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In Vivo
MEDICAL EDUCATION



For the past 25 years, Tom Jacobs, M.D., professor of clinical medicine, has rarely turned down an opportunity to teach. Despite the fact that he runs a thriving endocrinology practice upon which he is almost entirely dependent for his income, Dr. Jacobs has devoted literally thousands of hours to training medical students and house staff over the years and he has done so largely without compensation.

Each newly minted M.D. is the product of many hours of faculty teaching efforts. While much
Photo: Charles Manley
Ralph S. Blume
Rheumatologist Ralph S. Blume was the longtime physician of the late Thelma Ewig, an ardent supporter of medical education.
of the foundation of medical knowledge is learned in lecture courses, clinical skills are learned in the clinic and at the bedside with individual attention to each student, resident, or fellow. Katherine Nickerson, M.D., associate professor of clinical medicine and vice chair of the Department of Medicine, estimates that the Department of Medicine provides 60 percent of the faculty time involved in teaching medical students. Indeed, a 1992-93 study, published in the New England Journal of Medicine in January 1996, revealed that full-time faculty members in Columbia University’s Department of Medicine devoted on average 137 hours per year to teaching, most with little or no compensation.

Tuition dollars and other sources do not come close to covering the true costs of undergraduate and graduate medical education. That same article calculated that the Department of Medicine received less than $16 per hour to cover its faculty’s efforts in educating students and residents. Those dollars largely provide salary support for course directors and support the infrastructure for the residency program.

The problem is the same at medical centers across the country. As hospitals increasingly compete for limited research and patient-care dollars, fewer doctors can afford to be generous with their time. Clinical education has been getting short shrift.

For this reason – and to honor physicians like Dr. Jacobs and the values he embodies – philanthropist Thelma Ewig was moved to provide a $9 million bequest to support clinical education within the Department of Medicine. Her appreciation of the importance of clinical education grew from a decades-long relationship with her personal physician Ralph S. Blume, M.D., clinical professor of medicine. “Thelma Ewig recognized that medical education is dependent on clinical faculty’s mostly voluntary efforts,” Dr. Blume says. “It would be wonderful if this great step she took to help educate physicians was followed by more generosity, because the need remains very high.”

Income from the bequest will be awarded as $30,000 prizes to individual faculty members selected by committee for their outstanding contributions. (See sidebars for this year’s recipients.) The monetary awards will be granted to four junior, four mid-career, and four senior faculty members each year, for periods of three years, two years, and one year, respectively.

“Ms. Ewig’s bequest is a huge boon to the Department of Medicine,” says Dr. Nickerson, who served as a member of the selection committee, along with Dr. Blume and David Brenner, M.D., professor and chairman of medicine. “The grant is significant both in terms of its dollar value and also as a symbol of the role philanthropy now plays in the formation of our nation’s doctors. Strategically, it allows the department to foster innovation among young doctors, free up teaching time for overextended mid-career faculty, and recognize the contributions of those, like Dr. Jacobs, who have given so generously of themselves over the years.”

—Eva Marer


Ewig Award Recipients
TOM JACOBS, M.D.

Professor of Clinical Medicine

Photo: Charles Manley
Tom Jacobs
Tom Jacobs

Teaching credits: To name a few: Chief of Section, Pathophysiology Course; Lecturer in Pharmacology; Preceptor, Medical Clerkship; Chief of Service Rounds; Attending Physician on the Medical Service; Preceptor in Endocrine Clinic; Attending for the Endocrinology Consult Service; also takes resident and intern reports whenever requested to do so.

Why he teaches:"I learn so much from students and other attendings. When I give a talk to students or housestaff or to my peers, I have to be prepared. If possible, I try to pick a topic that I don’t know a great deal about, to deepen my own expertise."


Favorite recent lecture: Discerning evidence of torture in persons seeking political asylum and exploring how physicians get involved in the torture of others.

Typical student comment: “He never gets ruffled. His presence in the room is calming to students and patients. Despite being a specialist, he can teach on anything, and his fund of knowledge is seemingly endless. An inspiration.”

Take-home points: “You should think as hard as you can about your patient’s problems, care about what happens to them. And when teaching, especially at the bedside, be willing to make mistakes in public.”

How he’ll spend the money: “I think my wife has already spent it. If not, it will go toward next year’s malpractice insurance.”

The real payoff? “Sometimes there’s a great moment when you ask a question about a sick person that hasn’t been asked before, and thereby advance that person’s care.”

Proud moment: “Learning that my former student, Dr. Nell Eisenberg, has also been named a recipient of the Ewig award.”


DAVID DIUGUID, M.D.
Associate Professor of Clinical Medicine and Clinical Pathology (Hematology and Medical Oncology)

Photo: Charles Manley
David Diuguid
David Diuguid
Teaching credits: A sample: Hematology Section Leader, Pathophysiology Course; Lecturer, Advanced Clinical Pathology (a fourth-year elective); Attending for the Harkness Report, a consultation service geared toward outpatient management.

Known for: The subtlety of his thinking regarding differential diagnosis, potential treatment options, and follow-through. Also considered easy to work with and patient-focused.

Typical student comment: “We would have needed a whole year of rounding with Dr. Diuguid before we could have even tapped into his knowledge base.”

Favorite teaching venue: “All have their advantages. Teaching medical students is like shaping unmolded clay. Teaching residents is easier, because they have the knowledge base and you can get to the meat of the issue quickly. Teaching attendings is even easier but they are also more set in their ways, and experience can be a detriment.”

Why he teaches: “My personal reason for doing it is that at some point I will retire and someone else will do this job. I hope that all the extra effort I’m putting into training students will not just advance the science, but also inspire them to give back in turn.”

The take-home point: “The facts change all the time. More important than book learning is your approach, keeping an open mind, and applying problem-solving skills.”


NELL EISENBERG, M.D.
Assistant Clinical Professor of Medicine

Photo: Charles Manley
Nell Eisenberg
Nell Eisenberg (foreground)
Currently teaches: First-, second-, and third-year medical students in Clinical Practice, Physical Diagnosis, and Medicine Clerkship as well as medicine interns and residents in outpatient clinics.

Teaching style: “I like to teach medical students the most practical, hands-on skills that they need first, from proper hand-washing technique, to adjusting a hospital bed, to preserving a patient’s privacy and dignity.”

Greatest challenge: “Teaching students in an underserved community, where many patients are poor immigrants, and often have social, economic, or language barriers to optimal health. These challenges often make the clinical interaction between student and patient even more difficult.”

Students call her: “Energetic,” “Creative,” “Patient-centered.” One student marveled that, on her own time, Dr. Eisenberg helped her wrestle a payment from Medicaid on behalf of a patient, literally phoning and filling out paperwork herself.

Why she was chosen: Her approach is integrative, extending across technologies and disciplines. In addition to her generosity as teacher, she has developed an interactive Web, which provides access to Physical Diagnosis course materials and Web links to various aspects of the physical examination. She has also enhanced the curriculum with a series of seminars in conjunction with the Clinical Practice II course, and continues to work on curriculum innovations.

The twist: She shares the spotlight as an award recipient with Dr. Tom Jacobs, her third-year instructor and mentor. “I can’t imagine a greater honor than that,” she says.

Other Recipients

Gail Williams, M.D.,
Clinical Professor of Medicine

Arthur Magun, M.D.,
Clinical Professor of Medicine

Chun Yip, M.D.,
Clinical Professor of Medicine

Evelyn Horn, M.D.,
Associate Professor of Clinical Medicine

Anita Darmanian, M.D.,
Associate Clinical Professor of Medicine

Leroy Rabbani, M.D.,
Associate Professor of Clinical Medicine

Jai Radhakrishnan, M.D.,
Assistant Professor of Clinical Medicine

Christine Hogan, M.D.,
Assistant Professor of Clinical Medicine

Nancy Chang, M.D.,
Assistant Clinical Professor of Medicine







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