Advisory Deans: Helping Students Adjust to P&S and Plan Their Careers

Mucio Kit Delgado'06 with his advisory dean, Lisa Mellman
Mucio "Kit" Delgado'06 with his advisory dean, Lisa Mellman

DURING HIS FIRST YEAR AT P&S, BRAD ZACHARIA'07 FACED A question that often causes medical students to lose sleep: How could he make the best use of his time during the coming summer? He hoped to do research that would enrich his understanding of a possible future specialty neurosurgery. But what kind of project should he do? And what opportunities existed for a first-year student?
Students at P&S traditionally have answered such questions through ad hoc strategies talking to classmates, buttonholing busy doctors in hallways, seeking out professors willing to offer advice on a volunteer basis, or muddling through on their own. But beginning in the fall of 2003, they had another option: They could consult with a new group of student affairs deans who advise students on matters that involve their performance in medical school or their future careers.
Mr. Zacharia took his questions about his summer plans to the dean assigned to him, Dr. Lisa Mellman, associate clinical professor of psychiatry. Dr. Mellman had seen the benefits of a formal advisory program as a medical student at Case Western Reserve University, which had a well-established system. Dr. Mellman put him in touch with another advisory dean, Donald O. Quest'70, the J. Lawrence Pool Professor of Neurological Surgery, who suggested that he explore opportunities at the cerebrovascular neurosurgery lab at P&S.
Mr. Zacharia took that advice and spent the summer at the lab doing research into the molecular events that occur during a stroke, examining the regulation of cell surface complement inhibitors. Beyond giving Mr. Zacharia research exposure, the experience showcased the value of the initial guidance he received from Dr. Mellman and helped him to see that he had a reliable source of support during his years at P&S.
"I would feel totally comfortable in approaching Dr. Mellman about any questions or concerns that I have," he says. The additional help he received from Dr. Quest, he adds, shows "the collaborative nature of the advisory deans program."
That's exactly the kind of response that Dr. Peter Puchner'62, retired professor of clinical urology and chairman of the advisory deans program, had hoped would occur. Dr. Puchner sees as a major goal of the program the building of trust between students and faculty members that will enable students to feel more at home at P&S and use the many resources P&S has.
"The level of students' anxiety is very high," he says. "This is a way of alleviating that anxiety and making P&S a much more pleasant experience."
Of course, medical students have never been strangers to stress. And faculty members at P&S have been serving as advisers on an informal basis for years. But as the practice of medicine has become more demanding, many doctors have had less time to spend on advising, and students have expressed a desire for more mentoring. Other top medical schools have faced similar pressures, and some have responded by creating a corps of salaried advisory deans.
Two years ago, Dr. Linda D. Lewis, clinical professor of neurology and senior associate dean for student affairs, and Dr. Puchner began to study what had worked best at other schools. The process led the P&S administration to create five new posts for advisory deans for student affairs, each making a five-year commitment to spend 10 hours a week advising students. The jobs were open to faculty members with a track record in clinical medicine and a demonstrated interest in students' professional development. An e-mail was sent to all P&S faculty, and 140 submitted CVs for the positions.
Both students and administrators interviewed 43 finalists before the selection committee chose Dr. Mellman, Dr. Quest, and three others: Dr. John D. Allendorf'97, assistant professor of surgery; Dr. Dolores Bacon, assistant clinical professor of medicine, director of medical student education for the hospital's Ambulatory Care Network Corp., and co-director of the Brown Scholars Program in Primary Care, a privately endowed, four-year selective for P&S students; and Dr. Gwen L. Nichols, associate professor of clinical medicine and director of the hematologic malignancies program at the Herbert Irving Comprehensive Cancer Center.
Each dean receives a small salary supplement for the work. Dr. Quest stresses, however, that the additional salary is not the motivation for the deans. "The salary is really a token and all five of us do it because of our commitment to the students."
Following their selection, the five deans underwent an intensive eight-week program to learn about student support systems ranging from financial aid services to housing. The deans learned about the curriculum, the roles of course directors, information technology, and the school's administration. The program culminated in a one-day retreat led by a dean from the Rochester medical school who had been instrumental in establishing similar programs at Duke and Harvard. "This was teaching the deans how to be deans," says Dr. Lewis.
Each dean advises 20 percent of each P&S class, usually about 30 students, or 120 students in all. The deans typically meet with first-year students every week, with second-year students every two weeks, and with third- and fourth-year students every month. The deans themselves meet every other week to discuss their progress, set the agenda for the following weeks, review and share experiences of the previous two weeks, and discuss common issues. Course directors, education deans, and even P&S dean Gerald Fischbach sometimes join the deans at these meetings.
"The regular meetings help us develop common themes for the deans' discussions with students," says Dr. Lewis, "and the planning helps protect against the sessions deteriorating into gripe sessions. The students always have time to introduce issues important to them, and those issues can be taken back to the meetings the advisory deans have. Each dean has introduced novel discussions that are then shared with the other deans and ultimately shared with the students. The great thing about sharing with the students and among the ADs is the sharp learning curve for all."
As chairman of the program, Dr. Puchner doesn't advise students but serves as a unifying presence whose tasks include, as he puts it, acting as a "fly on the wall" who can watch for strengths and weaknesses in the sys-tem. Dr. Lewis credits Dr. Puchner's "fly on the wall" influence as a significant contributor to the program's quick launch just two years after considering the effort. "Peter Puchner has been phenomenal," says Dr. Lewis. "He has been the link among all the deans, attending all their sessions with their students at various times. His years of experience as a P&S student, resident, and faculty member have made his contributions priceless, and I have enduring gratitude to him for all his work on this."
The deans offer practical information and support intended to help students make the most of P&S and its resources, of life in New York City, and of the opportunities they will have for residencies, fellowships, and other forms of education or professional development. This task often involves correcting misconceptions that students have picked up from classmates, sometimes by bringing in residents, attendings, or others who talk about topics such as how they studied for boards or why they chose their specialties.
"The students will say, 'I don't know what my specialty is, but everybody else in my class does,'" Dr. Quest says. "It isn't true, but they hear all these rumors, and we can alleviate some of their concerns."
The practical support the deans provide may extend to using their network of contacts to snip red tape. One student told Dr. Quest that she had been waiting for weeks to find out whether she could get into the M.D.- Ph.D. program at P&S. He was able to ease her frustrations by calling the head of the program on the spot and handing the phone over to the student so that she could find out when she would learn of the decision.
The advisory deans also deal with quality-of-life issues that may enable students to get more enjoyment from P&S and to become fully rounded doctors. Dr. Quest talks to students about the cultural assets of New York City that he has enjoyed, such as chamber music concerts at the Juilliard School or an exhibit at the Metropolitan Museum of Art. And he once stepped in to help when students complained that the latch on the door to a squash court in Bard Hall was broken.
"They don't know how to get something like that fixed," he says. "We know whom to call."
In addition to providing tangible assistance, the deans stay abreast of what students are learning so that they can help them deal with complex emotional issues that arise in the classroom and beyond it. Dr. Mellman says she tries to take cues from students and to respond to their needs and interests. But she also raises subjects they may hesitate to bring up or may not have a chance to discuss in other settings, such as how it feels to witness a death, cut into a cadaver, or put on a white coat for the first time. Dr. Puchner encourages the deans to allow students to speak freely about such questions and others that may be more delicate, including, "How do you deal with an angry patient?" and "How do you deal with a patient who's different from you?" Fostering a climate of candor, he believes, can help students become better doctors.
"Being a physician means you have to deal with many issues that aren't in textbooks and that you have to learn by osmosis," he says.
But even the lessons learned from osmosis can benefit from reality testing. Dr. Puchner cites the example of students who see an attending behaving in an inappropriate way. Earlier generations of P&S students might have internalized that behavior and perpetuated it. The meetings with advisory deans give students a safe place to talk about what they saw and to explore other ways of handling the situation.
Dr. Nichols believes that all of this can have particular benefits for medical students who don't stand out for their brilliance or lack of brilliance. "There are an awful lot of students who aren't Rhodes scholars and who aren't failing," she says. "The middle can become a faceless group in medical school. Having a person who knows you can be important not only for letters of recommendation but for really guiding you in the right direction in your career and for answering questions in a personalized fashion."
The program has found some of its most ardent fans in the students it was designed to serve, including Rebekah Hofstra'06, president of her class. "Each year of medical school is progressively isolating," she says. "Second year, you move out of Bard and into apartments and studying becomes much more constant. Sitting down and talking with my advisory dean about nonacademic topics is incredibly rewarding, relaxing, and enjoyable."
Ms. Hofstra adds that the program has been wellreceived by students and fills a large need among them: "It is great to know that someone knows who you are, cares how you are doing and coping, and will help you make decisions."


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