Summer 2004

A Medical School Without Walls

It was Christmas Day 1971, and Kathryn Mitchell Gilkey and some of her fellow fourth-year students had just a finished shift in the emergency room at Marion County General Hospital. Tired and hungry after thirty-six hours in the ER, Gilkey and her group found one of the few places open where a meal could be found on Christmas Day: the Greyhound Bus Station in downtown Indianapolis.

“We saw some of the same people in the station diner we had just cared for in the emergency room,” said Dr. Gilkey,’72, writing in her alumni class book a few years ago. “It was kind of strange, but it really stands out in my memory.”

Indeed, the life of a medical student always has been a mixed bag of experiences. It begins with intense lectures and labs, the proverbial science boot camp for doctors in training. The final years are a whirl of intense clinical rotations, when students apply what they have learned into patient care and prepare for whatever medical specialties they will pursue after graduation

Medical Education Advances

Educating future physicians was the foundation on which the Indiana University School of Medicine was built in 1903 and remains so even to this day. Yet, in the 1ate 1960s and into the early 1970s, the IU and the School of Medicine leadership embarked upon a visionary plan designed to enhance the curriculum and expand education beyond the School’s campuses in Indianapolis and its founding site at Bloomington. The plan was fueled, too, by a statewide doctor shortage; though the School was admitting and graduating nearly three percent of medical students in the nation, many did not remain for residencies or to establish practices in Indiana.

Under Dean Glenn W. Irwin Jr.’s direction, a special IUSM committee, chaired by George T. Lukemeyer, MD ’47, was asked to develop a plan to meet those challenges. Out of this intensive study was born the 1967 “Indiana Plan,” formally adopted as the Indiana Program for Statewide Medical Education by the Indiana General Assembly. The timing was good: At one point, some state lawmakers were considering a proposal to develop a new medical school at Ball State University.

Two years later, in response to its rapidly growing enrollment, a state commission approved a plan to establish seven new IU centers for medical education, each of which would offer the first two years’ curriculum. By 1980, those institutions were in place at the campuses of Northwest-Gary (IU); Lafayette ( Purdue University); Evansville ( University of Southern Indiana, formerly Indiana State University-Evansville); South Bend (University of Notre Dame); Terre Haute ( Indiana State University); Fort Wayne ( Indiana-Purdue University); and Muncie ( Ball State University).

Enrollment grew steadily throughout the 1970s and 1980s, the high water mark being 1973 when 305 students were admitted. In 1993, an enrollment cap of 285 students per entering class was established, a limitation that exists to this day.

After an extensive study of the medical school curriculum, a totally different system was implemented in 1969-70. The components included basic sciences the first year and for half of the second year. This was followed by an introduction to clinical medicine in the second year and core clinical clerkships during the third. The final year was a totally elective program, and students could choose from more than 300 clinical and basic science offerings. Many of the clinical electives were offered in hospitals throughout the state.

More changes in IUSM medical education were on the horizon. In 1992 Dean Walter J. Daly, MD ’51, directed the School to commence a curricular review, not from a conviction that the curriculum was seriously flawed, but from the desire always to improve it. The outcome was the development of the competency-based curriculum, and IUSM was one of the first medical schools in the nation to establish such a program.

This shift moved traditional subject-oriented studies toward a more integrated learning experience, emphasizing not only basic clinical skills and medical diagnosis, but also the social and community contexts of health care, moral reasoning, ethical judgment and effective communication. The so-called “Indiana Initiative” was implemented in 1999 and the Class of 2003 was the first class to graduate under the revamped system.

But more than curriculum changes and expansion to other sites throughout the state, an IU School of Medicine education means something far more to many who have received training at the institution.

“I practice family medicine in Vicksburg, Michigan, and it’s all that I dreamed that medicine would be,” says Eric Houchin, MD ’95. “I come across a lot of graduates from other medical schools and I believe that Indiana offered me superior training to that of my colleagues.”

Growth and the Clarian Call

The nature of health care and its administration was changing in the 1970s and 1980s and the School held its own in keeping pace with Stephen C. Beering, MD, at the helm. In 1975, Phase II of the Indiana University Hospital was completed, providing more beds, clinical laboratory and radiology space, a clinical research center and some outpatient services.

That same year, Marion County General Hospital (soon to be renamed Wishard Memorial Hospital in honor of Niles Wishard, who played a key role in establishing IUSM in 1903) was languishing as were many charity hospitals across the country at that time. IUSM assumed management of the facility, and in doing so, the School integrated and coordinated the operation of its own programs of patient care, education and research. The Regenstrief Institute for Health Care, established in 1967, found a new home in a new facility constructed adjacent to Wishard.

In the 1980s, additional floors were added to the VanNuys Medical Science Building to accommodate more labs and offices for the increasing basic science faculty (further expansion added new space on the building’s side in 1998 and further renovations currently are under way elsewhere on the original structure). Planning also got under way for major expansion at Riley Hospital for Children. At the close of the decade, the Medical Research and Library Building opened.

Expansion has continued since. In 1996, the Indiana Cancer Pavilion was opened, offering the latest in care to patients statewide and elsewhere. The following year included the dedication of the IU Cancer Research Institute, and in 2000, the sprawling Riley Outpatient Center began serving young patients and their families.

But growth at the School was not measured solely by bricks and mortar. The people who occupied those facilities were gaining prominence for their health care expertise. Oncologist Lawrence Einhorn, MD, pioneered a cure for testicular cancer. The IU Distinguished Professor later would treat cyclist Lance Armstrong, who later would go on to win the Tour de France five times.

IU physicians brought many firsts to the IU Medical Center, particularly its surgeons, who have been on the cutting edge for Hoosier patients since the 1980s. Indiana’s first liver recipient was operated on by Drs. Peter Friend and Ronald Milo; Drs. Mark Pescovitz and Stephen Leapman performed Indiana’s first pancreas transplant. In 1989, ten-month-old Megan Stedman received a new heart thanks to the talents of John W. Brown, MD, and his surgical team. The following year, Brown would perform the world’s first twin-to-twin heart transplant.

Cardiologist Douglas Zipes, MD, director of the Krannert Institute of Cardiology, worked with Medtronic Inc. to develop the automatic cardioverter, a device that corrects heart arrhythmia. The IU Distinguished Professor was the first in the world to implant it in patients. In 1979, Richard Miyamoto, MD, chair of the Department of Otolaryngology-Head and Neck Surgery, performed Indiana's first cochlear implant in an adult and the first in a child in 1983.

As the end of the century approached, change was sweeping through the health care industry and IU was part of it. In 1996, IU entered into a partnership with Methodist Hospital of Indianapolis, consolidating the operations of their hospitals and outpatient centers and those of Riley Hospital for Children. The $1.1 billion corporation, now called Clarian Health Partners, was not meant to alter the mission or course of the School, said then-President Myles Brand.

“The high quality of medical education in Indiana will be sustained by this agreement,” Brand said when the consolidation was announced. “The School will retain control over all decisions related to clinical training sites and academic affiliations with institutions, such as the new entity.”

From the Benchside To Beyond

Preparing top-notch doctors to provide first-rate care to patients does not occur by chance. Medical advances and technology, and modern approaches to treat disease and injuries are products of long, tedious study. Research has been a solid cornerstone of IUSM since its founding, particularly in the last three decades.

Since the early 1970s, several research endeavors have flourished at IU and its medical campus. Among them: Hypertension Research Center, Herman B Wells Center for Pediatric Research, Diabetes Research and Training Center, Multipurpose Arthritis and Musculoskeletal Diseases Center, Walther Oncology Center, Alcohol Research Center, Otis R. Bowen Research Center, Center for Alzheimer Disease and Related Disorders, Devault Otologic Research Laboratory, Center for Aging Research, Center of Excellence in Women’s Health, National Gene Vector Laboratory and many others.

External research funding from both public and private sources grew significantly as Robert W. Holden, MD ’63, began his duties as dean in 1995. That year, the School received $110 million in funding, more than half of it coming from the National Institutes of Health. Dr. Holden was one of the chief architects of Indiana’s 21 st Century Research and Technology Fund, established by the Indiana General Assembly to encourage biomedical and related research and innovations throughout the state. Total research funding at the School in 2002-2003 was $187 million – a few dollars more than the $11,000 spent in 1947 when John VanNuys, MD, began his tenure as dean.

With the advent of the new millennium, much of IUSM’s research journeying into the realm of human genetics and the role it plays in maladies such as cancer, heart disease and a variety of other disorders. The world’s first DNA bank was established within the Department of Medical and Molecular Genetics in 1984. Blood samples from persons at risk for Huntington’s disease were the first to be analyzed. White blood cells are used to extract the DNA needed by geneticists to diagnose and counsel the bank’s clients and families who have a history of genetic disease.

A $105 million grant from the Lilly Endowment to IU in December 2000 – the largest single donation ever made by the Indianapolis-based endowment or received by IU – created the Indiana Genomics Initiative. The grant, which has stimulated a range of genetic and related research at the School, came at a time when scientists completed their “working draft” of the human genome. In 2003, the Lilly Endowment granted IU an additional $50 million to advance INGEN further.

The School took another major step to advance its research goals in 2002 when it became part of a partnership whose goal is to transform central Indiana into a corridor of life sciences and biotechnology research and development. The partnership, BioCrossroads, seeks to develop Indiana as a world-class health and life sciences hub. The non-profit partnership brings together IU, Purdue University, the Central Indiana Corporate Partnership, the City of Indianapolis and the Indiana Health Industry Forum.

D. Craig Brater, MD, who was appointed IUSM dean in 2000 has made it no secret that all research activities are critical to the School’s future.

“All of our expectations of future health care depend on a whole new way of treating disease and on physicians and scientists who will develop those treatments. This means working from a genomic-based knowledge base,” says Dr. Brater. “Since many physicians treating citizens in Indiana are educated at the IU School of Medicine, it is vital that we provide them with the best education and training in the country.”