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Student Notebook

A moving target
By Seth Crockett

As I traveled across the United States this past year, interviewing for residencies in internal medicine, I found myself unconsciously comparing each academic medical center I visited to DMS and DHMC. Most of the time Dartmouth was the clear victor. I believe that we are blessed with a talented student body, a wonderful and committed faculty, a state-of-the-art medical facility, and a uniquely collaborative and nurturing environment in which to study, work, and live.

But as I prepare to leave DMS after four wonderful years, I have a few suggestions regarding its future. Health care is changing rapidly. Advances in technology and biomedicine are colliding with diminishing reimbursements, a declining economy, and increasing numbers of uninsured people. I hope DMS will continue to grow in these uncertain times.

We are blessed with a talented student body, a wonderful faculty, a state-of-the-art facility, and a uniquely collaborative environment. But I have a few suggestions for the future.
Illustration by Suzanne DeJohn

International health: As a second-year student, I cochaired the student- run Dartmouth International Health Group. We distributed fellowships to medical students who were working on international health projects. One of those fellowships helped to fund a trip I took to Ecuador. We also organized monthly talks by physicians and others who captivated us with tales of their experiences working in international health.

But student groups like ours are limited in what they can do. With the increasingly global market for health care, it is crucial that medical schools teach students to practice culturally sensitive medicine, both in the U.S. and abroad. DMS does encourage students to do cross-cultural rotations within this country, and there are some opportunities for international work. But I would love to see DMS expand its international programs and even create an international health institute that would capitalize on the experience of the many DMS physicians already involved in international projects.

The evaluative clinical sciences: Founded in 1989, the Center for the Evaluative Clinical Sciences (CECS) is the only program of its kind anywhere and it is truly a jewel in DMS's crown. CECS Director John Wennberg's Dartmouth Atlas of Health Care is a seminal work on the geographic variation in health-care expenditures in the U.S. The CECS faculty is an interdisciplinary team of epidemiologists, psychologists, sociologists, economists, and physicians who study the health-care system, the distribution of health-care resources, and differences in patient perceptions of health care. CECS has granted numerous doctoral and master's degrees over the past 14 years. This year, the first candidates for master's of public health degrees were to graduate from DMS. And an M.D.- M.P.H. program is in the works. But I would love to see DMS take better advantage of the CECS program by integrating more evaluative clinical sciences coursework into the M.D. curriculum.

Curricular change: Overseeing the curriculum of a medical school is a challenging business, as I have come to realize in my two years serving on DMS's Medical Education Committee. Although DMS does an excellent job of preparing its students for residency positions, I think it could do still more. The School needs to have a more flexible and innovative curriculum in order to keep pace with the rapid changes in the practice of medicine and the needs of modern physicians.

DMS also needs to adopt new technology more quickly, too—many of our peer institutions are ahead of us in their use of computer-based instructional tools for basic science courses and clinical clerkships. In addition, DMS should improve faculty teaching and reward excellence in clinical and basic science teaching in the same way it rewards excellence in research—with academic promotions.

A definitive home: Dartmouth Medical School was founded in 1797 and has the proud distinction of being the nation's fourth oldest medical school. Ever since Nathan Smith was roaming about northern New England, our School has had a rich and colorful history. DMS was even the site of the first building erected specifically for the study of medicine in the United States. The "New Medical House" as it was called, was built by Nathan Smith in 1811 with a $3,450 grant from the New Hampshire legislature. This historic building, which will be forever emblazoned on the DMS crest, served as the Medical School's primary building for over 150 years. Sadly, it was razed in 1963. Since the destruction of this building, the students of DMS have lacked a definitive home.

Needless to say, there are both psychological and logistical bene- fits that come from having a recognizable "front door" to your institution. It would bring me great joy to see DMS construct a well-de- fined portal for the Hanover campus that would serve to better identify and unite the Medical School.

I have thoroughly enjoyed my time here, and there is no doubt but that this was the best medical school for me. I believe it to be an excellent educational institution, but I also understand that excellence is a moving target. I anticipate that DMS will continue to grow under the leadership of the new dean, Dr. Stephen Spielberg, and I look forward to hearing in the years to come about progress and increasing recognition for the students and faculty of Dartmouth Medical School and Dartmouth-Hitchcock Medical Center.

"Student Notebook" shares word of the activities or opinions of students and trainees. Crockett is the 2002-03 president of the DMS Student Government, though the opinions he expresses here are his own rather than the Student Government's. A member of the M.D. Class of '03, he will be doing his residency in internal medicine at Stanford.

If you would like to offer any feedback about this article, we would welcome getting your comments at DartMed@Dartmouth.edu.

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