Leaders in Medical Education

Dr. N. Kevin Krane, Vice Dean for Academic Affairs at Tulane University's School of Medicine

Thasin Jaigirdar
Published on Nov 14, 2014. Updated on Invalid date.

Dr. N. Kevin Krane is the Vice Dean for Academic Affairs at Tulane University's School of Medicine, where he has served for 30 years. He is an Internist who specialized in Nephrology. We are excited to be featuring him today in our Leaders in Medical Education Series.

How did you decide on a career in Medicine, and can you elaborate on your background and what has brought you to where you are today?

The decision to pursue a career in Medicine was easy for me.  I was born when my father was in medical school and he went on to become an obstetrician-gynecologist so my whole life revolved around medicine and I could see how much my father loved what he did.  Realizing that you could impact the lives of so many people while waking up every day excited about what you do made the decision to go into medicine easy.   To this day, students notice that I love what I do and always ask me how I planned my career, which is still anchored in patient care, but focuses primarily on medical education.  The clinical care planning was easy, like so many, I worked with a brilliant, charismatic physician, (a nephrologist), my very last month of medical school and he was my role model for patient care.  While I was in training, I became involved in teaching medical students and I pursued this interest as much as I could as a junior faculty member.   This passion for education helped me become successful as a teacher and opened career doors:  becoming a clerkship director, meeting and networking with colleagues who provided both inspiration and mentorship, and finally stimulating me to learn and improve what was really involved in teaching and learning.  When I was offered the opportunity to move to the Deans office and oversee medical student education at Tulane, I fortunately I took advantage of that opportunity.   The moral of the story is that while planning is helpful, one is often giving unique opportunities that may not have been part of the plan - just don’t miss them.

What is some advice you would give to an undergraduate student interested in pursuing a career in medicine?

Make sure you are going into medicine for the right reasons.   Many want to pursue medicine because they can “help” others, which of course is essential, but there are many outstanding professions both in healthcare and other fields where one has that opportunity.  Medicine is more than just helping others - you have to be passionate about becoming a physician because of what it takes to get through school and training and what it takes to remain on top of your game.  They don’t tell you that every time you move up a level, as a student, resident, fellow, or practice, you actually work harder.  If you love what you are doing, whether it’s in direct patient care, research, medical education, or medical administration, you will embrace the work necessary to become outstanding for your career.  Similarly, for medical students, I tell them the most important thing to do is pursue training in the field they are most excited about.  This is a personal decision and it should be based on passion, not a USMLE score, economics, or the desires of others.

I have seen that you have done research on the attributes of effective medical scholars. Could you briefly explain some of those characteristics as well some of the challenges medical educators face?

Education of any kind is a calling and medical education is no different.  When I first became involved in medical education, there was limited mentorship other than senior colleagues who I met at educational meetings and provided both practical advice and moral support, and medical education was not seen as much of a career path.  Medical education however is truly a scholarly activity, and as such, those interested in becoming effective medical scholars should pursue their training with this in mind.  They should get advanced training in educational methods, theory, and research that can be part of specialized fellowships, advanced degrees, or even certificate training programs.   Relative to other areas of medicine - clinical care, research, it is often not given the same value, respect, or attention, but that doesn’t make it any less rewarding.   Therefore, one needs to have great self-confidence and passion and accept some of these limitations.

What are some changes you would like to see in the healthcare system today? 

From an educational perspective, one of the greatest challenges is that too much medical care is in silos, and therefore its very challenging for future physicians, as students or residents, to learn how to provide care systematically.  It would be ideal if there were better ways of modeling multi-disciplinary care, particularly if students and residents could participate in the process in a meaningful way.   This is exacerbated by the time pressures placed on all healthcare professionals who are being pushed to see more patients in less time while dealing with the challenges of incorporating many changes including EMR’s, administrative edicts, and sometimes fewer support personnel.  Additionally, I’ve become significantly more involved in team training for patient safety where the goal is to change aspects of the healthcare culture by using evidence-based approaches (i.e. TeamSTEPPS) to truly improve patient safety.  I think we are all struggling to see how all these pieces fit together and how we can best serve our patients and have an “ideal” system in which we could train future physicians would benefit everyone.   Of course challenge creates opportunity and that’s how we should approach this issue:  how can we best prepare students and residents for the practice of medicine 5-10 years from now?

What are two or three of the most rewarding things about being a dean of a Medical School?

While all faculty can impact the students they teach, as a dean, I have had the opportunity to shape and mold the entire educational process for hundreds of medical students at a time, and influence how they will learn in their future careers.   Knowing that you are having this impact, despite the lack of direct recognition can be particularly rewarding by seeing this as a team process, for whom the dean serves as captain.  At the end of the day, graduating students who you would want to take care of your own family is what we all hope to accomplish.   Also, as a dean, I work hard to maintain opportunities to interact and teach students and residents at every level of their training so I can be rewarded by being intimately involved in their progression and maturation as future physicians.  In addition, as a dean, one should have the big picture in mind, and while the devil may always be in the details, being a dean provides an opportunity to paint that big picture for colleagues:  how can we maximize learning and how can we assure that students progress and graduate with the right behaviors, skills, and attitudes?  Creating this framework is an art and extremely rewarding as one advances down this path.