A Different Doctor

For 50 years, UC San Diego School of Medicine has trained a different kind of doctor in a different kind of way. This is what that difference looks like.

In 1968, Bill Jessee, MD '72, received acceptance letters from two medical schools: UCLA, a well-established and respected institution in a thriving metropolitan city, and UC San Diego, which consisted of one partially constructed building on a former Marine Corps base and a newly acquired County Hospital miles away in Hillcrest. But that wasn't the only difference between the schools. 

1980 class at UC San Diego School of Medicine"The letter from UCLA was just a mimeograph—the precursor to the photocopy," Jessee said. "From UC San Diego I received a personal letter from Hal Simon, the associate dean for student affairs. I knew then that UC San Diego would give me the kind of personal attention I wouldn't have found elsewhere."

Jessee decided to take a chance on the new medical school, despite its lack of history or reputation. He and 45 others comprised the charter class that fall. "It was a risk," Jessee admitted, but one he saw worthwhile. It was an opportunity to take part in a completely new type of medical education—one where he even got to help develop the curriculum. 

"It was a selling point that if you want to do something new, there's no precedent to say you can't," Jessee said. "We had a lot of flexibility to pursue whatever interested us."

More than memorization

One of the innovators of the school's lasting approach to education was its first dean, Joseph Stokes III, MD, who set the foundation before the first class even entered. Stokes was a leader in preventive medicine, infectious and cardiovascular disease, and even the burgeoning field of genetics. And perhaps due to his varied, interdisciplinary research interests, Stokes and other founding faculty wanted to build a school where medical students didn't just memorize disease symptoms and treatments from a textbook. They wanted to provide a medical education rooted in the basic sciences and the underlying causes of disease. 

From the beginning, Stokes believed the basic science of a medical school curriculum didn't need to be taught in isolation in the School of Medicine. There was much to gain from the resources of the campus at large and he drew heavily upon departments like biology and chemistry to give students a firm scientific foundation. The approach exemplified the words of David Bonner, PhD, founding chair of the Department of Biology: "There is no such thing as basic versus applied science; there is only good or bad science."

That philosophy led to the "Bonner Plan." Eventually, UC San Diego medical students would take graduate-level classes in biochemistry, physiology and pharmacology alongside graduate students devoted to those fields. Second-year medical students took their anatomy and pathology courses with clinical faculty, but could continue working in labs and taking electives in general campus graduate departments. 

For one of Stokes' first faculty recruits, Eugene Braunwald, MD, founding chair of the Department of Medicine, there is one School of Medicine milestone that most clearly demonstrates the school's desire to interweave science and medicine: the school's very first lecture, held at the Hillcrest hospital on a Saturday in September 1968.

"That was the start of a series in which Linus Pauling, two-time Nobel Prize laureate, discussed the basic science of a disease and I covered the clinical side, to show the relationship between the two," Braunwald said. "We started with sickle cell anemia, for which Pauling had worked out the genetics. So for me, a young person working side by side with this great scientist, it was a thrill."

While the Bonner Plan set the stage for an unparalleled intermingling of basic sciences in a medical school, Clifford Grobstein, PhD, the school's dean when the first class entered in 1968, continued that tradition. 

"Dr. Grobstein was a cellular physiologist and it was unusual at that time to have a medical school dean who was not a physician," Jessee said. "But it was consistent with the concept of a strong basic science foundation."

But Stokes, Grobstein and their faculty recruits didn't stop there.

"One of the problems in American medical education at that time was that the medical schools were divided—two years in classroom, two years in the clinics," Braunwald said. "These two had little to do with each other, and yet they are intellectually intertwined. We saw that as an opportunity for making a change in medical education."

So the founding faculty integrated both worlds. They introduced students to patients the first week they arrived. "We stood the curriculum on its head—we intermingled clinical and science work like nobody else was doing at the time," says Braunwald. "UC San Diego was a model for what everyone else is doing now."

If standardized exams are a measure of success, the Bonner Plan and this integrated vision of the founding faculty worked: The school's second class of 48 graduates ranked #1 in the U.S. on the 1971 board exams. 

Historical Image Gallery

Turning medical education on its head—again 

But the world has grown a lot since 1971, and the thought of a "career in medicine" has evolved over the decades to mean something much more elaborate to recent UC San Diego medical students. They are trained clinicians, of course, but also stewards of society's resources: medical economists, efficiency experts, disparity reductionists, big data gurus and CEOs.

"They will enter a world as complex as the diseases they treat," said David Brenner, MD, the current vice chancellor of health sciences and dean of the School of Medicine.

2017 class at UC San Diego School of MedicineJust like those before them, Brenner and colleagues are pushing UC San Diego's medical education to constantly evolve as they prepare students for the ever-changing pressures and opportunities of modern medicine. In 2010, Brenner, Maria Savoia, MD, dean for medical education, and Jess Mandel, MD, associate dean of undergraduate medical education, overhauled the curriculum again, launching what's known as the Integrated Scientific Curriculum. This move cut the number of lecture hours in half, freeing up the afternoons for students to pursue individual academic and clinical interests. 

What's more, the old pillars of medical school classes—Pathology, Anatomy, Histology and Pharmacology—are no longer standalone courses. Instead, they are woven into new courses organized by organ system. This "tapestry" approach gives students a solid grounding in science as a foundation for clinical practice, and in the important role of genetics and molecular biology in the delivery of highly personalized care. 

The Integrated Scientific Curriculum also emphasizes problem solving- and team-based learning. According to Savoia, who first came to UC San Diego School of Medicine as an intern in 1976, medicine is now a "team sport," where physicians, nurses, pharmacists, social workers, physical therapists and others all work together to give patients the best possible care, and medical education needs to reflect that.

"The days of the 'solitary genius' are over," Mandel agrees. "Students can't just study subject matter in classrooms and carrels, take a test, and learn how to be a physician. They need to talk as much about what they don't know as what they do know, ask questions and work with their peers to solve problems. That's what leads to lifelong learning, and that's what drives medicine forward."

At the same time, that personal touch that first attracted Jessee to the charter class hasn't changed. Under the Integrated Scientific Curriculum, incoming classes are divided into six "communities" of students who remain together for their entire academic career. Each community has its own faculty mentor and includes members from each year's class, giving newcomers built-in mentors and colleagues who can provide support guidance as they face the challenges of medical school. 

"In my mind, the integrated curriculum built a clinical-centered scaffolding that has helped me think and problem-solve like the best diagnosticians, while never failing to emphasize the importance of patient-centered care," said Darrell Tran, MD '15, who now serves as chief resident in the Department of Anesthesiology at UC San Diego Health. "I feel especially fortunate to have been an early part of the inspiring changes in our medical school's curriculum." 

This philosophy continues to attract adventurous students like Tran and Jessee, yet the risk of an unknown reputation has vanished—today, the School of Medicine is routinely ranked in the top 20 medical schools in the nation by U.S. News & World Report.

Student-Run Free Clinic

In January 1997, Ellen Beck, MD, professor of family medicine and public health, and a team of medical students and community partners opened the first not-for-profit Student-Run Free Clinic in the basement of the Pacific Beach United Methodist Church. Today, the clinic is nationally recognized for providing accessible, quality health care at no cost to underserved communities. 

The Student-Run Free Clinic, now one of the medical school's most popular electives, is staffed by UC San Diego medical students under the full supervision of faculty and licensed health care professionals. Students and faculty from the fields of medicine, pharmacy, dentistry, social work, law and nursing collaborate in this transdisciplinary model. The clinic currently maintains two sites in San Diego.

Elissa Kim, MD

Elissa Kim, MD, '17

"Programs such as ours are necessary, both to begin to address the enormous gaps and tattered holes in the safety net, and to train and inspire the next generation of healthcare leaders to work with underserved communities," Beck said.

Elissa Kim, MD, '17, was originally attracted to UC San Diego in part because of the Student-Run Free Clinic, and other hands-on opportunities she couldn't find at other medical schools. While in medical school, she served as the women's clinic manager at the Student-Run Free Clinic in Pacific Beach and cared for women in Tijuana, Mexico.

"I came out of the experience stronger and I learned a lot about differing cultures, medicine and myself," Kim said. "I was there to see it and experience it. I didn't have to read about it from a textbook. I will take those skills with me wherever I practice medicine."

Science informs medicine

Outside the classroom, the integrated, team-based approach is also embedded in the culture of the labs and clinics throughout the School of Medicine, UC San Diego Health and Skaggs School of Pharmacy and Pharmaceutical Sciences. And the old Marine Corps base surrounding has since grown into a hotbed of collaborative life science research partners, such as the Salk Institute for Biological Studies, The Scripps Research Institute, Sanford Burnham Prebys Medical Discovery Institute and many others, many of which are powered by a diaspora of UC San Diego alumni.

It's no surprise, for instance, that when Human Longevity Inc., the nearby genetics-based health care firm founded by genomics pioneer J. Craig Venter '72, PhD '75, began looking to sequence the genomes of people with ready-to-go clinical histories and blood samples, scientists at UC San Diego's Shiley Eye Institute jumped in.

Since 2012, the institute's director, Robert N. Weinreb, MD, and colleagues have been building a repository of frozen blood samples from more than 5,000 patients with common eye conditions, accompanied by detailed clinical histories. The Institute provided more than a thousand de-identified blood samples to Human Longevity, which has since generated full-genome sequences for each. Researchers can now use this information to look for genetic markers before eye disease develops and help determine whether an individual may need early, preventative treatment.

"Some of the things we do now were science fiction when I was an undergrad at UC San Diego more than 40 years ago," said Larry Goldstein, PhD, '76, director of the Sanford Stem Cell Clinical Center at UC San Diego Health and scientific director of the Sanford Consortium for Regenerative Medicine, a "collaboratory" of stem cell researchers from several institutions. 

Goldstein's own pursuits are no less astounding. He's essentially become the face of local stem cell research, having played a seminal role in the establishment of a $3 billion state fund for stem cell research in 2004, which launched the California Institute for Regenerative Medicine (CIRM), the state's stem cell agency.  

Goldstein continues to be a vocal advocate for stem cell research, and as a scientist has created unprecedented laboratory models of Alzheimer's and other diseases. His team can now convert skin cells of an Alzheimer's patient into a special type of stem cell that can then differentiate into neurons that retain the patient's own unique genetic makeup and disease features. These personalized "neurons-in-a-dish" allow researchers to study how a patient's brain cells function (or don't) and test new therapies quickly, without putting patients at risk.

"From the enormous potential of stem cells to illuminations of the inner workings of cells to new surgical techniques, UC San Diego has always been a catalyst for extraordinary research and advanced medical care," Dean Brenner said. "Even when I first came here on a fellowship in gastroenterology in 1985, our medical school was unlike any of my previous learning experiences, which no doubt was the purposeful intent of its visionary founders. The School of Medicine was—and continues to be—a home for bold people who want to reimagine and revivify the teaching of medicine, the training of doctors and the mission of conquering disease."

Written by Heather Buschman, PhD. 
This article originally appeared in Triton, UC San Diego's alumni magazine

Match Made

While many aspects of medical education and practice have changed since the UC San Diego School of Medicine admitted its first class, one thing has not: Match Day. 

Excited Match Day student from the pastEvery year since 1952, at precisely the same moment, thousands of graduating medical school students across the country simultaneously tear open an envelope. The single sheet of paper inside informs each graduate where he or she will do their residencies—in other words, where each will spend the first several years of their lives as working doctors.

Operated by the non-profit National Resident Matching Program, the emotional event culminates months of student's applications and interviews with a dozen or more hospitals and institutions, all in search of their perfect match. 

Each student creates a ranking of their choices, while each hospital and institution creates its own list of preferred students. A computer algorithm compares the lists, crunches the numbers and produces a single choice for each matched student.

current excited Match Day student "Match Day is a dramatic and joyous event that symbolizes the start of the next phase of our students' medical education and training in their chosen fields," said Carolyn Kelly, MD, associate dean for admissions and student affairs. "I don't think Match Day events have changed much in the last fifty years, and that seems to be fine with just about everyone!"