Leaders in Medical Education

Dr. Thomas Aretz, Vice President of Partners HealthCare International and Affiliate Pathologist of Massachusetts General Hospital

Osmosis Team
Jul 8, 2016

Dr. H. Thomas Aretz, M.D. serves as Vice President of Global Programs at Partner Harvard Medical International and also serves as an Associate Pathologist of Massachusetts General Hospital. He is also an Associate Professor of Pathology at Harvard Medical School. Dr. Aretz is a member of the PHMI's senior management team focusing largely on academic programs and institutions.Dr. Aretz is a Program Director for the Harvard Macy Institute and has been involved in international programs since 1996. He served as Cardiovascular Patho-Physiology Course Director at Harvard Medical School from 1992 to 2005. He is the Co-Founder of three medical device companies and serves on many academic and hospital (IRB chairman) committees and industrial boards.  Dr. Aretz has been in the academic practice of Cardiovascular Pathology since 1981. He has lectured and published extensively and has received multiple teaching awards at Harvard Medical School and MGH. Dr. Aretz has also won recognition for his efforts to improve medical education around the world through intra-institutional collaborations. In 2006, he was named an "Ehrenbürger" (honorary citizen) of the Ludwig Maximilians University in Munich for his contributions to the long-standing PHMI-LMU alliance. Recently, Dr. Aretz was recognized with a MILES Award (Mentoring, Innovation, and Leadership in Educational Scholarship), given by the Yong Loo Lin School of Medicine at the National University of Singapore for outstanding contributions to the advancement of global medical education and academic medicine. He holds a clinical appointment at the Massachusetts General Hospital (MGH), where he completed his Post-Doctoral training. He holds a B.S from Villanova University. Dr. Aretz completed M.D at Harvard Medical School and also completed Academic practice of cardiovascular pathology.

Can you shed some light on your background as well as how you got interested in medicine in the first place?
I grew up in Germany and spent the first 20 years of my life there. After taking 1 semester of chemistry in a German University, I was drafted into the military. At the time I was swimming competitively and met another swimmer who had received a scholarship offer to swim in the United States. He talked to his coach at Villanova University and I ended up getting an athletic scholarship there to continue my chemistry studies.

My mother was a nurse and my godmother was a physician; so I had been exposed to medicine throughout my life, and I’ve always been fascinated by science and, in particular, how humans are structured and function. While at Villanova, I re-evaluated made the decision to apply to medical school, and received an acceptance from Harvard Medical School, where I matriculated.

How did you grow interested in medical education?
When I was a pathology resident at Massachusetts General Hospital, I was asked if I was willing to do some teaching. My mentor, a cardiovascular pathologist, was running a course in the joint Harvard-MIT program, which is separate from the regular Harvard curriculum, called the “Health Sciences and Technology” Program. I started teaching there and received positive feedback and enjoyed what I did.

In the 1980s, a colleague of mine who ran the second-year Human Systems course asked me if I wanted to run the cardiovascular portion of the course. When I was running the course, I was given the opportunity to attend a Harvard Business School course on teaching by the Case Method. This experience prompted me to change the way of taught, following some of the pedagogic principles I had learned.

As I was running the course, and as it was getting more complex and longer, I learned that medical education wasn’t just about the content, but about a lot of other things, including organization, governance, values, faculty development, just to name a few. In 1994, I took the Harvard Macy course for Physician Educators and was exposed, for the first time, to scholarly approaches to curriculum planning, pedagogy and learning theory, assessment , the informal curriculum and other topics.

In 1996, the Ludwig Maximilians University of Munich came to Harvard and asked for help in reforming its medical education curriculum, at a time when Germany was changing its regulations. I was asked to be on the Harvard team and helped create their new curriculum, including its first integrated course, and design and implement faculty development programs. This was the beginning of my international medical education consulting work. Over the years, I worked not only on reform projects but also on building new models for health sciences education and workforce development,  and helping with the creation of new schools.

What are your thoughts on the US Medical Education System?
I think compared to other countries (e.g. India), the US allows institutions and faculty to be more inventive and flexible, since its regulations are not quite as rigid and prescriptive.

I would say that what’s still often missing is learning to apply principles and concepts rather then learning facts, especially now, when information is universally available. Scientifically, medical school students should understand man as a system and man as part of systems. I think medical schools do a reasonable job in teaching man as a system, but an insufficient job on man as a “social animal” (i.e. part of family, community, nations and the world) and man as part of  a culture ( i.e. Understanding what shapes people – history, values, principles, conventions, mores, origins, backgrounds, experiences)

Physicians need to move on from the Marcus Welby 1-on-1 model of patient care, as “romantic” as it may seem. Healthcare is changing, and we need to be better in teaching future healthcare providers how to work in teams. Presently, a lot is still done by parallel processing instead of putting together the appropriate diverse teams to find the best solution. I think physicians today still do a lot of work that could be done – often better - by other professionals, and there are still significant turf battles in healthcare.

I also believe that physicians should be exposed to liberal arts education. In many countries including the US, medical school is still considered an academic pursuit that focuses on mastering content rather then the creation of a professional identity, an aspect that has been the subject of multiple recent publications.

In addition, we will need to start looking at performance data like other industries do and hold physicians responsible based on accepted metrics. Recent technical developments and the concomitant availability of data will drive this development, something a lot of physicians find quiet threatening. We will need professionals that can not only co-exist with technology, but can use it to keep people and populations healthy.

What direction should medical education move in to improve the quality of physicians in the future?
We have to better understand and define what is expected from physicians at the various stages of professional development; hence, for instance, the movement to EPAs (Entrustable Professional Activities), i.e. a set of competencies that define an activity, which one can without supervision. These in turn, describe milestones, the direction towards which medical school and graduate medical school education should move. It will require that we are able to certify that someone can do certain tasks independently, beyond the traditional academic examinations, which may not be relevant to practice.

We need a clearer understanding of where medical students, trainees and practicing professionals are, where they should be, what they can and cannot do yet, and devise focused and targeted interventions to allow them to develop the needed competencies. As a result, medical education should move from time based to competency based, but at the same time, will be ever present.

What was it like cofounding various medical technology companies? What are some of the biggest challenges you faced and how did you overcome them?
Because I was a single parent at the end of my residency, I needed an 8-5 job and I joined the Lahey Clinic rather than stay in an academic institution. It was a great place to practice and I was there for 8 years. We were located on Route 128 in Boston, then known as one of the “technology  highways” in the US. There were a quite a few technology companies around, and we made presentations to a lot of those companies to see if we could collaborate.

I met a physicist and we came up with an idea for an intraluminal ultrasound catheter. We got the interest from a Venture Capital Fund and made a presentation on a simple concept through which we raised $2.5MM in seed funding. We started the company and managed to raise $35MM over a 10 year period. Unfortunately, we hit some regulatory hurdles and didn’t realize that the main product we were trying to create wasn’t going to work as planned. My colleague managed to sell our catheter navigation system to a large medical technology firm after we wound down the company.

I saw a company rapidly ramp up to 110 people, with a European and Japanese office, and then have to wind it down. I learned that even having bright and dedicated people and money doesn’t guarantee success, but I got a lot of exposure to venture capital and financial matters, as well as the regulatory process of medical devices.

I did another company with a similar group of people to create a radiotherapy device, which we sold off to a Belgian company.

I got a lot of exposure to how businesses work and consequently sat on several boards, and worked as a an advisor and consultant. It was good to see the other side of medicine, the commercial side, which I believe all physicians should be exposed to because as a physician we don’t realize how difficult and expensive it is to create the products we use.

Do you have any final thoughts regarding the Medical profession as a whole?
I think medicine is a fantastic profession but it does need to anchor itself more in the community than it has done in the past, especially the academic medical centers. It has to look at population needs and re-orient itself accordingly. This viewpoint is often seen as a loss of autonomy for physicians and healthcare institutions but it’s actually a reaffirmation of the mission of medicine – to serve. We as a profession have to work together more with other stakeholders to serve our patients and the needs of society.

With regards to my career, you can see that it was not exactly linear. My career sometimes took detours due to personal circumstances, but I always tried to look at opportunities around me and take advantage of them. I like education and I like to teach and I really feel that creating the workforce of tomorrow by changing our organizations and culture is important.

I went with my gut a lot; sometimes I flopped, but sometimes it worked out okay.