belshe said. Were hoping its going to stay that way, but we dont really know. As many as 60 million Americans or one in five are predicted to become infected this season with pandemic flu, and the number of serious health complications and even deaths could soar. Its critical that we find a way to protect people from this disease. The center is well known for its influenza research. One of our most notable projects is the development of the intranasal vaccine for flu prevention and demonstrating that it works better than the flu shot in children,

said Belshe, who conducted the pivotal trials on the nasal spray flu vaccine. We have had a role in developing vaccines for meningitis, diarrhea and pneumonia, but our leadership role in developing vaccines that prevent influenza and its complications has been our biggest accomplishment, he said. Belshe, a 2009 recipient of the St. Louis Business Journals Lifetime Achievement Award for his work in health care, was among the scientists who described how the H1N1 influenza works its way through the population. In an editorial in the June 18, 2009 issue of the New England Journal of Medicine, he explained why the virus didnt seem to sicken older adults, who typically are victims of influenza. The H1N1 flu is the remnants of the 1918 virus, he said. If you were alive between 1918 and 1957, youve

Poised for Discovery

Robert Belshe, M.D.
Professor | Dianna and J. Joseph Adorjan Endowed Chair in Infectious Diseases and Immunology Director | Center for Vaccine Development

 omeofthevaccinesarenew,someareforrarediseases,someareimproved S versionsofanoldvaccine,someareforverycommondiseases.Itisarealfeatherin SLUscaptobechosentotestnewvaccinestoimprovepublichealth.

by Nancy Solomon

G R A N T S at a Glance
Duane P. Grandgenett, Ph.D.,hasreceivedafive-year,$406,000grantfromtheNationalInstituteofAllergyandInfectious DiseasesfortheprojectHIV-1Integrase/DNAcomplexesandConcertedIntegration. Krista L. Lentine, M.D.,assistantprofessorofinternalmedicine,receiveda$325,000grantfromNovartisPharmaceuticals Corp.fortheprojectExpandingtheAnalyticPotentialofRegistryDataforEnd-StageKidneyDisease:LinkageofUnitedStates RenalDataSystemwithPharmaceuticalBillingClaims. Ranjit Ray, Ph.D.,professorofinternalmedicine,receivedafive-year,$1.6milliongrantfromtheNationalInstitutesofHealth fortheprojectMechanismsofLiverDiseaseProgressingbyHepatitisCVirus. Ratna B. Ray, Ph.D.,professorofpathology,receivedafive-year,$1.6milliongrantfromtheNationalInstituteofDiabetesand DigestiveandKidneyDiseasesfortheprojectInnateImmunityandHepatitisCVirusInfection.

probably got substantial immunity or protection from the H1N1 flu. Its one of the few good reasons to be older than 50. In early October, U.S. Secretary of Health and Human Services, Kathleen Sebelius, visited Belshes lab as she highlighted the arrival of the first shipments of H1N1 vaccines. During a news conference, she encouraged people to receive the vaccination, emphasizing it is safe and thoroughly tested. Science has always fascinated Belshe, who switched gears on a career choice about 40 years ago when the job market for physical chemists dried up after America won the race to put a man on the moon. Thousands of physical scientists were put out of work because NASA didnt need them anymore, Belshe said. So I went to medical school and changed career goals. Be flexible is the message here, he continued. And then along came viruses, and I was off on new adventures with bigger molecules than those I had studied previously. I had a chance to use my skills from one field in another new area. Three years in a lab at the NIH, and I was well trained in virology. Belshe joined the School of Medicine faculty in 1989, the year the NIAID added the Center for Vaccine Development to its funded vaccine research institutions. Our Center for Vaccine Development is truly a national resource. SLU is the place that the NIH asks to develop complex protocols and develop data on vaccines for diseases including TB, pneumonia, smallpox and influenza, Belshe said.

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markyourcalendar

Alumni Pulse
Living the Mission Removing Tattoos Restoring Potential

Tolbert S. Wilkinson, M.D. (Res. 67-69), does not advertise his tattoo removal program, yet every other Saturday morning his clinic in San Antonio is filled to capacity with patients who are trying to get out of gangs, get jobs, save their scholarships or erase relationships gone sour. They come to Wilkinson because he has pioneered a tattoo removal protocol that uses infrared coagulation to shatter tattoos into tiny particles the body can absorb. The procedure is known as Tattoo Obliteration by Infrared Light or TOBIL. Because TOBIL is significantly less

expensive than laser tattoo removal, Wilkinson offers the service at low or no cost to his patients. Wilkinson, a plastic surgeon who performed his residency at the School of Medicine under Francis X. Paletta, M.D., said he never imagined he would get into the tattoo removal business. He said he removed enough ink while serving as a plastic surgeon with the Air Force. One of my jobs was to remove inappropriate tattoos from airmen, he said. We used dermabrasion that removed the skin and dermis along with the ink. It usually left a nasty scar no matter what you did. Its not the kind of work you can feel good about. When Wilkinson opened his private practice in San Antonio, tattoo removal was not one of the services he promoted. In 1995, however, the American Society for Aesthetic Plastic Surgery issued a challenge. The organization wanted surgeons to find a safe, inexpensive way of removing tattoos from patients who could not afford laser treatment removal.

After conducting extensive research, Wilkinson began using TOBIL, which costs about $50 a patient. Laser treatment, on the other hand, costs about $5,000 a patient. Initially, Wilkinson traveled to prisons and juvenile justice boot camps to remove tattoos free of charge. Then police officers, judges and military recruiters began sending patients to his office, and patients began coming from out of state. It wasnt long before Wilkinson and his volunteers could not keep up. The next thing I know, Texas Governor George W. Bush gives us a grant to open 14 tattoo removal clinics throughout the state as part of an anti-crime initiative, he said. That was in 2000. Wilkinson not only opened all of those Texas clinics and trained their volunteers, he has since helped to open clinics in a dozen other states and five countries. He trains volunteers on the TOBIL equipment and proper aftercare for patients the key to limited scarring. A few years ago he trained a Maryknoll priest who uses the portable procedure to remove an average of 6,000 gang tattoos a year throughout Central America. A majority of the tattoos Wilkinson removes are gang related, but he sees a little of everything. He helped two teenage girls get re-admitted to high school by removing sexually explicit tattoos from their ankles. He helped a football star save his military scholarship by removing a tattoo from his neck. He has removed tattoos from infants and a Born to be Wild tattoo from the backside of an 85-year-old cowboy.
wilkerson and his TOBIL machine

He said he just couldnt go to his grave with it, Wilkinson said. For his efforts, the American Society for Aesthetic Plastic Surgery Inc. granted Wilkinson its 2009 Outstanding Volunteer of the Year Award. Tattoo removal may not be the most glamorous work, but its gratifying, he said. Getting rid of a tattoo can mean a whole new start for someone. It can open doors to people whove had doors closed in their faces, and they are incredibly grateful patients. Ive even had a patient kiss my hand. Ive never been kissed for doing a face lift. For more information about the TOBIL program or for information about opening a clinic in your area, e-mail Wilkinson at drt1901@sbcglobal.net.

has become a tradition that Orientation Week for the incoming medical school class begins with a White Coat Ceremony. As you may have read a few pages earlier in this magazine, students, family and faculty gathered on Aug. 2 in St. Francis Xavier College Church for the 12th Saint Louis University School of Medicine White Coat Ceremony. Alumni and faculty participated as members of the Class of 2013 were cloaked with their first white coat. Robert J. Blaskiewicz, M.D. (75), the keynote speaker, reviewed the significance of the white coat and emphasized the importance of professionalism in the care of patients. This is a good

From Your Association President Thomas J. Olsen, M.D. 79 | It

time for each of us to reflect on the role professionalism plays in our lives and on the resurgence of interest in professionalism that has been evident for the past several years. A profession is a vocation in which the practice of an art is used in the service of others. Traditionally, doctors, teachers, lawyers and members of the clergy are considered professionals. A physician has mastered special knowledge and skills including anatomy, physiology, diagnosis, treatment, communication, coordination of care and knowledge of health care systems. Some believe that this knowledge is not proprietary and that the profession holds this knowledge in trust for the good of society. Physicians are expected to place the interests of the patient and society above their own. They are expected to care for the sick and suffering and regulate the behavior of the members of the profession. The American Board of Internal Medicine defines medical professionalism as those attributes and behaviors that serve to maintain patient interest and welfare above physician self-interest. These include altruism, accountability, excellence, duty, service, honor, integrity and respect for others. We learned professionalism from our teachers and peers who were mentors and role models. We studied their behavior, reflected on it and incorporated it into our own practice of medicine. Some may ask why an ancient profession needs to be reminded of its fundamental principles.

Oct. 25 March 5 March 10-13 March 27 May 1-6 Dec. 6 April 3 April 10

Alumni Receptions San Francisco-area Alumni Reception/American Academy of Ophthalmology San Francisco American Academy of Dermatology - Miami American Academy of Orthopaedic Surgeons - New Orleans Missouri State Medical Convention - St. Louis Digestive Disease Week - New Orleans University Alumni Events Breakfast with Santa Saint Louis University campus Easter Egg Hunt Saint Louis University campus Health Resource Center Auction Saint Louis University campus Please visit medschool.slu.edu/alumni for additional activities and events. Continuing Medical Education programs Advanced Techniques in Facial Rejuvenation 5th Annual Cachexia Conference Best of AASLD Craniofacial Surgery and Transfacial Approaches to the Skull Base Cerebral Revascularization Cosmetic Blepharoplasty For information on the CME programs, please call the SLU School of Medicine continuing medical education office at 314-977-7401. See updates and details about Practical Anatomy Workshop programs at pa.slu.edu. For any other events, please contact the Alumni Relations Office at 314-977-8335.

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Threats to professionalism have come in the form of commoditization of health care, managed care and economic market forces, and emphasis on quantity not quality of patient care. Technologic advances challenge the ability of the profession to appropriately integrate new treatments in a cost-effective and appropriate manner. Inequities in access to medical care affect both individual health and the health of society. Each time we put on our white coat, we need to be reminded of the significance of this mantle of our professionalism. We need to be the mentors and role models for these incoming students who will continue to fulfill medicines commitment to society.

Stephen M. Ayres, M.D.,

former chairman of the department of internal medicine, died Sept. 12 in Newport News, Va. He was 79. A cardiologist and critical care specialist, Ayres joined the School of Medicine in 1975 and chaired the department of internal medicine for 10 years. During that time, he also served as medical director of Saint Louis University Hospital and chairman of the medical schools curriculum committee. In 1985, Dr. Ayres left the University to become dean of Virginia Commonwealth University School of Medicine. He was appointed in 1991 to the U.S. Science Advisory Board of the Environmental Protection Agency.

In Memoriam

Daniel Donahue, M.D. (41) Leo LeBlanc, M.D. (41) Vincent Eisele, M.D. (43) Tyrus Winter, M.D. (43) John Dernoncourt, M.D. (46) Clarence Ward, M.D. (46) Edward Peterson, M.D. (47) Harold D. Lankford, M.D. (48) Vernon Smith, M.D. (48) Daniel Shea, M.D. (51) William W. Sullivan (51) Aloysius Proskey, M.D. (54) Joseph Zeleny, M.D. (54) Robert Keene, M.D. (56) Jack McDonough, M.D. (56) Robert Desmarais, M.D. (57) Robert Wall, M.D. (57) Charles Wolf, M.D. (57) Raymond Probst, M.D. (58) Daniel Martin, M.D. (59) Donald Mierzwiak, M.D. (59) Robert Twohey, M.D. (59) Donald Vogel, M.D. (64) Charles Koenig, M.D. (65) Robert Horvath, M.D. (68) Terry Laird, M.D. (68) William Knight, M.D. (73)

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PROFILE OF PHILANTHROPY
Joseph M. Ojile, M.D. (84), assistant clinical professor of internal medicine, is an expert on sleep, but its amazing he has time to get any for himself. Ojile has a vigorous private practice in pulmonology and sleep medicine in St. Louis and is the founder and CEO of the nationally recognized Clayton Sleep Institute, which provides technical support for the SLUCare Sleep Disorders Center. He also is medical director of St. Anthonys Sleep Disorder Center and chairman of the National Sleep Foundations Continuing Medical Education Task Force. In addition, Ojile does a significant amount of teaching and lecturing throughout the country. Sleep affects almost every aspect of a persons life their quality of life, their heart health, their memory, weight loss or gain, diabetes. I find that interaction really compelling, Ojile said. I absolutely love what I do. I love coming into work and interacting with my staff and my patients. Im the guy whos glad when Monday comes. Ojile said his passion was ignited, in part, by the faculty at the School of Medicine who ran the sleep program during his years as a medical student, an internal medicine resident and a pulmonary fellow. Ojile is the first in his immediate family to graduate from the medical school but not the first to graduate from Saint Louis University. His father, uncle and multiple cousins have attended the University. Ive been going to Billiken games since Ive been able to walk, he said. Ojiles support goes beyond team spirit. He, his wife, Marianne, and their five children, are generous supporters of the School of Medicines Revolving Student Loan Fund, which Ojiles class initiated. We were in medical school when tuition exploded, Ojile said. The government stopped supplementing tuition and it went from $7,000 a year to $18,000 just like that. I think its important to keep the School of Medicines humanistic approach to teaching accessible to quality students, he said. Our graduates and clinicians are ranked among the best in the country, and that reputation is well deserved. I give because I want to see that excellence sustained.

Back row, left to right: Sam, Dr. Ojile, and his wife, Marianne, Front row, left to right: Sophie, Jack, Joe and Olivia

T O L E A R N M O R E about giving opportunities and tax benefits that may be associated with your gift,
contact the office of development at the School of Medicine at (314) 977-8303 or msalsic1@slu.edu.