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With health care reform on the near horizon and other social realities (aging, immigration, chronic conditions, quests for prevention and wellness) dramatically changing health care in the U.S., what kinds of doctors will our health care system (and its patients) require? Clearly, not just medical school curricula but also the selection process for medical students will be key determinants of whether we have physicians fully prepared to practice as the 21st century progresses. This Medical center hour addresses transformational changes underway in the pre-professional preparation and selection of the nation's medical students, including a new version of the MCAT exam, which goes "live" in 2015. What does this new MCAT signal for premedical students as they prepare for medical school? How might colleges and universities offer their premedical students academic experiences that will better equip them for medical school and medical practice in the 21st century?
Co-presented with the Institute for the Humanities and Global Cultures, UVa
A John F. Anderson Memorial Lecture
The opioid epidemic raging in the U.S., including in Virginia and neighboring states, took nearly two decades to develop and will take years to quell. So says the recent National Academy of Medicine (NAM) report, Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use (July 2017). Drug overdose due to opioid medications is now this country's leading cause of unintentional injury death. The current crisis is particularly challenging because the epidemic's broad reach "has blurred the formerly distinct social boundary between prescribed opioids and illegally manufactured ones, such as heroin," asserts the NAM committee's chair, UVA law professor Richard J. Bonnie.
In this Medical Center Hour, Professor Bonnie and palliative care specialist Dr. Leslie Blackhall address the impact of this epidemic on public health and patient care and discuss what actions regulatory bodies, health care organizations, and health care professionals could take.
A John F. Anderson Memorial Lecture
Despite their reliance on technical knowledge that requires mastery, medicine, law, and business are all deeply human professions. Medicine is more than body repair, law more than legal systems, business more than the physics of money. While professional education necessarily must be at the cutting edge of technical expertise, it must remember too the human nature—including the values, emotions, and richly complicated lives—of professionals and professional organizations. In this Medical Center Hour, Professor Ed Freeman from UVA's Darden School of Business demonstrates how the creative arts and humanities can be embedded in professional education to address and actively teach ethical conduct in professional life and leadership of complex professional organizations. What lessons in course design, student engagement, and classroom outcomes might medical educators draw from Professor Freeman's courses, "Business Ethics through Literature" and "Leadership, Ethics, and Theater"?
A John F. Anderson Memorial Lecture
Co-presented with the Institute for Practical Ethics and Public Life, UVA
The Diagnostic and statistical manual of mental disorders (DSM) is perhaps the most contested document in American medicine, vital for the organization and funding of psychiatric research and mental health care, yet perennially criticized both from within and behond the mental health community. Heated debate accompanied the 2013 publication of the manual's fifth edition, DSM-5. Critics charged that the new edition masks political interests (e.g. interests of psychiatrists and pharmaceutical companies) under the guise of science at patients' expense. DSM-5 defenders championed the inclusiveness and transparency of the review process and evidence-base behind the manual's diagnostic decisions. In this Medical center hour, psychiatrist and theologian Warren Kinghorn argues for a mediating alternative: that the DSM may be best understood as neither an apolitical "encyclopedia" of psychopathology nor a political cloak for psychatric power, but rather as a working document of a living moral tradition. In this case the tradition-constituted discourse allows for appreciation of the DSM as a useful scientific document that reflects the moral assumptions and convictions of the communities that created and continue to sustain it.
Co-presented with the History of the Health Sciences Lecture Series
With the aging of our nation's practicing physicians and the recent, steep decline in medical graduates choosing careers in primary care for adults, U.S. patients today are hard pressed to find a primary care doctor. And the already impressive gap between supply and demand of primary care physicians will likely widen once more than 30 million people gain access to health insurance under the Affordable Care Act. The urgent shortage of primary care physicians compounds this country's already significant health care challenges regarding access, delivery, and cost of care. In an era when all of health care is undergoing potentially transformative change, what will be the role of primary care doctors? For patients, what will be the "value added" of having a primary care M.D.? What roles will other primary providers (physician assistants, nurse practitioners) play? Is the primary care physician an endangered species, or a key participant in a newly configured primary care team? How can we devise, model, deploy, and teach new ways of delivering primary care that are team based, interprofessionally collaborative, effective, and satisfying to patients and practitioners alike? In this Medical Center Hour, family doctor and medical journalist Susan Okie draws on her recent Perspective article in the New England Journal of Medicine to explore the prospects ahead for the primary care physician. Two of UVA's primary care physicians: one a mid career family medicine physician and teacher, the other a medical student planning a primary care career offer their perspectives as well.
Co-presented with the Generalist Scholars Program in observance at UVA of Primary Care Week
Marijuana has had a rocky and peculiar history in the United States. The early history of marijuana prohibition is fairly well known, thanks in part to a classic work on the subject, The Marijuana Conviction, co-authored by Richard J. Bonnie while he was associate director of a commission apppointed by Richard Nixon. In 1972, to the surprise of many, the commission recommended decriminalizing marijuana use, but it also rejected the idea of legalization, expressing major concerns about the public health consequences of doing so. While loosening marijuana laws became a mainstream policy idea through the Ford and Carter admisistrations, in the Reagan White House, a policy of "zero tolerance" took hold and evolved into a new and costly war on all illegal drugs. Millions of marijuana arrests ensued. As the drug war's costs accumulated in the early 21st century, support for decriminalizing marijuana returned. Some states defied the federal government by legalizing medical use. Then, suddenly, in 2012, voter initiatives in Colorado and Washington legalized marijuana for recreational use and, in 2014, voters in Washington DC did the same, with legalization in the District due to take effect 26 February 2015. The worries raised by the commission in 1972 are back, complicated by the challenges of implementing the law. This Medical center hour's principal speaker, who has both chronicled this story and been a player in it for more than four decades, will reflect on why marijuana prohibition suddenly collapsed and on what should happen next.
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
When it comes to matters of health, environment, and urban history, lessons of the past are often forgotten by Americans. However, in many ways, fears from American epidemics in the last 150 years have all become acute again with the COVID-19 pandemic. Working at the intersection of public health and urban/environmental history, architect Sara Jensen Carr investigates how shifts in the American urban landscape were driven by health concerns, and how these have led to this inflection point between living in the pandemic and a post-pandemic future. She's joined by urban and environmental planner Tim Beatley in this Medical Center Hour that addresses the "topography of wellness" in our urban public spaces even as we anticipate COVID-driven design changes.
History of the Health Sciences Lecture
Co-presented with Historical Collections, Claude Moore Health Sciences Library; Center for Design + Health, School of Architecture; and University of Virginia Press
We hear almost daily about the rapidly increasing rate of type 2 diabetes in the U.S. population. Many pronouncements are dire, proclaiming an "epidemic," and most make it sound as though this problem is relatively new-just three or four decades old. Yet almost 100 years ago a small group of U.S. health care professionals was already warning that diabetes was "a public health problem," fated to become worse if nothing was done soon. But what did they mean by this? Why had they grown concerned? And what measures did they recommend to try and reverse the upward trend in diabetes rates? In this Medical Center Hour, historian Arleen Tuchman asks what we can learn from history that might help us understand better how we are framing the diabetes "crisis" today, and why. How do cultural assumptions about diabetes, and about the particular populations believed to be most at risk, influence not only our understanding of this disease but also our efforts to gain control over it?
Co-presented with the History of the Health Sciences Lecture Series
The first global wave of reform in modern medical education occurred early in the 20th century, following the Flexner report. The second wave came in the latter half of that same century, led by innovations in problem-based learning and community orientation. Recently, the Lancet Commission called for a third wave of reform to create transformative system-based medical education that is socially accountable. This may be a fine aspiration, but is it possible? How can we translate new understandings from neuroscience, sociology, and the sciences of learning to meet this aspiration? In doing so, may we also transform research on medical education from eminence-based to evidence-based medical education? How accountable are we prepared to be for the results of our efforts? And to whom?
In his Brodie Medical Education Award Lecture, Dr. Paul Worley draws on evidence from medical schools around the world to explore these critical questions and consider the challenge that social accountability brings to academic medicine's combined research, education, and service mission.
The Brodie Medical Education Award Lecture
Co-presented with the Department of Medicine and the Brodie Medical Education Award Committee, in association with the School of Medicine’s Medical Education Week, 29 February-4 March 2016.
The opioid epidemic is currently exacting a terrible toll on the health, lives, safety, and livelihood of persons and communities across Virginia, the Appalachian region, and, indeed, much of North America. What is being done to address this crisis at the levels of policy and practice in the Commonwealth of Virginia and in Charlottesville-Albemarle and environs? In this Medical Center Hour, the Honorable William A. Hazel Jr MD, Secretary of Health and Human Resources for the Commonwealth, discusses Virginia’s five-pronged approach to the epidemic and the impact of that approach to date. He is joined in this conversation by a primary care physician and community mental health professionals.
The Jessie Stewart Richardson Memorial Lecture of the School of Medicine
Co-presented with the Office of Quality and Performance Improvement, UVA Health System
Will Rourk, Megan Page, Charity Revutin, Amelia Hughes, Adriana Giorgis
Summary:
This is a flythrough animation of the 3D data captured at the Villa Almerico Capra Valmaran, aka Villa la Rotonda, in March 2019. Data was captured by University of Virginia Architectural History students under the direction of Andy Johnston and Will Rourk in collaboration with the Institute for Advanced Technologies in the Humanities at the University of Virginia and the de Valmarana family. The animation was created in Autodesk ReCap v.2023 by Will Rourk.
This is a video of aerial footage of the Villa Almerico Capra Valmarana, aka Villa la Rotonda, Vicenza, Italy. This video was created by Shayne Brandon, Institute for Advanced Technologies in the Humanities, University of Virginia Library. It was produced from aerial footage captured by a DJI Inspire 1 quadcopter with X1 HD camera. The footage was captured during field work by UVA Architectural History students performed in March 2019 under direction of Andrew Johnston, Worthy Martin and Will Rourk for their 3 Cavaliers granted project to 3D scan the Villa la Rotonda in Vicenza, Italy.
The 1918 influenza pandemic was a global calamity that brought death on an unprecedented scale and intensified the devastating impact of World War I even as the armistice was signed in November 1918. Statistics tell the tale of this flu in one way, science tells it in another, but this Medical Center Hour—the third in a mini-series marking the pandemic's centenary—lets poetry speak to the human toll exacted by the 1918 H1N1 virus. In 1995, Virginia native and distinguished poet Ellen Bryant Voigt published Kyrie, a book-length sequence of poems in which small town speakers live through the harrowing epidemic and remember, defy, and mourn. Kyrie's fierce, moving poetry brings the global calamity home. In this Medical Center Hour, Voigt (on video) reads selections from Kyrie and discusses with poet Marianne Boruch the making and meaning of this American masterpiece.
Co-presented with the Bjoring Center for Nursing Historical Inquiry, Historical Collections in the Claude Moore Health Sciences Library, and Influenza! 1918-2018
Some physicians are born to write, while others have writing thrust upon them. As one of the latter, 2013 Moore Lecturer Margaret Mohrmann discusses what she has learned from writing about doctoring. The act of articulating her experiences as a pediatrician and teacher has shown her, over time, much more about her encounters with patients, and about herself, than she could see at the time those events occurred - or even at the time she wrote about them. Rereading one's own stories and having others read (and co-construct) them can expose the "ghost" in the story - "the story's silent twin," as British novelist Jeanette Winterson puts it. What couldn't be said, or wasn't noticed, or was forgotten often gets written in anyway, quietly, between the lines and within word choices and narrative structures. The process of discovering what went unseen before cultivates in both writer and reader the practice of paying close, compassionate attention to what's happening now, an essential ingredient of good doctoring.
The Moore Lecture
What still resonates with you when you're spent? What can a caregiver—or a teacher, a leader, a colleague—offer and do when all else fails, when all that's left is our humanity? In this Medical Center Hour, Tim Cunningham weaves together three stories from disparate sites and desperate situations—the Ebola crisis in West Africa, rural Haiti, and an elite pediatric emergency unit on the Upper East Side of New York City—to inquire into what might matter the most at trying times. A clown, then a nurse, and now the director of the Compassionate Care Initiative and an assistant professor in UVA's School of Nursing, Cunningham shares what he believes matters most when all else is lost—and shows how we all have the capacity to access it.
Co-presented with the Compassionate Care Initiative, School of Nursing
Whether we are students, educators, or clinicians (learners all!), our stated assumptions and principles are sometimes at odds with our actual practices. In this Brodie Medical Education Award Lecture, learners of all stripes will practice foundational skills such as cultivating beginner’s eyes and more accurate data collection in order to uncover and examine habits and thought patterns that may no longer serve us. Understanding our own assumptions and the values they reflect will allow us to be more intentional in designing educational programs and clinical learning/practice environments that are principle-driven and meet the needs of patients, learners, and caregivers.
The Brodie Medical Education Award Lecture/Medicine Grand Rounds
Since passage of the Patient Protection and Affordable Care Act (ACA) in 2010, this particular road to health care reform in the U.S. has been riddled with political potholes and subject to slowdowns as a result of legislative and judicial challenges. But with the Supreme Court's landmark stamp of constitutional approval this past June and with President Obama's reelection on 6 November, it is now clear that some form of "Obamacare" is here to stay, at least for four more years. Indeed, repeal of the ACA may no longer be a top Republican priority, as House Speaker John Boehner noted on 8 November: "The election changes that-Obamacare is the law of the land." So what's ahead as we implement the ACA? In this Medical Center Hour, Washington and Lee law professor and ACA expert Timothy Jost and University of Virginia health policy analyst Carolyn Engelhard outline what must be accomplished in order to realize this ambitious overhaul of our health care system. And what will be the responsibilities of and implications for academic health centers like UVA as the ACA takes effect?
Co-presented with the Sadie Lewis Webb Program in Law and Health, the Institute for Practical Ethics and Public Life, the Department of Public Health Sciences, and the Bioethics and Health Policy Medical Student Interest Group
A John F. Anderson Memorial Lecture
