SOLS Podcasts

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Peggy Coulombe: Hi, this is Peggy Coulombe, and welcome to Science Studio. We are living in a world that is rapidly changing, through technological and medical discovery. It often seems like, as a society, we are constantly struggling to keep up and evaluate these changes intellectually, morally and socially. Witness the controversies that revolve around stem cell research, nanotechnologies, gene therapies, and bionics and robotics.

With such complexity in an ever changing social context, how do doctors decide what interventions are acceptable, and how do you teach those coming up in the medical community medical students and future researchers to make the best judgments about new treatments, interventions, and public health policy?

Today we have two guests from the ASU School of Life Sciences, ethicist Jason Robert, an assistant professor, and geneticist Kenro Kazumi, an associate professor whose research focuses on the early development of the spine and elucidating the genetic causes of vertebral birth defects.

Jason and Kenro are researchers and adjunct faculty in the University of Arizona College of Medicine, Phoenix, in partnership with Arizona State University. They are two of ten creative professors from the College of Liberal Arts and Sciences that will be part of the 24 members of the faculty of this college. Basically, one faculty member for each student.

Today we are going to talk about their innovative plans for training this next generation of clinicians.

Welcome gentlemen.

Jason Robert: Hello.

Kenro Kazumi: Hi.

Peggy: Jason, I'd like to talk first a little bit about bioethics, and then focus on some of the innovative aspects of the College of Medicine, like the Learning Community program, which addresses ethics training in ways that set it apart from other medical institutions.

Tell me, what is bioethics?

Jason: Bioethics, in its most simplest guise, is the application of moral thinking so, principles and insights and values in the context of biological and biomedical sciences. Traditionally the focus has been on medicine. At ASU I work at the School of Life Sciences, where we can focus as well on biological sciences beyond the medical sciences, but at the College of Medicine my main focus is going to be on the medical sciences and the research contexts that support the biomedical enterprise.

At the medical school we are actually talking about training the next generation and I actually don't even like "training" educating the next generation of physicians in Arizona, to be exceptionally critical thinkers, to be fantastic diagnosticians, and to be people with a real social conscience, who are able to contribute to medicine in Arizona and beyond. I have got a great opportunity with the wonderful faculty at the medical school, and a really innovative curriculum, to, I think, make a big difference in medical education.

Peggy: How do researchers or doctors determine what interventions are acceptable? What do they base their judgement on? What is legal? What a patient's personal values dictate? What is acceptable based on social context? What is mandated by medical institutions?

Jason: Yes.

[laughter]

This is part of the reason that medical decision-making, and decisions in the first place about what particular technological interventions to pursue, from a research perspective, are so incredibly complex. The decisions that patients make about their own medical treatment, usually in consult with a physician, sometimes against a physician's wishes, are based on a complex array of factors, including upbringing, socioeconomic status so, what they can actually afford, what the insurance company is likely to provide, what the standard of care is in their jurisdiction or their hospital.

For instance, there are very big differences between rural settings and urban settings, in terms of what the standard of care might be for particular kinds of conditions.

And, of course, what the law says is permissible and isn't permissible sometimes although it doesn't always limits the kind of decisions people make. Very often people make medical decisions in contravention of the law, specifically in order to force the issue about the morality of particular prohibitions. So, for instance, the prohibition on physician assisted suicide.

I think that it really is important for physicians in training, and for biologists in training, to get some background in how to think about the complexity of the decision making processes that regular people go through as patients, as consumers, as citizens; and it is also important for patients and consumers and citizens to have some awareness of the scientific rationale and the medical rationale for the recommendations that physicians or researchers might be making as well.

So one of the things we are trying to do, both in the School of Life Sciences, with the Center for Biology and Society but also the Center for Nanotechnology and Society on the one hand, but also with regard to the College of Medicine, these are opportunities for us to begin to have appropriate education for scientists and physicians, to enable them to engage in these very complex decision making processes with an appropriate degree of humility because it is not just what the doctor ordered that matters and also with an appreciation of how richly complicated these decisions are for us.

Kenro: One of the key emphases in the College of Medicine, Phoenix, is of course evidence based medicine. So I think, everyone is prone to that goblin where, "Oh, I played these numbers in the lottery once and they won, so I'll keep playing the same numbers." So instead of thinking of things in this anecdotal or non statistical way, really looking at evidence and using statistical evidence, analyses, to really make sense of what is the best course of action at any one time.

That is something that is being highly emphasized in medicine now, and will be a key component of the medical education, especially since statistics usually goes against intuition, so it is really a matter of learning the tools, the analytical tools, but also the informatic and computer based tools that you would need to come to a decision. So that is something, also, that we hope will play a key role, because it is just the beginning of the students' education. They will continue to be learning throughout their lives. In fact, there is obligatory continuing medical educational requirement for physicians, so this is just something that sets them going at the beginning, and evidence based medicine, I think, will be a key part of their education.

Jason: Right. I think it is important to make sure that we all understand that physicians shouldn't just be the tools of the will of their patients, but at the same time they also should be sort of automata that make these recommendations based on whatever evidenced based algorithms spat out as the appropriate course of action. It is really important to have good evidence for the recommendations, and to put that into an appropriate context, in order to be able to deliver, say, on the promise of personalized medicine, and also be able to make a big difference in the lives of the patients that our physicians of the future will be engaging.

Peggy: So, tell me something about the University of Arizona College of Medicine, in partnership with Arizona State University, and what do you think it will bring to Phoenix?

Jason: Phoenix is on the verge, I think, of an interesting suite of developments related to the biomedical sciences. We have got new hospitals, we have got the University of Arizona College of Medicine, Phoenix, in partnership with Arizona State University, a genuine partnership between the two institutions, to bring together the best opportunity for clinical education as well as basic medical and humanistic and social scientific education of the next generation of clinicians.

And we have got, I think, a significant investment in biotechnology, for instance through the Transitional Genomics Research Institute in downtown Phoenix, and the Arizona Biotechnological Collaborative, the first building of which has just opened up on the Phoenix Biomedical Campus, next to the medical school. All of these are promising an exciting future for breakthrough research as well as excellent clinical care in Phoenix in the coming years.

I think it will also contribute in interesting ways to the revitalization of Phoenix's downtown core, possibly the vitalization of Phoenix's downtown core, as considerably more people will be spending time downtown, possibly living downtown, and as a result, perhaps changing the face of this commuter city into something that is quite different and exciting.

For me it is very exciting. I am looking forward to the collaboration between the two institutions, and my particular charge at the medical school is as exciting as can be. There is nothing like what I am trying to do anywhere else in the country, and so it is a terrific opportunity for me as well as for the city.

Kenro: It is a wonderful opportunity for Phoenix, which is now the fifth largest city in the United States. We hope that this will have at least two major impacts in terms of improvement of medical care in Arizona.

One is, of course, we are training a generation of physicians that will hopefully mostly stay in this state. Already the state is projected to double in size by 2025 or so, so we really do need the physician population here to serve the valley and the state.

And of course the other thing is that some of the brightest and most creative doctors, they really like to do research and they like to teach, so we hope that we are a magnet for the people that really want to do more than just one thing, they want to have a role in shaping education, in testing out their ideas, and basically creating this medical knowledge community, just like Silicon Valley is a cluster for the technological knowledge community. To create that by a medical community that really, I think, will enhance automatically the people who are living here in the valley now.

So, bringing in the physicians, and also helping to foster the physicians who are already here that have those interests and have that creativity. So we hope that the College of Medicine, Phoenix, will really serve as one of the lynchpins of that sort of vitalization, this experiment, for what is really now a very large city within the country.

Peggy: Jason, I understand that you are the director of a program in the College of Medicine, Phoenix, known as the Learning Community, that would go a long way in equipping medical students with the tools to develop and direct treatments and pursue medical research over their lifetimes. Tell me something more about what a Learning Community is designed to do.

Jason: Sure. So, the Learning Community is a longitudinal course, by which I mean it starts in the first week of medical school and persists until the end of the fourth year, and though most of the student contact with me occurs in Year One, there are nonetheless biweekly meetings throughout Year Two, and then monthly meetings in Years Three and Four.

We call it a Learning Community primarily because as the students become pulled in different directions, with their scholarly projects, as they conduct a research project as part of their medical school education, with their clinical experiences which are going to be spread throughout the valley, and with, eventually, in Years Three and Four, their clinical rotations, we are going to see the student body become a little bit more disparate.

One of our hopes was that starting on Day One, we'd like to build and sustain a community of scholars, of physicians, who are in training and who have a wide variety of experiences that they will need to share with each other in order, really, to redouble and scaffold our educational efforts at the medical school.

So my course is designed, really, as a site where three very important things happen.

The first of these really important goals of the Learning Community is to serve as a site of foundational knowledge for students, as they prepare to undertake a scholarly research project. So there are four areas that they can choose a project in: molecular medicine, biomedical informatics, public and population health, and medical humanities and ethics.

We want the students to be able to make a really well informed decision, not just based on what they have done before and what they think is interesting when they come into medical school, but based on exposure to the variety of interesting projects that they might undertake across these four domains. Also, there are some things that every student needs to know when they are about to conduct a scholarly research project, and we are going to be the site of that knowledge in the first roughly ten weeks of the medical school curriculum.

After that, as the students break off into those four different scholarly project areas for further training, the Learning Community is going to be a site where the students will come back and this is the second goal, really just to serve as a site of reflection, really humanistic reflection, on what it is they are learning in their scholarly projects, how that interacts and integrates with what they are learning in their basic medical knowledge blocks, and how those two touch on the really important clinical dimensions of their education. We think it is absolutely integral that students are able to piece together the research component, the basic medical knowledge component, and the clinical component, in a humanistic way.

Then, really, primarily, at the end of the day the major goal for me is to develop and this is the third is to develop a site for the students to be able to really think very critically and carefully about the nature of medicine as a calling, the nature of medicine as a profession, and of the role of physicians and of medicine in society at large. So the Learning Community is an opportunity for all of these things: for the scholarly research, for the integration of that research with basic medical science and clinical care, and for humanistic reflection on medicine as a calling.

Peggy: What course s will you be teaching, Kenro, and how will the Learning Community contribute to your curriculum?

Kenro: I have the pleasure of being part of two courses at the medical school.

The first, in September, is to teach medical genetics within what is called "the molecular basis of life and disease." It is basically the scientific foundations to further medical training. This is a great opportunity. We are partnering with T GEN, the Transitional Genomics Research Institute, and Dietrich Stephan there will be giving a guest lecture, and we are also partnering with the Barrow Neurological Institute, and Burt Feuerstein, who is a famous cytogeneticist, will be guest lecturing also.

We have behavioral scientists, psychiatric geneticists. We have many people taking part in that week of boot camp for medical genetics, as well as, Jason Robert will be working within that week in terms of medical genetic ethics. So that is a great chance to get them launched on what will be ongoing training in genetics.

The other course is, I am the director of the musculoskeletal systems course, and that is a particularly relevant course because really, everyone, even at a young age, really has experienced some kind of musculoskeletal injury, and it is quite a familiar type of situation.

Especially with, also, our aging population in Arizona, musculoskeletal issues like rheumatoid arthritis, osteoarthritis, osteoporosis, are a major concern for a segment of the population. So many medical schools don't have a musculoskeletal course, so we think that this, in Arizona and for this community, it is essential that they get good grounding in the basic biology of the musculoskeletal system before they go into their clerkships and residency training.

Jason: One of the exciting opportunities for me, to get to work with somebody like Kenro in the Learning Community, is that both in terms of this Medical Genetics Week, where we've got a two hour session devoted to philosophical, historical and ethical issues associated with medical genetics, and also in the musculoskeletal systems block, where we are going to have two Learning Community sessions, focusing on aspects of pain, of aging, of healthy aging, of the development of resilience.

These are aspects that are behavioral, they have ethical dimensions, they are health services kinds of considerations. These are the kinds of things that we think are going to help put the musculoskeletal system block in context for the next generation of physicians in Arizona.

Kenro: And it's great working with Jason, because we were also meeting with our clinical colleagues yesterday, and that really, musculoskeletal system illustrates how much medicine is practiced as a team. So each course has, after it, a week called "capstone," which really gives students further clinical experiences that really help to tie everything they learned together, and in the capstone they'll be working with physical therapy.

The orthopedic team, for example, or the rheumatological team, really combines counselors, physical therapists, physicians, nurses a whole team of people.

And that actually, that team approach, also is exemplified on the campus itself, which has already the medical school, it has the ASU School of Nursing, we'll have the University of Arizona College of Pharmacy, and it will also have a medical related practices for the Northern Arizona University. So really it is an opportunity to bring multiple different disciplines in together, because that is the modern medical team.

Peggy: What excited you about becoming a faculty member in the new U of A College of Medicine in partnership with ASU?

Kenro: I think the interdisciplinary, the trans disciplinary aspect of medicine and medical treatment really definitely was a big draw.

Jason: And for me, the opportunity to develop a course that doesn't exist anywhere else in a medical school, but that draws on sometimes failed experiments but sometimes successful experiments on a smaller scale, at medical schools such as Harvard Medical School, Stanford Medical School, and elsewhere. That is what really attracted me.

When I first got involved and I got to meet people like Kenro, like the other ASU School of Life Sciences faculty who are involved, and like some really remarkable individuals such as Rebecca Fisher, who is going to be teaching the Clinical Anatomy course, and who is deeply interested in humanistic aspects of human anatomy, getting to meet those people and to work with them to develop a course that is deeply integrated with what else is going on in the curriculum, this is the kind of opportunity that you just don't pass up.

Kenro: I came from the oldest medical school in the United States, and now, coming to the newest medical school in the United States, it is a tremendously fun exercise, because you don't have to just say, "Oh, it is always done this way." We are the ones who are creating the very beginnings of how things are done, and instead of having an 18th Century medical education, now we can look at a 21st Century medical education and bring in the best practices of 2007 and beyond.

Peggy: What are some of the challenges facing young clinicians today?

Jason: One of the ones that I see people grappling with most often is the difficulty of balancing a sort of humane or humanistic perspective with the demands of the insurance industry on the one hand, and the development of new medical technologies on the other, that are really making for interesting conflicts within even individual patient encounters with a physician. So for me, one of the things that I think we are going to be able to really contribute to, is giving physicians, as they are beginning, a strong sense of how to piece together those complex parts of the puzzle, in order to provide excellent patient care.

That's a huge challenge, how to integrate the humanistic with the technological and the economic dimensions of medicine as we know it.

Kenro: I think preparing the students for change, change, and more change is really the challenge. I think that if we can prepare them to face all the changes that they are going to experience, that will be at least helpful in their progression. They will be facing changing medical health care financing; they will be facing changing demographics. Preparing them for changing medical knowledge; being comfortable with change, and also knowing how to make use of the available tools to both cope, but also excel with a constantly changing world.

We hope that that is something that we can prepare the young clinicians of the future for as we develop this medical school.

Jason: Absolutely. Two quick examples are, a strong focus in our curriculum on biomedical informatics. Basically across the entire clinical spectrum health information technologies are going to impact every aspect of research and clinical care, and so our students are, I think, going to have a real strong foundational training in those tools and techniques that will enable them to be ready for the changes that Kenro, I think rightly, envisions.

And at the same time, the focus on the scholarly research project, which isn't really to develop physician researchers. We are really trying to develop excellent clinicians who are able to give excellent clinical care, but who, because they know about the process of knowledge generation and how new knowledge impacts their clinical practice, will be able, we hope, to integrate new knowledge as it emerges in the future.

Peggy: Thank you for joining us today, Jason and Kenro.

Kenro: It's a pleasure talking with you.

Jason: It really has been. It makes me even more excited than I already was for what we are about to embark on.

Peggy: Jason Robert and Kenro Kazumi are just two of the five faculty members from the School of Life Sciences that will become adjunct professors with the University of Arizona's College of Medicine, Phoenix, in partnership with Arizona State University. They are to be joined by School of Life Sciences researchers Jean Wilson Rawls, Alan Rawls, Doug Lake, and five others from the College of Liberal Arts and Sciences. Together they will fill out the 24 members of the teaching staff. We wish them all the best of luck in this new collaborative and creative venture.

This is Peggy Coulombe, and you have been listening to School of Life Sciences podcast, Science Studio.

You may have noticed that we have acquired theme music. Our music comes from the web site Magnatunes, and was composed by Yongan, from the collection Moonrise.

School of Life Sciences and the College of Liberal Arts and Sciences are on the Tempe campus of Arizona State University.

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Clinicians and Cyborgs (Part I)

Transcript - [Printable PDF format]

SOLS Podcasts 2007