GrandRounds

Fall 2012

Saint Louis University School of Medicine

Seeds of Student Wellness Take Root

Educators Reflect

Outcomes Research Shapes Policy

From the Dean | As I write this message, we are
a few short weeks away from electing the next president of the United States. Regardless of the outcome of that election, the next four years almost surely will see major changes in the organization of and payment for health care services. This will cause us to modify certain aspects of our medical practices and to teach our students about new models of medical care. In addition, we will need to teach our students to withstand the pressures of the seemingly constant regulatory changes and bureaucratic ambiguities of modern medicine. Here at SLU, we are trying to get ahead of this wave of change with new educational programs that are highlighted in this issue of Grand Rounds. Resilience training for first- and second-year medical students at SLU is part of the new approach and seems to be making a positive difference. The rates of anxiety and depression in our freshman and sophomore students have declined significantly. New curricular changes provide the opportunity for students to break away from the constant flow of new information and the stress of exams. Our students now begin their first year in classroom courses where they get to know one another and develop a bit of confidence. A few weeks later, they address the challenge of the rigorous course in human anatomy. This change has led to better performance and more enjoyment of the anatomy course than in previous years. Medical students work with hundreds of students from six other health professions in the third-year Interprofessional Team Seminars. In the fourth-year capstone, one of the most popular and useful courses addresses the business aspects of medical practice. In a new health care environment that is likely to be characterized by more emphasis on primary care, on more physician employment in hospitals or health systems, on compensation related to quality metrics and to efficiencies obtained through collaborative care with non-M.D. health care providers, young physicians need more than the skills learned traditionally in medical school. We believe that training in resilience and related psycho-social skills as part of the new curriculum at SLU is helping students prepare to be tomorrow’s leaders as the health care system evolves.

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|Medical Affairs Schwitalla Hall M268 1402 S. Grand Blvd. St. Louis, MO 63104-1028
GRAND ROUNDS EDITORIAL BOARD

On the cover

Whether they’re cultivating fresh basil in the student garden, attending yoga classes or taking a frozen custard break, SOM students learn that in order to take care of others they first must take care of themselves. Third-year students Stefanie A. Rademacher and Amy R. Hurt find it therapeutic cultivating their shared plot in the student garden on campus.|page 11

Philip O. Alderson, M.D. Edward J. O’Brien Jr., M.D. ’67 Cheryl Byrd Coordinator and Writer|Marie Dilg|SW ’94 Designer|Dana Hinterleitner Laura Geiser|A&S ’90|Grad ’92 Nancy Solomon Carrie Bebermeyer|Grad ’06
MAGAZINE CONTRIBUTORS

Steve Dolan|front cover, 1-16 and back cover Michelle Marie Peltier|3 President| Edward J. O’Brien Jr., M.D. ’67| St. Louis

PHOTO AND ILLUSTRATION CREDITS

ALUMNI EXECUTIVE BOARD

Emil DiFilippo, M.D. ’66| St. Charles, Mo. James T. Merenda, M.D. ’82| St. Louis Leroy F. Ortmeyer, M.D. ’55| St. Louis Joan M. Pernoud, M.D. ’74| St. Louis Keith M. Starke, M.D. ’81| St. Louis Thomas F. Lieb, M.D. ’82| St. Louis

Anne T. Christopher, M.D. ’94| St. Louis

Ellen M. Nicastro, M.D. ’04| Chesterfield, Mo.

Terrence A. Tyrrell, M.D. ’73| Belleville, Ill.

Jane Willman Turner, M.D. ’92| St. Louis

Peter Kong-Woo Yoon, M.D. ’81| St. Louis © 2012, Saint Louis University All rights reserved

Fall 2012

GrandRounds
Vol. 10 No.2

Saint Louis University School of Medicine

Award Winning

Respected SOM educators find that teaching future physicians is as much about inspiration as it is information. They reflect on what their students continue to teach them.| page 6 Philip O. Alderson, M.D. Dean | Saint Louis University School of Medicine Vice President | Medical Affairs
For more information about the magazine or to submit story suggestions, please contact 314 | 977-8335 or grandrounds@slu.edu.

Positive Prognosis

Student wellness initiatives woven into the curriculum to decrease stress and depression are having the desired impact on campus. The initiatives also are attracting attention from medical schools throughout the country. | page 10

Mining for the Gold Standard

Poised for Discovery

Outcomes research has become a hot topic and the SOM is helping lead the discussion. Collaborating with national health care providers, researchers and drug companies, the University is discovering what works at the bedside and what doesn’t. | page 14

Big risks lead to big rewards for researchers studying breast cancer and antibiotic resistance. | page 16

Living the Mission
| page 18

Vital Signs | page 2 Alumni Pulse | page 19 Profile of Philanthrophy | back

A SOM alumna leaves private practice to serve a public need.

Student wellness

initiatives are achieving desired results.

PROGNOSIS

Gillian S. Stephens, M.D., M.Sc., was not the traditional medical student. She was 42, married and had four children when she entered medical school in 1994. “Medical school was an isolating experience for me,” said the assistant professor of family and community medicine. “I was overwhelmed with the stress, and struggled quite a bit at times with my mood and self-esteem. I assumed it was hard for me because I was older and had a family.” Stephens’ assumption was proven wrong in 2001 when her son, a traditional medical student — 21, outgoing and brilliant — entered the same medical school. Stephens said her son excelled academically and was a leader among his peers, but he experienced similar isolation and stress. “His experiences made me feel somewhat better because they validated my impressions,” she said. “Clearly, I wasn’t alone.”

Slavin and the curriculum management committee are attempting to do this through curriculum changes. They implemented the first change in 2009 when the school joined about 40 of the nation’s 125 medical schools in adopting a pass/fail grading system for the pre-clinical years. Studies have demonstrated that a 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. Next, the Office of Curricular Affairs (OCA) created longitudinal electives. Instead of engaging in electives one-half day per week over a seven-week span, electives were extended across the majority of Year One and Year Two, with one full day of elective time every two weeks. The idea is to allow students to focus less on absorption of knowledge and more on finding their passion. Two years ago, the OCA instituted a required resilience and mindfulness curriculum for first-year students comprised of five 30-minute sessions on stress management, positive psychology and cognitive-behavioral practices.

BREAK THE ROUTINE

WHITE COAT-BLUE MOOD

Stephens definitely is not alone. Several studies have indicated that about one-fourth of medical students suffer from symptoms of depression and significantly more suffer from anxiety, especially during the first and second years. Stuart Slavin, M.D. (’83), M.Ed., associate dean for curriculum and professor of pediatrics, was aware of the studies, but when he looked around SLU’s Medical Center he saw students who seemed happy and engaged. Those studies were about students at other schools, not his. Because he is charged with doing everything he can to ensure student success, however, Slavin decided to survey SLU School of Medicine students anyway. Using validated depression and anxiety instruments, he began with the Class of 2011. He said the results were shocking. “We looked like everybody else, and it wasn’t pretty,” he said. Twenty-seven percent of the students had moderate-tosevere symptoms of depression by the end of their first year, and 57 percent suffered from moderate-to-high levels of anxiety. Twenty-nine percent of second-year students and 31 percent of third years had moderate-to-severe symptoms of depression. “Things had to change,” said Slavin, chair of the curriculum management committee. “I didn’t want to be in charge of an enterprise that had such poor mental health outcomes. Think about it. How can we expect our students to become wonderful doctors if we injure them in the process?”

AGGRESSIVE APPROACH

Fourth year student Amy Nuismer

Slavin said medical education’s traditional approach to mental health intervention largely has been to remove the stigma of seeking help and provide students with better psychiatric care. His approach, on the other hand, is preventive. Reduce unnecessary stress in medical school and give students better coping skills so they don’t become as depressed and anxious.

The OCA also created learning communities in which students and faculty members who share a common interest — sometimes interests that transcend medical specialties — spend time working on projects outside the classroom. The learning communities were divided into five groups: Global Health, Medical Education, Research, Service and Student Wellness. When Slavin presented his idea for the wellness learning community to faculty, Stephens said she was eager to serve as liaison. “It was a very personal thing for me,” she said. “I saw this as an opportunity to make medical education a better experience than it was for me.” Once a month, Stephens meets with students to discuss ideas for keeping balance in their lives. During the past three school years, the students have organized ski trips, ice skating parties and Mardi Gras celebrations. The community sponsors Pumpkin Pie Day, a watermelon festival, a photography contest, Jelly Donut Day and movie nights. Ting Zhang, a third-year student from Beijing and a member of the learning community, has participated in the photography contest and a student cook-off. She said the events are diversions that actually improve her study habits. “I’ve gone to the library and tried to study for eight hours, but it’s impossible,” she said. “I zone out for at least two of those hours. I’m reading the same thing over and over. But if I have something to pull me out of the library for a little while, I find I’m much more focused and the break refreshes me.” The community also sponsors lectures on good sleep habits and stress management. And, during high stress times, such as right before exams or waiting for results, Stephens sends motivational emails to students reminding them to eat properly, sleep adequately, exercise regularly and think positively. Each email ends with a trivia question about her homeland, Australia. The first student to respond with the correct answer is awarded a package of Tim Tams, a chocolate biscuit popular down under and coveted by School of Medicine students.

Grand Rounds

11

1. Students take a break from studies for a cup of frozen custard and some sunshine during the Student Wellness Community’s annual ice cream social. 2. Third-year student, Amy Hurt, uses a day off from her
internal medicine rotation to do a little pruning in her plot at the student garden on campus. 3. Victoria E. Cornelius, M.D., adjunct associate professor of pediatrics, has been leading the weekly yoga sessions for more than a year. 4. Weekly yoga classes help students maintain balance in their lives. 5. Gillian Stephens, M.D., (right) at the August ice cream social with first-year student Abby Thuet.

Trends in Anxiety and Depression Symptoms Before and After SLU Medical Student Wellness Initiative Trends in Anxiety and Depression Symptoms Before and After SLU Medical Student Wellness Initiatives
65% 60 55 50 45 Medical Students 40 35 30 25 20 15 10 5 0 One Week Before Medical School After 1 Year of Medical School After 2 Years of Medical School After Wellness Initiative (2011-12) Significant Anxiety Symptoms Before Wellness Initiative (2007-09) Significant Depression Symptoms After Wellness Initiative (2011-12) Significant Depression Symptoms Before Wellness Initiative (2007-09) Significant Anxiety Symptoms

1

2

3

4

5

MIND AND BODY

Other health diversions created by students who are part of the wellness community include a student garden, a book club, a knitting club and a weekly yoga class held in the Learning Resources Center. Fourth-year medical student Amy Nuismer has attended regularly since her first year. “Originally I came to the class to reduce stress and meet other people with similar interests, but I discovered a lot more than that,” said the Michigan native. “I learned how to breathe, how to relax and was able to make dietary changes for the better. I learned the importance of focusing on something other than my books, even just for an hour a week.” Nuismer was so empowered by the yoga classes that she completed the rigorous 200 hours of training to become a certified yoga instructor and plans to bring the philosophy and lifestyle behind yoga into her practice.

“I think medical school would have been infinitely harder had I not found this outlet,” she said. “No matter which path you choose, you have to find something that keeps you balanced and energized because if you don’t you’ll hurt yourself and by extension hurt those you’re trying to help. I’m grateful to be part of a school that takes this aspect of self-care seriously.” Slavin said the combined curriculum and wellness interventions, unprecedented in medical education, are effective tools in student recruitment. “I believe we’re the only medical school in the country taking this comprehensive approach to student wellness, and word is spreading,” he said. “We have prospective students asking specifically about opportunities that will help them grow outside the classroom and library. It shows we care not just about a grade but the whole person.”

POINT OF IMPACT

Slavin said that the curriculum changes and the wellness community are having the desired impact on students. His data indicate that since implementation of the wellness initiatives, depression and anxiety levels have dropped significantly [see graph]. “The changes are staggering,” he said. “Plus, there’s no evidence of a drop in performance. If anything, the average scores on our exams are slightly up, which makes sense. If you’re depressed or anxious, you’re not going to perform well.” As for the future, Slavin and his team will allow the longitudinal electives and learning communities to flourish. Other changes are in the works. Most of the attention has been limited to the first two years of medical school. Now, he is restructuring the third year.

Third-year students usually go 24 weeks without a vacation, but a curriculum restructuring in the works will give third years a break after 16 weeks. Also, every eight weeks, third-year students will not be required to report for their clerkships. Instead they will have breakfast with their classmates, attend a lecture on topics such as end-of-life-issues or pain management, and break into small group discussions facilitated by fourth-year students. The students will discuss the lecture, as well as process their clinical experiences in a safe environment. “We’ve made all of these changes at little or no cost,” Slavin said. “And we’ve done nothing to compromise the educational quality of our program. In fact, I would argue that these efforts have significantly enhanced the education and training we provide.”

12

Grand Rounds

13

Sign up to vote on this title
UsefulNot useful