Leaders in Medical Education

Dr. Paul Evans, Vice President and Dean of the Marian University College of Osteopathic Medicine

Alan Tang
Mar 25, 2015

Dr. Paul Evans was named vice president and founding dean of Marian University's college of osteopathic medicine in August of 2010. A U.S. Army veteran of 26 years, Evans was also the founding dean of another college of osteopathic medicine: Georgia Campus, Philadelphia College of Osteopathic Medicine in Suwanee. He spent 12 years in osteopathic medical education, with the last six as dean. He has 16 years in medical education in the military, and has been in medical education teaching residents and students since 1982.

Evans is particularly interested in creating exceptional learning opportunities for new physicians in Indiana. "Being a part of the team that builds a new college of osteopathic medicine at Marian University is an extraordinary opportunity," he said. Read the interview with Dr. Evans published in the November/December 2010 issue of the Indiana Hospital Association newsletter Harmony.

What was your background going into medicine and how did you get interested in medicine?

I started out studying biology at the University of Miami as I was interested in Marine Biology. I then decided pretty early on in my freshman year that medicine was a little more appealing to me. I decided to pursue pre-medical studies during my second year of undergrad. After I graduated from Miami, I had an obligation due to an ROTC Scholarship to serve time in the US Army. I did that for three years and was stationed in Germany. I applied to Medical School and got accepted during my time in Germany. I then began my medical education in 1975.

I got involved in family medicine because as an osteopathic physician, I received a very-generalist focused education. A lot of my role models were good family physicians. I did initially want to be an orthopedic surgeon but when I finished my rotations, I didn’t want to give up seeing different types of patients and being a part of the healthcare of the entire family, not just deal with a specific procedure with a patient.

How did you get involved in medical education?

I had an interest in medical education back during my residency. Senior residents teach junior residents and I got interested in the process from there. Additional work during my intern year as a basic life support (BLS) instructor further drove my interest in teaching. One of my mentors actually transferred to become chair of a family medicine department in Honolulu and invited me to be a junior faculty member there, jumpstarting my career.

What are some major changes you have seen during your time as a physician?

When I graduated from Medical School in the late 70s, and graduate medical education (GME) in the early 80s, there were a lot more private practices and independent, autonomous physicians. Now things have changed. Most physicians leaving residencies are joining group practices, hospital owned practices, or larger systems where they are employees versus operators of a small business. There has also been a change in scope of practice with the loss of hospital work and many procedures I was trained to do.

Another factor is the influence of technology on medicine, not just in providing care. There’s also a lot more data driven mechanisms now in practice than there were 20 years ago. Those three things have influenced how the practice of medicine has evolved.

What are the biggest problems physicians currently face in the United States? Healthcare system

Reimbursement processes are going to have to change. Right now everything in the reimbursement system is more procedural. A lot of work in primary care is not reimbursed because it is not a procedure (ie: long-term care management, conferencing, etc). There’s a movement now to change this and pay physicians for the work they do.

What are two or three changes you would like to see in medical education today?

We are doing some innovative things at Marian. We have a competency based curriculum structured on the integration of Biomedical and clinical sciences, so we are presenting information to students from a physician’s viewpoint in linking basic science and clinical work. For example in cardiology, we do an organ based course process where students start with biomedical concepts that directly explain some clinical scenarios.

The assessment and processes are based on competencies, not just learning and getting a grade. Traditional medical education (2 years classroom learning in basic science, then 2 years of clinical rotations) forces medical students to integrate both worlds on their own in the third year. People forget information from the first 2 years. A better way? Take the biomedical principles and apply them directly to patient care processes to show that basic science dictates what’s happening to patients and why the patient is managed in certain ways. Students are a lot more engaged and think like a doctor early on, versus picking up the skills in the 3rd and 4th year.

Most gratifying part of being a dean of a medical school?

A dean can make changes at a high level that affect many people. As a practicing physician, I often only have influence on one family at a time. In education and during the teaching process, you are a force multiplier. If I am one physician I would see one patient at a time. However, as a teacher of one hundred medical students, I am helping shape one hundred future physicians. Then, when they are fully trained, they end up seeing one hundred patients at a time. I have a better ability to influence the larger medical care process in relation to the students when I am teaching. That is very satisfying.

The other piece I am fascinated by is the process of taking a pre-med student and making a physician in four years. It is tough, complex, and challenging. The students we work with are bright, talented, and dedicated. It’s a joy watching them launch their careers and become competent new physicians.

What do you believe we should do in order to improve interprofessional care in the US?

That is one of the hot topics right now. Some of the accrediting bodies are requiring medical schools to undertake an interprofessional curriculum. I think it is a trend that will continue to expand. The old concept of physicians being independent and doing their thing by themselves is going away and a new team-based process is becoming more and more operational in the provision of medical care. So, new physicians need to be very skilled at working in teams and encouraging other professionals to perform at the highest level of their training in a group environment. We are doing this training at Marian; the College of Osteopathic Medicine is in the same building as the School of Nursing, and we are sharing educational experiences with fields like medical ethics, team skills and communication. I see this trend expanding to other medical schools across the country.

Do you have any final thoughts you would like to share or if there is anything particularly interesting you are currently involved in?

I think one of the big challenges for deans, looking down the road, is dealing with the impending physician shortage. It is interesting today that AMA released a projection report of physicians for the next ten to fifteen years. The results are discouraging because of the demographics of our country and the greying of America; the number of people over the age of 65 is projected to double from 2000 to 2030. It is going to change the way medical care is planned for in the future. Other workforce issues such as retiring physicians, increases in part-time clinicians and greater administrative expectations will affect physician need.

Deans of medical schools are part of the long-term solution to this process. How are we going to influence health care to meet these shortages? How in particular will the expanding number of medical students help solve this problem? It is a real challenge that we are all facing now, not just in my state but throughout the country. You get your degree when you finish your medical education from the school you are going to, but you do not become a competent physician until after residency. Those opportunities must be there for our graduates. I think that’s a great challenge for most deans.