On medical education

President Wynne and AAMC President David Skorton talk medicine

In his first visit to an Association of American Medical Colleges member institution since becoming the organization’s president, Dr. David J. Skorton sat with UND President Dr. Joshua Wynne for a wide-ranging conversation. Photo by Mike Hess/UND Today.

Dr. David J. Skorton is president and CEO of the Association of American Medical Colleges (AAMC), a not-for-profit institution that represents all of the accredited medical schools in the United States and Canada (154 here and 17 more in Canada), major teaching hospitals, and academic societies in the United States. He previously served as president of two universities — Cornell University (2006 to 2015) and the University of Iowa (2003 to 2006 )— and, most recently, as the 13th secretary of the Smithsonian Institution.

Dr. Skorton visited the UND School of Medicine & Health Sciences in August to speak at the school’s MD White Coat Ceremony at the request of UND’s interim president and dean of the SMHS, Dr. Joshua Wynne. The visit was Dr. Skorton’s first to a member institution since becoming AAMC president. 

Dr. Skorton and Dr. Wynne sat down for a conversation about medical education in the United States. The following is a transcript of the two physicians’ visit, edited for clarity and space. For a fuller transcript of their conversation, see the latest issue of North Dakota Medicine, the quarterly publication of the School of Medicine & Health Sciences.

David Skorton: For the record, let me just first say that I’m thrilled to be here. I’ve been a fan of Dr. Wynne for a very long time. You’re very lucky to have him leading the whole University of North Dakota, not only the School of Medicine & Health Sciences. Dr. Wynne has two attributes that are made for the moment. Not only is he a distinguished academic who’s got chops in research, patient care, teaching, and more recently, health care policy. He’s the genuine article. Two—he’s never satisfied. He always wants to push the envelope a little bit and make things better.

Joshua Wynne: [Smiling] Something that is very important to me, as I know it is with you, is combining the arts with the sciences. I wanted to start by asking you to talk about that a little bit. When we look at the jobs you’ve had — some at the very big research universities, but also at the Smithsonian — I’m wondering what you think the importance is of the liberal arts to the sciences, especially as it relates to the health care field.

DS:  Well, I know you and Susan (Dr. Wynne’s spouse) are this combination of scientists, physicians, teachers, and lovers of the arts. And it’s not a mistake or totally surprising that those bridges can be built. There was a study by Root-Bernstein  that showed that the odds of a scientists who reached the top level of scientific accomplishment — Nobel Laureates and so on — are over 20 times more likely to have an avocation in poetry, the arts, something like that. So, I think there’s human evidence that the arts are important.

But most importantly, these [biomedical] problems just aren’t so easy to categorize. In the medical sphere, places like UND have brought the humanities into the mainstream of medical education, which is fabulous.

To answer your question, I’ve had a nonlinear career path which I’m happy about. There’s a recent book I’d been reading called Range on the notion that specialization in one’s life early on — which used to be a mantra — is maybe not the best way to reach excellence. I didn’t do it on purpose, but I bounced around a lot. I wanted to be a musician. Obviously, I was a flop at that, since you’re not streaming my music or paying to hear me play now. But I never lost my interest in the performing arts.

Much later, when I was a medical student, and later doing research, it came to me from reading thought leaders over the generations that problems and challenges in the world don’t come in neat categories. Even medical problems — patients don’t walk in and say, “I have a problem with this particular part of my biochemical pathway.” They come in with a whole bunch of things. Problems, fears, the need to communicate and be heard.

So, the movement the AAMC made before my time of looking at the person in a holistic way both in terms of medical school admissions and throughout the journey is the right way. You know Einstein has this quote from the thirties in an essay where he says — and I’m paraphrasing — that all science, religion, and arts are branches from the same tree. And I really believe that’s the case.

JW: One of the things we do to share what medical education is like is use the AAMC blueprint for our “MD in A Day” program. We invite legislators here, and they spend the day here and go through pseudo “acceptance” into medical school, through the White Coat Ceremony to graduation and placement into a residency. The feedback from that has been phenomenal. And we try to expose these legislators to the broad range of things we do here, not only the technical stuff, but everything. And they love it.

DS: This is a great example of the partnerships the AAMC hopes to forge with its membership.

One of the challenges that you and I both have is the problem of our success in increasing the number of med schools in the country, the number of students per class. At one point in my career, there was a time where we all thought there were too many doctors being trained. It turned out that we were not thinking enough about maldistribution, which is a big issue in North Dakota and almost everywhere that I’m aware of, especially in rural areas. It turns out that we missed the boat on that.

And now, just recently, the medical schools in the United States have caught up with the goals set up by the AAMC to increase the number of doctors being educated by 30 percent. We’ve gone just over that.

Photo by Mike Hess/UND Today.

(On learning communities, where allied health professionals, including medical students, are trained in the same building):

DS: What a fabulous idea. Because, given the shortage of physicians, and given the maldistribution of physicians, and having practiced in rural settings in Iowa and at a distance, I think that one of the ways you’re addressing this is your ROME [Rural Opportunities in Medical Education] program — thinking about what a team can do, and making sure every member of the team does all that they have the capability of doing. You guys are way ahead of the curve with learning communities. Such a great idea.

JW: They are both physical and virtual. We put the students together physically, but we also do some educational activities with them together as a group, such as our Interprofessional Health Care course.

DS: What a great idea. Think of all the people who contribute to health care in the country. The physicians, the nurses, the physician assistants, the pharmacists, the medical librarians, occupational therapists, physical therapists. And you’re bringing them together. That’s very exciting.

I want to ask you a quick question. Do you think what you’ve been discussing about efficiency in education, putting on your presidential hat for a moment for the University of North Dakota writ large, does that go for the other kinds of education? You have professional schools, you have undergraduate, you have graduate programs, master’s programs, a massive organization. Have you thought about extending that concept of efficiency to all of your flock?

JW: I’m smiling because this reminds me of a conversation when I was contemplating accepting the interim presidency, with a former fellow dean of a medical school, who now has a very senior position where he oversees both the medical campus as well as the non-medical campus. He urged me to accept this interim position for the following reason: He said, based on his experience at this other major public institution, that the most attractive part was being able to find partnerships between what was going on at the medical campus as well as the non-medical campus, which was largely but not completely undergraduate. They have a lot of other graduate programs, but not medically focused.

And he thought that the articulations that they found between the two institutions were extremely productive in building this idea of maximizing productivity by bringing together different members of the educational team. And it worked to the benefit of both.

So I think the answer is yes, and it was one of the reasons why I decided to take the interim position, because I think it offers me the opportunity to try to encourage those types of partnerships.

DS: I want to say, having been in public higher education for most of my career at University of Iowa, and having a chance in revel in the success that you’ve had in public higher education here at UND, it’s obvious that the Legislature of the State of North Dakota, and this university, have found common ground. We’re sitting in a building that’s magnificent, a great investment for the future. Looks like it was a sizable investment to my eye, but obviously a great investment for the future, and I congratulate you and the Legislature.

I had a chance to meet a member of the House and a member of the Senate in the hallway on the way in. To have formed a great communication partnership, to realize how important it is to invest in this future. It’s one of those investments that’s not going to pay next quarter. It’s going to pay as the years go on. And that shows enormous insight of the Legislature and the governor, and enormous insight of the leadership of the University. I congratulate all of you.

We’re going to have to expand that as much as possible to every public university in the country and every medical school linked to a public university, and of course to the federal government. And so I think our best argument, for making whatever legislative changes would need to be made is the success of places like UND. You can talk all day long about these things, but if you can show an example of things working in a community and across the state, it shows the strength of the general idea.

JW: Just as a point of information, this is not going to be the answer in all states, obviously. But as you may know, we actually have gotten the State Legislature as a partner in graduate medical education slots, and the state is now funding 35 GME slots in the State of North Dakota.

DS: Amazing.

JW: This is provided through state appropriations. Those are tax dollars, and when this bill came up, in a state that is well known for its fiscal care, almost 80 percent of the Legislature voted for the bill.

DS: Amazing.

JW: Nearly 80 percent is a landslide in any state, and these are very careful legislators who spend the public’s money very carefully. And they realized the importance of this issue. We didn’t have much relief from other sources, so the State of North Dakota stepped up to try to meet its own needs by providing additional post graduate medical education slots.

DS: It’s interesting. There’s so much denigration of elected officials these days everywhere. What a great thing to see: a partnership, an example.

JW: Really, the Legislature has been amazing.

DS: Forgive me, I didn’t want to lose this. You get to a certain age and you definitely will lose it. Josh doesn’t know that yet, even though he’s a tiny bit older than me. He’s drawn from the well of perpetual youth or something.

But anyway, you brought up public universities. I just want to say one more thing. Having been both in public and private sector, the public higher education system is the bulwark of American higher education. And of course the private sector is also extremely important. But the public higher education system is what people are depending on in every corner of this country.

It’s not a mistake that the first visit I’m making as president of the AAMC is here. Part is because it’s you, somebody I admire so much. But part of it is also that I wanted to visit a public university in a community based setting, and it’s very, very impressive.

Interview transcribed and edited by Brian Schill, UND School of Medicine & Health Sciences, and Jan Orvik, UND Today.