Leaders in Medical Education

Dr. Robert Means, Dean of the James H. Quillen College of Medicine at East Tennessee State University

Osmosis Team
Published on Jul 25, 2016. Updated on Invalid date.

Displaying Means_Robert001.jpgDr. Means is Professor of Internal Medicine and Dean of the James H. Quillen College of Medicine at East Tennessee State University. He received his bachelor’s degree in Biochemistry from Rice University and his medical degree from Vanderbilt University. He trained in Internal Medicine at Baylor College of Medicine and in Hematology at Vanderbilt. Dr. Means is Board certified in Internal Medicine and Hematology. After completing his fellowship, he was appointed to the Vanderbilt faculty as Instructor and then Assistant Professor in the Hematology Division. In 1992, Dr. Means was recruited to the University of Cincinnati as Associate Professor of Medicine in the Hematology/Oncology Division and Director of the Diagnostic Hematology Laboratory. He moved to the Medical University of South Carolina as Professor of Medicine, Associate Director of the Hematology/Oncology Division, and Chief of the Hematology/Oncology Section at the Ralph H. Johnson VA Medical Center in 1998. Dr. Means was Director of the Hematology/Oncology Division there from 2000 until his recruitment to the University of Kentucky in July 2004 as Professor and Associate Chair for Research in the Department of Internal Medicine, and Chief of the Medical Service at the Lexington VA Medical Center. He resigned as Chief of the VA Medical Service to serve as Interim Director of the Markey Cancer Center from 2006-2009. From 2007 to July 2011, he was Senior Associate Chair of the Department of Internal Medicine at UK. He was Executive Vice Dean and later Executive Dean of the College of Medicine from 2011 until his recruitment to ETSU as Dean in March 2014.

Dr. Means is an internationally recognized authority on red cell production and its diseases, and maintained an active and funded research laboratory for more than 20 years. He has published more than 120 papers and book chapters. Dr. Means is a member of the Hematology Examination Committee of the American Board of Internal Medicine, the Medical and Scientific Advisory Board of the Iron Disorders Institute and has served as a grant reviewer for the National Institutes of Health, the Department of Veterans Affairs, and other funding agencies in the US and abroad. He is an editor of the 12th through 14th editions of Wintrobe’s Clinical Hematology. Dr. Means serves on the editorial boards of the International Journal of Hematology, Blood Research, and the American Journal of the Medical Sciences, and is a Deputy Editor of the Journal of Investigative Medicine, as well as being a frequent referee for other journals.

Awards received by Dr. Means include the Henry Christian Award from the American Federation for Clinical Research, the “Faculty of the Year” award from the UK Internal Medicine Chief Residents, and the Founders Medal from the Southern Society for Clinical Investigation.

In addition to his activities as Dean, he continues to practice Hematology, teach, and to contribute to the medical literature.

How did you decide on a career in medicine?
I am not entirely clear on it myself. I was always interested in science and from 1st through 9th grade had a little corner in the garage or basement with a microscope and a chemistry set. However, my ambitions probably revolved more along growing up to be Sherlock Holmes or Perry Mason. My father worked for an oil company and we moved a fair amount when I was in school. Our last move was from Connecticut, where we had been for seven years – longer than anywhere else – to California. As a new kid starting 10th grade, somebody asked me what did I want to be when I grew up, and I told him I wanted to be a doctor. It had never really been something I thought about much before but it was also a decision that never changed.

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the James H. Quillen College of Medicine at East Tennessee State University?
I went to college at Rice, where I got a wonderful education and was very happy. I liked chemistry much better than biology and so elected to become a Biochemistry major for my premed studies. Biochemistry at Rice was much more chemistry focused than biology focused in those days, and heavily laboratory oriented. Majors were strongly encouraged to do a year-long research project as seniors, and that likely helped establish an interest in a potential career in academic medicine. I was accepted to medical school at Vanderbilt (among other places) and made the very fortunate choice to go there. In those days Vanderbilt’s medical education had a heavy hematology influence, and that largely directed my career choice. I am reasonably confident that if I had gone to one of the other specific schools where I was accepted, I would have ended up a nephrologist. After my residency at Baylor in Houston, I returned to Vanderbilt as a Hematology fellow, and was asked by my chief if I was willing to spend sometime in the research laboratory. I was, and got involved in a good project which led to my getting a grant as soon as I was done with my fellowship. I stayed on the faculty there for four more years, by which time my fiancé was being recruited to the University of Cincinnati. It turned out they were looking for a funded experimental hematologist, and I fit the bill. When I got there, they needed somebody to take over the Diagnostic Hematology Laboratory, which was mostly in the business of processing and interpreting bone marrow specimens, as well as some studies of iron status. Since I was a “classically trained” hematologist with a lot of morphology experience, I was given that job. I realized that in addition to being a source of clinical and administrative experience, it provided me additional opportunities for accessing new areas of research. I will not go through the details of all the subsequent moves of my career which eventually involved working at the Medical University of South Carolina and the University of Kentucky before moving here as Dean about two years ago, becoming a division child, chief of the medical service at a VA, and interim director of a Cancer Center, and then progressive administrative experiences at the department and College of Medicine. I think the lesson is to do well at the things you undertake, and to be open to the opportunities that present themselves. As a final example which is likely the most relevant, up until four or at most five years ago, my ambition was to be Chair of a Department of Medicine. I never got one of those jobs, but the last time I interviewed for one, several people on the search committee asked me why I was looking at these jobs when it was clear that my variety of experiences and institutional and interdepartmental level made me highly qualified to be a Dean. I had not thought about it before, but on reflection began looking at Dean jobs and here I am.

What is the greatest difference between the clinical side of medicine and the administrative side?
I do not regard these as necessarily exclusive. In my view, seeing patients is the major element of my definition of myself as a physician, and I still have a clinic. I cannot imagine having a job where I had no patient interaction. It helps me feel connected to the activities of the faculty, and I suppose it also helps them feel connected to me. I lecture in a couple of courses, give Grand Rounds in one or two departments every year and still continue to publish, although mostly review articles and chapters now. I gave up my research lab when I became a Dean. Both the administrative and clinical side of medicine are about solving problems, and both of them are about interaction with people and their needs. The administrative side is more about creating an environment in which the clinical and educational sites can flourish. The satisfactions of administrative medicine are less immediate and less emotionally enriching than those in clinical medicine, and indeed may occur fairly far down the road. One of the Deans I worked with back when I was division chief spent an afternoon every week practicing anesthesiology in the operating room. He told me once that it was his favorite part of the week: he had the immediate satisfaction of a job accomplished, and nobody asked him for money. I understand how he felt.

What does an "average" day look like for you?
There really aren’t “average” days. I get up early, look at my night’s emails on my phone, answer the one or two urgent ones, then look at my calendar. When I get to the office, I review a medical update service to which I subscribe, pull up some of the papers referenced, and read them Then I launch into my day’s appointments. If I don’t have a lunch meeting, I work on some of my book chapters and review articles and catch up on my journals. I try to finish up with some of my academic work at the end of each day before I go home. At the beginning and at the end of the school year, and also in December, there are frequently work-related events I need to go to in the evenings. Fortunately, most of the rest of the time I can spend the evening at home with my family.

What was/were the most memorable experience(s) during your medical education?
There were so many, and most of them were related to encounters with patients. Although I understand and accept the reasons for workload limitations in training, I do believe that something is lost in a circumstance that mandates fewer interactions with patients. I remember the first time I took a history from an actual patient: we had been told to ask open-ended questions and to avoid premature diagnostic closure. I asked the lady, “What brought you to the hospital?”, and she said, “Wegener’s granulomatosis”. But even more memorable was the first time a person stopped me on the street and said “Aren’t you Dr. Means? Thank you for taking care of my baby in the hospital”. When you are a new third year medical student, it does not get more thrilling than that.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
In the interest of full disclosure, I first must say that the rules of this medical school prohibit the Dean from any involvement in admissions decisions or from reviewing applications. This rule has saved me countless hours on the telephone and pages and pages of letter writing, and allows me to escape from parents at cocktail parties. That being said, what I tell students is that they need to show a commitment to excellence in whatever field they chose as their major; they need to show that they have the intellectual capacity to handle the scientific aspects of the curriculum; they need to show commitment to a career of service in general and medicine in particular; and finally, they need to show the elements of character that would make this school proud to number them among our graduates.

How do you foresee medical education changing in the next few years?
I foresee a greater emphasis on the provision of care as part of a multidisciplinary team as probably the major change in medical education compared to when I was in school. I also anticipate a greater emphasis on prevention and on the costs of medical care: not just the costs of treatment, but the costs both economic and non-economic of the diagnostic work. When I was a student, we were expected to work up every problem of every patient on our service, regardless of whether or not it was the problem that brought them to the hospital. The physicians we are turning out will tend to focus on the primary problem, and other problems will likely be evaluated in the outpatient setting, if at all. The challenge will be training physicians who can recognize when what appears to be an insignificant abnormality may be an indicator of a meaningful underlying problem.