History

• History of the FSU College of Medicine
  
• Founding Principles  

Dean Harris

J. Ocie Harris, M.D., was named dean Jan. 28, 2003, replacing Scherger. Harris had been an associate dean at the FSU College of Medicine since November 2001. In that capacity he had overseen the development of the college’s three initial regional medical school campuses and the recruitment of clinical faculty. Harris came to FSU from the University of Florida College of Medicine, where he had a distinguished career spanning nearly 30 years. At UF, he had most recently served as associate dean for community-based programs and director of the North Florida Area Health Education Centers Program.

The College of Medicine welcomed its first 30 students, the Class of 2005, in May 2001. Class sizes steadily increased to 104 students in the Class of 2010. Starting in June, 2007, the College of Medicine will admit the maximum 120 students a year on the way to a full enrollment of 480 students.

The FSU College of Medicine was designed as a community-based medical school with regional campuses originally opening in Orlando, Pensacola, Sarasota and Tallahassee. Additional campuses in Daytona Beach and Fort Pierce will help accommodate 240 third- and fourth-year students training with more than 800 clinical faculty throughout the state.

The students spend their first two years taking basic science courses on the FSU campus in Tallahassee and are then assigned to one of the regional medical school campuses for their third- and fourth-year clinical training.

Originally housed in Duxbury Hall (administrative offices and student community room), Montgomery Gym (anatomy lab), several science buildings (classrooms) and portable buildings (administrative offices), the college moved into transitional facilities at the former FSU Developmental Research School on the northwest corner of the FSU campus in three phases between December 2001 and April 2002. The college broke ground Feb. 4, 2003, on a new 300,000-square-foot complex of buildings to house the first- and second-year educational program, and moved into these buildings in October 2004.

The history of medical education at FSU dates back to 1971, the year the Program in Medical Sciences (PIMS) was founded as an expansion program of the University of Florida College of Medicine. Funded by a National Institutes of Health grant, PIMS was designed to address the need for physicians in the rural areas of Northwest Florida. Through PIMS, students completed their first year of medical school at FSU and then transferred to UF to complete their medical education. Initially, the PIMS pharmacology course was taught by faculty from Florida A&M University, which was a partner in the program. In 1975 the state of Florida assumed the funding of the program in FSU's budget. PIMS had been providing the first year of medical education for 30 students a year since the 1970’s. The traditions and successful policies and philosophy of FSU’s Program in Medical Sciences influence and guide the continued development of the College of Medicine.

In the early years (1971-1992), only students from FSU, the University of West Florida, FAMU, and some UF students who were not accepted directly in Gainesville (upon referral by the UF College of Medicine admissions chair) could apply to PIMS for admission. Under the directorship of Dr. Hurt, PIMS became a participant in the AMCAS application process in 1992, and the applicant pool was opened to all legal residents of the state of Florida. However, the original recruiting mission of the program was retained. Housed first in the Thagard Health Center and then Montgomery Gym on the FSU campus, PIMS moved into new administrative offices and a new student resource center in 1993.

The FSU College of Medicine uses similar admissions criteria to that of PIMS. From the first PIMS admission cycle, diversity in life experience was sought in applicants to the program. Application of "nontraditional" students, and students from rural and urban underserved areas was, and still is, encouraged. Older returning students, students from financial and/or educationally disadvantaged backgrounds, minority students, females, students from rural and urban areas, as well as diverse ethnic backgrounds were selected for admission to PIMS. Consequently, PIMS classes tended to have an older average age and to be more diverse than classes at traditional medical schools.

Early clinical experiences in community settings have been a curricular component of the program since the beginning, as has been a culture that values group study, teamwork, patient-centered medical care, and service to others. Paul Elliott, Ph.D., served as program director from 1971-1978 and Robert Reeves, Ph.D., from 1979-1992. Hurt was named Director in 1992.

To promote a liberal studies background and a humanistic medical education, PIMS was placed within FSU's College of Arts and Sciences. FAMU, Florida's historically black university, and UWF became PIMS recruiting partners in 1971 and 1985, respectively. Hurt was the third and final director, serving from 1992 until 2000, when the College of Medicine was created.
 

THE FUTURE OF MEDICAL EDUCATION: THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE   Myra M. Hurt, Ph.D. Director, Program in Medical Sciences (1992-2000) Associate Dean, College of Medicine   August 1999

Preamble

As we face a future in which human embryos can be genetically manipulated, or cloned, a future in which the sequence of the human genome is completely known, we are faced with the ironic situation that academic medical centers are not producing the physicians our society needs.  In the late twentieth century, the well-trained physician is equipped to treat Degos’ disease but not shoulder pain, eosiniphilic fasciitis but not the much more common condition, plantar’s wart. The medical text books used to train these physicians are written about the most unusual cases of disease known to man, not the common medical conditions upon which most of medical care is based.  Internists leave their medical center training sites having not been exposed to a single case of osteoarthritis, early stage diabetes or allergic asthma; never having examined a normal geriatric patient versus such a patient close to death, or a rural farmworker suffering from exposure to herbicides.   These kinds of patients do not visit the academic medical center. Ironically, the knowledge and skills required to treat these kinds of common medical problems are  specialized,  yet this knowledge is not the focus of medical education in the late twentieth century.

In an article from the New England Journal of Medicine entitled The Ecology of Medical Care  written by a group of researchers in the departments of Preventative Medicine, Medicine, and Biostatistics at the University of North Carolina, the following is reported:  in a population of 1000 adults (age sixteen or older), 750 will experience an episode of  illness in a particular month; of these, 250 will consult a physician; 9 of these will be hospitalized, and 1 will be referred to a university medical center.  The focus of medical textbooks is that 1 case (in the metaphorical sense) that makes to it to the university medical center.  The year the article was written was 1961 (NEJM, 1961, 265:885).   The focus of medical education in academic medical centers today is largely the same.

In his book, The Innovator’s Dilemma, 1998 (Harvard University Press), Clayton Christensen describes the forces against change in established corporate structures.   Using examples from corporate America, he illustrates how innovation almost always comes from outside a corporate structure, from what he calls disruptive technology.  The values, the culture, the way decisions are made within the established corporate institution producing the sustaining technology in a field make it impossible for that institution to change quickly enough to meet the demand of customers for change.    The ability of academic medical centers to meet the need for educational reform can be examined using this paradigm. Their product, medical care, is ever more technically driven and the performance of their product is needed by an ever smaller group of patients (those with the rarest diseases not treatable anywhere else).  Meanwhile the mainstream customers (patients), have needs which are very different from this rarefied set of the most demanding customers. The resulting situation we find today sets up beautifully a platform for launching the development of a disruptive technology, a new approach to medical education and health care delivery. This disruptive technology would embody different values, build a new culture and succeed where the sustaining technology fails because the disruptive technology is unencumbered by the culture of the sustaining technology, which values only the research contributions to the health of the sickest, the most exotic patients under medical care today.  By canvassing the consumers of medical care, and by taking aim on meeting the health care needs of the majority of patients, the disruptive approach to medical education can be launched, with high likelihood of success.

In response to the changing environment in which doctors practice today, medical leaders have recognized the need for addressing present-day shortcomings in medical education. The American Association of Medical Colleges (AAMC) has sounded the call for deep reforms in the way physicians are trained in AAMC –accredited medical schools. In 1995, a strategic plan was adopted by the AAMC to meet the challenges facing medical schools and teaching hospitals (Taking Charge of the Future, a Strategic Plan for the Association of American Medical Colleges).  The president of the AAMC, Jordan Cohen, M.D., in an article in Academic Medicine (1998; 73:132-137) called for leadership in improving the education of doctors, and stated that change is not happening fast enough, that there is no time to waste even while recognizing there are many obstacles to change. And perhaps the biggest obstacle to the necessary changes is the culture and the value system found within America’s medical schools.

Mission

Our goal is to broadly train the physicians of tomorrow, giving them learning opportunities which will make them lifelong learners--to equip them so that they can teach themselves what they need to know to practice medicine in an era of genetic intervention, the application of stem cell technology, massive choices of pharmacological applications, the use of a broad array of new diagnostic and therapeutic technologies in their own offices. The basic science component of this training program will occur in a university setting, integrated into the culture and value system of a liberal arts university, The Florida State University.  The clinical training component will occur almost completely on the front lines of the health care delivery system, in the north Florida region as well as sites across the State of Florida--ambulatory care settings including physicians’ clinics, HMOs, and chronic care facilities in rural, urban, and suburban settings.  The curriculum will be comprehensive, preparing students to enter residency training in any specialty. However, it will emphasize the college’s mission of providing primary care to Florida’s elderly, rural and other medically underserved populations.  Finally, the training program will focus on creating a culture which places value on the doctor-patient relationship, generalist ambulatory medical care and working as part of the health care delivery team.

Curriculum

The dynamic curriculum will incorporate the competencies mandated by the customers-- patient groups including the elderly, chronic disease foundations, patients of HMOs, patients from rural and inner-city areas, gender groups, etc., the patient populations found in Florida and across the United States. This new curriculum will undoubtedly create new research opportunities-- in the academic medical center, research drives the curriculum.  In our disruptive technology model, the curriculum will drive new research initiatives. The Internet will play an integral role in the educational program--it will be used to link clinical training at diverse ambulatory sites, facilitate small group interactions of students, faculty, community physicians, or patients at proximal or distant geographic sites across north Florida, the state, the country or the world.  It can be used to facilitate learning activities for all of the above groups and to assure comparability of educational experiences at multiple training sites. 

Much of the basic science curriculum will be delivered in a case-based, small group approach utilizing teams of instructors which may include basic science faculty, clinical faculty, other health care delivery team members (nurse practitioners, physician assistants, pharmacists, etc.), other students, social workers, therapists, and patients.  The McMasters (Canada), Harvard Medical School New Pathway, and University of New Mexico models for the case-based approach are mature and tested and have been shown to work in schools accredited by the LCME of the AAMC;  a multitude of  published cases are available for use in this curriculum should they be desirable.  Clinical training will occur primarily in ambulatory settings.  As will be described under clinical curriculum below, we will use well-tested clinical training programs in AAMC-accredited medical schools which focus on ambulatory training sites as models in the development of our clinical curriculum. 

Basic Science

An integrated curriculum will be developed containing a core curriculum-- the fundamental and unchanging concepts of how humans work at the macroscopic, microscopic, and molecular levels (physiology, anatomy, biochemistry, cellular and molecular biology, and human behavior)--which will be defined and incorporated.  Preparation for the practice of medicine in the next 5-15 years will necessitate additional curricular components of molecular biology such as genomics, molecular embryology, molecular pharmacology, etc. Other components of the curriculum which will be continuous throughout the 4 years may include: 

Clinical Curriculum

As stated above, the curriculum will be integrated, so the boundaries between basic science vs clinical curriculum will to some degree disappear.  Training in the care of patients will be a continuum throughout all 4 years of medical training.  The required clinical clerkships which traditionally occur in the third year of medical education will occur almost entirely in ambulatory settings - 3 months or less of specialized clinical training in hospital settings will be part of this curriculum.  The University of Minnesota School of Medicine Rural Physician Associate Program (RPAP) has such a clinical training program as a pathway within the School of Medicine and has a long history which demonstrates that this approach to medical training works.   The University of Washington School of Medicine WWAMI program also utilizes ambulatory sites in 5 states for clinical training of physicians in Family Medicine.  Michigan State’s College of Human Medicine uses 6 Michigan communities for clinical training of future physicians and also focuses heavily on training with local physicians in the communities.  These are mature programs with long histories of meeting AAMC standards for accreditation.  In the Minnesota RPAP program, students spend only 3 months of the two clinical years in teaching hospital settings in Minneapolis, and spend the rest of their clinical training in physicians’ offices in rural areas of Minnesota.    In the University of Washington WWAMI program, students spend years 1 and year 3 in rural settings in Wyoming, Alaska, Montana and Idaho.  Michigan State’s Upper Peninsula clinical training program is focused entirely in rural community settings. These schools have tried and true mechanisms in place to assess students, physician preceptors and training sites to assure comparability for the LCME of the AAMC.  These programs will be used as models for the development of the clinical curriculum.

The FSU clinical faculty will be comprised of some full-time physician educators but will draw heavily on the pool of local and regional community physicians who will be compensated for the training of students in their practices.  Minnesota, Washington and Michigan State provide models for the credentialing process for such community clinical faculty. Because of the unique curriculum and structure, Florida State University will not own a teaching hospital nor a physician practice plan for clinical teaching faculty. All clinical teaching faculty will have ongoing faculty development/training as part of their compensation package. 

Class Size

The historical size of the PIMS class was 30 members. Great value has been placed on the PIMS culture and values by the PIMS students, alumni and faculty, as well as the administrations of UF College of Medicine and FSU. A major challenge for the FSU medical program is to retain this culture and set of values in the face of change.  This is possible if the PIMS recruiting and admission philosophies are retained, and if the curriculum and facilities are designed to foster small group interactions, both in delivering the curriculum as well as in provision of dedicated study environments such as the current PIMS class has in the PIMS resource center, a dedicated study facility available to the students 24 hours a day. Upon completion of the new medical school facility, the class size would reach full maturity at 100-120. The inaugural class of 30 students will graduate in the year 2005, and will be the first class to earn their M.D. at The Florida State University. The second year is being offered for the first time in 2002, and in 2003 the first regional medical school campuses will be operational.

Summary

Today, such diverse groups as HMO administrators and the leadership of the AAMC, medical educators and medical students, and most importantly, patients of all kinds agree on the following. Our nation’s medical schools are producing the finest medical specialists on the planet and their faculties are producing research astounding in both breadth and depth. Yet, many patients are not getting the medical care they want or, more importantly, need.  Recently, a large survey of people representative of all population groups within an entire population identified the roles the ideal physician should be competent to perform (CanMEDS 2000, The Royal College of Physicians and Surgeons of Canada, 1996).  These roles are: Medical Expert (clinical decision-maker), Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional. These same competencies were recently endorsed by several American medical specialty societies. The time is right to launch a new approach to equipping physicians with the skills to play these roles in the lives of their patients.  That approach will be launched at The Florida State University.