Smego, Raymond A. Jr MD, MPH; D'Alessandri, Robert M. MD; Linger, Barry EdD; Hunt, Virginia A. MUA; Ryan, James; Monnier, John; Litwack, Gerald PhD; Katz, Paul MD; Thompson, Wayne
The Commonwealth Medical College will educate aspiring physicians and scientists to serve society using a community-based, patient-centered, interprofessional, and evidence-based model of education that is committed to inclusion, promotes discovery, and utilizes innovative techniques. - —Mission Statement of The Commonwealth Medical College, Scranton, Pennsylvania, 2009
From the increasing number of physician-supply reports, it is clear that the national physician shortage is upon us and looms large in the future. The Council for Graduate Medical Education,1 in 2005, estimated a shortage of 85,000 doctors by 2020, or approximately a 10% shortage in the national physician workforce. In June 2006, in a complete reversal of its policy position only a decade earlier, the Association of American Medical Colleges (AAMC) issued a statement that recommended an increase of 30% in the number of enrollees in MD-granting schools over the number of enrollees in 2002.2,3 As a result, the entering class for U.S. MD- and DO-granting medical schools in September 2007 was the largest in history. Most of the increased future enrollment will occur through the expansion of existing medical schools. However, as many as 10 emerging MD-granting schools will enroll a projected 1,080 students by 2015.4
The Commonwealth Medical College (TCMC) in northeastern Pennsylvania is a new, private, not-for-profit, independent, community-based medical school, with regional campuses in Scranton, Wilkes-Barre, and Williamsport (Figure 1). TCMC opened its doors to a charter class of 65 students in August 2009. The purpose of this article is to describe the early history and anatomy of TCMC and to outline the challenges, goals, strategies, and innovations for this new medical institution in areas such as curriculum, faculty, accreditation, finances, communications, partnering, and planning.
Identifying a Need
Despite the very large number of graduates from the six medical schools currently operating in the state, there are significant physician shortages in numerous specialties in many Pennsylvania communities. More than one-third of the practicing physicians in the northeastern portion of the state are expected to retire in the next decade. Many of the state's rural communities have tremendous primary care and subspecialty needs. Physicians have been leaving the region, and virtually every hospital in northeastern Pennsylvania is recruiting for doctors. In many local communities it takes about three months to get a new patient appointment, and many area physicians complain they are compensated substantially less for their services than counterparts in other locales. It is likely that an adverse malpractice environment, perceived inequitable reimbursement patterns, and the region's designation as a Health Professions Shortage Area—especially for primary care providers with substantial education debt—have all been major deterrents to physician recruitment and retention in northeastern Pennsylvania.
In 2003, as a result of the confluence of an aging medical community, an acute shortage of physicians, and a need to begin to change the economic climate and create a knowledge-based economy in northeastern Pennsylvania, the vision of a new medical school in Scranton began to find traction. Following a year of unstructured discussions, an initiative was undertaken to leverage the regional residency programs into a medical school. The vision of an early group of largely physicians quickly expanded into the grassroots Northeastern Pennsylvania Medical Education Development Consortium (MEDC), with nearly 20 members, including leaders and representatives from government, business, and medicine, as well as hospital executives. The MEDC board's mandate was to determine the feasibility of a new medical school; the TCMC Board of Directors was created in 2007 to assume oversight and operations of the new school forward. From its inception, the TCMC Board of Directors has been composed of 10 regional and/or academic leaders. In 2004, MEDC began the financial planning process for a new regional medical school that would be independent of a parent university. This process, along with benefits and challenges, is discussed below.
One of the most important factors in contemplating creating a new medical school is the belief that medical schools hold the potential to be engines of local economic development by attracting research dollars, creating new jobs, and enhancing the image of a parent university or a surrounding community.5 This belief, in part, persuaded community leaders to support the development of TCMC as a way to bolster its challenged economy. Raymond S. Angeli, president of Lackawanna College, where the new school is housed temporarily, told a local newspaper, “I think it [the development of a medical school] would be the largest thing to hit the city of Scranton since coal left.”6 During the next 20 years, the new medical school is expected to add 425 practicing physicians to this part of the state. This estimate is based on 1,500 graduates with a 30% retention rate. In reality, this likely underestimates the retention impact. In addition, the new medical school is expected to create 1,000 new jobs that directly and indirectly support the school's operations and add $70 million annually to the local economy.7
Early in the financial planning phase, MEDC commissioned a feasibility study to identify potential start-up sources of funding. Regional community leaders were closely involved in the process through regular meetings with MEDC members. The initial capital for the feasibility study was contributed by four regional hospitals and the Scranton–Temple Training Program in Internal Medicine. MEDC recognized the importance of developing positive political relationships. Among these political ties was a strong relationship with State Senator Robert Mellow, which brought a direct state commitment of support for TCMC along with leverage on a number of organizations to provide resource commitments. Financing of TCMC began with a $35 million grant from the Pennsylvania Redevelopment Assistance Capital Program, a $25 million leadership grant from Blue Cross of Northeastern Pennsylvania, and a number of other state, federal, and private philanthropic sources. The local banking community in Scranton made commitments for letters of credit and a $40 million tax-exempt bond issue, both facilitated by one of TCMC's early board of trustees members. By the time TCMC began operations in June 2007, $75 million of funding had already been committed, remarkably all without a full-time management team in place for TCMC.
As a private, independent, not-for-profit institution, there is an obvious need for financial sustainability, and philanthropic giving is expected to play a major role in TCMC's future. Charitable contributions were modest in the first year as the development program began to evolve. Nevertheless, there continues to be a perception of real value by many in the lay community, and the enthusiasm and anticipation across the three campuses offers extensive development possibilities. It has been and will continue to be critical to interact with the communities served by our regional campuses to sustain and enhance support for TCMC.
Student indebtedness plays an important role in determining the career pathways of medical graduates. In an attempt to limit the financial burden of education for our students, as well as to successfully recruit our charter class, the college sought and raised scholarship support of $20,000 per student in the charter class for each of their four years of study—$80,000 per charter class student. These scholarships were raised from a variety of community and charitable sources. A financial challenge will be to determine whether it is possible to continue absorbing substantial percentages of tuition and associated costs.
An independent medical school
One of the most intriguing challenges for TCMC, posing both limitations as well as distinct opportunities, has been the decision to create TCMC separate from a parent university. Despite the potential advantages of becoming part of an established university structure (and, in fact, several local universities expressed significant interest in incorporating TCMC into their organizations), the concept of a freestanding medical college was important to the TCMC founders to ensure the school's autonomy and limited-bureaucracy structure. A parent university provides obvious useful infrastructure involving financial, administrative, technologic, research, political, and human resources. However, the board believed that freedom from existing bureaucracy would permit unique institutional flexibility in decision making and implementation at administrative and operational levels. As a result of this insight, such administrative flexibility has proved beneficial in many areas, including governance and by-law modifications, innovative curricular development, responses to accreditation body queries and requirements, and admission and personnel policies. Furthermore, from the start TCMC wanted to create its own institutional culture, one of openness and transparency, collegiality, and respect for all opinions. Ideas and suggestions flow from leadership, faculty, and staff, and there is a grassroots development of founding policies and procedures that is unimpeded by already-existing administrative obstacles.
Finally, the founders wanted to ensure that the mission of TCMC remain focused on regional health needs and not drift into institutional-based missions. The sense was that large institutions often redefine their goals based on specific institutional needs. The founders believed that a community-oriented board of directors would stay focused on community needs and direct the college's mission appropriately.
The value of collaboration
Despite TCMC's administrative independence, the leaders envisioned that the college would work closely with many of the regional institutions of higher learning, many of which have health professions programs. TCMC local partners in northeastern Pennsylvania in undergraduate education include Scranton-based Lackawanna College, Marywood University, and the University of Scranton, and Wilkes-Barre-based Wilkes University, Kings College, and Misericordia University. The specifics of these partnerships vary. Almost two-thirds of our basic sciences adjunct faculty have their primary appointment at one of these institutions. Temporary research space has been donated by three of these partners, and TCMC research conferences are well attended by local basic sciences faculty.
Working collaboratively with all of the regional hospitals and health care providers is another priority. Major affiliate health care institutions in the region include Mercy Hospital, Moses Taylor Hospital, and Community Medical Center in Scranton; Wyoming Valley Health System, the Wilkes-Barre Veterans Administration Medical Center, and Geisinger Wyoming Valley Health System in Wilkes-Barre; Susquehanna Health System/Williamsport Hospital in Williamsport; and the Guthrie Clinic in Sayre.
TCMC has developed its Clinical Skills and Simulation Center as a resource for all health professional students in the area and has created the first regional model of interprofessional education (IPE) in the United States, the Northeast Pennsylvania Interprofessional Education Coalition (NEPAIPEC) (http://nepaipec.friendlyfirm.com/home.html). Founded by TCMC, NEPAIPEC is a cooperative effort of 17 colleges and universities, as well as postgraduate education programs in the region, which have agreed to integrate IPE into their health education curricula. This innovative approach is a model for IPE that is applicable to other institutions with a distributive, regional campus model of medical education.8
The critical staging of recruitment
TCMC began in April 2007 with two employees using their own laptop computers and cell phones. Obviously, recruitment was a crucial issue, but the dean wanted to create a professional “family” with shared vision and values and to establish a culture that would live the institution's mission of service and facilitate collaboration and innovation at every level. In the early stages, every member of the staff and faculty interviewed every new candidate. Key first recruits included senior administrative leadership, especially, the associate dean for planning and the chief financial officer/vice president for administration and finance. The associate dean for academic affairs supplied the needed curriculum expertise, and the director of facilities and construction provided direction related to temporary and permanent facility lease, purchase, renovation, and construction.
The first faculty member was the perfect person to tell the community about what the school could bring to them. She was a local woman, an accomplished and funded researcher, who had moved away from Scranton to pursue her academic career. She embodied the values the school espoused, and her hiring sent a message to the community that a place was being built where young adults would not have to leave the area to pursue medical and research careers.
Other key early staff included a director of marketing, regional campus development director, and assistant dean for technology/chief information officer. Interestingly, the support staff in the Office of Student Affairs (e.g., director of admissions, director of student affairs, director of the center for learning excellence, assistant director for human resources, director of financial aid) came on-board before the associate dean for student affairs was hired. In the earliest stages, and even today, most everyone wore a variety of hats and assumed a multitude of duties, and the new “family” has worked tirelessly and unselfishly.
Enlisting basic science and research faculty
A major task antedating the entry of our charter class in August 2009 has been the recruitment of the basic sciences teaching and research faculty. Somewhat unexpectedly, the candidate pool from established research universities has been quite large. New faculty members, like charter students, are excited about being involved in the creation of a new medical school from its inception. They have voiced that they feel like pioneers in a new and innovative educational endeavor, as if their individual impact on the institution will be greater than at larger, established institutions where they often feel less contributory.
A factor in TCMC's being able to attract top-notch basic science investigators has been the laboratory start-up package. Although the faculty recognizes that external funding is required for promotion and tenure, no specific percentage for self-funding has been defined. The number of new hires in the research tenure track (with 80% research, 20% teaching responsibilities) is presently limited by the temporary research space available until the new medical school building is completed. At the time of this writing, 28 full-time research scientists at all ranks have been hired, and 32 adjunct professors have been appointed.
To start, TCMC will have one department of basic sciences consisting of several disciplines: anatomy, biochemistry, cell biology, computational biology, molecular biology, microbiology and immunology, neurosciences, pathology, pharmacology, physiology, and genetics. The decision to create one basic sciences department was made to facilitate recruitment and encourage collaboration. There are 12 faculty members in the educator track and 16 in the research tenure track, in various disciplines.
Enlisting clinical faculty
The distributive, community-based model of medical education that TCMC has adopted necessitates a small, core nucleus of geographic full-time faculty, but a very large cadre of part-time, regional campus-based clinical faculty. We have identified three major roles for clinical faculty (continuity mentors, clinical preceptors, and clinical educators), and each clinical faculty member can serve in one or all of these roles.
Continuity mentors are family medicine and internal medicine practitioners who establish a relationship with an assigned first-year student and who will provide guidance and direction over the ensuing four years. From their practices they identify and assign a three-generational family for the student to follow for the next four years and demonstrate how a community-based physician interacts effectively with community leaders. Although the continuity mentor concept and longitudinal ambulatory care experiences are now common in the United States, the four-year duration and rigor of methods used to evaluate educational outcomes of the TCMC family care program are unique. Clinical preceptors are both primary care and subspecialty practitioners who offer shadowing experiences and other educational opportunities in clinical settings (e.g., office, clinic, hospital). Clinical educators participate in on-campus teaching and learning activities and offer clinical insights to augment lectures, demonstrations, and small-group exercises in the classroom and in the clinical skills and simulation center.
We anticipated that a major challenge would be the successful enlistment of a sufficient number of volunteer teachers, especially in light of the projected hundreds of clinical faculty required and the busy schedules of the regional practitioners. The tremendous, area-wide publicity afforded to TCMC has effectively reached many interested clinicians in the three communities where our first clinical campuses are located. Still, recruitment efforts for qualified clinician–educators have been extensive and have involved TCMC-sponsored meetings at our administrative offices, medical society meetings, and hospital administration and medical staff meeting venues where the dean, vice dean, and associate deans have been campaigning for more than one-and-a-half years. In addition, members of the TCMC team visit key lay and medical community leaders in their offices on a one-on-one basis, to seek support and advice. Components of the faculty recruitment strategy include appealing to community-based physicians' altruism as potential teachers of the next generation of regional doctors, as well as promotion of TCMC's diverse faculty development program. Participation in TCMC's mission is presented as an ethically guided, mutually beneficial professional endeavor whose ultimate goal is excellence in teaching.
For the clinical experiences of our charter class of 65 students during years 1 and 2, the college has recruited more than 600 new clinical faculty members across our three regional campuses. Initially, continuity mentors and clinical preceptors have been assigned one student at any one time. As the class size gradually increases to 120 students per year by 2013, more regional campuses are likely to be launched, additional clinical faculty will be recruited, and clinical faculty may be assigned two students at a time. Apart from exceptional contributions in terms of time commitment, clinical faculty are unpaid volunteers. Although initial queries regarding payment for teaching were made by a very small number of potential volunteer faculty members, the lack of reimbursement has not hindered recruitment of clinical faculty. Although they are not financially compensated, clinical faculty have access to information and library resources and, eventually, nationally accredited continuing medical education at TCMC.
The most important and comprehensive challenge that TCMC faced in establishing itself was to secure accreditation and state approval. This included not only Liaison Committee on Medical Education (LCME) and Middle States Commission on Higher Education accreditation but also approval by the Pennsylvania Department of Education (PDE) as a degree-granting institution. For a freestanding school, gaining PDE approval was a daunting task; the State of Pennsylvania application, site visit, and documentation took considerable effort and time on the part of the entire fledgling institution. The state requirements for faculty numbers, the required offering of a second degree (TCMC offers the MBS as well as the MD), and legal and governance issues demanded significant efforts for compliance. State accreditation is a prerequisite to application for accreditation from the Middle States Commission on Higher Education, which accredits degree-granting colleges and universities in a region including Delaware, the District of Columbia, Maryland, New Jersey, New York, Pennsylvania, Puerto Rico, the U.S. Virgin Islands, and several locations internationally. The Middle States Commission requirement that students be enrolled and matriculated before an institution can apply for accreditation means that TCMC students will not be eligible for federal loan programs until our MBS students graduate (i.e., they will be available for our classes as of June 2010. Thus, the full scholarships we awarded to our charter class members have become of crucial significance. Provisional PDE and preliminary LCME accreditations were granted to TCMC in June 2008 and October 2008, respectively, and the Middle States Commission granted accreditation candidacy status to TCMC in 2009.
Education and Research
Medical school curriculum
There are 20 AAMC-defined community-based medical schools in the United States9 and almost 20 more with community-based elements; many of these latter schools have a central, integrated academic health center and one or more satellite campuses with more-limited educational facilities and faculties than the main campus has.10 In our distributive model of medical education, each of our three regional campuses has comparable educational resources and opportunities for students. Our seven affiliated community teaching hospitals are similar in size to one another (mean, 278 beds; range, 210–412 beds), each has all or most medical and surgical subspecialists on staff, and all offer a range of secondary and tertiary patient services.
Several curricular elements are worthy of mention because of their contrast with those of traditional schools. First, clinical experiences begin in the first year of study and consist of three, one-week preceptor sessions on the student's assigned campus, with the student shadowing a primary care physician. The above-mentioned longitudinal, multigenerational family care experience begins in the first year to provide a sense of continuity in patient care and to help students gain a firsthand understanding of access issues, health care costs, and the personal choices patients make. Students navigate the health care system with their assigned family, and the long-term experience will have a health-system- rather than disease-based learning focus. These experiences also provide an opportunity for students to hone their communication skills and other skills-based competencies and to develop respectful, beneficial relationships with patients and their families. There will be three, one-week sessions during the second year as well, but these will expand to include specialty physicians according to the students' interests. There is a public health component with a community-based research project requisite during the first year. Finally, the third year will consist predominantly of ambulatory-based core clerkships that are integrated and longitudinal rather than in blocks. This educational model has been advocated by the Harvard Medical School–Cambridge Integrated Clerkship.11,12
Regional learning communities begin forming during first-year orientation with region campus team social activities and assignments, and continue as classes start. These learning communities will be facilitated by the three, one-week, regional campus-based clinical experiences in the first and second years, the mandatory regional community-based research project for first-year students, and small-group experiences (e.g., case-based learning groups in several courses) involving regional campus students.
Students will train in risk-free, high-tech simulation centers located on the central and regional campuses. To fulfill one of the important elements of our mission statement, TCMC has significantly embedded IPE into the first- and second-year curricula, and the simulation center will share its resources with NEPAIPEC partners and provide an excellent venue for interprofessional learning. For the third and fourth years, students will live in one of the communities that host our three clinical campuses. It is expected that three to five additional regional campuses will be developed during the next 5 to 10 years. Students will serve clinical rotations in multiple settings throughout the region including hospitals, physicians' offices, health departments, and federally qualified health centers.
The regional, collaborative model is expected to help create “pipeline” programs to enhance the continuum of health education in the region from high school to postgraduate medical and allied professional programs. TCMC, in conjunction with Wilkes University, Luzerne County Community College, and the College Board, recently announced the Pipeline to Medical Colleges Initiative.13 This initiative will focus on increasing the number of rural, minority, first-generation, and low-income students in the health professions.
Faculty development for new and established faculty members is a crucial element of faculty recruitment, retention, and professional growth and enrichment. TCMC's faculty development program initiates, conducts, and coordinates activities to assist faculty members in preparing themselves for a variety of educational and scholarly roles within and outside the college. The TCMC approach to faculty development is grounded in the belief that preparation in clinical teaching leads to enhanced learning for the student and provides clinical faculty with a more satisfying teaching experience.
Educational training is mandated by the LCME and is necessary in order to ensure teaching competence and comparability of clinical experiences for students across the regional campuses. Before their first student assignments, all new clinical faculty members are required to receive faculty development training designed to strengthen their teaching skills in the ambulatory and hospital setting. All new volunteer clinical faculty participate in a six-hour introductory educational development program and then maintain their clinical teaching skills (and faculty status) by participating in four hours of professional development activity annually. In addition to teaching and learning effectiveness strategies, the faculty development program offers a variety of modules in areas such as research and scholarship enhancement, medical informatics, library and electronic resources, online learning and technology, communication, evaluation and assessment skills, and academic leadership development, all unified by access to the TCMC information technology (IT) portal, or intranet. Faculty development formats include live presentations (e.g., workshops), CD-ROM self-study modules, college portal- and Web-based self-study materials, and meetings with educational leaders (e.g., associate deans for academic affairs and educational development, regional campus deans, clerkship directors).
Graduate medical education
TCMC's strategy for graduate medical education (GME) is based on four assumptions: (1) that undergraduate medical education is most effective when connected with GME, (2) that recruitment of future physicians to northeastern Pennsylvania will be most effective if graduating TCMC students have residency and fellowship options in our regional affiliate hospitals, (3) that additional GME training programs will be significant tools in recruiting physicians from other geographic areas to our hospitals and region, and (4) that physicians-in-training intellectually stimulate health care professionals at all levels, from student to faculty member, and provide a catalyst for enhanced patient care, teaching, and research.
In northeastern Pennsylvania, there are presently only eight residency programs—Scranton has an internal medicine program (the Scranton Temple Residency Program), Wilkes-Barre has two family medicine programs and one sports medicine program (Wyoming Valley Health Care System and Geisinger Health System), Williamsport has a family medicine program (Susquehanna Health System), and Sayre has internal medicine, family medicine, and general surgery programs (the Guthrie Clinic). Each year, northeastern Pennsylvania exports an estimated one billion health care dollars to Philadelphia, New York, Baltimore, and other cities, as its citizens must travel to other providers for medical services that are not regionally available. TCMC's goal is to establish residency and fellowship programs in as many of the region's hospitals as possible and to create a region-wide system connected by technology, driven by innovation, and aimed at reducing the isolation that convinces many young doctors not to engage in rural practice. It is not simply a question of “build it and they will come” but one of “build it across the community and they will stay.”
Our priorities for new GME program development are dependent on several variables including the interest, commitment, and expertise of our regional campus faculty, Medicare funding realities, and local and regional economic conditions. The plan is to begin with three core clerkship residency programs (i.e., general surgery, psychiatry, and obstetrics–gynecology), a residency program in child and adolescent psychiatry, and one fellowship in cardiology. Regional specialty and subspecialty physicians in these fields have begun holding meetings to discuss roles and responsibilities, plan curricula, outline future collaborations, determine additional manpower and research infrastructure needs, and begin completing Accreditation Council for Graduate Medical Education program information forms. Second-tier priority training programs for development, depending on funding availability, include geriatrics, palliative medicine, nephrology, hematology–oncology, pediatrics, internal medicine, radiology, and emergency medicine.
From the inception TCMC has been intended to be a balanced institution with excellence in the academic areas of patient care, teaching, and research. TCMC has begun an ambitious laboratory, clinical, and epidemiologic research program that is based on the health needs of our aging population (Pennsylvania has the third-oldest state population in the nation, behind Florida and West Virginia) with its high prevalence of diabetes, cancer, and heart disease. We expect our research program to contribute to the local economic development via collaborations with businesses, industry, and medical organizations. Other major areas of initial focus will include genomics as it relates to pharmacology, cancer, prevention of infectious diseases, and geriatrics supported by the development of a population-based genetic (tissue) database. Furthermore, we have begun discussions regarding creation of a community-based clinical trials program as well as a regional primary care research network.
Designing temporary facilities
For the academic years 2009–2011, TCMC students will use temporary facilities in Lackawanna College, located in downtown Scranton just three blocks away from the college's main administrative offices. The temporary site houses classrooms, limited laboratory space, the medical library, the associate dean for academic affairs office, and the associate dean for student affairs office and associated services (e.g., Center for Learning Excellence, director of student affairs). Construction began in April 2009 on a 188,000-square-foot permanent educational and research facility in Scranton that will eventually serve more than 500 students and 175 faculty.
Student and faculty labs
The curricula in the first two TCMC years do not require student laboratories except in the Human Structure and Function course, where students will conduct dissection and demonstration sessions in gross anatomy using cadavers. By far, the most expensive part of the renovations involved in using Lackawanna College as a temporary facility has been developing the gross anatomy laboratory. Nearly $2 million was required to put in air handlers, drainage, storage, cooling, security, and all the technology necessary to equip a space. Although many medical schools are considering or have opted for alternative means of teaching anatomy, including computer-based virtual dissection, it is our belief that a cadaver represents a first-year medical student's first “patient” and, therefore, has symbolic interpersonal as well as educational value. Furthermore, our anatomy faculty, like most professional anatomists, favor the use of human cadaveric dissection over other teaching methods, and the use of cadaveric dissection may be more widely advocated when considering the skills base, rather than just the content (knowledge) base, of an anatomical course.14
Nine faculty investigators are presently located in three large laboratories in temporary space at Lackawanna College. For eight incoming basic sciences faculty, temporary laboratory space has been secured at neighboring University of Scranton, in the well-equipped Institute of Molecular Biology and Medicine. The new Biomedical Sciences Building will eventually house about 40 scientists in 60,000 square feet of laboratory space.
Because the TCMC library is 95% digital, services are available from seats both in the library and from any of the five classrooms or seven group study rooms at the temporary facility in Scranton. Library resources will ultimately include 30 print journal subscriptions selected by course directors, and 500 electronic journal subscriptions for the first three years, with 1,400 by year 5. Additionally, 200 print book titles are on hand, with the goal to expand to 500 titles by year 5. Finally, 100 electronic books round out the collection in our first year, with a goal of expanding to 300 electronic titles by year 5.
The unifying role of IT
Because TCMC is a freestanding organization, it provides most of its own information resources. IT services at TCMC are the driver of faculty communication, interconnectedness, and regional campus development. The interim facility at Lackawanna College, the permanent site, and all regional campuses operate with wireless communication throughout, providing access to TCMC's network from any location. The campuses also have videoconference capability allowing for efficient “face-to-face” communications. A key component facilitating faculty, staff, and student communication across campuses is the TCMC portal. This intranet forms a central, Web-based point of access to courses, e-mail, calendar, library resources, announcements, news, group activities, and many other essential components. The portal gives students (each of whom is provided with a laptop computer and printer on matriculation) access to student services and library electronic materials on a 24-hour-a-day basis, and it also provides them the ability to communicate with peers, faculty, and staff. Internet-2 access is available with a link to the University of Scranton. Regional campuses are linked to the TCMC network, providing clinical faculty access to the portal and supporting communication throughout the TCMC community. The IT department works with affiliate hospitals to ensure that faculty and students are provided with access to the Internet while at the hospital or regional campus site.
Pursuing the Path of Social Medicine
In 1973, in his observations on new medical schools, Dr. Cheves Smythe,15 then dean of the new University of Texas Medical School at Houston, described three groups of new medical schools:
Based on my personal impressions, the 23 schools have been divided into three groups—those with severely constrained resources, those emphasizing scientific medicine, and those emphasizing social medicine. In classifying the schools I have attempted to divide them by their relative emphasis on these complementary approaches to solving the problems plaguing people. Let me emphasize that I do not see these as competing concepts. Let me also emphasize that all these schools are eclectic and aspire to transmit to their students the best of both approaches. The differentiation is not absolute, but only relative.
These remarks are strikingly relevant to today's expansions in medical education. TCMC falls squarely into Dr. Smythe's third group of “new venture schools” and is characterized by the following: autonomy, private and public money, assured resources in good supply, a relatively secure clinical base, strong cultural ties to the northeastern Pennsylvania region, recruiting practices that reflect the convictions of its dean, and strong support from its board of directors. Typical of this type of new school, TCMC has placed a heavy investment in social and community medicine, while not turning its back on scientific medicine, by seeking an academic balance with a strong research emphasis. If Dr. Smythe's observations were accurate, as a new venture medical school TCMC's development should be smooth, the leadership will be relatively stable, and it will not be troubled by high faculty turnover. The above set of descriptors may define a new type of medical school most likely to bring about a change or new emphasis in medical education as a result of its definition of ideologies, goals, and values.