By Bonita Eaton Enochs, Editor
Lee GoldmanHe was introduced at a community breakfast as the greatest thing recruited from the San Francisco Bay Area since Reggie Jackson left the Oakland As (with a brief stopover in Baltimore) to join the New York Yankees in 1977. Lee Goldman’s response to the analogy: “I haven’t hit a home run since Little League, and I’m the only one who remembers that I did.”
   Many more will remember that in July 2006, on the very location where the Highlanders, the team that became the Yankees, once played, Lee Goldman hit the ground running as Columbia University Executive Vice President for Health and Biomedical Sciences and Dean of the Faculties of Health Sciences and Medicine — making him dean of the College of Physicians & Surgeons and head of Columbia University Medical Center. He served for 11 years as chair of medicine at the University of California, San Francisco’s medical school and built a successful career as a cardiologist and health outcomes researcher at Harvard before joining UCSF. He received M.D. and master of public health degrees from Yale.
   His favorite topic of conversation is the future of P&S and his hopes for a robust outcome from plans he and others have put in place to stabilize the financial picture, strengthen the school’s intellectual resources, and develop a new medical school curriculum that will be the envy of medical schools everywhere.
   In an interview with P&S Journal, Lee Goldman discussed his own path to medicine and how his experience in medical school has motivated him to find the best way to teach medicine and to instill in students the importance of lifelong learning.

P&S Journal: Tell us about your first impressions of P&S.
Lee Goldman: People have been not only very receptive, but also very tolerant. My new colleagues and the people I have met have been remarkably friendly and have consistently told me how much they would like to help me — help Columbia — succeed. I could not have asked for a better welcome. The loyalty of people here and their feelings about Columbia are stronger and even more positive than I imagined.

You often say you want to make P&S indisputably one of the top five medical schools in the country and, arguably, No. 1. How do we make that happen?
First, I expect the medical school curriculum will be totally revamped. We get spectacular medical students, and we train
Dean Goldman at a community breakfast
Dean Goldman at a community breakfast
them in an official curriculum that is the same, more or less, as it was in 1991. In meetings with students, it has become clear to me that the unofficial curriculum, including all the non-classroom activities, is extremely successful and compensates for shortcomings in the official curriculum, but it is time to upgrade the official curriculum as well. The second thing that will change is the way the place looks. We have started a major campaign to make our campus clean and safe and to look like a world-class medical school that can be a model for northern Manhattan, which is also on the upswing. Third, we have a large number of absolutely spectacular individuals, and one of our major goals is to have them work together as a team, so that the whole is greater than the sum of its parts. Finally, for the next five years we expect to make substantial investments in the academic mission and become even stronger in the things that we are known for while simultaneously building new strength across a much broader spectrum. Very few institutions can legitimately strive to be outstanding across the full spectrum of what a medical school does, and we are one of them.
   One of our major goals is to aggregate talent through what I call academic venture capital. We need to help young people starting out and successful people who want to do something new and innovative that will position them for the next portion of their careers. Academic venture capital can be a risky investment but it also can be high yield. One of the coins of the realm in academia is the ability to provide some degree of partial security to the best people over the long haul. Where we really need help is getting a young scientist or clinical researcher started; we need to be able to give
Dean Goldman with TV and Broadway legend Angela Lansbury, who met with students in November for a Medicine and the Arts seminar
Dean Goldman with TV and Broadway legend Angela Lansbury, who met with students in November for a Medicine and the Arts seminar
people nationally competitive start-up packages. Investments range from $300,000 to $400,000 at the very minimum to a million dollars or more. One hopes that they will then blossom after a three-year period and be wildly successful, garner NIH support, publish terrific papers, and become major national and international figures. The next challenge comes seven, eight, nine years down the line when faculty members are pursuing tenure. Partial long-term support makes a huge difference in a faculty member’s sense of security or bonding with the institution. Retaining high-caliber faculty is as important as recruiting them. That is where professorships come in. We need to address our professorship gap. UCSF, counting state positions and professorships, could provide support for close to 550 to 600 faculty. We have 158 endowed professorships, not counting state-supported positions at the Psychiatric Institute. Some other institutions that are smaller than we are hire people only if they have money in the bank. We have a major professorship gap between us and the top places, and the way to be in the top five or get to No. 1 is to aggregate more talent.

Tell us more about what you term “blowing up” the curriculum.
First of all, let me say that every dean, especially every new dean, talks about changing the curriculum. These are my own crazy, sometimes not so crazy, ideas. Each is borrowed from a place that has done something like this in the past, although the whole package has not been put together this way. P&S educational leaders, with a lot of input from our students, are considering all options. We also have a search for a vice dean for education, and I expect that my personal ideas will go into the hopper with other ideas.
   Medical education — at medical schools everywhere — has been driven too much by what faculty members think
Dean Goldman meets with new P&S students
Dean Goldman meets with new P&S students
people need to know and how the faculty is willing to teach it as opposed to teaching medicine as a profession of lifelong learning. My hope is that five years from now, a person will graduate from P&S with an area of concentration or a major, like we all had in college. The major could be research — either basic biomedical research, patient-oriented research, or epidemiologic research — or public service or, perhaps, education. Public service could be either domestic, predominantly local in the Washington Heights/Upper Manhattan neighborhood, or international. Whether you become a neurosurgeon or a general pediatrician, you would have this area of major concentration. To do that we have to free up at least a year or a year and half beyond the required clinical clerkships. This time would give students the
The disconnect between the
formal curriculum and the overall P&S experience is fascinating.
chance to take advanced clerkships in areas of interest and also pursue their major or area of concentration. We are not looking to add a year to medical school. My expectation is that during the required clinical clerkships, we would have interludes, some places call them intersessions. Between each clerkship would be a one- or two-week break from clinical rotations, when all the students in the class would come back together for a didactic experience. We could divide these sessions into two components. One could be devoted to subjects for everyone, ranging from the care of a dying patient to reading the medical literature to applied pharmacology — which you appreciate much more after you start seeing patients and are actually using the drugs. The other component would be for something directly relevant to a student’s major. The major could lead to a second degree, enabling some students to complete joint degrees in four
Lee Goldman, dean, and Anke Nolting, alumni relations, visit with 
Richard and Sylvia Cruess, P&S alumni, at the annual meeting of the Association of American Medical Colleges in Seattle. In the background is Peter Wyer, a P&S faculty member in emergency medicine.
Lee Goldman, dean, and Anke Nolting, alumni relations, visit with Richard and Sylvia Cruess, P&S alumni, at the annual meeting of the Association of American Medical Colleges in Seattle. In the background is Peter Wyer, a P&S faculty member in emergency medicine.
years instead of adding a year. Our clerkships also need to be reassessed, and we need to be sure that they provide the right balance of learning and participation in daily tasks. Our preclerkship classroom curriculum might be a lot shorter, especially if basic science can become part of the intersessions or even part of the clinical clerkships. If we condense the preclerkship curriculum, we may need to use the summers, including the summer before the first year for students who do not have the same scientific background as others to get everyone to a reasonably level playing field.
   I would like us to have a curriculum that everyone else emulates. We already have what I call an “unofficial curriculum” that our students love and that is the envy of other schools. There is something about the experience here that is extraordinarily positive, helps us attract top medical students, and makes the alumni so loyal because they remember such fond experiences. The disconnect between the formal curriculum and the overall P&S experience is fascinating.
   In developing a new curriculum, we should find the best way to teach adult learners. My motivation for changing the curriculum is highly influenced by my medical school experience. Classes were highly variable, usually far too detailed, and poorly integrated. As a result, I frequently did not go to class but instead embarked on my own independent study program. I asked students several years ahead how they studied for the boards, and I read those books. I took the boards at the beginning of second year, passed them (my highest grade was on pharmacology, which we had not had yet), and then was able to gerrymander the schedule to get an M.D. and MPH in four years, while still taking all the electives my colleagues took. My hope is that the P&S curriculum will be so good that my approach, which was more of a survival strategy than anything else, will never have to be duplicated. We need to provide flexibility for students to pursue their dreams in an environment sufficiently structured so they will not go off course.

Why do you think P&S is still a popular choice for medical school applicants in spite of our dips in rankings?
The main reason why we have not suffered in recruitment is because students look beyond rankings and see that we offer a spectacular range of experiences important to them. P&S provides a great experience in a great city. Medical
The 2006 White Coat Ceremony
The 2006 White Coat Ceremony
students are drawn to a small number of cities that work for them and often for their significant others. We have a tremendous built-in advantage in New York. And, with an alumni network that is unsurpassed, applicants recognize from their first interview here that they are joining a great community, a family. The educational experiences, world-class affiliates, and the range of clinical experiences are very appealing. We have high-tech medicine, first-rate research, community service, and, increasingly, international health programs. The caliber of students we attract is incredible. Improvements in our formal curriculum and incremental aggregation of faculty talent will close the gap between where we are in some rankings now and where we would like to be. Much of the teaching here is really terrific, and if one could reorient the teaching 30, 60, 90 degrees to be consistent with a truly modern curriculum, we could be very, very special. My guess is that the current curriculum would have failed long ago if the teaching and informal curriculum were not so outstanding.

What makes P&S alumni so devoted or, as you put it, unsurpassed?
One factor is the number of alumni who have remained in geographic proximity to the school. Another factor is the
The 2006 White Coat Ceremony
The 2006 White Coat Ceremony
success of the alumni across a broad spectrum. Most schools that are nationally competitive tend to have alumni dispersed. Other schools that keep graduates nearby often are not nationally competitive, research-oriented schools. It is unusual being both. If you look at leading physicians and scientists in the New York metropolitan area, a huge proportion of them are P&S graduates.
   Alumni, on average, had good experiences here. A lot of things are right at P&S or the alumni would not be so loyal. It will be important to remember that as we consider radical changes to the curriculum. We need to ensure that what has worked well continues to work.

How did you choose medicine as a career?
I was not sure whether I wanted to be a doctor or lawyer, so after my junior year in college I worked as an orderly in an emergency room in New Jersey. I specifically asked to work the 11 p.m. to 7 a.m. shift because one of my concerns about medicine was whether I could work crazy hours. Believe it or not, I never stayed up all night in college. On the night shift, only a doctor and a few other people were there, so if the doctor was sewing people up I would help. I played a much bigger role than I would have played on the day shift. It was no fun to be an orderly, but I could see it would be
With an alumni network that is unsurpassed, applicants recognize from their first interview here that they are joining a great community, a family.
fun to be the doctor. I chose Yale because Yale had no exams and no grades. Writing a thesis got me hooked on research, which is the last thing that I expected to happen. My thesis was on attitudes of Yale medical students and graduates toward national health insurance. I did a survey of Yale medical graduates going back 40 or so years, using a structured questionnaire that asked about each of the relevant pieces of pending legislative issues on national health insurance. During the Nixon administration we actually came close to having national health insurance, much closer than under President Clinton. However, the Nixon plan was opposed by the Democrats, led by Ted Kennedy in the Senate, and they could not find a compromise. I took key pieces of each bill and asked what people liked rather than asking about the Nixon bill or the Kennedy bill. That way I could construct what doctors liked and correlate their opinions with age, political leaning, specialty, and geographic location. I designed the questionnaire, analyzed the data, designed programs using software packages. You have to understand what it is like to do questionnaires before Xerox machines. We are talking mimeograph machines. Remember mimeograph machines? And mimeograph machines did not collate.

Tell us about your family and your adjustmentto life in New York.
My wife, Jill, is a genetic counselor (in the Sergievsky Center). We met when she was a graduate student in biology and I was a medical student at Yale. After getting a master’s degree, she earned a second master’s degree in counseling and a third master’s degree in genetic counseling. At UCSF, she worked in the Memory and Aging Disorders Center and is
Writing a thesis got me hooked on research, which is the last thing that I expected to happen.
one of a rather small number of genetic counselors who focus on adult neurologic diseases. She has authored a number of papers and has been especially interested in early-onset Alzheimer’s, frontotemporal dementia, and prion diseases.
   We have three children. Jeff, the oldest, is a lawyer in Portland, Maine. He married Abigail, also a lawyer, in September. Our twins, Daniel and Robyn, are both in business school after being in the work force for four years, each of them living part of that time here in Manhattan and loving it. Daniel is at Kellogg, and Robyn is at Stanford. They both graduate on exactly the same day this spring, and they are flipping a coin to see which parent goes where.
   We have a dog, a Tibetan terrier named Draper, who is 12. He was a bribe for our kids when we moved to San Francisco, and now he is adjusting to become a New York dog. New York is a very exciting city. We love the theater, we enjoy the energy, and hopefully we will have the right balance of time in the city and relaxing time outside the city.

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