WHAT HATH BROWN WROUGHT? A PRELIMINARY ANALYSIS OF BROWN UNIVERSITY'S FIRST TEN MEDICAL SCHOOL GRADUATING CLASSES

Medicine and Health Rhode Island, Dec 2004 by Aronson, Stanley M

On a sun-drenched Monday morning in June, 1975, Brown awarded its first MD degrees of the 20th Century. By noontime on that special day, fifty-eight men and women carried away diplomas asserting that they had successfully completed a rigorous four-year course of study in the basic and clinical medical sciences. Since that auspicious day Brown has graduated some 60 to 65 physicians annually; and with the establishment of the Brown-Dartmouth program in 1981, each subsequent graduating class of physicians has often numbered 70 or more.

The Brown Medical School and the Brown Medical Alumni Association diligently followed these many graduates but no comprehensive review had yet been undertaken until last year when a committee of former deans Aronson, Greer and Marsh, Pardon Kenney, President of the Brown Medical Alumni Association, Professor James Maclllwain, Ruth Sauber and Anne Paton jointly designed a brief questionnaire which was distributed to all graduates from the first ten classes [1975 through 1984] numbering 594 men and women. Over half of these graduates returned completed questionnaires often supplemented by lengthy explanatory letters and accompanying documents.

The avowed purpose of this questionnaire was to seek answers to the customary demographic questions: places of birth, institutions of undergraduate education, activities in intervals before and between formal education, residency training programs for specialty training, specialties selected, and cities where the graduates have established their practices.

But there was a deeper motive in distributing these questionnaires to the first ten graduating classes. It was to answer the more searching questions: To what extent have Brown's efforts in medical education been successful? Has Brown's system of integrating the undergraduate and medical educations, to exploit the scholarly riches of such nonmedical departments of sociology and anthropology, produced distinguishable-and perhaps even distinguished-graduates? Or to restate a question first posed in 1975, "What hath Brown wrought?"

While answers to banal questions such as places of birth or specialties practiced are readily gathered and summarized, success as a medical school is not so easily measured. And while many criteria may be profitably analyzed, no one yardstick can be comfortably used to measure either institutional or individual success. Certainly answers to the most basic of questions can be retrieved. To what extent, for example, have our medical trainees remained in the active practice of medicine? In contrast to the seminaries, where fewer than half end up as active clergy, slightly over 98% of Brown's medical graduates are now actively engaged in some form of medicine: practice, teaching, administration or research. And an astonishingly high 97.3% of our graduates are now Boardcertified in their chosen clinical specialty.

Can academic appointments serve as a valid criterion? In these first ten classes over 70% hold professorial positions in 72 different American medical schools, including virtually every school in the New England and Middle Atlantic region, some as chairs of major clinical departments. And yet even this tells us little. One graduate, trained in ophthalmology, holds a crucial chairmanship of ophthalmology in a prestigious West Coast medical school. Another graduate, equally well-trained in the art and science of ophthalmology, relinquished a thriving private practice in an East Coast city to travel to Asia to establish a series of children's' eye clinics in Nepal. Who is the more successful?

A gifted Brown graduate conducts basic research in dermatological disease. Another Brown graduate initiated an innovative community program, in Oklahoma, to obliterate tattoos, by surgical means, thus enabling teenagers to re-enter mainstream occupations. Who is the more successful?

The committee has no illusions that questions will provide reliable answers to the most fundamental of questions asked by Brown's faculty and administration: Has our admissions process chosen the right people for the difficult lifetime tasks that our graduates must inevitably confront in the profession of medicine? And have we then provided them with the most appropriate moral atmosphere, guidance, technical training and clinical experience to prepare them as independent practitioners for the immense professional burdens that they will necessarily assume in this unfolding century?

No single questions can answer our basic inquiry. But absorbing all of the answers, and the many unsolicited commentaries appended to the returned questionnaires, tells us this: yes, we are on the right path and Brown can take legitimate pride in the attitudes, commitments and accomplishments of its medical graduates. Some graduates expressed disappointment in the way their profession is evolving, particularly the volume of paper work, but the great majority are still enthusiastic and encourage their children to pursue careers in medicine.