Dr. Thomas L. Schwenk, Dean of University of Nevada, Reno, School of Medicine
Aug 21, 2016
Dr. Schwenk received his B.S. in chemical engineering and M.D. from the University of Michigan. He trained in family medicine at the University of Utah, including a Robert Wood Johnson research fellowship, following which he practiced in Park City, Utah. He served on the faculty of the University of Utah Department of Family and Community Medicine for several years before returning to the University of Michigan in 1984.
He served as Chair from 1986-2011, during which time the department grew to become one of the premier departments of family medicine in the country with over 80 full-time faculty members. He served on the American Board of Family Medicine from 2000-2005, including as Vice-President from 2004-2005. He was elected to the National Academy of Medicine (formerly the Institute of Medicine of the National Academies) in 2002. His most recent research and writing focuses on mental health in medical students, residents and physicians.
He assumed the role of Dean of the University of Nevada School of Medicine and Vice-President for Health Sciences of the University of Nevada, Reno in July 2011.
How did you decide on a career in medicine?
My undergraduate major at the University of Michigan is Chemical Engineering, but as I finished my junior year, I became more interested in Biomedical Engineering, a nascent discipline in the early 1970s. My advisor said he didn’t know where Biomedical Engineering was headed, but going to medical school and doing an MD/PhD would help, because “physicians will only talk to other physicians!” So I finished in Chem Eng, went on to medical school at the University of Michigan, and the longer I was in medical school, the more interesting people became and the less interesting engineering was, leading ultimately to Family Medicine and a strong interest in mental illness.
What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the University of Nevada School of Medicine?
One could not possibly plot a course from medical student to dean, but I trained in a very academic environment at U. Michigan, which is famous for turning out more department chairs than any other school. After finishing residency, I was offered a fellowship position, but felt compelled to go to a small town and start a practice, at least for several years, before returning to complete a Robert Wood Johnson research fellowship at the U. Utah and then moving to Michigan for a more traditional academic career. For better or worse, I was asked to step in as interim department chair shortly thereafter, was selected as the permanent chair 2 years later, and went on to serve as department chair for a total of 25 years. I think my path to being a dean has more to do with a passion for medical education and research, writing, mentoring and other aspects of academic life, than for the job itself. It just happens to be a way to have a huge impact on medical education. I benefited from strong mentors all along the way who served as role models of outstanding service-based leaders. I have also maintained a strong commitment to basic clinical, teaching and research responsibilities while serving in leadership roles, so as to keep some professional balance.
What is the greatest difference between the clinical side of medicine and the administrative side?
Clinical medicine could be described as having an impact on a community or large population of patients by taking care of patients one at a time, whereas leadership roles have an impact on individual faculty and staff members, students, residents, and patients by making decisions on a large-group or system basis. But the net effect is the same, improving the life, career, or health of a large group of people. I have always found to helpful to continue to be active in research, writing, speaking, teaching and clinical care, so I always remember the roots of being a physician.
What was/were the most memorable experience(s) during your medical education?
One of the most powerful experiences was a summer traineeship in Physical Medicine and
Rehabilitation, during which I was assigned to follow a 17 year-old young man who had just become quadriplegic in a motor vehicle accident. I was only 22 years old at the time. I followed him for 3 months as he adjusted to his devastating injury, and I learned a tremendous amount about the experience of illness, the experience of being a patient, and how the medical care system functions.
What do you think is the biggest challenge facing physicians today?
I think physicians have been selected and trained to be “captains of the ship”, with high levels of autonomy and personal accountability, but now find themselves functioning in highly integrated systems with high levels of oversight, regulation and requirements for team-based communication and function. It is not an issue of which system is right, but that physicians are trained one way and then asked to function in a different way, leading to high levels of frustration, burnout, and discouragement. We need to match our admissions and selection process and training and socialization to the professional skills and traits that will be required in the future.
In a time where technology is rapidly advancing and there is a push toward “precision medicine” initiatives and moving medical records to electronic databases, how can we best streamline this process while keeping in mind patient privacy?
Privacy is impossible—just as it is with a Home Depot credit card—and an illusory goal, but professional and discrete uses of personal information with appropriate disclosure and permission are possible and desirable.
There is an enormous debate these days as to whether resources should be primarily allocated to fighting diseases or the distal causes of diseases. What are your thoughts on this issue of proximal causes versus distal causes?
Prevention is always better than cure, but Western culture does not value long-term preventive approaches that require personal responsibility. We are a society that values and rewards reductionistic thinking and approaches. A pill or a procedure are seen as far preferable to exercise or a change in diet. We are now finding that we cannot afford this approach, but we are unwilling to invest in the long view and reimbursement has yet to catch up with the desire to provide more preventive services.
What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
Admissions committees most want to see passion, resilience, commitment and hard work, assuming that many applicants have the requisite GPA and test scores. Shadowing physicians is relatively worthless, but working as an EMT, or hospital tech or aide, or a nursing home assistant, or other roles that give a clear view of the realities of medicine is of great value.
How do you foresee medical education changing in the next few years?
There will be in increasing use of online and other digital approaches to transmit knowledge, and computer and simulated approaches to training for skills, with a focus of precious faculty teaching time on analytical, evaluative and problem-solving skills so as to use that knowledge and skills in more precise and smarter ways. We will quickly come to the point where no procedures will be allowed to be done on patients until a student or resident has been certified in a simulation lab. The locus of responsibility for mastering basic knowledge will move to the learner, who will be expected to prepare for class discussions with knowledge acquisition before class, and then be able to apply that knowledge in class discussions.