Leaders in Medical Education

Dr. Quentin Eichbaum, Associate Professor of Medical Education and Associate Director of Transfusion Medicine at Vanderbilt University

Alan Tang
Published on Jan 11, 2016. Updated on Sep 29, 2020.

Dr. Quentin Eichbaum, MD, PhD, MPH, MFA, MMHC, FCAP, FASCP is the Fellowship Program Director, Associate Professor of Pathology, Immunology and Microbiology at Vanderbilt University. Dr Eichbaum is also the Associate Professor of Medical Education and Administration and Associate Director of Transfusion Medicine. Dr. Eichbaum also founded the Consortium of New Southern African Medical Schools, an organization dedicated to improving communication and cooperation between newly established medical schools. Dr. Eichbaum was born in Namibia and received his MD at Harvard University.

How did you become interested in medicine?
I was born and grew up in Namibia, which was part of South Africa at the time. It was a very sparsely populated country, with less than one million citizens. My father had escaped Nazi Germany and came to Africa, falling in love with the country of Namibia. I did my early schooling there in an all-boys Catholic high school and encountered some incredibly good teachers there, one of whom taught science and math and remains to this day the best teacher I have ever had. South Africa was under Apartheid then and fortunately, I had been taught by my father, who had been strongly influenced by his escape from Germany, that it was an evil and a social wrong.

I grew up with a strong sense of social justice and wanted to devote my life at that point to dismantling Apartheid. The most effective option at the time, as a white person it seemed to me at the time, was to study law and be a anti-apartheid legal activist. I enrolled in law at the University of Cape Town (UCT) while also playing an active role in the anti-Apartheid movement and student press at UCT which had a strong tradition of opposing Apartheid . During the Soweto Riots and in the 1980’s police were constantly on the university campuses breaking up demonstrations with tear gas and batons and detaining students.. I edited a student newspaper, and participated in demonstrations in the townships where I witnessed police brutality first hand and was detained along with other students on several occasions. It was an incredible period to live through. Sitting in classrooms seemed almost socially irresponsible when the country was in flames and one was living in the eye of history. I came to realize how the law had been through manipulated in South Africa to create the evil of apartheid, despite the initial stellar efforts of the country’s supreme court justices to disallow apartheid, and I became disillusioned with it as a discipline.

I delved deeply into literature, the humanities and sciences and eventually started a PhD in immunology and medical biochemistry that led me to Harvard Medical School and Childrens’ Hospital in Boston. I did my PhD postdoctorate at Children’s Hospital in highly competitive labs initially in hematology and oncology before our group broke away and started working on innate immunity. While working in research I became aware that as a scientist I didn’t see the clinical context of what I was researching. I developed an urge to understand that clinical context and to see patients. So while a postdoctorate, I started studying for the MCAT and I did well enough to be admitted to Harvard Medical School, specifically the Massachusetts Institute of Technology (MIY) joint Health Sciences and Technology (HST) program. The program’s goal is to bring researchers and especially engineers into medicine and to encourage its graduates to stay in academic medicine. (About 75% of its graduates are professors of medicine). The program offered its participants a stipend to work in research labs and for teaching assistantships. I put in so much extra time that I managed to pay my entire medical school tuition After I finished medical school, I did my residency and clinical fellowship at Massachusetts General Hospital. I continued research on HIV at the Partners AIDS Research Institute (now the Ragon Institute of MGH, MIT and Harvard). It was a circuitous but interesting route. I’ve never been a straight arrow – which has pros and cons.

What made you pick transfusion medicine as your specialty?
I was set on doing infectious diseases but then many teachers kept telling me to do pathology as I had already done a PhD and postdoc so they thought I should go into research. I was initially not too happy with this decision but then found my niche in transfusion medicine which is very clinical and one sees patients every day. Some studies suggest that, based on one’s learning style (as determined for instance by the Kolb Learning Style Inventory), medical specialties might be divided into those that are more “cognitive” (like pathology, neurology, psychiatry, radiology) and those that are more procedural where one uses one’s hands more (like surgery, emergency medicine, pediatrics and internal medicine). It’s an interesting way of considering which field of medicine to enter – are you more of “thinking” or “doing” type? They are obviously not mutually exclusive but I think I tend towards the thinking side. Transfusion medicine has a lot of thinking for physicians (and more “doing” for nurses and technologists) and it spans the entire breadth of medicine as blood is the biggest body organ (blood is “everywhere” in the body). So overall specialty suites me and has become quite fascinating. Lots of excellent research is being doing and (rather strangely) only more recently has it’s central role in global health been realized.

Could you give us more insight on what transfusion medicine is?
Transfusion medicine deals with blood and blood products; it’s a relatively new discipline that has developed rapidly over the past decade with a substantial body of basic and translational research. We deal with red cells, plasma, platelets, as well as all the other cells in blood, coagulation, and stem cells. It’s the most clinical of the pathology disciplines and I see patients daily. It is a fascinating blend of diagnosis and clinical treatment spanning virtually all fields of medicine. Blood is the largest body organ and transfusion the most commonly performed medical procedure. What’s attractive about transfusion medicine as a career is that you have time involves patient interaction on a daily basis but you also have time to think and do research.

What was your first foray into medical education?
A friend of mine told me to come and look at a new medical school being established in El Paso on US-Mexican border. They were implementing a fascinating curriculum developed in Canada called symptom-based teaching. Instead of teaching blocks of microbiology, biochemistry, and immunology, etc., the symptom-based curriculum is based on about one hundred and twenty symptoms (sore throat, headache, etc.), and the scientific disciplines are taught in contextual association with each symptom. One symptom is taught per week over the first two years of medical school and students study the sciences in a continuous and integrated fashion associated with each symptom rather than in isolated blocks.

For example, for the symptom of “sore throat,” students will first received a presentation by an expert clinician on various presentations of “sore throat.” During the rest of the week, they will dissect the throat in anatomy class, study the various organisms that infect the throat in microbiology class, study the mechanism swallowing in physiology, mucosal immunity in immunology, esophageal cancer in genetics. So the sciences are studied in a clinically contextual manner. The next week, another symptom is explored. Symptom-based teaching has been adopted in a number of medical schools in the Netherlands, England, and newer American medical schools. While in El Paso, I also developed an innovative medical humanities curriculum based on metacognition. I was then recruited to Vanderbilt for both medical education and transfusion medicine.

How did the Consortium of New Southern African Medical Schools come to fruition and what are some of its goals and future directions?
I had been involved in curriculum development at both established and new medical schools in the U.S. and elsewhere. I had grown up in Africa and always retained a fierce interest in working there. Ive always felt like my ‘soul’ has remained on the African continent..An African idiom says “You can take a person out of Africa, but you cannot take Africa out of that person.” Since I had traveled and worked in numerous global health projects across Africa, I was asked by the Vanderbilt Institute of Global Health to assist with the development of a curriculum for a medical school being established at Copperbelt university in Ndola, in northern Zambia. I went out to Ndola and initially spent a week with the new dean to map out the basics of their medical school curriculum. Then, I had arranged then to visit my hometown in Windhoeek Namibia and decided to meet with the dean of the new University of Namibia School of Medicine . It struck me that these schools were both facing similar challenges. Why were they not talking to each other? I decided to put these new schools in touch with each other, and they immediately found common ground. Faculty from the University of Oulo in Finland were also working independently with both institutions as well as with the new medical school at Lurio University in Nampula, Mozambique. We decided to work together and invite other new medical schools in the region into establishing a consortium, that we named the Consortium of New Southern African Medical Schools, or CONSAMS Initially, the consortium was comprised of five African medical schools and two northern partner medical schools (in the US and Finland), Several other medical schools in other African countries soon asked to join but we were constrained by funding. The new medical schools felt excluded by the Medical Education Partnership Initiative (MEPI) that Dr Eric Goosby, Global AIDS Ambassador, had established with PEPFAR. We made our views known through some published articles. Eventually, we received funding that Ambassador Goosby approved after we submitted a funding application to OGAC (Office of the Global AIDS Ambassador). With this funding we managed to achieve numerous goals by bringing the CONSAMS schools into more regular contact with each other to share ideas, programs and faculty, and to initiate various projects.

We initiated various programs and set up annual conferences between member schools, as well as student and faculty collaborations amongst the schools. The idea of CONSAMS is to share resources, faculty and programs. It stems in part from a seminal artivle in the Lancet in 2010 by Julio and Frenck and colleagues on the critical importance of working through alliances, networks and consortia in global health rather than an isolationist approach of people needlessly competing and doing battle with each other. Our focus was new medical schools, schools less than five years old, New medical schools can be potentially more innovative than established schools. We now ave so many new medical schools wanting to join that we may rename ourselves Consortium of New African Medical Schools (CONAMS). By some estimates, about one hundred more medical schools may open in Africa over the next decade. These schools will be welcome within CON(S)AMS as they have similar problems and would benefit from increased communication and collaboration between other medical schools.

What are some problems with the isolated approach that medical schools undertook prior to joining the consortium?
The lack of communication between different schools pre-empted them from taking advantage of each other’s strengths. For example, the University of Namibia School of Medicine (UNAMSoM) had an innovative anatomy program with state-of-the art facilities that remained unbeknownst to other new medical schools in the region such at the University of Botswana that might have learned from this program and how they had planned the facility. With the emphasis on collaboration in CONSAMS, anatomy faculty were brought over to Botswana from Namibia to advise the development of their anatomy program.

With the consortium, the schools have also shared external examiners who upheld a uniform standard between the medical schools. Teaching platforms, teaching resources and curriculums have also been shared between many schools. We are generally opposed to the wholesale import of Western medical curricula and accreditation standards into African medical schools as this fails to take account of the critical relevance of local contexts. This is what the British humanist Alan Bleakley has call the “McDonaldization of Western medical education” ie the import and selling of Western medical education brands around the world.

Some CONSAMS schools have also implemented innovative policies to staunch the “brain drain” of medical expertise from Africa. Namibia, for example, has established a quota system that selects a specified number of rural students since rural students are more likely to return to practice in rural areas but may initially may not have the same selective advantages as urban students coming our of elite high schools This policy has been replicated to some extent with other medical schools due to the consortium.

What are some challenges to the success of CONSAMS?
There are certainly always challenges; I think the biggest challenge we face today is financial. How much can you do and how much are people willing to fund? It becomes a challenge when the consortium spans several nations.. There is much more we would like to do with CONSAMS, such as incorporating all new medical schools in Africa. Many of these schools are limited by lack of physical resources and human capital. For example, Namibia has a beautiful new medical school but are short of some critical faculty. Salary is not the only factor and the problem is complicated with no simple solution. Studies have shown that physician retention in rural areas depends also on other factors such as adequate capacitation and support networks as well as infrastructure, schools and family facilities.

How are medical schools internationally different from American medical schools?
There are many contrasts. One of the greatest contrasts is the duration of medical education. In the United States, four years of undergraduate education are required before medical school admission. Medical school is then another four years. Most other medical schools around the world admit students straight out of high school and enroll them for about six to seven years. The first three years tend to focus on the basic sciences, while the fourth to sixth year are purely clinical. The seventh year is an internship, before a position is often offered. Some students may take an eighth or ninth year to do a more extensive internships while awaiting a consult/faculty appointment. This education model has advantages and disadvantages compared to the American system..

The longer duration of the non-American medical degree can give students more exposure to clinical medicine and especially to perfecting their physical exam and diagnostic acumen as the education is also somewhat less technology based. Disadvantages include the fact that students must make up their mind very early on and they are judged by their high school results.

Compare the admissions process between American and African medical schools.
I would say that as a whole, the admissions process is similarly merit-based. In Africa the process is not as holistic as I would like it to be. They often merely look at results from school, and a well-rounded person may lose out to someone with better test scores. I think the American system has some advantages in that you have four years to catch up and diversify your interests, CV and application. In some African schools, you may still see undue influence being exercise over the application process by people in power but that occurs in many parts of the world including the US. I think this has also gradually it has changed for the better.

What are some changes you envision in the American medical education and the health system in general?
We can no longer expect medical students to absorb the entire corpus of medical information. The complexity of knowledge has long outstripped the capacity of the human brain to absorb it all. Rather than teaching just information and facts, we need to teach students how to be better users of their brain, to be flexible thinkers and agile learners, with a mindful capacity for cognitive and emotional regulation. As the poet W.B. Yeats said, “education is not the filling of a pail, but the lighting of a fire.” We want to cultivate people who can adapt to change and can seek out knowledge that is needed. We need to move away from outdated models of the transfer of knowledge from teacher to student, towards equitable learning communities and self-directed learning with more formative feedback and assessment rather than just end-semester summative exams. It is also important to develop resilience in medical students, because the practice of medicine can be demanding and emotionally draining at times.

I think that the humanities deserve more space in the medical curriculum. Medicine is both an art and a science. The idea of medicine as an art is being gradually eroded with all the increasing technical advancements and the pressure to master such new knowledge. There is no evidence to suggest that student applicants with a pure science background perform better in medicine than those with humanities backgrounds. Studies have shown that they perform equally well in medicine.It may not be necessary to learn all that organic chemistry. Instead, studyingthe humanities such as literature may better serve to nurture empathy in students.

In terms of the American medical system specifically, I think that it is quite broken and disjointed. I work in the clinics where I see patients disoriented and shunted from one service to another. The complexity of the system escalates the potential for medical error. The Institute of Medicine estimates that over one-hundred thousand people die a year from medical error (like four filled jumbo jets crashing every week and killing everyone on board). I have worked in European systems where medical records are confined to a small, personal card. The card is scanned into a machine and an entire medical record pops up. This eliminates bureaucracy and minimizes the chance of medical error. Here, one must fax various records from one physician to another and, along with infighting, often increases chances of a mistake.

I am a strong believer in a national health service. It is disturbing that the debate has been complicated and confused by political special interests in this country. Obamacare did not solve all issues but it is certainly a step in the right direction. I predict that we will steadily move towards a two-tiered health system, with a basic national health service and upscale private insurance care.

Are there any final thoughts you would like to add?
I think medicine in this country is so competitive that they have set up so many competitive barriers to weed students out of the medical profession, and this is sad. I think there is a huge selection bias in medicine; I think we are too often selecting students who are excellent test takers with well-trained memories, not to mention wealthy parents who could afford to send them to the best high schools and colleges. We need to do a lot more to democratize medicine. This means not only opening it up to disadvantaged students but also re-humanizing the discipline by breaking down its inherently authoritarian structures and allowing more space for the humanities - or at least better integrating them into the basic and clinical sciences.