John R. Gimpel, DO, MEd, FACOFP, FAAFP is President and CEO of National Board of Osteopathic Medical Examiners (NBOME). He sits down with Osmosis to talk about his background and give his thoughts on leadership and healthcare. He previously served as a Dean at University of New England and was Director of Predoctoral Medical Education at Georgetown University School of Medicine. Dr. Gimpel received his bachelors and masters in education from La Salle University and studied medicine at Philadelphia College of Osteopathic Medicine.
What was your background and how did that lead you to decide on pursuing a career in medicine?
My educational background was fairly traditional at the time, with a liberal arts program majoring in Pre-Medicine/ Biology at La Salle University in Philadelphia. Looking back, in addition to my parents, the other major influences in my “premed” career were my seven younger sisters (two who are also DOs), the Christian Brothers who taught me at La Salle College High School and La Salle University, and my extensive participation in athletics and music theatre growing up. All of these influences helped me to develop as an interested observer of the human condition, including human body kinetics and the biopsychosocial approach, and to formulate a rather holistic view of medical care and health, one involving body, mind and spirit.
How did you choose where you went to medical school, residency, and beyond?
Several premedical clinical experiences in hospitals and clinical experiences exposed me to many excellent physician role models. One happened to be a DO, and one of my high school biology teachers, who was heading to med school himself the next year had a father who was a DO, took me under his wing and introduced me further to osteopathic medicine. Coupled with my own thinking at the time about the physician’s role in partnering with patients to find health, the body’s innate capacity to heal, and what I learned from these role models, osteopathic medicine was a natural fit for me. My own emerging philosophy that drugs and scientific technologies were not going to be all that was needed to help to heal and to cure people strongly influenced my thinking then, and still does 30 years later. The early training I received furthered my thinking that, in the words of prominent physician Dr. Frances W. Peabody many years ago, “ the secret of the care of the patient is in caring for the patient.”
Residency training in Family Medicine at Chestnut Hill Hospital, a well-regarded, community-based program in Philadelphia and the hospital in which I was born, provided me the opportunity to receive excellent and comprehensive training in the community that I anticipated practicing in.
What got you interested in taking on active administrative roles such as being President and CEO of the NBOME?
Well, that was certainly not planned! After residency, I did “hang a shingle” and practiced in the Chestnut Hill community for a number of years, but my former medical school dean contacted me early on and convinced me to continue some teaching of medical students part-time. I decided to also pursue further education on teaching, learning and assessment, pursing the MEd degree at my alma mater La Salle University, somewhat concerned at the time that the best practices from the emerging cognitive sciences related to learning and teaching were not well practiced in medical education in general, and certainly not in assessment for medical students and physicians. Along the way I met Dr. Howard Barrows, the medical education pioneer in the use of simulated patients, and learned from him the benefits of engaging learners with teaching and assessment using simulation. My involvement with the standardized patient program at PCOM as a junior faculty member led to being recruited to the National Board of Osteopathic Medical Examiners (NBOME) as a board member at the time in 1994. While I have been associated with NBOME since that time, I also held full-time roles at PCOM (Director of Ambulatory Medical Education), Georgetown University School of Medicine (Director of Predoctoral Medical Education and Associate Professor, Family Medicine), St. Luke’s Medical Center (Residency Program Director), and the University of New England College of Osteopathic Medical Center (Dean, Vice President for Health Services, and Professor). I was able (and continue) to learn more about leadership and administrative roles in these various positions, and from wonderful role models and mentors- leaders, faculty colleagues, staff, students and patients. I was very fortunate to lead a talented and committed team with the NBOME in 2004 that added the national clinical skills examination to the COMLEX-USA examination, and the catalytic effect that this type of testing has had in medical education and training since that time has been extremely gratifying.
To what do you attribute the rapid growth of osteopathic medical schools?
Osteopathic medical schools have grown now to over 30 DO-granting medical schools, teaching at more than 40 campus locations, with more than one in four entering U.S. medical students in 2016 now entering a DO-granting medical school. The tremendous growth is certainly influenced by a number of factors, including the call by the American Association of Medical Colleges and other thought-leading organizations to increase the number of physicians in training to respond to predictions of profound physician workforce shortages. In addition, the DO medical education model was a bit more agile in responding to the call for physician growth, not requiring the expansive and costly research enterprise seemingly needed to support the MD-granting school model at the time. Perhaps most importantly, DOs have a demonstrated track record of producing relative more primary care physicians, those who practice in rural and other underserved areas, and an approach to medical care that has ascended to tremendous popularity in today’s American culture. Patients are seeking care from physicians who partner with them to promote health, care for the “person” and not just the “patient”, and seek to find preventive and therapeutic options that are less invasive or prone to side effects or secondary problems. This concept seems to resonate now with patients as well as with today’s young people who are pursuing health care careers, with a continued increase in applications to DO-granting medical schools to more than 3 for every available position.
What are 2 or 3 changes you’d like to see in the medical education and healthcare system of the United States moving forward?
Medical education continues to advance with educational programs that increasingly engage the learners, consider formational aspects of the program and culture, and seek to continue to fill the classes with those who have been carefully selected not just because they have the ability to serve, but because they have the inclination to serve. And I think the future is bright with the quality of people our nation’s medical schools are bringing in. A physician once said, “The best medicine for humans is love”. Someone asked, “What if it doesn’t work?” She smiled and said, “Increase the dose.”
So rather than launch into the politically charged and complicated arena of what is wrong with our current “non-system” of health care in the US, I will add only these simple observations. Doctors, nurses, all of us in health care must remember the privilege we have such that others entrust their care to us. We must avoid the sense of entitlement that sometimes seems to permeate the health care system. We must learn to care more than others think we should, at the same time learn to build our own resilience and achieve a balance for ourselves. Electronic health records, third parties, prior authorizations, medical malpractice, educational debt, and the like, often described as the burdens and barriers between patients and physicians in our system, will need to be addressed to allow physicians and their other professional colleagues on the health care teams to work together and support one another and provide the care and time that our patients need from us.
What does it mean to be a leader in medicine today? What qualities does it take to be a leader among physicians? What is most challenging about this?
We sometimes need to continue to remind ourselves, given some of the challenges, that the patient is and must always remain “our North Star.” We must remember that society offers us the privilege of being in a very honored and trusted profession, with the resultant responsibility for self-regulation. We must continue to learn and solicit evaluation and feedback on how we can get better, individually and collectively, and use that to continuously improve. We must dramatically improve in the area of implicit biases, both in the care of patients and in inter-professional collaboration. And we likewise need to be kinder and more empathetic to each other (as physicians, and other members of the teams), as well as to our trainees (medical students and residents), and to our own families. We have the opportunity to continue to change the culture of medicine from one that is only focused on “curing” to one that is a community of those dedicated to healing and curing. And to support one another better along the way.
Do you have any words of wisdom for those trying to pursue future leadership roles in medicine and/or medical education?
In the words of Martin Luther King, “Our lives begin to end the day we become silent about things that matter.”
How should medical schools develop more patient-centered education?
The focus on the patient should be the emphasis throughout all four years. A number of medical schools have a “Doctors from Day One” approach now where students are introduced to clinical experiences early on. The osteopathic medical schools have had an advantage there because they all have the Osteopathic Manipulative Medicine lab, where once or twice a week the students are engaged in hands-on clinical work. Most medical schools now include standardized patient simulation and year 1 or 2 outpatient preceptor or shadowing; some even have longitudinal clerkships in the first or second year where students are getting involved in continuity of care. Use of standardized patients and other forms of simulation can help to keep the focus on the patient. Dr. Howard Barrows was a neurologist in the 1970s at USC who was a significant mentor of mine. Dr. Barrows taught students in neuroanatomy as first year students, and he established a great rapport with them. He taught those same exact students two years later when they had a required clinical rotation in neurology. He scratched his head because they couldn’t apply the same neurosciences concepts that they had seemingly mastered 1-2 years prior. He asked himself how this was possible, and soon realized that the way he was teaching neuroanatomy (i.e., didactic lecture, then regurgitate), the students couldn’t retain the information and apply it to real patient scenarios just a year or two later. So he redesigned his approach and began to use simulated patients early on in medical education. He’s sometimes called the father of the simulated patient because he emphasized the need to teach in the context of patients and clinical care.