At the apex of her decades of transformative leadership, Gail Morrison, MD’71, GME’76, has one piece of unfinished business: transforming medical education on the internet.
By Rachel Ewing
Photos by Peggy Peterson
In the heady, early days of popularized dial-up internet, when the phrase “World Wide Web” was common parlance and programmers raced the clock to squash Y2K bugs, change was in the air. Gail Morrison, MD’71, GME’76 had recently overhauled the University of Pennsylvania’s entire medical curriculum into a novel format that was modular, interdisciplinary, technology-driven, and flexible. But that wasn’t all she envisioned. Now she wanted to take the concepts behind that curriculum and reach out to the world of medicine beyond the students enrolled in the four-year MD program on Penn’s campus. The internet-connected wave of the future was rising. It would be a “school without walls.”
Plans were drawn up, domain names registered, university approvals secured. The brochures were printed before the dot-com bubble burst on Wall Street, the $10 million funding to launch the project disappeared.
Morrison’s track record of success was unmarred, though; two decades later, she is without question a nationally recognized innovator and leader in medical education. The Y2K iteration of the “school without walls” would barely merit a footnote, if not for the fact that Morrison never abandoned the vision behind it. This February, she passed the torch of her longtime role as senior vice dean of medical education at the Perelman School of Medicine to Suzanne Rose, MD, MSEd, and took on a new title of executive director of the Innovation Center for Online Medical Education and special advisor to the executive vice president/dean. Now, she hopes, the walls are coming down.
“What we are doing now is an outgrowth of Curriculum 2000,” Morrison says, a large iced coffee on the table beside her, a mix of calm optimism and determination in her voice. She is taking time out to connect the dots of her legacy while juggling a pile of decisions to be made about technologies, outreach strategies, collaborations, collecting tuition.
Curriculum 2000, the massive overhaul of how medical students learn over the course of four years, launched in 1997 under Morrison’s leadership, early in a wave of curricular reform at a few of the country’s top medical schools.
“Gail is a true visionary in re-inventing the entire medical education experience: a re-imagined curriculum, state-of-the-art facility, and a culture of caring. Her commitment to cultivating leadership in all medical students and alumni continues to inspire me in my own career.”
– Darryl Landis, MD’89, MBA, Member, Medical Alumni Advisory Council
“The curriculum up to that point of time had been very much siloed into normal, abnormal, and clinical,” she says. Recognizing that physicians and researchers already worked across department lines to solve clinical challenges—pharmacologists with physiologists, physiologists with biochemists—she saw that medical students needed to learn according to a plan that from its start was similarly integrated “without walls,” and one that was coordinated to avoid repetition. The curriculum thus had a modular structure, with major ideas grouped by theme, rather than by academic discipline.
Grouping education into modules, along with technological innovations of a virtual classroom with all lectures available via online video, gave medical students more flexibility and freedom with their time. After their core clerkship rotations, from January of their second year through December of their third year, they had room in their schedule for electives, scholarly pursuits, and what Morrison dubs the “MD plus” degree that could be anything from a Wharton MBA to a certificate in global health. The number of certificate programs available to medical students ballooned from two when Morrison took the helm to nine today, and master’s degree programs from two to 10. Today, more than half of the 2018 class are “MD plus” graduates.
But arguably the idea tying Morrison’s curriculum transformation together, and the one most relevant to her next project, is that it prepares medical students and physicians to keep themselves up to date as self-directed, lifelong learners.
“That was one of the founding pillars of the curriculum, and it's even more so today,” says Anna Delaney, the chief administrative officer and head of academic programs. “There's just too much content out there. They can't possibly learn it all.” And so, learning how to find answers was built in: “We give them the tools, we give them the time, and we test them.”
Finding the Answers
“In 1950, it took 50 years for the amount of medical information to double,” Morrison says, during a conversation in the glass-encased meeting room in the Henry A. Jordan M’62 Medical Education Center (JMEC) that bears her name thanks to her gift to the school honoring its 250th anniversary. She pauses then to think of the rest of the oft-cited statistic she’s reaching for—and pulls out her iPhone to look up the paper where it was published. By 1980, that doubling of medical knowledge occurred in just seven years, she recites, and in 2010, that time was halved. In 2020, it’s projected to happen in the space of 73 days.
“That changes how you think about what you need to teach people,” she says. It necessitates the mindset—one she already sees in her own daughter and her medical school classmates—that you have to carry your smartphone or tablet everywhere, to pull out that phone and look up the relevant paper so you find the right information at the right time. What you think you already know is just a starting point.
And the key question for educators: “How do medical schools become part of helping people try to keep up?”
It is a tribute to her leadership that our school attracts such accomplished individuals who will go on to become leaders in their areas of medicine.”
– Howard Eisen, MD’81, GME’84, Chair, Medical Alumni Advisory Council
In this domain, Morrison does not claim to have all the answers. But she does have a track record of finding answers to vast, ambitious challenges. In 1976, when she joined the Penn faculty in the renal division, she was asked to set up a dialysis program. After a pause, she said, “Okay. What’s a dialysis program?” Then she agreed to do it.
“That was the beginning of me going, ‘Hmm, okay. Well, I’ll go ask a lot of people a lot of questions and try to see what I can do,’” she recalls. She continued to take on other challenges in the Department of Medicine and for the school and national groups. In the mid-1990s, the curriculum transformation to revolutionize how medical students learn for the 21st century was the biggest challenge yet. She knew that the principles of interdisciplinary integration, flexibility, and an emphasis on humanism in the profession would all be key. To get there, she got people together and listened to what they needed. She had basic science and clinical faculty sit down together and figure out what problems they needed to solve. “When it came to either medicine or education, I felt comfortable I could find the right people and listen and ask enough questions and figure out what we could do,” she says. “It just seemed to work.”
Listening on an ongoing basis remains part of the curriculum’s strength. “One of the things we do here that's quite unique,” says Stanley Goldfarb, MD, the associate dean of curriculum, “is the fact that we have weekly meetings with the students to review the curriculum in real time.” Additionally, Goldfarb notes, a large curriculum committee involving all faculty members who run a course—about 80 in total—weighs in on decisions that affect student learning.
That constant curricular review is “ahead of its time,” according to Kate McOwen, MSEd, the director of educational affairs at the Association of American Medical Colleges (AAMC). For the past nine years at AAMC, McOwen has worked with Morrison, Goldfarb, and their counterparts nationally; she previously worked at Penn. “Curriculum 2000 was certainly a leader and in many ways continues to lead the pack,” she adds. “If you look at the landscape of medical education today, many schools have been going through either a curricular refresh or a redo. In all of those cases, the integration of basic sciences and clinical experience is top of mind; everyone is doing that earlier, and Penn was one of the first.”
Theoretically, Morrison thinks she only wants to work three more years before she retires. That is what she told the dean last year, saying she wanted to transition her role as senior vice dean smoothly to a successor during that span. And so the Innovation Center for Online Learning sparked into existence with the follow-up question: What else could she achieve during that transition? Morrison said she thought Penn Medicine could do better at disseminating the information created here outside the institution’s walls, to practicing physicians and to the world beyond medicine.
As with Curriculum 2000, in launching the new center, Morrison knows a few key principles that are essential to her goals. Now she is bringing people together, asking enough questions to figure out what to do, and trying out a few ideas while soliciting feedback on what does or doesn’t work well. Several different pilot projects for online education have launched this spring or are scheduled for later in 2018. There’s an online class on the business of medicine, a collaboration with Wharton, open to people in both the business and health care realms. There are online anatomy classes offered via Penn’s College of Liberal and Professional Studies for post-baccalaureate and graduate students to strengthen their scientific background for health sciences careers. And then there is the vast area of continuing education for working physicians and other health care providers: Another pilot program will offer continuing education and accreditation credit for anesthesia providers, both doctors and nurses, who need to provide safe anesthesia in outpatient settings for common procedures such as endoscopies.
In planning these ventures, Morrison began with listening to what providers need and want. Every year at Penn’s Medical Alumni Weekend, Morrison observes, she meets alumni who are enthralled with the lectures and seminars they attend there. “I want conferences like these at Penn, and I want these Grand Rounds,” they’ve told her, but those who practice outside of academia said that nothing comparable was available to them. And she’s continuing to listen. As they plan for future programs, Morrison and her team are planning to survey 5,000 Penn faculty members to learn what they need to know and what they would like to learn through online educational offerings. They are thinking about packages of materials for continuing medical education by specialty and for primary care, with an eye toward reaching wider communities of practicing physicians with the information they need, right at the time that they need it.
Those are real needs for which online education is an area of active growth nationally that is “100 percent necessary,” says AAMC’s McOwen. “What people are grappling with nationally is how to do [online medical education] well. We rely on leaders like Penn and leaders like Gail to blaze the trail and help us learn. I’m actually excited to see what she comes up with.”
An Open and Connected Place
The glass-encased Jordan Medical Education Center (JMEC), which spans the fifth and sixth floors of the south tower of the Perelman Center for Advanced Medicine, is physically interconnected with the Penn Medicine clinical and research enterprise.
The question of a door arose during the process of planning the Jordan Medical Education Center before it opened in 2015. The airy glass-encased hub of medical student activity is centrally located on Penn’s medical campus, but at five stories up, access to it is not obvious at street level.
“But we're talking about integrating something into the entire health system,” Morrison says. And when you make a separate door, you are building a wall, she realized. That separate entrance would tell medical students that what they do is separate from the clinical enterprise and separate from research. “The mantra became, no, we don't want a separate door,” she says. “And the fifth floor was great because of the views, and because we could connect it to all this outside space, and we could connect it to [research at the Smilow Center for Translational Research], and we could connect it to [outpatient facilities at the Perelman Center for Advanced Medicine], and we're going to connect it to the new hospital [inpatient] Pavilion.”
The bright and interconnected spaces in JMEC are now constantly in demand, not only by groups hosting events on campus, but also by leaders of other medical schools. The latter group brings architects who want to find inspiration for their own new medical education facilities.
The atrium here was also the site where Morrison has been feted in recent months with high honors from her peers at the medical school. In December, she received the Elizabeth Kirk Rose M’26 Women in Medicine Award. In March, before fourth-year medical students received their residency matches, Dean J. Larry Jameson, MD, PhD, took a moment to acknowledge Morrison’s service to medical education and impact on the thousands of physicians who gained from her leadership, mentorship, and vision—and the estimated 10 to 12 million patients receiving care from those physicians today. He gave her two dozen red roses before a standing crowd’s applause. In May, she was not only the Perelman school’s commencement speaker, but the fifth-ever recipient of its alumni lifetime achievement award.
But even with that lifetime of achievement to celebrate, Morrison still has eyes set on the opportunities ahead, on the thousands, hundreds of thousands, or more people working in medicine who need to keep learning, who aren’t necessarily walking through any doors on Penn’s campus.
“It's not going to happen overnight,” she says, “and you're going to have to have a lot of people working to move it along. But that's what we did with the curriculum. We had close to 150, 200 people when we were building the curriculum. I just had to get them at the same table, working together. Smart people. And once that happened, I could pull back completely.”
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