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Fall 2012 Saint Louis University School o MedicineGrandRounds


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Positive PrognosisStudent wellness initiatives wo-

ven into the curriculum to de-

crease stress and depression

are having the desired impact

on campus. The initiatives also

are attracting attention from

medical schools throughout the

country.| page 10

For more information about

the magazine or to submit story

suggestions, please contact

314| [email protected].

Vol. 10 No.2 Saint Louis University School o MedicineFall 2012

Grand Roundsis

published biannually by

Saint Louis University

Medical Center

Development and

Alumni Relations.

Grand Roundsis mailed

to alumni and friends of the

School of Medicine.

Philip O. Alderson, M.D.

Dean|Saint Louis UniversitySchool of Medicine

Vice President|Medical AffairsSchwitalla Hall M268

1402 S. Grand Blvd.

St. Louis, MO 63104-1028

GRAND ROUNDS EDITORIAL BOARD


Edward J. OBrien Jr., M.D. 67

Cheryl Byrd

MAGAZINE CONTRIBUTORS

Coordinator and Writer|Marie Dilg|SW 94Designer|Dana Hinterleitner

Laura Geiser|A&S 90|Grad 92Nancy Solomon

Carrie Bebermeyer|Grad 06

PHOTO AND ILLUSTRATION CREDITS

Steve Dolan|front cover, 1-16 and back coverMichelle Marie Peltier|3

ALUMNI EXECUTIVE BOARD

President|Edward J. OBrien Jr., M.D. 67|St. Louis

Anne T. Christopher, M.D. 94|St. Louis

Emil DiFilippo, M.D. 66|St. Charles, Mo.

Thomas F. Lieb, M.D. 82|St. Louis

James T. Merenda, M.D. 82|St. Louis

Ellen M. Nicastro, M.D. 04|Chestereld, Mo.

Leroy F. Ortmeyer, M.D. 55|St. Louis

Joan M. Pernoud, M.D. 74|St. Louis

Keith M. Starke, M.D. 81|St. Louis

Jane Willman Turner, M.D. 92|St. Louis

Terrence A. Tyrrell, M.D. 73|Belleville, Ill.

Peter Kong-Woo Yoon, M.D. 81|St. Louis

2012, Saint Louis University

All rights reserved

From the Dean |As I write this message, we area few short weeks away from electing the next president

of the United States. Regardless of the outcome of that

election, the next four years almost surely will see major

changes in the organization of and payment for health care

services. This will cause us to modify certain aspects of

our medical practices and to teach our students about new

models of medical care. In addition, we will need to teach

our students to withstand the pressures of the seemingly

constant regulatory changes and bureaucratic ambigui-

ties of modern medicine. Here at SLU, we are trying to get

ahead of this wave of change with new educational pro-

grams that are highlighted in this issue ofGrand Rounds.

Resilience training for rst- and second-year medical

students at SLU is part of the new approach and seems to

be making a positive difference. The rates of anxiety and

depression in our freshman and sophomore students have

declined signicantly. New curricular changes provide the

opportunity for students to break away from the constant

ow of new information and the stress of exams. Our

students now begin their rst year in classroom courses

where they get to know one another and develop a bit of

condence. A few weeks later, they address the challenge

of the rigorous course in human anatomy. This change

has led to better performance and more enjoyment of the

anatomy course than in previous years. Medical students

work with hundreds of students from six other health pro-

fessions in the third-year Interprofessional Team Seminars.

In the fourth-year capstone, one of the most popular anduseful courses addresses the business aspects of medical

practice.

In a new health care environment that is likely to be

characterized by more emphasis on primary care, on more

physician employment in hospitals or health systems, on

compensation related to quality metrics and to efciencies

obtained through collaborative care with non-M.D. health

care providers, young physicians need more than the skills

learned traditionally in medical school. We believe that

training in resilience and related psycho-social skills as part

of the new curriculum at SLU is helping students prepare to

be tomorrows leaders as the health care system evolves.

Mining or theGold StandardOutcomes research hasbecome a hot topic and the

SOM is helping lead the

discussion. Collaborating with

national health care providers,

researchers and drug compa-

nies, the University is discover-

ing what works at the bedside

and what doesnt.| page 14

Award WinningRespected SOM educators

nd that teaching future

physicians is as much

about inspiration as it is

information. They reect on

what their students continue

to teach them.| page 6

Poised or DiscoveryBig risks lead to big rewards

for researchers studying

breast cancer and antibiotic

resistance.| page 16

Living the MissionA SOM alumna leaves private

practice to serve a public need.

| page 18

Vital Signs| page

Alumni Pulse|

pa

Profle oPhilanthrophy| b

GrandRounds


Dean | Saint Louis University School o MedicineVice President | Medical Aairs

Whether theyre cultivating

fresh basil in the student gar-

den, attending yoga classes or

taking a frozen custard break,

SOM students learn that in

order to take care of others

they rst must take care of

themselves. Third-year students

Stefanie A. Rademacher and

Amy R. Hurt nd it therapeutic

cultivating their shared plot

in the student garden on

campus.|page 11


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Grand Rounds 11

Gillian S. Stephens, M.D., M.Sc., was not the

traditional medical student. She was 42, married

and had four children when she entered medical

school in 1994.

Medical school was an isolating experience

for me, said the assistant professor of family and

community medicine. I was overwhelmed with the

stress, and struggled quite a bit at times with my

mood and self-esteem. I assumed it was hard for

me because I was older and had a family.

Stephens assumption was proven wrong in

2001 when her son, a traditional medical student

21, outgoing and brilliant entered the samemedical school. Stephens said her son excelled

academically and was a leader among his peers,

but he experienced similar isolation and stress.

His experiences made me feel somewhat better

because they validated my impressions, she said.

Clearly, I wasnt alone.

WHITE COAT-BLUE MOODStephens denitely is not alone. Several studies have indicated

that about one-fourth of medical students suffer from symp-toms of depression and signicantly more suffer from anxiety,

especially during the rst and second years. Stuart Slavin, M.D.

(83), M.Ed., associate dean for curriculum and professor of

pediatrics, was aware of the studies, but when he looked aroundSLUs Medical Center he saw students who seemed happy andengaged. Those studies were about students at other schools,not his. Because he is charged with doing everything he can toensure student success, however, Slavin decided to survey SLU

School of Medicine students anyway. Using validated depressionand anxiety instruments, he began with the Class of 2011. Hesaid the results were shocking.

We looked like everybody else, and it wasnt pretty, he said.Twenty-seven percent of the students had moderate-to-

severe symptoms of depress ion by the end of their rst year,

and 57 percent suffered from moderate-to-high levels of anxiety.Twenty-nine percent of second-year students and 31 percent ofthird years had moderate-to-severe symptoms of depression.

Things had to change, said Slavin, chair of the curriculummanagement committee. I didnt want to be in charge of anenterprise that had such poor mental health outcomes. Thinkabout it. How can we expect our students to become wonderfuldoctors if we injure them in the process?

AGGRESSIVE APPROACHSlavin said medical educations traditional approach to mental

health intervention largely has been to remove the stigma ofseeking help and provide students with better psychiatric care.His approach, on the other hand, is preventive. Reduce unnec-essary stress in medical school and give students better copingskills so they dont become as depressed and anxious.

Slavin and the curriculum management committee are tempting to do this through curriculum changes. They impmented the rst change in 2009 when the school joined ab

40 of the nations 125 medical schools in adopting a pass/grading system for the pre-clinical years. Studies have dem

strated that a change to pass/fail was accompanied by a stacally signicant improvement in psychological factors relat

anxiety, depression, positive well-being, self control, vitalitthe general physical health of students in the early semestmedical school.

Next, the Ofce of Curricular Affairs (OCA) created lo

dinal electives. Instead of engaging in electives one-half daweek over a seven-week span, electives were extended acromajority of Year One and Year Two, with one full day of

time every two weeks. The idea is to allow students to focuon absorption of knowledge and more on nding their pa

Two years ago, the OCA instituted a required resiliencemindfulness curriculum for rst-year students comprised o

30-minute sessions on stress management, positive psycho

and cognitive-behavioral practices.

BREAK THE ROUTINEThe OCA also created learning communities in which stud

and faculty members who share a common interest somtimes interests that transcend medical specialties spend working on projects outside the classroom. The learning cmunities were divided into ve groups: Global Health, Me

Education, Research, Service and Student Wellness.When Slavin presented his idea for the wellness learnin

munity to faculty, Stephens said she was eager to serve as It was a very personal thing for me, she said. I saw th

an opportunity to make medical education a better experiethan it was for me.

Once a month, Stephens meets with students to discusfor keeping balance in their lives. During the past three schyears, the students have organized ski trips, ice skating partand Mardi Gras celebrations. The community sponsors Pu

kin Pie Day, a watermelon festival, a photography contest, Donut Day and movie nights.

Ting Zhang, a third-year student from Beijing and a mof the learning community, has participated in the photog

contest and a student cook-off. She said the events are divthat actually improve her study habits.

Ive gone to the library and tried to study for eight hobut its impossible, she said. I zone out for at least two othose hours. Im reading the same thing over and over. Bu

have something to pull me out of the library for a little whnd Im much more focused and the break refreshes me.

The community also sponsors lectures on good sleep h

and stress management. And, during high stress times, sucas right before exams or waiting for results, Stephens sendmotivational emails to students reminding them to eat prosleep adequately, exercise regularly and think positively. Eaemail ends with a trivia question about her homeland, AusThe rst student to respond with the correct answer is aw

a package of Tim Tams, a chocolate biscuit popular downand coveted by School of Medicine students.

PROG

NO

SI

Student wellness

initiatives are achieving

desired results. Fourth year student Amy Nuismer


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Grand Rounds 1312

I think medical school would have been innitely harder had

I not found this outlet, she said. No matter which path youchoose, you have to nd something that keeps you balanced and

energized because if you dont youll hurt yourself and by exten-sion hurt those youre trying to help. Im grateful to be part of aschool that takes this aspect of self- care seriously.

Slavin said the combined curriculum and wellness interven-tions, unprecedented in medical education, are effective tools in

student recruitment.

I believe were the only medical school in the country takingthis comprehensive approach to student wellness, and word isspreading, he said. We have prospective students asking spe-cically about opportunities that will help them grow outside the

classroom and library. It shows we care not just about a gradebut the whole person.

MIND AND BODYOther health diversions created by students who are part ofthe wellness community include a student garden, a book club, aknitting club and a weekly yoga class held in the Learning

Resources Center. Fourth-year medical student Amy Nuismerhas attended regularly since her rst year.

Originally I came to the class to reduce stress and meetother people with similar interests, but I discovered a lot more

than that, said the Michigan native. I learned how to breathe,how to relax and was able to make dietary changes for the better.I learned the importance of focusing on something other thanmy books, even just for an hour a week.

Nuismer was so empowered by the yoga classes that she

completed the rigorous 200 hours of training to become acertied yoga instructor and plans to bring the philosophy and

lifestyle behind yoga into her practice.

1. Students take a break from studies for a cup of frozen custard and some sunshine during the StudentWellness Communitys annual ice cream social. 2. Third-year student, Amy Hurt, uses a day off from herinternal medicine rotation to do a little pruning in her plot at the student garden on campus.

3. Victoria E. Cornelius, M.D., adjunct associate professor of pediatrics, has been leading the weeklyyoga sessions for more than a year. 4. Weekly yoga classes help students maintain balance in their lives.5. Gillian Stephens, M.D., (right) at the August ice cream social with rst-year student Abby Thuet.

POINT OF IMPACTSlavin said that the curriculum changes and the wellness commu-

nity are having the desired impact on students. His data indicatethat since implementation of the wellness initiatives, depressionand anxiety levels have dropped signicantly [see graph].

The changes are staggering, he said. Plus, theres noevidence of a drop in performance. If anything, the average

scores on our exams are slightly up, which makes sense. If youredepressed or anxious, youre not going to perform well.

As for the future, Slavin and his team will allow the longi-tudinal electives and learning communities to ourish. Other

changes are in the works. Most of the attention has been limitedto the rst two years of medical school. Now, he is restructuring

the third year.

Third-year students usually go 24 weeks without a vacabut a curriculum restructuring in the works will give third break after 16 weeks. Also, every eight weeks, third-year stwill not be required to report for their clerkships. Instead will have breakfast with their classmates, attend a lecture o

topics such as end-of-life-issues or pain management, and into small group discussions facilitated by fourth-year studThe students will discuss the lecture, as well as process theclinical experiences in a safe environment.

Weve made all of these changes at little or no cost, Ssaid. And weve done nothing to compromise the educatiquality of our program. In fact, I would argue that these ehave signicantly enhanced the education and training we

provide.

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Trends in Anxiety and Depression SymptomsBefore and After SLU Medical Student Wellness Initiatives

65%

0

5

10

15

20

25

30

35

40

45

50

55

60

One Week BeforeMedical School

M

edicalStudents

After 1 Year ofMedical School

After 2 Years ofMedical School

Before WellnessInitiative (2007-09)Significant AnxietySymptoms

After WellnessInitiative (2011-12)Significant AnxietySymptoms

Before WellnessInitiative (2007-09)Significant DepressionSymptoms

After WellnessInitiative (2011-12)Significant DepressionSymptoms

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