Back to the future of continuing medical education

Predicting the future is a popular means to finish a review of past accomplishments. Often, these forecasts rely heavily on current trends in technology to safely guess advances and efficiencies.

An example of one such prediction is in the 1955-1957 Biennial Report of the Department of Continuation Medical Education.

Formalized in 1937, the Department of Continuation Medical Education, formerly known as Postgraduate Medical Education and today named the Office of Continuing Medical Education, enjoyed a major boost to its programming in 1945 through a nine year, $250,000 grant by the Kellogg Foundation to increase opportunities for participation in its teaching programs. Although review courses for practicing physicians were part of the Medical School’s curriculum for decades, the department provided a permanent home for the “interdepartmental” education program.

The 1955-1957 report cites recent developments in the audio-visual field as a major future trend. Specifically it looks toward the use of television as a means to distribute postgraduate medical education. The report then imagines a world where continuing medical education moves past the limited scope of closed-circuit television and will be

“widely disseminated allowing physicians, even in remote areas, to keep abreast of medical progress simply by watching their TV screens for appropriate periods each week.”

An equivalent modern predication might be live-streaming of lectures or procedures via one’s smart phone or other mobile device. Gone will be the tether to the lecture hall or conference room. And as for the future of PowerPoint as an educational tool? The Magic 8-Ball says “Ask again later.”

Read the 1955-1957 Biennial Report below. The report also includes an overview of the department beginning with the 1945 Kellogg grant through current programs.

CME Report

Joining the fold

This year marks the fortieth anniversary of the Academic Health Center at the University of Minnesota. The anniversary specifically acknowledges the reorganization of the health sciences units on campus into a new administrative structure that combined the schools and colleges of medicine, nursing, public health, pharmacy, and dentistry under the leadership of the newly created office of the Vice President for Health Sciences.

Notice, however, that the College of Veterinary Medicine is not apart of the original grouping?

In the document Health Sciences Mission Statement and Proposed Structure and Governance, approved by the Board of Regents on July 10, 1970, the relationship between the restructured Health Sciences and the College of Veterinary Medicine is described as close, but separate. The document explains that

“The Regents have authorized a unified organization of the health sciences that will bring together in a single administrative structure programs in medicine, nursing, public health, dentistry, pharmacy, and the University hospitals. Veterinary medicine which has related interests will be joined closely to this administrative unit.”

And continues

“The Regents recognize the multi-lateral relationships in which the College of Veterinary Medicine is involved. The affairs and activities of the College of Veterinary Medicine will be important to the Health Sciences and vice-versa. It is proposed that the Dean of the College of Veterinary Medicine carry adjunct status in the Health Sciences to facilitate coordination and cooperation but that the status of the College otherwise remain as it is at present.”

The status of the CVM was a free standing professional graduate program led by a dean who reported to the senior vice president for academic affairs.

This organizational structure differs from the recommendations put forward by the External Committee on Governance of the Health Sciences in 1970 that encouraged the Dean of the College of Veterinary Medicine report directly to the Vice President of Health Sciences.

When did the College of Veterinary Medicine officially join the Academic Health Center?

On September 13, 1985, the Board of Regents approved the recommendation of the Education Planning and Policy Committee to change the administrative reporting structure of the College of Veterinary Medicine so that it

“Shall be designated as a unit of the Health Sciences with a line reporting relationship to the Vice President for Health Sciences.”

This year actually marks two anniversaries: First, the 40th anniversary of the Academic Health Center, and second, the 25th anniversary of the full partnership of the College of Veterinary Medicine.

Map it: Then & now

Day to day activities tend to undermine an appreciation for institutional history. The memory of what has come before is often lost to the slow, incremental changes that keep moving us forward. It is easy to forget that things have not always been this way, nor have they always looked as they do today.

In an attempt to better visualize the history of the Academic Health Center and the longer history of the health sciences on campus, the map below overlays photographs and documents from the archives onto a modern day map of the campus.

See Medical Hall (now Wulling Hall) in 1901; watch the growth of the University Hospitals from Elliot Memorial in 1912, the additions of Eustis, Todd, and Christian in the late 1920s, and finally the completion of the Mayo Memorial; and view the initial excavation for Unit A (Moos Tower) while reading the remarks given at the groundbreaking ceremony in 1971.

Interact with the map or follow it to a full page version that allows street views to better compare the then and now.

View Academic Health Center History Map in a larger map

The photographs and documents represent a sampling of material from the archives. Additional material will be added in the future. Check back to see the changes.

Report of the External Committee

In the recent State of the Academic Health Center address, Dr. Frank Cerra, Senior Vice President for Health Sciences, referenced a 1970 report by the External Committee on Governance of the Health Sciences to then University President Malcolm Moos.

In December 1969, President Moos asked the committee, chaired by Alexander Beard of Vanderbilt University, to address the following issues:

1. Is there a need for a Regents’ definition of the missions and responsibilities of the health sciences?

2. Given the history, current situation, existing competence and needs of the health sciences, both within and without the University of Minnesota, what alternative administrative structures could be developed for units in this area? Such administrative structures should also take cognizance of the needs of the allied health professions.

3. How should the responsibilities for continuing and graduate education in the health sciences be divided between the health science units, the Extension Division, and the Graduate School?

4. What steps should be taken to assure satisfactory relationships between all professional units in the health sciences and the hospitals?

5. What steps should be taken to assure satisfactory relationships between all professional units and the basic science departments?

6. What should be the pattern of relationship sought with affiliated hospitals, and other community agencies and services and the locus of decision making on contracts specifying these relationships?

The report outlines the committee’s suggestions on the mission, administrative structure, and relationships to basic sciences, allied health, the University Hospital and affiliations, and the Graduate School.

As an audience member at the State of the AHC noted, the report called for the establishment of a School of Allied Health Sciences, an achievement now taking form.

The groundwork for the report came from a campus visit in January 1970 as well as two supporting documents: Discussion Papers for External Committee on Governance of the Health Sciences and Background Information for External Committee on Governance of the Health Sciences.

Read the final February 26, 1970 report in full below.


First mention

History is often focused on the first instance, the first mention in order to identify when something happened and how it relates to what followed. The New York Times offers a column ‘First Mention‘ that uses its own archives of news articles to determine when something was first reported. This isn’t too different from the way the Oxford English Dictionary traces the etymology of a word to its modern meaning.

As more and more documents are transferred to a digital format, our understanding of the ‘first’ of anything will become more accurate.

As an example, in the spring of 1954, the beginnings of open heart surgery took a major step forward at the University of Minnesota. A team of surgeons including C. Walt Lillehei, Richard Varco, Morley Cohen, and Herbert Warden developed and implemented a new technique called cross circulation.

On April 30th the University News Service held a news conference and issued a corresponding press release heralding the new achievement. Pushed out to the national media, the story of Dr. Lillehei’s success soon became a popular print and television phenomenon.

Historically, this was a major accomplishment in the world of surgery and captured the world’s attention.

From a digital archives perspective, we are now able to re-live those early first moments as presented to the public by locating the procedure’s first mention.

In addition to the New York Times’ pay service, Time.com offers free online access to their articles dating back to 1923. A simple search easily retrieves the May 10, 1954 announcement of cross circulation. Google’s News Archive Search also offers the ability to discover multiple articles on the subject from news sources across the country.

Closer to home, the University Digital Conservancy, the digital archives for the University of Minnesota, provides online access to the original news release on cross circulation issued at 2 PM on April 30, 1954.

There are even some remnants of film surviving from the press conference that have transitioned from analog to digital format. This may not be on par with today’s Driven to Discover videos but it surely captivated the interest of viewers at the time.

Tracking down these first mentions usually provide other insights that historical researchers are unaware of. For instance, until Herbert Warden started the pump in the above video, I had no idea that cross circulation was a LOUD technology; something akin to an air compressor in the operating room.

What did this place used to be?

From time to time, I get questions about what a certain office, location, or building use to be prior to its current function. These are always fun to answer and usually provide a sense of institutional history to the person who asked the question.

img0148.jpgA recent donation by the AHC Office of Facilities & Capital Planning to the archives has made this task even easier. Pictured is a 239 page listing of each room and its use in the health sciences complex from February 1982. The document, titled “Current Assignment of Health Science Space: Detail by Building and Room,” is particularly helpful because it provides information on how the Mayo Memorial Building served as both a patient care facility as well as research/office space prior to the construction of the new hospital in 1986.

A few examples include:

In 1982 Room #602 in Children’s Rehab Center was a faculty office. Today it is my office.

In 1982 Rooms #605-607C in Mayo were Psychiatry faculty offices located near patient rooms. Today it is the Medical School Dean’s office.

In 1982 395A Mayo was a Coffee Shop. Today it is the AHC Office of Communications office.

With this handy reference tool, feel free to ask “What did this place used to be?”

Questions, questions

As part of the History Project, I assist others in using archival materials to answer questions and conduct research. People who use the archives are undergraduates, grad students, staff, faculty, administrators, scholars from other institutions, and the general public.

Email & phone inquiries are the most popular methods of contacting me but the occasional letter or drop-in happens as well.

Using the archives and asking questions are free of charge and open to anyone. Some questions are easy to answer while others require time to review materials and dig a little deeper. And, sometimes a definitive answer cannot be found (although hopefully enough information can be obtained to at least support a conclusion).

A few examples of recent reference questions and the answers are below. Perhaps you where wondering the same thing. . .

Question: Could you verify for me that Powell Hall could have been a place where families might have stayed when they had family members in the hospital?

img0145.jpgAnswer: Yes. Powell Hall served a variety of purposes from its dedication in 1933 to its demolition in 1981. Powell Hall was primarily, and is most known for being, a residence hall for nursing students. During its last two decades it also provided dormitory housing for women from across campus, housed administrative office space for the School of Public Health, and was used as a resting space for on-call hospital staff. In the 1970s, families who traveled to the Twin Cities to be close to a family member at the University Hospitals had the opportunity to stay at the “Powell Hall motel as a convenience for patients and their relatives.”

Question: I am looking for information about the establishment of a Learning Resource Center for the health sciences in the 1970s. It was one of the first in the nation to be housed within a biomedical library.

img0146.jpgAnswer: Yes, there is information related to the establishment of the Learning Resource Center (originally known as the Instructional Resource Center) for the health sciences, the precursor to the AHC Learning Commons, at the archives. In 1968 a subcommittee for long-range planning for the health sciences investigated the programmatic & spaces needs of a learning resource center. In 1970 a prototype center was established in Diehl Hall by the Medical School in conjunction with the Bio-Medical Library. A sampling of documentation related to this subcommittee originally chaired by Dr. Ramon M. Fusaro is available in the digital archives.

Question: Where were the original operating rooms in Elliot Memorial Hospital?

img0147.jpgAnswer: The exact answer to this question still eludes me but trying to answer it has been a very enjoyable process. Elliot Memorial Hospital was dedicated in September of 1911 as the first university teaching hospital. In subsequent years it was expanded to include the Todd and Christian wings and the Eustis Children’s Hospital. In 1954 this U-shaped configuration served as the east, south, and west sides of the new Mayo Memorial Building.

I have looked at original blueprints from 1911 although they mostly depict external details, reviewed floor plans from the late 1950s after the completion of the Mayo Memorial Hospital, and walked the halls. I’ve spoken with faculty and staff who have some insight but to no avail. Although I have not exhausted my sources, evidence indicates space on the 5th and 6th floors could have contained an observational gallery and sky lights that would have overseen the surgical room. Hopefully more on this to come.

Question: I was told that the archives has faculty lists for the Urology service–right? I don’t need salary or any other info, only a list of those with title of assistant professor or higher after 1966.

Answer: There are a variety of sources to try and determine faculty lists, however, one of the easiest sources to use are the course catalogs and bulletins for undergraduate, graduate, professional, and non-degree programs. Within the description of each school and program there is almost always a list of affiliated faculty by their rank. Most bulletins were published on a biannual basis and may miss a name or two but are generally considered reliable in their accuracy. The bulletins date from 1871 to the present. A print set is available at the University Archives. Most of the bulletins from 1871 through the 1940s are also available online.

Have a question you’d like to ask? Have a better answer to any of the above? Please, feel free to contact me.

A look back, then ahead, & back again

“As this decade begins, there is no shortage of challenges and opportunities for the Academic Health Center. All of the issues – cost containment, access, managed care, an aging population, facilities and equipment replacement, educational reform, and further development of the team approach to health care – require increased collaboration in the Health Center and within the University.”

This statement is not the current outlook in 2010, rather the look forward from 1990.

The above quote is from the report “Health Sciences at Minnesota: A Look Back and a Look Ahead” (Sept. 1990). It documents the administrative history of the AHC during its first twenty years and describes the changes in both the health needs of the state of Minnesota and teaching health care in higher education.

This year marks the 40th anniversary of the Academic Health Center. Documents such as this help identify the AHC’s passage over time and allow readers to place historical mile markers along the way of its development.

While reading this report, certainly many will consider 1990 as the recent past and 1970 less so. Yet, today the AHC is different than it was in 1990. In fact the AHC of 1990 is much closer in structure and governance to its earlier self of 1970.

As it looks far forward into the future, the report tries to imagine how individuals will get their health information in the year 2000. The role of personal computers, self-care, and prevention strategies are all forecasted. In many ways, the later part of twentieth century focused on what promises the twentieth first century would bring. This report is one such document. Unlike some of the preceding forecasts of the future of health sciences, this review of challenges and opportunities is on trajectory to intersect with its future to create a present that has now become our past.

Read the report in full below. Unfortunately, the listed attachments were not saved.


A home for Dr. Robert Meyer

In the February 13, 1939 issue of Time Magazine, an article described the plight of Jewish physicians in Germany. The Nazi government revoked their licenses and asked many to leave the country all together. The response in the United States included a fear by some that emigrating physicians would compete with U.S. doctors while others created support networks to find homes for their European counterparts.

During the spring of 1939, Dr. John L. McKelvey received notice from Germany that his colleague and mentor, Dr. Robert O. Meyer, would soon become one of the displaced. Dr. McKelvey, who became the first full-time department head for obstetrics and gynecology the previous year, set out to secure Dr. Meyer a position at the University of Minnesota.

Dr. Meyer, a world renowned pathologist, had a full career in Germany. In 1935, at the age of seventy-one, the Nazi government relieved him of his position at his university. With support of his colleagues he remained unofficially on staff and continued to conduct research and collect consultation fees. In December of 1938 the Nazi Ministry of the Interior informed him he would no longer be able to remain in Germany.

By the end of May 1939, Dr. McKelvey secured approval from Dean Diehl and President Ford as well as the Board of Regents to send an official letter of offer to Dr. Meyer. Funding for the position came from a variety of sources. The primary source was the Emergency Committee in Aid of Displaced Foreign Medical Scientists (New York) who provided $1,500 per year for two years. The American Gynecological Society and its members provided $1,309. The Manhattan Research Foundation provided $500. Various friends and associates raised $648. Additional funds raised from lectureship fees added to the overall amount needed to fund his research position. The total of this revenue established the Robert Meyer Clinical Associate Professorship Fund in Obstetrics and Gynecology at the University of Minnesota.

On September 1, 1939, Dr. Meyer, then seventy-five years old, and his wife planned to fly out of Berlin but could not due to the Nazi invasion of Poland. Instead, they took a train to the Netherlands to meet their ship to the U.S. After a brief stay in New York, they arrived in Minneapolis on September 21.

From 1939 until 1947 Dr. Meyer actively participated in the Department of Obstetrics and Gynecology as a researcher. He also worked with the Minnesota State Board of Health as a part-time obstetrics pathologist with their home deliver training.

Dr. Meyer passed away at the age of eighty-three in 1947 after having retired from the University of Minnesota in June. Before he died he wrote the Autobiography of Dr. Robert Meyer: A Short Abstract of a Long Life serialized in the Journal of the History of Medicine and Allied Sciences.

Several documents related to the establishment of the Robert Meyer Fund and Dr. McKelvey’s letter offering Dr. Meyer the position at the University of Minnesota are available below.


Soft drinks and polio

Soft drinks rarely get positive marks for health benefits. In fact soda consumption is linked to increase risks of diabetes, cardiovascular disease, tooth decay, obesity, and most recently pancreatic cancer according to a recent University of Minnesota study.

But have soft drinks taken the blame for diseases without any clearly linked evidence? Internet rumors include carbon dioxide poisoning due to over consumption and deaths resulting from mixing soda and certain candies that create a combustible combination.

Yet, targeting soft drinks is not a new phenomenon.

In the late 1940s polio continued to elude researchers and their ability to isolate the virus and create an effective vaccine. At the University of Minnesota a team of medical scientists funded by the National Foundation for Infantile Paralysis (now March of Dimes) worked to better understand the disease and search for treatments and a cure. This group known as the Minnesota Poliomyelitis Research Committee included such notables as Ancel Keys (physiological hygiene), Cecil Watson (medicine), Elexious T. Bell (pathology), Ernst Gellhorn (neurophysiology), Irvine McQuarrie (pediatrics), Raymond Bieter (pharmacology), Gaylord Anderson (public health), Berry Campbell (anatomy), A.B. Baker (neurology), and Maurice Visscher (physiology) as its chair.

The committee’s focus on such a widely feared and often misunderstood disease resulted in a deep public interest in their progress. Letters to the committee offering advice, theories, and potential solutions were common.

Suggestions received included dropping DDT on the city of Minneapolis by airplane to kill the virus,looking at the public health menace of dog feces in yards and parks as a transmitter of the virus, and recognizing the unfettered spread of world capitalism as a proponent of the disease (this letter also included a card to join the Socialist Party).

Also included in the committee’s files are two letters from a St. Paul chiropractor who puts the blame squarely on the popular consumption of soft drinks. Written at the end of 1946 the letters blame the chemicals included in the drinks and the government for ignoring the issue. The author theorizes the increase of polio corresponds to warmer weather when more soft drinks are consumed and concludes, “I am sure it is the soft drinks that is causing polio.”

Read the letters below.