New medical school will train physician-investigators

OB/GYN News, Jan 1, 2003 by Doug Brunk

Are you an accomplished, enthusiastic physician-investigator who can inspire medical students to chase their dream of advancing biomedical research and clinical practice?

If so, you might fit the bill to be a guest lecturer for students on the first day of an innovative medical school: the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. The school is slated to open in July 2004.

"On the first day of school, I want the students to meet someone who is an incredibly charismatic physician-investigator to talk to them about what they do and how they got to where they are, and what excites them about it," said Dr. Lindsey Henson, vice dean for education and academic affairs at Case Western Reserve University (CWRU).

The goal of the new 'college is to educate medical doctors who intend to devote their careers to patient-oriented clinical research, a segment of medical science that has experienced serious growth problems for more than 30 years, said Dr. David Korn, senior vice president of the division of biomedical and health sciences research at the Association of American Medical Colleges in Washington. Indeed, the Institute of Medicine estimates that less than 2% of physicians are adequately prepared to perform clinical research.

In the report of its 1999 Clinical Research Summit project, the AAMC called this deficit "a bottleneck that would severely impede the translation of headline-grabbing advancements in basic biomedical research into public benefit through new diagnostics, treatments, and preventive strategies."

If the goal of the new college is met, "it will represent a significant contribution toward mitigating this vexing problem," Dr. Korn said.

In an agreement reached in May 2002, physicians and scientists at CWRU and the Cleveland Clinic Foundation will work together to develop a 5-year curriculum that prepares students for careers as clinical investigators and physician-scientists. While some medical schools offer clinical research experience in students' third and fourth years, this curriculum will devote nearly 2 years to basic science and clinical skills learning objectives, followed by 3 years of clerkships, elective clinical and noncinical rotations, and research projects based on a thesis each student develops.

Teaching methods will be rooted in practicality. The core basic science curriculum, for example, will be centered on problem-based learning supplemented by other active learning methods such as labs, problem sets, electronic self-study, and seminars. Each student will have both a clinical adviser and a research adviser.

This approach runs counter to the traditional medical school model that trains physicians in one-dimensional patient care, noted, Dr. Eric Topol, a cardiologist who is the Cleveland Clinic's provost and chief academic officer.

"It's a totally different mindset," Dr. Topol said. In traditional medical schools, "there is not a whole lot of engagement in research" nor do the schools foster an atmosphere conducive to caring for one's patients while seeking a better way to care for' future generations.

Enrollment in the school's first year will be limited to 32, "because a problem-based learning group works well in a size of 7 or 8, and that gives us four groups, said Dr. Henson, who joined CWRU last year from the University of Rochester (N.Y), where she served as senior associate dean for medical education.

Ideal applicants, she said, will like to take risks, work well in groups, and be committed to a 5-year program "because they want to do research in academic medicine from the get-go.

Coursework will take place primarily in the educational facilities of the Lerner Institute on the Cleveland Clinic campus. Funding for the medical school comes in part from a $100 million endowment by late Cleveland Browns owner Al Lerner.

CWRU and the Cleveland Clinic Foundation have agreed that research grants from the National Institutes of Health to support work by Cleveland Clinic Foundation-based investigators will be awarded to and administered by the new college of medicine as an academic unit of CWRU. These awards will be included in the total of research support for CWRU School of Medicine, which currently receives about $174 million from NIH. The Cleveland Clinic's Lerner Research Institute receives about $99 million in research awards from all sources, including nearly $53 million from NIH.

Dr. Henson and her associates are still working out the details of financial-aid packages, but they hope to offer a stipend to students during the research project component of the curriculum.

"We're starting to look at merit- and needs-based 'scholarships, too," she said. "We want to ensure that [students] don't have so much debt coming out of medical school that they have to make a different career decision simply because they can't afford" to stay in research.

Scholarship support from the pharmaceutical industry "is possible, as long as there are no strings attached," she added. "I think there are ways to work productively and cooperatively with all sorts of companies. We're very interested in being able to do that."