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SECOND OPINION
BY SIDNEY HARRIS

Make premed courses more relevant

One of the benefits that are sure to result from making the premed curriculum more relevant to medical practice [“Reform of Premed Education Under Way,” Yale Medicine, Winter 2009] is that it will attract more students into primary care.

Most medical schools are research-based and naturally favor students with outstanding aptitudes in basic science. This has produced many advances and well-trained specialists, and society has benefited immensely. The focus on specialization, however, has also led to a serious shortage of primary care doctors. The lack of access to primary care has prompted policymakers to consider giving authority to nurse-practitioners to practice some aspects of primary care independently.

In my 34 years of practice as a primary care doctor, I have found almost no use for the intense exposure I had in premed to calculus, organic chemistry, physics, invertebrate biology and physical chemistry. This is not to say that these courses were worthless, but they could have been abbreviated and simplified.

I can remember several students in my premed class who struggled through the basic sciences. Their grades in the sciences were average and they did not do well on the MCATs. Turned down by medical schools at home, many attended foreign medical schools, as I did.

The point is that the move to make premed courses more relevant is a good one. Perhaps students with the abilities to be good general practitioners will not be weeded out and eventually the primary care physician shortage will be corrected.

Edward J. Volpintesta, M.D.
Bethel, Conn.

Thanks for the photos from a fan of the big dig

My 2-year-old son would like to thank you for the wonderful photos in your Winter 2009 issue [“As the Medical Center Grows, So Grows the City,” Yale Medicine, Winter 2009]. He is a BIG fan of “dig, dig” and the ongoing projects at the medical center have given him much enjoyment over the past year.

Sandra J. Bishop-Josef, Ph.D.
Assistant Director, Edward Zigler Center in Child Development and Social Policy; Associate Research Scientist, Child Study Center, Yale School of Medicine

Article on physical exam recalls Klatskin’s skill

I just received the Winter 2009 edition of Yale Medicine and enjoyed a number of articles, including the roast of Yale’s “pathological triple threat.” Both I and my father, Wilbur G. Downs, M.D., M.P.H., much enjoyed our acquaintance with Michael Kashgarian, M.D. ’59, HS ’63.

There was considerable mention of the Wilbur Downs International Health Travel Fellowship Program, as well as a nice piece about Curtis Patton, Ph.D., professor emeritus of epidemiology.

I myself am a fan of the Oxford English Dictionary and I’ve read The Professor and the Madman. … and so I enjoyed the article on William Minor.

Additionally, as a practitioner of ER medicine, I am acutely aware of how technology has served to erode our physical exam skills. The article by Jill Max was very apropos and I admit I had forgotten about the Adson maneuver. One of the professors of my era, Gerald Klatskin, M.D., could percuss out a liver edge or a heart border such that a student across the room could hear it.

Monty Downs, M.D. ’70
Kapaa, Hawaii

Writing award for Yale Medicine editor

In February we learned that John Curtis, managing editor of Yale Medicine, had received the Award for Excellence in General Staff Writing from the Group for Institutional Advancement of the Association of American Medical Colleges. Curtis received the award for his feature article in the Winter 2008 issue, “On the Wards in Uganda.” To report on an ongoing collaboration between Yale and Makerere University in Kampala, Curtis spent two weeks shadowing Yale attendings, residents and medical students as they worked alongside Ugandan colleagues at the government-run Mulago Hospital. He also accompanied them on field trips to camps for internally displaced persons in northern Uganda and to the fishing village of Kasensero on Lake Victoria, where Uganda’s AIDS epidemic began.

Starting point:

World events bring change to Yale and to Yale Medicine

Changes—some long-planned, others arising of necessity—are in the air for Yale Medicine. For more than a year we’ve been contemplating a redesign of the magazine. In the nine years since the last redesign, as some sections and pages have begun to show their age, we have seen a need to bring variety and flexibility to them. Our first step will be to survey our readers to ask what you like—or don’t like—about the magazine. Many of you should expect to receive a survey, by mail or e-mail, in the coming weeks.
Then came word last December that the global economic crisis had reached the university, reducing its endowment by a quarter and requiring cuts in spending. In February came another announcement—the crisis was more severe than anticipated and belts would have to be pulled even tighter.
The School of Medicine is not immune to these events. To meet requests to reduce spending, we are scaling back on Yale Medicine. We are still looking at ways to cut back, but options include shrinking the magazine from our current size of 48 pages for the winter and spring issues and 64 for the autumn issue to a standard 32 pages for all three issues. Or we may cut back from three issues a year to two. These changes will drive our redesign; and sadly, we’ll see the reduction or elimination of certain pages and sections.
Despite these changes we will continue to produce what we consider a first-rate publication, with compelling stories about the medical school and the issues and events that affect it. We hope that Yale Medicine will continue to engage you and help you to maintain your ties to the School of Medicine.
John Curtis
Managing Editor