Leaders in Medical Education

Dr. Lois Nora, President of the American Board of Medical Specialties

Thasin Jaigirdar
Published on Jul 17, 2015. Updated on Invalid date.

Dr. Lois Margaret Nora is President and Chief Executive Officer of the American Board of Medical Specialties (ABMS). ABMS is a not-for-profit organization that supports its 24 medical specialty Member Boards in developing and implementing educational and professional standards to certify physician specialists and encourage lifelong learning and assessment. Through these efforts, ABMS helps ensure high quality health care for patients, families and communities.

Prior to joining ABMS in 2012, Dr. Nora served as Interim President and Dean of The Commonwealth Medical College in Scranton, Pennsylvania, one of the nation's newest medical schools. From 2002-2010, Dr. Nora served as President and Dean of Medicine at Northeast Ohio Medical University. During Dr. Nora's tenure, institutional accomplishments included the founding of a College of Pharmacy and College of Graduate Studies; a founding partnership in the Austen BioInnovation Institute in Akron; and selection as one of Ohio's best workplaces, among others. Previously, Dr. Nora served as Associate Dean of Academic Affairs and Administration and Professor of Neurology at the University of Kentucky College of Medicine, and Assistant Dean and Assistant Professor of Neurology at Rush Medical College in Chicago.

Dr. Nora's scholarly work focuses on issues in medical education, particularly the student environment, and issues at the intersection of law and medicine. Her honors include the American Medical Women's Association President's Recognition Award, the AAMC Group on Educational Affairs Merrel Flair Award in Medical Education, The Phillips Medal of Public Service from the Ohio University College of Osteopathic Medicine, and the 2010 Northeast Ohio Medical University College of Pharmacy Dean's Leadership Award, among others.

Dr. Nora received her medical degree from Rush Medical College, a law degree and certificate in clinical medical ethics from the University of Chicago and a Master of Business Administration degree from the University of Kentucky Gatton College of Business and Economics.

She is board certified in neurology by the American Board of Psychiatry and Neurology, and is participating in Maintenance of Certification.

How did you become interested in medicine and neurology/psychiatry? How did you become interested in Medical education?
I am a third generation physician and one of eight children. One of the ways my father would spend one-on-one time with each child was to take us on house calls. This was my early exposure to medicine. My sister has cerebral palsy, and I grew up watching her and some of her friends overcome neurological challenges. As a medical student, neuroscience was the first course that I loved. I met devoted, passionate neurologists who served as wonderful mentors.

I spent my first years in neurology in private practice. During that time, I had the chance to be a community-based faculty member at Rush Medical College. There I facilitated in a new, problem-based curriculum and became involved in student committees. This led to a part-time role as assistant dean for clinical curriculum and the opportunity to interact with both students and faculty. This experience made me realize how personally important it was to me to make a contribution to medical education.

Can you dive a bit more into your overall background?
I attended Rush Medical College which was one of the first schools in the 1970s that worked to increase diversity in its student body. I was one of many women in my class, and I benefited from having racial, age, and background diversity in my class. After serving as assistant dean at Rush, my family relocated, and I joined the University of Kentucky (UK) Medical College as associate dean of academic affairs. The dean there, Dr. Emery Wilson, is a remarkable individual and is known for having developed many other medical school deans.  At UK, I worked with tremendous students and faculty/staff colleagues,  was involved in curriculum reform with outstanding colleagues in our medical education office, taught in the law school, continued my medical practice part-time, and  experienced UK basketball March-madness, as well as had the chance to volunteer at my children’s school and with the Girl Scouts. UK also allowed me to spend a year as an American Council on Education fellow at the Ohio State University, working under then-President William Kirwan.

After seven years at UK, I was privileged to be selected as president and dean of medicine at the Northeast Ohio Medical University (then called NEOCOM). Working with a stellar team of faculty, staff, and students, we strengthened the school’s research program, began a pharmacy and graduate college, and worked with a multitude of partners to strengthen the healthcare in the community and region. After I stepped down from that position, I had the chance to work at the Commonwealth Medical College, which was one of the newest medical schools in the country with an amazing, integrated longitudinal curriculum in a community-based setting. I served there for 13 months as interim president and dean before coming to ABMS.

Throughout my career, I have had varying roles and responsibilities.  But across these experiences some common themes persist:  commitment to quality care for the patients we serve, strengthening medical education, and an interest in my students. I have been privileged to work with extraordinary people and to have wonderful mentors wherever I have been, making it a very productive and fun career in medical education.

What was the transition like between private practice and academia?
It was a great transition that extended over a number of years. While I was in the dean’s office at Rush, I still had a private practice in neurology. My private practice experience has contributed to my ability to counsel medical students about their own career decisions and is equally useful at ABMS.

What was your motivation behind pursuing a JD and a MBA?
My motivation was different in each case. I was always interested in health policy and medical ethics. During my residency in neurology, there were many ethics questions being discussed within the specialty. I debated between obtaining an ethics fellowship and going to law school, and eventually decided to attend law school at the University of Chicago. Later, Dr. Mark Siegler, who leads the MacLean Center for Clinical Ethics there, allowed me to pursue an ethics certificate as well.

Pursuing a MBA was an unexpected opportunity. While at UK, Medical Center Chancellor Jim Holsinger created a leadership development program for 20 mid-career physicians with promise. I was fortunate enough to be selected and spent a rigorous year combining my “day-job” with select courses in the business school and leadership development exercises. At the end of the year, members of our group were offered admission to the Business School and credit for a few of the courses we had taken. Five of us chose to pursue a MBA.

These educational experiences greatly influenced me. Business school teaches you how to work in teams and law school helped develop my critical thinking skills. Because I have been trained across professions and disciplines, I am able to see intersections and linkages across areas that appear distinct and separate to others.

What are some of your responsibilities as President of the American Board of Medical Specialties? What are your short-term and long-term goals with the organization?
ABMS is the umbrella organization for the 24 specialty organizations that set the standards defining the 37 specialties and 123 subspecialties of medicine and which certify physicians and scientist diplomates who meet those standards. There are 800,000 physicians with Board Certification from one or more of the ABMS Member Boards. ABMS Board certified credentials have been recognized for more than 80 years as an indication of training and quality of the individual holding the certificate.

ABMS works to support our Member Boards in their efforts as well as help lead continual improvement across our community. Medicine is a profession, and as such engages in collective self-regulation. Board Certification plays an important role in physician self-regulation. As a profession, we are here to serve patients and communities first and foremost. We take this obligation to the public very seriously.

Early in our history, ABMS Board Certification was granted at a single point in time. With the emergence of Emergency Medicine and Family Medicine as new specialties in the 70s, a conversation about eliminating a single point-in-time Board Certification process ensued and periodic recertification was introduced. With advances in medical knowledge and the rapid changes in societal expectations, the Member Boards have evolved certification during the past 10 years to incorporate additional expectations. Today, our diplomates participate in Maintenance of Certification (MOC) processes that incorporate professionalism, self-assessment, learning, assessment by the Boards, and engagement in ongoing quality improvement.

This transition has had some challenges. Some in our profession have not welcomed MOC. For some there is a philosophical difference as to what certification should mean. Others’ concerns are related to change-fatigue due to the many substantial changes happening in medicine and, for some the concerns relate to the manner in which MOC was initially introduced. ABMS is working with the Member Boards to respond to these concerns in order to maintain a rigorous program that is relevant and meaningful both to the public, as a demonstration of the commitment that physicians and other diplomates make to remain up-to-date, and also to those physicians/diplomates as a framework for ongoing learning and development.

What are 2-3 changes you would like to see in the current medical education system?
In many ways, the US medical education system is one of the best in the world. An area for continued improvement is reaching diverse populations of people and encouraging them to consider a career in medicine. It’s a serious concern that 80 percent of medical school students come from the top 20 percent of parental income in this country. We need to continue to reach students from backgrounds and locations who may not have had access to Advanced Placement courses, magnet high schools, and enrichment programs, but who will be extraordinary physicians. We have made some excellent progress in this area, beginning with the placement of new STEM (Science, Technology, Engineering, and Math) high schools in rural areas. The Association of American Medical Colleges has also worked to address this issue through its new Medical College Admission Test, and the adoption of a more holistic admissions process. These are excellent examples of how the collective medical education community is working to encourage and attract a more diverse population of new physicians.

A second area that needs attention is continuing to make sure the “hidden curriculum” that medical students and residents experience is consistent with the explicit curriculum being taught. Research on the student experience, Clinical Learning Environment Review or CLER visits by the Accreditation Council for Graduate Medical Education, and cross-cultural awareness and training are just some of the ways that medical educators are working to establish more consistency. Finally, the integration of quality science, population health, and social contributors to health and illness into medical education must continue and expand.

What about some changes you would like to see with the overall healthcare system?
A continued focus on patient safety, wellness, the engagement of patients in their own care, and team interaction will be important as we work to achieve the access and quality promises inherent in the Affordable Care Act.

Electronic health records (EHRs) need to be leveraged properly. According to a recent RAND study on physician satisfiers and dissatisfiers commissioned by the American Medical Association, EHRs topped the list of dissatisfiers. We have yet to embrace, train for, and work with EHRs to fulfill their promise to help providers analyze their practices, identify best practices, and use it most effectively in patient care.

Do you have any final thoughts you would like to share either about your career or about the field of medicine as a whole?
I have two thoughts. First, medicine as a profession and career is unparalleled. The intellectual stimulation, the collegiality, and the ability to positively impact people’s lives make it an extraordinary choice. In my role at ABMS, I see the tremendous work and contributions made by thousands of our country’s physicians every day; it is a tremendous honor. Second, professions are defined as groups of people who have special skills and who make the commitment to use those skills first and foremost, to serve others. They are trusted by those they serve to keep that commitment and granted, by that same society, the ability to self-regulate. The mission of ABMS and our Member Boards is to set collective standards for physician education, assessment, and professionalism for the benefit of patients, families and communities. This is an enormous privilege that we must individually, and collectively, continue to earn.

We work every day to reinforce the public’s confidence in the profession; a faith and trust that is truly deserved because of the commitment and dedication of so many physicians practicing in this country today.