Education and Independence

Happy July Fourth, a day early. Tomorrow marks 244 years since 56 men dipped a sharpened quill in ink and signed the Declaration of Independence, risking their lives to resist the largest empire in the world at the time. Although many have recognized and commented on flaws that accompanied the courage of the signers, their written articulation of the “self-evident truths” as a foundation for a new way to organize a society has undergirded America’s ability to renew itself and prosper through adversity over the past two centuries. Today, as the holiday approaches, the concepts of freedom and independence are—more than ever—being actively debated in light of present challenges facing our society and communities. As we continue to strive toward a balance between social responsibility and liberty, we should reflect on our commitment to the founders’ original project of freedom. As health care providers, the Fourth of July always carries some worry (especially for our colleagues in the Emergency Department). However, this year, as we face a national health crisis, independence should mean more than personal freedom, but also personal responsibility. I endorse these guidelines and the reminder sent out yesterday by our CEO and our Chief Medical Officer reminding us of our responsibility to our families, community, colleagues, and patients to adopt universal face covering and social distancing, even as we contemplate and plan for ways to celebrate the holidays. Additionally, as we continue to acknowledge and examine issues related to racial equality and justice let us use the holidays to reflect on what independence means, and what we are willing to do to secure it for everyone. Freedom must accommodate individual rights and public well-being, the difference between what is comfortable for some and what is good for all. This year’s celebrations may (and definitely should) be different than those of years past, but I hope it also allows us to cherish new elements of our shared identity a little more dearly.

This week is not just for a renewal of patriotism, but it is also a renewal of the academic year, a clean slate with a new cohort of learners. Ever since we had to send them away from our clinics and rotations, we have eagerly awaited the return of our medical students. Many faculty, particularly Drs. Milena Gebska and Laurie Lyckholm in the Sub-I, found creative solutions to ensure education continued in the interim. But there is no substitute for bedside training, both for student instruction and faculty inspiration. Recently on Chair’s Rounds, I was particularly struck by the presentation of a case by one of our sub-interns. There were many unusual aspects to the case and I asked the medical student to do some additional reading and report back to me about the follow-up of the patient and how what she learned could inform the management of this case. I will share the first part of the email that I received: “It was really great to meet you the other day. I wanted to let you know how educational I found chairman rounds to be. It made me realize why I love medicine and I wish there were more opportunities for the kinds of discussions we had.” Our learners are an important part of our community and one of the reasons why many of us chose to pursue Academic Medicine. Thanks to everyone in the Carver College of Medicine who have spent these last months preparing for this week, so that we could welcome our students back safely into the full complement of their training.

Our interns are also finishing their first week with us and, in addition to the standard orientation, they have weathered a COVID19-adapted version of our innovative Objective Structured Clinical Examinations, which establishes a baseline assessment of their clinical skills. My thanks to Jane Rowat, Dr. Manish Suneja, and all the faculty and staff who contributed to that complicated operation. A fuller account of this year’s OSCE is coming soon. Our Chief Residents are busily implementing a series of new initiatives as well, including an upgrade to last year’s Chiefs’ blog, which serves as both a repository of information for residents and a showcase of our program to prospective recruits. 

What our trainees will find in their time at Iowa is a wealth of opportunities to bolster their chosen career path, whether it is in quality improvement projects, medical education, or in scholarship. This recent story about a handy clinical tool developed by Drs. Arvind Murali and Antonio Sanchez to help determine a patient’s risk for NAFLD decompensation contains an interesting fact near its end. In addition to assistance from a member of our Institute for Clinical and Translational Science, two of the co-authors on the publication describing the tool are former residents, Drs. Heidi Ahmed and Natalie Pedersen. It should be clear to all that residency here is not just a time for observing the work of others but an opportunity to roll up your sleeves and, with dedicated mentorship, contribute to real advancements in medicine. We are excited to see what your interests and enthusiasm will uncover in your time with us.

Innovations in therapeutics and diagnostics abound at Iowa. Not only are they grabbing national attention, but they reflect the fertile soil in which all of our trainees will develop. I will highlight a recent example. Dr. Pashtoon Kasi has been working with the so-called liquid biopsy for some time. This analysis identifies circulating tumor DNA in a blood sample and can let providers know far sooner than traditional scans whether a surgery may have missed some portion of a tumor or there has been recurrence. Recently Dr. Kasi and an organization that performs in-home blood draws for analysis of certain types of GI cancers were featured in an extensive news story on Quad Cities’ news channel KWQC. A version of this story has since been syndicated to dozens of NBC affiliates around the country. At last report, more than 1.3 million viewers have seen this story. Well done! 

Finally, our commitment to medical education does not end at the county line but extends across the state of Iowa. We welcome our colleagues in Des Moines at our extension campus and around the state to this page’s readership and look forward to introducing them to the rest of our campus here in some future articles. Moreover, the Office of Statewide Clinical Education Programs recently shared with me its final data for the preceding academic year and once again, Internal Medicine has contributed heavily to the Visiting Professor Program. Eleven faculty members from six divisions filled more than a quarter of all total sessions provided. Thank you to the faculty listed below for the time and effort taken to travel to these locations to share your expertise.

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About E. Dale Abel, MD, PhD

E. Dale Abel, MD PhD Francois M. Abboud Chair in Internal Medicine John B. Stokes III Chair in Diabetes Research Chair, Department of Internal Medicine Director, Fraternal Order of Eagles Diabetes Research Center Director, Division of Endocrinology and Metabolism Professor of Medicine, Biochemistry and Biomedical Engineering

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