General Medical Disciplines Department of Medicine

Quarterly News -- Summer 2013

Mark Cullen, MD reports to you the quarterly news for Summer

Mark Cullen Mark Cullen, MD

As I watch the annual changing of the guard—our students and trainees graduating, new faces appearing on our explosive roster of new faculty—I cannot help but marvel at the transformation in the Division of General Medical Disciplines (DGMD) and, indeed, the very environment in which we live and work. Where once the cognitive work we do for patients and our studies of population health merited hardly a glance from the attentions of our students and faculty colleagues, we find ourselves suddenly at the very epicenter of a new paradigm in which our ability to care for large and diverse groups of patients in coordinated fashion, and perhaps more importantly to design, implement and assess new modes of delivering that care to improve quality, value and patient experience, are as highly valued as the work of biologic discovery for which Stanford has been long renowned.

The evidence? Just look around: Over a third of the graduates of the medical school class have chosen Internal Medicine (IM) or Family Medicine (FM) for their residency training, unprecedented in recent Stanford history. Of the graduates of the IM training program, jobs and advanced training in primary care and hospitalist medicine have gone from “rare” to “typical”, and no one has been a greater beneficiary than DGMD, snagging top grads from both the categorical IM program and our affiliated program in Family Medicine at O’Connor. Even our Physician Assistant’s (PA), long directed towards returning to primary care in the communities from which they were drawn are increasingly finding homes in the Stanford firmament. Our faculty, numbering 26 when I arrived in 2009, will soon burst into the three digits, fully a third of the entire Department of Medicine.

But as proud as I am about our progress, this is hardly the time for us to rest on our laurels—we have only just begun to fulfill our triple mission in care, education and research. On the care side, even as we forge into brave new territory with a spate of clinical offerings up and down the spectrum our disciplines, each program is far from achieving its potential as an innovative, patient-centric, high value proposition offering a gateway to a system of coordinated care; indeed the goal of adopting the best of the many ideas spawned by our Clinical Excellence Research Center remains far off on the horizon, even if now faintly visible to the naked eye.

In training we have swarmed the curricula of the medical students and house-officers, but have yet to transform either into a true pipeline for future faculty and practitioners; we are not yet teaching the core skills physicians in DGMD will need in the future: team building and management; task sharing and coordination, population systems and information technology which will need to take their place beside interpreting the genome and new imaging techniques as the core tools of our trade. We will need to develop novel ways to co-train with PA’s and nurses and the other health professionals who will be key members of the very teams we must start to build. And while we are at it, imagine our burden to advance the training of the many physicians and mid-levels in the community who are rapidly becoming part of the expanded Stanford Medicine network.

And my own very special hope to become a hot zone for advancement of research in primary care and population health, while strengthening every day, remains as well more concept then reality. True, we have built some of the infrastructure, but have not yet effectively transferred the skill sets of our most research-oriented faculty to the clinicians and educators who remain—close as they are to the bedside and the populations that matter-- our greatest potential human capital. Is it time for a DGMD fellowship?

So as we each take our time during the coming months to be with our families, to unwind a little from the most arduous periods in the academic cycle, we should at once exult in our achievements and prepare for the challenges ahead. I’m counting on all of you!

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