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As they donned their white coats, they looked like any other
first-year medical students ‚ only these were congressional
staff members about to engage in a new pilot educational
program designed specifically for them.

"The idea of the white coat ceremony seemed so elementary at
first," said Amy Hanson, legislative assistant to U.S. Rep.
Walter B. Jones Jr., R-N.C. "But it made a real difference to
me in terms of feeling like I was really experiencing the
educational process."

Hanson was one of seven North Carolina congressional staff
members who visited Duke Medical Center Nov. 11 and 12 to take
part in the Duke Congressional Medical Education Program. The
pilot program was developed for Project Medical Education
(PME), a coalition of 28 leading medical schools and teaching
hospitals. Cultivating a core constituency in Congress that can
provide support on issues critical to academic health centers
is PME's primary goal.

Within minutes of their arrival, staff representatives were
given envelopes containing an "acceptance letter" to Duke's
School of Medicine. For a hands-on approach to learning, the
program called for the staff members to role-play by assuming
the identity of a medical student, resident and practicing
physician during their visit.

The "students" then received an introduction to the
structure and role of an academic health center and the
challenges and opportunities that exist in the health care
marketplace.

"Academic health centers are the cornerstone of American
health care" said Dr. Edward Holmes, vice chancellor for
academic affairs and dean of the School of Medicine at Duke.
"They provide services and knowledge that are not readily
available elsewhere. Funding challenges have made it harder to
make these provisions, and research, patient care, medical
education and faculty recruitment are all being impacted."

To illustrate the complexity of medical education, program
planners used the standardized patient program, run by Joan
Tetel-Hanks. Presented with a scenario that is given to all
first-year medical students at Duke, the participants were
faced with the challenges of establishing a good rapport with
their "patient," diagnosing the illness and deciphering
non-verbal clues while communicating a caring attitude.

The students, working collaboratively, needed more than 30
minutes to make their medical assessment. According to
Tetel-Hanks, doctors have an average of 10 minutes in which to
accomplish these important tasks in the real world.

Within a few hours, the students "graduated" from medical
school with a debt burden of nearly $70,000 and were then
"matched" to a subspecialty. The new residents then received a
glimpse of the next 3 to 5 years of their lives: graduate
medical education, very little income with which to make their
medical school debt payments, and fellowship, followed by a
lifetime of continuing education.

"Academic health centers (AHCs) are truly in crisis," said
Mike Israel, vice chancellor of health affairs and CEO of Duke
University Hospital. "We need to serve our patients in the
community as our highest priority, while maintaining the
viability of our educational and research missions. If those
suffer, society will suffer in the end, and we cannot afford to
let that happen."

Israel painted a grim financial picture of the issues facing
AHCs nationally. He cited increased investments in physician
practices and hospitals, operating cash drains, the Balanced
Budget Act of 1997, and the increase in charity care as big
contributors to the financial problems faced by Duke.

The second day of the program consisted of patient care
rounds in the students' assigned subspecialty (pediatrics,
surgery, cardiac or emergency medicine) and presentations
detailing the relationship of research to medical education and
patient care.

"Even though we graduated in a matter of hours, we really
did get an effective view of all levels of medical education,
how the system operates and the impact of funding," said
Elizabeth Barnhardt, a legislative assistant to U.S. Rep. Robin
Hayes, R-N.C. "I've met with countless people in my office, but
nothing beats the hands-on approach. The timing of this program
is excellent because we can get a head start on the 2001
appropriations."

Laurie Armstrong, health legislative assistant to U.S. Sen.
John Edwards, D-N.C., concurred.

"It has certainly added to my understanding of how the
system operates, especially concerning the clinical research
environment," Armstrong said. "I think this program is a
wonderful model for learning."

The PME coalition was established in July 1998 and is
endorsed by the Association of American Medical Colleges. Duke
is serving as the lead institution in the educational endeavor
and will continue to develop the model program and coordinate
future implementation at other coalition institutions.

According to Paul Vick, associate vice president for
government relations at Duke University Health Systems and the
director of the national PME coalition, each member institution
will host a program based on the Duke model for representatives
in their respective states.

"I feel we have created a program that will be very
successful in accomplishing the goals and mission of the PME
coalition," Vick said. "A terrific group of people worked hard
to make this program a reality and it has been fun to watch it
come together in this manner."

Other staff representatives in attendance were Chess Bedsole
of the office of U.S. Sen. Jesse Helms, R-N.C.; Beverly Manley
of the office of U.S. Rep. Eva Clayton, D-N.C.; Ashley Hoy of
the office of U.S. Rep. Sue Myrick, R-N.C.; and Jodi Keyserling
of the office of U.S. Rep. David Price, D-N.C.