A Dreyfus National Merit Scholar at the University of North Carolina, Stephen Ray Mitchell completed his undergraduate medical education as well as training and certification in internal medicine and pediatrics at the North Carolina Memorial Hospital in Chapel Hill.
He currently serves as the Joseph Butenas Professor and Dean of Medical Education at Georgetown. He also serves as a member of the National Council of Deans of the AAMC, and as an ad hoc site visitor consultant to the Liaison Committee for Medical Education, the national accrediting body for Medical Schools and has lead numerous accrediting visits to other medical schools. Currently he is the fifth longest serving member of the AAMC’s Council of Deans.
Dr. Mitchell has been honored numerous times for his teaching excellence, including receiving multiple “Golden Apples” for medical student education at Georgetown. In addition, he has received the Kaiser Permanente Award from the faculty for the outstanding clinical teacher in the Medical Center, as well as every residency teaching award in the Department of Medicine, including induction into the Sol Katz Society.
Dr. Mitchell was awarded a Laureate Award from the Washington Metropolitan Chapter of the American College of Physicians/American Society of Internal Medicine in 2002 and in 2004, he was inducted into Mastership of the College. In 2011, the University Of North Carolina School Of Medicine awarded Dr. Mitchell the Distinguished alumni award. In 2016, he was invited to deliver the Keynote address on the future of Medical Education at the UNC school of Medicine Education Day. He serves as a member of the Board of Directors of Loyola University Health System, and Medstar Georgetown University Hospital.
How did you decide on a career in medicine?
As the son of two wonderful parents from South west Virgina who did not attend college, spending my early years on a tobacco farm, I found inspiration outside my family. In a different time and place, My mom would have been the doctor I am convinced. My education and most of growing up was in Western North Carolina and a wonderful Pediatrician became a role model.
What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the Georgetown University School of Medicine?
After attending the University of North Carolina –I applied and was accepted off a wait list to the School of Medicine at UNC- where my aspirations were affirmed. The clinical education at that institution varied from traditional to a wonderful exposure to multiple rural opportunities through the Area Health Education Centers. It was in Tarrboro, NC that I met a group of primary care physicians trained in combined Medicine-Pediatrics There were only two of those programs in the country at the time. I was inspired to complete that training also at N.C. Memorial Hospital in Chapel- on a Health Professions Scholarship with the United States Air force. The Air Force brought me to Washington, DC- where I met some wonderful alumni form Georgetown, Met my wife, Completed a fellowship in Rheumatology and realized I loved to teach.
When I went to work for the Jesuits at Georgetown, I realized that “cura personalis” care of the whole person- resonated with why I entered medicine. I spent 10 years as a program director in Internal medicine and created another Medicine Pediatrics Combined residency at Georgetown – bringing the total of those residencies to over 100 nationwide. I maintained a clinical practice in Adults and children with Autoimmune disease and taught medicine and pediatric, drawing much reward from mentoring young medical students and Residents.
I first came to the Dean’s side as an Associate Dean for clinical education which brought my experience to mentoring other clerkship directors at the University and at our affiliates, I guess the transition for all of us as teachers is how do we grow more who have a passion for teaching.
When the Dean’s job opened up- it seemed a daunting challenge to me, but I stepped up because there were things I felt we could improve for students and residents. Now I have been in that leadership role entering my 17th year- perhaps the 5th longest sitting dean in the AAMC.
What is the greatest difference between the clinical side of medicine and the administrative side?
Importantly we must strive not to make distinction between the two. It is important for educational administrator to maintain a solid foundation in their area of experts. That means that medical science educators must maintain a presence in the basic science specialty of their background. While not all of my colleagues choose to do so, I feel strongly that clinician educators must remain clinicians. For me to teach on an inpatient ward or at the podium in basic immunology, I need to be seeing patients in that setting, managing inpatients and consults, and still precepting in the HOYA free clinic in our city’s homeless shelter. Otherwise counsel rings hollow. Some would disagree that it is possible to do both well. It is challenging to do so.
What was/were the most memorable experience(s) during your medical education?
When I finished senior year and had completed my match – I finished school early, obtained a license, had a gap to work before residency started. I worked supervised by University Faculty for six months in a small town primary care practice near Chapel Hill. The role models I encountered among primary care physicians and leaders in that community were a treasure to me. I was able to maintain the connection to that community over four year of residency working in their emergency room and that practice. It made me a better physician and a better person.
What do you think is the biggest challenge facing physicians today?
I am concerned that physicians, residents, and medical students are increasingly burned out and discouraged. Our school and others are tackling these issues as are major health systems. One approach is that 40% of our students take Mind Body electives learning stress management, relaxation techniques, group support and maintain these Mind Body groups over four years. We have recently added a classwide portfolio project to teach reflection and mindfulness techniques imbedded in their smaller academic families
In a time where technology is rapidly advancing and there is a push toward “precision medicine” initiatives and moving medical records to electronic databases, how can we best streamline this process while keeping in mind patient privacy?
My bias first of all is that precision medicine begins with the precision application of the technology of deep skills in taking a thorough and reproducible history and consistent and thorough physical exam –including comfort with the stethoscope before ultrasound , the ophthalmoscope etc. Increasingly on an individual basis- we must learn to tailor diagnosis and therapy to individuals based on our rapidly expanding genetic knowledge of new drugs, tumor subsets, pharmacogentics, and response of the individual to much more focused, effective therapies.
The big challenge also must address disease and its management in populations. We should also have interoperable systems to explore de-identified data across large populations. Each of us has a responsibility as a school to provide population based skills and to encourage the right curiosity and query formation to ask the right questions. We are increasingly pairing our students in their required scholarly projects to work with mentors who are addressing these real time questions with growing large populations. Most of now are part of a large health system which must be asking these questions for quality health care. This genie is out of the bottle.
There is an enormous debate these days as to whether resources should be primarily allocated to fighting diseases or the distal causes of diseases. What are your thoughts on this issue of proximal causes versus distal causes?
One might argue that we should focus research on therapeutics to “Health” as opposed to the disease based and even disease prevention based curriculum that each of our schools has predominantly delivered over recent decades. While we must continue to provide education for the tools of therapeutics in logical and rational fashion, Growing nutrition and wellness are challenging but long term targets.
What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
The applicant must complete the process, which the Jesuits call “discernment”- self inspection of motivation, passions, and heart. For our committee like others, it includes a holistic look at exposure- shadowing or otherwise in healthcare, research, and importantly for us, service to others. There must be an altruistic basis for most schools to resonate with an applicant. I would advise each student to decide their story, work through it carefully and stick to their narrative- It should drive personal statements, interviews, and the entire application in the most genuine fashion.
How do you foresee medical education changing in the next few years?
Increasingly, our schools respond to the challenge of different tracks that recognize passions, talents, and directions for different students from many different backgrounds. Increasingly we will see schools develop a capability for individualism in that education. That will require increased attention to competence based assessment that will allow a learner, be it student, resident, or fellow, to demonstrate their mastery of required skills and advance at their own rate.
That will hopefully also reduce time of training and reduce educational debt. Importantly we will continue to center our educational models around patient safety and quality of care that would make newer types of simulation and care hopefully. We will see more innovations in this area-procedure based simulation, followed by techniques like perfused cadaveric dissection, for surgeons before they do patient procedures. This will be a time when we will partner with our clinical systems to look at the patient care arena to create innovative new educational methods with shorter and shorter intervals from care to education.