TRANSCRIPT of the TALK given by Dr. CATUREGLI at PATHOLOGY GRAND ROUNDS on
NOVEMBER 24, 2014
Slide 1
Colleagues and friends, good morning. Thank you very much for coming to Pathology Grand
Rounds in this pre-Thanks Giving session. I thank Justin and our chair for giving me the
opportunity to present my work about a very fascinating topic. It is a true honor to give this
lecture, especially in 2014 because this year celebrates the 125th anniversary of the opening of
the Johns Hopkins Hospital.
Slide 2
That’s how our hospital looked like a few months before the opening, in the spring of 1889. You
can recognize the Administration building with the dome. And here is Monument Street and here
Broadway.
Slide 3
That’s how the hospital looks like today. You can still see the dome but most of the original
buildings have been replaced. So many changes.
Slide 4
My objective is to highlight some of these changes and provide a historical overview of the
residency program and our department.
Slide 5
I will mainly present the work I performed while I was codirect or of the pathology residency
program. The idea came in 2012 but the data collection was quite challenging and took almost 3
years. The actual writing of the manuscript was easy. We submitted it in September, it was
critiqued and we revised and resubmitted it last February. The manuscript was finally accepted
in April 2014 and will be published next spring in the Archives of Pathology and Laboratory
Medicine. Although challenging, the data collection was perhaps the most rewarding aspect of
the project because it gave me the opportunity to learn more about the history of medicine, the
history of our department, and Johns Hopkins as a whole. It is indeed fascinating to study history
of medicine. And no one says it better than Dr. Welch himself. Listen carefully.
Short video of Dr. Welch:
Nothing adds more to the interest and fascination of our profession than the study of this
historical and cultural background of medicine and the natural sciences through the ages. And I
venture to add that such study helps to make better teachers and better doctors.
Slide 6
I have organized my presentation into 3 sections. I will discuss briefly the origin of modern
universities, from 1088 to the opening of JHU in 1876. I’ll then show you how the hospital, the
school of medicine, and the residency programs came to light. And lastly I’ll show you my work.
You should have picked up at the entrance a handout with a departmental table and a set of 15
questions. You will able to answer them after this talk.
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Slide 7
This table shows you the first 10 universities of the world. The first one was in Bologna, Italy,
and opened in 1088. Then we have Oxford, Paris, and Salerno, Italy, where the first medical
school of the world was established. So, where are in history in 1088?
Slide 8
More or less we are around the time of the famous Battle of Hastings, which changed the fate of
England forever. In this battle, the French Duke William, Duke of Normandy, sailed across the
Channel, landed close to Hastings, and defeated the King of England Harold the II, naming himself
the new king.
Slide 9
William made several contributions during his long reign, but perhaps the most consequential
was the creation of a new English language, which fused the Germanic sounds of Old English with
unmistakable Romance overtones, a language that is called Middle English.
Slide 10
Shortly after William died, in 1096, the University of Oxford opened and in that year also the
First Crusade was launched. That’s climate in which Universities were born. They were built by
scholars and meant to be for scholars.
Slide 11
They were modeled on the Greek and Roman mode of teaching where you had a professor that
then created a school of scholars and students who were sort of devoted to him.
Slide 12
This way of teaching was certainly laudable, especially when the professor was charismatic, but
as you can see already back then some students were not paying attention. It is sort of not
different from what we see today.
Slide 13
So, this way of teaching, this way Universities were structured, lasted for about 8 centuries, more
or less up to the time of the American Civil War.
Slide 14
Two remarkable changes occurred during the mid 19th century: the first one was the
introduction of experimentation in German medical schools, later brought to America.
Experimentation is a great equalizer because it brings students and teacher elbow to elbow. So
rather than a vertical mode of teaching we have a horizontal transmission, which is much more
conducive for learning. The person who brought this way of teaching to America is Dr. William
Henry Welch, whom you saw before. He is the first and still longest serving chair of pathology in
our department, as you can check in the table. He served for 28 years as chair. And he is
recognized as the single most important event in the history of the Johns Hopkins.
The second event was the entrance of women in the workforce and the medical profession, and
with this the start of the feminist movement. The Civil Was had opened up numerous
opportunities for women in the workplace. About 623,000 young men had died during the war
and 500,000 more were wounded. As Maria Weston Chapman nicely and ironically put it:
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“Women have leaped from their spheres”. Many women contributed to the start of the feminist
movement. But for this institution the key player was Mary Elizabeth Garrett.
Slide 15
She came from the most influential in Maryland. Never married, she was passionate about
reading and education. Her self-proclaimed, lifetime goal was “to help women”. Mary’s gift of
over $350,000 made the school of medicine opening possible at the condition that women would
be accepted on equal terms as men. She exercised her trademark scheme of “coercive
philanthropy” to dismantle a century-old tradition of separate medical training for men and
women.
Slide 16
This institution owns its existence to the railroad. The Garrett family, Johns Hopkins and George
Peabody they all made their fortunes through the railroad.
Slide 17
I do not have time to discuss this very interesting connection between Hopkins, Garrett, and
Peabody. But suffices to say that in 1866 George Peabody inaugurated its institute and
transmitted to his friend Johns Hopkins a new way of doing philanthropy, based on gifts given
while the donor was still alive and managed by a Board of Trustees. The next year Johns Hopkins
made his will, leaving a bequest of 7 million dollars for the establishment of a University and a
Hospital.
Slide 18
He suggested to use his estate, Clifton, as the site for building the University but in 1873 he died
and in that year the market crashed causing the so-called “Long Depression”, a two-decade
depression. So the Trustees were forced to sell Clifton to the City of Baltimore and change the
site.
Slide 19
They decided to build the University downtown in a two-block area bounded by Howard,
Monument, Eutaw, and Centre streets. It featured state-of-the art buildings with a Physical
Laboratory, a Chemical Laboratory, and a Biological Laboratory.
Here it is. Actually, the history of our department begins here because it is in this building that
Welch first started working when he came to Baltimore in September of 1885.
Slide 20
I’ll summarize now the events that led to the birth of residency programs.
Slide 21
This is site that Johns Hopkins himself purchased before he died for the construction of the
hospital. The University was already open and now was the time to build the hospital. It is an
area of the city that was called Loudenschlager’s Hill, which is where we are today, and it was
mainly occupied by the Maryland Hospital for the Insane. This hospital was going bad and being
relocated to its present location in Catonsville. You may recognize some landmarks. The street in
the foreground is what will become Wolfe Street. The street running along the wall of the
hospital will become Monument Street. So, our pathology building would be at this corner. You
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can see the blue water of Fells Point and Inner Harbor in the back. And this modern-looking
building is Washington Medical College, which at that time was the main and only major
competitor of the University of Maryland for teaching medicine. It was then relocated to
Washington, DC to become George Washington University.
Slide 22
This is the plan of the Hospital. It was designed by Dr. John Shaw Billings and approved by the
Trustees in 1877. It was a 23-buildings complex that was going to provide for 400 beds. It
embodies Billings’ vision, which was this one:
You may recognize the administration building, where the dome is. These are the pay wards for
males and females. The famous octagonal room where the medical “rounds” were started. But
most of these buildings don’t exist anymore; they have been replaced, except for one. Can guess it
is? Very good.
Slide 23
So, while the Hospital was being constructed, with difficulties because of the market crash, the
University formed the first Faculty of Medicine, in June 1883. That’s what they said:
Slide 24
In January of the next year there was the first faculty meeting. They decided to hire a professor of
pathology and chose Welch, whom Billings had met in Germany. They invited him here for an
interview in March. And during that visit, Gilman offered him the position, which Welch accepted
after a few weeks. This is the official announcement with a starting date of September 1, 1884. As
Welch recalled in 1932:
Slide 25
The first 4 things that Welch did when he came to Baltimore, when he was hired, were these:
 He requested and obtained that professors of all pre-clinical subjects be appointed on a
full-time basis, so that they would not rely on private practice for their living
 He modified the plan of the pathological building to accommodate instruction of medical
students
 He took a year off, just after starting, he took one year sabbatical and $2,000 to travel to
Europe for learning the latest in bacteriology (Dr. Welch was essentially a CP guy, mainly
interested in bacteriology) and purchasing apparatuses and books for the Pathological.
 He established a friendship with the local pathologist, Dr. William Councilman, who was
going to become his lieutenant for life.
Slide 26
When he came back from the year off, Welch rented a flat at 935 St. Paul Street. And, because the
hospital was not yet ready, he was given space in the Biological Laboratory of the University,
which you saw before. And there he prepared his teaching material, modeled on the Robert
Koch’s course that was given in Berlin, and delivered his first lecture series in the spring of 1886
entitled “Micro-Organisms in Disease”.
Slide 27
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A few months later, in October 1886 the Pathological was ready and Welch moved in although
the hospital was still not open. That’s a photo taken from the back. So, basically you are looking
north at the corner of Monument and Wolfe Street on the other side of the building. The building
was a two-story high, as you can see, and had a laboratory, a photographic room, a pathological
museum, and a stat-of-the-art autopsy theater. He brought with him Councilman and hired a
fellow, Franklin Mall, who was going to become the first professor of Anatomy here at Hopkins.
Slide 28
This is the block plan of the building. You can see that the autopsy theater was full-height, to
allow abundant light to come in. This room here, on the North side, facing Monument and Wolfe
street, where Path Photo is now located, was the laboratory and that’s how it looked.
Slide 29
Very shortly this building became a hub for science in the entire country. Many people came here
just to work under Welch in that building. The trio organized very popular courses for young
physicians. The first 16 students are listed here. You may recognize some famous names. Dr.
Halsted is there. Christian Herter was a very famous scientist as well.
Slide 30
Many people came from other places and other universities. For example, you may recognize
Walter Reed, Jesse Lazear, and James Carroll of yellow fever fame. Here is another one. Dr.
Williams. As you can tell, he was thinking: shall I write a book or shall I not? He decided to do it.
Williams Obstetric is still in use, now in its 23rd edition, quite a popular book. Another very
famous student of Welch was Lewellys Barker, who was going to replace Osler as Physician-inChief for the Johns Hopkins Hospital.
Slide 31
The center, the focus of that building that Welch created was research. Here you see him working
with polyomyelitis rabbits, one rabbit is there in the corner, with Christian Herter who was a
brilliant scientist, founded JBC, and unfortunately died prematurely.
Slide 32
There were also few women under Welch in those days. Here is one of them, Dorothy Reed, who
as you know described the Reed-Stenberg cell. She married Mendenhall and had a son, John T.,
who came here for the residency during World War II.
Slide 33
As Welch recalled in 1932:
Slide 34
The hospital finally opened in 1889. For the first 4 years, the department of Pathology was very
small, only 5 faculty members: Welch, Councilman, Abbott, Nuttall, and Flexner.
Slide 35
And it was now time for the School of Medicine to open, but money was short: $500,000 more
was missing. The University had only $81 thousands or so. Mary Garrett stepped in. She
organized the Women Medical School Fund, which raised over $111,000, of which she
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contributed almost half. And then, on Christmas Eve of December 1892 she donated the
remaining $300,000 or so. So, basically she contributed over $350,000. And these $10,000 here,
she paid for the famous painting The Four Doctors as well.
Slide 36
Of course she had conditions. I already told one, which was to accept women. So, once the money
came in, quickly the university realized that space was short for teaching the basic sciences. In
just a few months, they added two floors to the Pathological: a third floor for biochemistry and a
fourth one for anatomy.
Slide 37
The school of medicine opens with 9 professors, 6 associates, and 18 medical students, all listed
here. You’ll probably recognize all the professors listed in the table. For sure you recognize the
last one: Hurd. We are standing in Hurd Hall, which was dedicated to him in 1932, one year after
his death. In this very same position, Harvey Cushing came to deliver the lecture about the
syndrome that bears his name. So, it is sort of humbling to do a lecture here. The medical
students are listed here and you can tell there were 3 women in the class.
Slide 38
Here they are. For Mabel unfortunately I could not find a photo. But Cornelia Church and Mary
Packard are shown. Mabel became famous because she married her anatomy professor, Dr. Mall.
This sort of let her out of her course and incited a famous remark by Dr. Osler who in 1904, when
was called to Harvard to lead the opening ceremony for the Commencement Day said that: Well,
Hopkins is doing fine with the women, a third of them marry their professors during the first
year. It was a very English type of humor.
Slide 39
So, as I said Mabel left during the first year. Cornelia was intimidated by Osler and left shortly
thereafter. But in the second year two new students came, joined the class. They will become the
first two residents in Pathology: William MacCallum, who will also be the second chair, and
Eugene Opie.
Slide 40
The class of 15 graduated and it was quite remarkable. The New York Times said that the
exercises for the graduation were made doubly interesting by the fact that the MD degree was
bestowed upon a woman, for the first time. It was a sensation. Just to give you an idea: at the
University of Virginia, the first woman graduated in 1922, so more than 2 decades after Hopkins.
Slide 41
Here is the famous photo of the first graduating class, which you’ve likely seen. It is inaccurate.
First of all, Mary should be shown. Then, these two never made it. And Frank Lupton graduated
two years later. But that’s the way the class was portrayed.
Slide 42
It was a tradition of Hopkins to have women as medical doctors since the very beginning. And it
is maintained, has remained throughout the years, as you can see from this graph. This is the
percentage of women in the graduating class. It was around 10% for several decades. After the
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civil right movements of the late 1960s, it sharply, steeply increased to arrive to equality in 1998.
In some classes now there are more female doctors than male. If you put on this graph the size of
the medical school class, you see that it was 15 when the school started and now is about 130
medical students. You may notice this spike here (1943): that’s World War II. They needed more
doctors and that’s whey they graduated twice in that year.
Slide 43
So, we have arrived to the start of the residency programs in the United States. It was Osler’s
idea. He originally proposed it to the Board of Trustees in 1890. He had adapted it from the
German system that permitted a physician to spend many years, 6, 7, 8 years after the MD degree
in the hospital, to acquire more specialized training.
That’s the letter that he wrote to the Trustees. There are several interesting things, as always
with Osler. First of all, he pays homage to the German system for where he got the idea. And here
he says “Perhaps the one special advantage that large German hospitals have over corresponding
American institutions is the presence of these residents who remain in some cases 3, 5, or even 8
years, and who, under the professor, have control of the clinical material”. And at the end he
makes a very astute comment on how important is to select the residents.
So, these are the first residents of the hospital, medicine, surgery, gynecology, and for pathology
it was MacCallum. It took several years and then the residency programs were administratively
approved in 1899. So, 1899 marks the start of the residency programs in the United States. Many
scholars consider this event Osler’s greatest contribution to American medicine.
Slide 44
So, this brings us to my work, which will cover the years from 1899 to present.
Slide 45
I have organized my work in 3 parts. The first one was to define the study outcomes, then to
collect the data, and then to the analyses and publish.
Slide 46
I identified 4 study outcomes. The first one was to identify the residents in terms of gender, race,
ethnicity, medical training, country of birth, and medical school, and relate their numbers to
those of the faculty year by year, as to have an indication of the growth of the department.
The second aim was to analyze the performance at the Resident In Service Exams and compare it
to the national performance. The third one was to do the same thing for the pathology boards.
And the fourth one was to analyze the careers taken after completion of the residency.
Slide 47
How did I collect the data? As I said before, it was the most difficult part. We did not have
actually a list of residents, or even faculty, that was accessible.
Slide 48
I used 7 sources. Mainly I used the published Johns Hopkins Hospital Catalogues and
Announcements, which are published every year and list who is who, and who is in what
department. I also used a list prepared by Dr. MacCallum in 1932 for his department, and a list
prepared by Dr. Oppenheimer in 1963. Then there was a published list of staff from the Archives,
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and an unpublished, unofficial list also from the Archives. The Residency office provided the
names for the last decade or so. And then I screened the photographs we have in the hallway.
Slide 49
Once the list was made, I gave it to Ellen to retrieve the resident files from the Iron Mountain
storage. Thank you Ellen, very much. It was very helpful your work. Then I gave it to the
American Board of Pathology who performed, on a fee-for-service basis the analysis of the
boards. Then I used it to compile the RISE. And then I used it with PubMed and Google to assess
the careers.
Slide 50
For the faculty, I used the 3 lists indicated before, so there is no need to repeat it.
Slide 51
Some terminologies. By “status” I mean either you are a resident or a faculty. Of course there are
two other scholar statuses, fellow and PhD student, which I did not analyze.
By appointment, the school of medicine recognizes 3 appointments. Primary, which is in the
department that pays the salary and provides the resources. Joint, of course is intuitive. And
emeritus is a title, an appointment given upon retirement in recognition of service and
achievement.
And about the ranks, the school of medicine recognizes two ranks: regular and special.
Slide 52
Regular ranks are listed here and in parenthesis you have the first pathologists who covered that
rank. So, there are 4 regular ranks: instructor, assistant professor, associate professor, and
professor. And 10 special ranks: assistant, research associate, the visiting categories, the adjunct
categories, and the lecturer. So, when I say “ranks” I refer to this classification. And when I say
“primary”, I’m not including joint or emeritus appointments.
Slide 53
So, you saw before the sources for the name lists. I entered those sources manually into a
database, year by year. And now the database contains 8 thousands records and spans the entire
history of the department.
Slide 54
So, let’s do the analysis.
Slide 55
Can you guess how many residents we have had in 125 years? You probably have already heard
this before from me: it is 555. How about the faculty members? How many faculty have been in
Pathology in 125 years? Rob (Kahl)? Which one? A? Which answer did you say? 2,000? You
would be wrong. It is almost half of that. It is 1,021 faculty members have been here. And this
number means primary, joint, and emeritus, everybody was included in this list.
Slide 56
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So, here they are: 1,000 faculty or so, listed as primary, joint, and emeritus, and 328 residents
only. Because I told you before the total residents were 555, this means that some of the
residents became faculty.
Slide 57
Here they are. Of the total 555 residents, 84 stayed as faculty for two or more years; 143 did one
year only as faculty, typically as assistant; and 328 left after the residency.
Slide 58
So you can say that the probability of becoming a faculty when you are a resident is 85 divided
by 555. Thus 15% of our residents will become faculty, so we have to select them wisely and
treat them well because they are our future.
Slide 59
Here you see the overall distribution of residents and faculty by gender. As you can see, the blues
are the males, the department traditionally has been a male-dominated department. But things
have changed.
Slide 60
If you look at the table that is in your handout, and plot these numbers, the females, first of all
you can see that during the Welch’s years, the first 28 years, there was no woman, either as
faculty or resident.
Slide 61
The first woman came during the MacCallum’s chairmanship. There she is. Ruth Guy, in 1917.
She was an assistant in bacteriology.
Slide 62
But, as I said, the female trend through the years has dramatically changed. This graph shows
you the percentage of women for residents and faculty members through the various chairs. As
you can tell, (the female:male ratio) is approaching equality. Actually for residents this year there
are more women than men.
Slide 63
These were the first 10 female residents. You may recognize some of them. I know Mabel (Smith)
will recognize all of them. You have Sharon Weiss at the top right, who came a few months ago to
give the Distinguished Visiting Professor lecture.
Slide 64
How about by race? White was the most common race for many years, but again things are
changing. Of the 555 residents, 498 (90%) were whites, 31 Asians, 14 African-Americans, and 12
Indians.
Slide 65
These are the first residents in each race. MacCallum for Whites in 1899. The first non-White was
in 1961. The first African American in 1979, and the first Indian in 1992.
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Slide 66
How about by ethnicity? Residents were mainly non-Hispanic with only a few Hispanic. But some
Hispanics are starting to appear among our residents.
Slide 67
Do you recognize any of them? It is sort of though to see, but this is Juan Troncoso. These are the
first 3: in 1967 we had the first known Hispanic in the department.
Slide 68
How about country of birth? Of course, most of the 555 (residents) were born in the US. But 36
other countries were represented. There is also one from Italy. How about that? Who is that guy?
Slide 69
For the medical schools, 133 total medical schools supplied our residents. The most dominant
was Johns Hopkins that gave us 136 residents. So about a quarter of our residents comes from
our own medical school. The second one is the University of Maryland, then Vanderbilt,
University of Virginia are the top four.
Slide 70
By degree, most of the residents held the MD-only degree. 92 of them (17%) also had a PhD
degree. By type of track, most residents were in the AP/CP track or the AP only track. Only a
minority did the CP only track or the AP/NP track.
Slide 71
This graph shows you the distribution of residents according to the length of their residency. As
you can tell, most residents, over 200, did 4 years of training, which is the standard length
nowadays. And some others did 3 years. But it is also interesting for historical reasons to look at
the extremities. So, some residents trained more than 6 years. These were mainly in the
beginning (of the residency programs). As you’ve seen, Dr. Osler had the idea of having the
residents stay for 5, 6, or 8 years. Some of them are very famous. I’ll just pick one
Slide 72
Dr. MacCallum. He was the first resident and the second chair of pathology, serving for 26 years.
He contributed very much to science and made, at least in my opinion, two important
contributions. First he helped to understand the pathogenesis of malaria.
Slide 73
Which in those days was very prevalent in this university and in Maryland as well. None of these
steps were known in those days. What MacCallum did was to observe that malaria parasites
came in two forms, males and females (now called gametocytes), and joined together sexually
(when ingested by a mosquito).
Slide 74
This discovery was very important and cited by the Nobel Prize winner in 1902 Ronald Ross,
who won the award for his study of malaria. He cited MacCallum, who was a resident here, he
cited his work. So it would be very good for a resident to be cited during a Nobel Prize speech.
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Slide 75
The second contribution was, he discovered what the parathyroid glands do, which is to control
the calcium metabolism. He did this work with the Carl Voegtlin, who was the director
Chemistry, at that time under Medicine. And then he became the first director of the National
Cancer Institute.
Slide 76
The other extreme (1 year of training) is also very interesting. Those are the residents who came
to pathology because pathology was so very prominent, famous in this hospital. Everybody
wanted to work with Welch. Many chairs like Halsted sort of pushed their residents to do one
year of residency in pathology.
Slide 77
There are many (residents), but I’ll show you a couple. One is Isaac Olch, who became the chair of
surgery at Cedars Sinai hospital in Los Angeles. He was the one to perform the first successful
operation on the parathyroid glands in 1928. Another one, who I like very much, is Mont Reid.
He established Surgery at the University of Cincinnati. You can see him here in very noble
company. Do you know who that man is? He’s Dr. Halsted. Dr. Halsted actually required,
requested Mont Reid to come to operate on him when he was sick and needed a
cholecystectomy. So, he was very fond of his resident.
Slide 78
This line graph shows the growth of the pathology department through the years.
It is useful to compare the number of professors with residents. But before we do that, let me just
tell about the professors.
Slide 79
How many professors do we have in 125 years? 77. Of them, 16 were hired as professors. The
other 61 were promoted to professor while in the department.
Slide 80
The 16 are listed here. I see some of them. Dr. Borowitz is over there. He came in 1993 with
Sanfilippo. But look at Welch and then Bennett. There was basically only one professor until the
1960s. Bennett was hired to become chair. So, there was only one professor, the chair, per
department. And it was only in later years that the number of professors has expanded
significantly.
Slide 81
This slide, a little bit busy but not difficult to follow, shows you the other 61 professors who were
promoted. They are distributed by the chair, so by time, showing on the Y-axis how long they
stayed associated before being promoted to professor. And the symbols here show you whether
they were NIH funded or not. As you can see, of these 61 most were promoted by Dr. Jackson. He
promoted 37 of them. And of these 37 mostly had an NIH grant as PI. But you can be promoted
without being PI on an NIH grant.
Slide 82
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This slide shows you the same data but it emphasizes who was resident here of those 61
professors. The ones in white are the residents who then have risen to the rank of professor: 21
of 61, 38%, became professor in this department.
Slide 83
If we now go back to that slide, we can compare the trend of residents, in yellow, over time to
that of professors (purple line). As you can tell, up to the 1960 it was almost a 1 to 1 ratio: very
few residents, one, two, or three, for just one professor. What do you think happened here? The
white line is the entire faculty. Can you guess what happened? Around 1960 or so. What
happened to NIH? From National Institute, singular, of Health it became the National Institutes of
Health. Mainly through the work of Mary Lasker and others, there was a lot of lobbying. The
number of grants started to come and therefore the hospital and its building exploded. The
faculty followed. Now, in 2014 there are even more professors than residents.
Slide 84
The second study outcome was to analyze the performance at the resident in-service exams.
Slide 85
These exams were first administered in 1983. They were initially voluntary but now are sort of
mandatory.
For the first 10 years Hopkins did not participate regularly, so we did not have the data. So, I
have only 20 years of data, from 1993 to 2013.
The exam is a set of multiple-choice questions.
Results are expressed on a standardized scale, so that they can be compared from year to year.
Results are given to the residency director, along with national means and standard deviations.
Slide 86
So, here are the results. The first panel shows just the Hopkins data. Each bar has a little white
line, which corresponds to the median score for the residents.
As yon can tell, the performance is increasing. Residents have gotten better over time. Some of
them really better, like this one, with outstanding scores.
If you compare Hopkins, in black, to the United States you can see that year-by-year the black dot
is on top of the national average. So, Hopkins residents perform significantly better than the
national average on this exam.
Slide 87
How about the Pathology Boards? The boards were first administered in 1936. They consist of a
written and practical component, again with about 350 questions. The candidate must pass both
components to be certified. And they are given just the pass or fail result, so I do not have the
actual score.
I sent a list of resident names to the board, who matched it with all the names they had and told
me whether the resident passed or not and the number of attempts needed to pass.
Slide 88
These are the first 10 residents who took the boards. There are some interesting things here.
Particularly, I will emphasize Dr. Whipple. He took the boards in 1948.
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Slide 89
But in 1934 he had won the Nobel Prize. So, this shows a very strong dedication to pathology.
Slide 90
So, this is the performance of 386 Hopkins residents. 361, so 93%, passed at the first time. A few
of them, 17, required two attempts to pass. Two (residents) required 3. One guy took 4 times to
pass. And 5 never made it.
Slide 91
If you compare the percent of those passing at the first time among the different pathology
tracks, you can see that AP only residents do best. AP/CP in the middle. And CP only has been
traditionally the most difficult subject to master: only 83% of CP takers passed at the first time.
Slide 92
If you compare the Hopkins AP board results with the national results, here is what we have.
Hopkins is in purple and the nation in yellow. As you can tell, Hopkins is above the national
average through the entire years that they had available for me to review.
Slide 93
And for the CP it is the same thing: Hopkins is outperforming the national average.
Slide 94
How about the career paths taken after the residency? About 50% or so, 52%, go on into private
practice. A third into academia. Some left pathology. Those are mainly the residents of the early
years, where they did one year of pathology residency as part of their surgical or gynecological
training. And for some residents, like 2% or so, I could not find any information.
Slide 95
Do you know this young guy?
This was Dr. Miller in 1969 and that is now. I’m very close to the conclusion of my talk. Basically,
because this collection of data was quite challenging, I thought it could be useful for the
department to have this resource available. So, not only having my own database, but also
making it available. So, Dr. Miller
Slide 96
Actually was I meant to say, he has been 46 years in the department. And he is ranked number 6
in the longest serving pathologists, after Hutchins, Bhagavan, Erozan, Yardely, and Boitnott.
Slide 97
I do not know if Dr. Boitnott is here. But Dr. Boitnott has been the longest serving member in the
department. He has basically witnessed half of the Hopkins 125 years of history. Very good,
congratulations.
Slide 98
So, Dr. Miller assigned the task to these two young talented web masters: Rod Julius, who is
sitting here, and Aidel Weisberg. What they helped me to do was to put my ideas on the web.
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This website is not approved yet. Dr. Hruban has to go through the “privacy” issues and so forth.
But anyway that’s the way it would like. It is a page that recalls our faculty and residents. You can
search this page basically by two modalities. You can search by year. For example, you can say
OK show me who was in the department in 1939. And that shows you the entire department. So,
19 people were in the department for faculty and residents in that year. And of course you can
click on one of these and say, OK I want to see when MacCallum was in the department. The list
shows you, sorted by year, all the time and the title and the rank he had. So you can see he was
first a resident and then so forth. That’s one modality.
Or you can search, probably more interesting, you can search by criteria. They are a set of 10
criteria, listed here. And you can search, for example: find me all the residents that were of
female sex and were (in the department) from 1970 to 1980. So here they are, 20 of them. Again
you can click on the names. A famous one, for example, Lorraine (Racusen). You can see that she
was here for 36 years.
So, that’s a resource that hopefully will be useful and maybe a source of other studies as well.
I’ll go back to the presentation, to conclude, quickly.
Slide 99
I just want to acknowledge the people who helped me.
Norman Barker basically helped me very much in many things, including the style of the
presentation and made me aware of the Welch video that I showed you in the beginning, which I
did not know about. I think it is fantastic. Thank Norman and the entire Path Photo staff.
The administration on Pathology 4th floor is excellent. We are so lucky to have very good
administrators as we do. I bothered them many times for this project. I’m sorry for this.
Starlene (Murray) helped me with the filing of the residents.
Marjorie Kehoe at the Medical Archives helped me a lot.
Phil Goertz in the school of medicine gave me access to their books.
And Jim Stimpert, who is a reference archivist for the University.
Slide 100
So, thank you very much and Happy Thanksgiving.
Questions & Answers
Thank you, Mabel (Smith). I appreciate it.
Dr. Ralph Hruban: Mario I want to congratulate you on this spectacular tour de force, effort to
extract our history. I think the attendance at this Grand Rounds speaks for itself. The many
people who are here really speak about the importance and the value of what you’ve done. In
addition to thanking you, I want also to recognize one special person who is here, who has been
at Hopkins almost as long as John Boitnott. And that’s Mabel Smith.
Dr. Mark Halushka: In doing this research what was the most surprising discovery that you
made about our program?
I was astonished at how good it is. How many good people were here! I did not list the names
because of the privacy thing, but so many went on to become professor. Of course I told you
about the Nobel prize. We have, I think, 7 Deans of medical schools. So many professors. It is
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unbelievable. If you learn about their work, you’ll learn a lot about medicine. That was for me the
most surprising or even the most fun thing to do.
Dr.: Do you have any idea of what makes this pathology residency at Hopkins so outstanding
compared to other residencies? What are the specific traits that make Hopkins different from
other residency programs?
Probably many other people who have a command of the English (language) better than mine
would answer this (in a more politically correct way). Dr. McCarthy, do you want to answer that?
Dr. Ed McCarthy: Mabel just whispered it in my ears: the faculty.
OK, so I'll copy her. I think, of course, the emphasis on good faculty, the emphasis on the scientific
method to approach things, from the scholar point of view, not just to get by the day, I think is
what makes the difference. That’s what I would say.
Dr. John Boitnott: I have a different answer than Mabel’s. Actually I have been interested in that,
in regards to medical schools and related things, Statistics are a player across the board no
matter what you are talking about. The quality of what goes out is most strongly related to the
quality of what comes in. So, the success of this department and residency training is in the
success of recruiting the best residents at the start. That’s a self-fulfilling prophecy but you just
need to keep it.
Yes, exactly. The persons who are in the residency selection committee have a very important
job. I cannot get tired to emphasize it. To me it was a very big responsibility. I tried to do it with
my heart because I think you select your future, so if you choose wisely you cannot go wrong.
Dr. Dennis Grab: I think you should direct a documentary.
Yes, in my next life I’ll do that.
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