Chapter 17: Developing Educational Initiatives in the Department of Internal Medicine
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Description
Dr. Escalante explains her educational mission as Department head. She talks about programs to develop educational initiatives to the same level as research and clinical programs. She notes that, in collaboration with Sai-Ching [Jim] Yeung and Robert F. Gagel she wrote the textbook, Medical Care for the Cancer Patient. She actively attends conferences on cancer patients and survivors. She notes that Dr. Jeong Oh received an Educator of the Year award. She explains that everyone in the Department has exceeded her expectations and her success is due to her good faculty.
Next, Dr. Escalante explains what remains to be done to develop the Department: build up the Hospitalist Program, invest in research, and develop the Suspicion of Cancer Program, which enables patients to obtain a diagnosis and get care at MD Anderson.
Identifier
EscalanteCP_02_20140514_C17
Publication Date
5-14-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; The Administrator; Education; Beyond the Institution
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Okay. Well, let me just start the recorder again. Okay. I’m turning the recorder back on after about a two-minute break, and we were strategizing a little bit about what to do next, just for the record.And I wanted to ask you about your role as Medical Director of the Emergency Center, and you said that that also connects up with the launch of the Department of Emergency Medicine in 2010, so it sounds like a big chunk of time there. So you became Medical Director of the Emergency Center in 1997. So tell me about that.
Carmen Escalante, MD:
Well, back then it wasn’t called the Emergency Center. Back then we had Station 19. It was called Station 19. And we split our time between, when I first started, Station 19, which is now the Emergency Center, and doing consults on the inpatient and outpatient areas, and over the years it grew. Well, when I took over as section chief, the previous section chief was also the medical director of the Ambulatory Treatment Center area and the Emergency Center area, which was all one area. It was called Station 19A was the Emergency Center area, Station 19B and C were the chemotherapy administration areas, called the Ambulatory Treatment Center. So when I took over as section chief, those roles were also rolled over to me, and that’s how I became the medical director.And over the years, the Ambulatory Treatment Center has grown, so that in 2000, when we split from Cancer Medicine, the Station 19A or the Emergency Center went to internal medicine, and Station 19B and C, the Ambulatory Treatment Centers, went to Cancer Medicine, but we as general internists continue to provide supervision through this day over the chemo areas, and I continue to be the medical director of the Ambulatory Treatment Center, although it sits in the Division of Cancer Medicine.The Emergency Center, I continue to be the medical director. I guess in 2000 is when I became medical director of each, because before, it was one. So regarding the Emergency Center, or Station 19A, when it moved from Clark Clinic in—it expanded its space. I don’t remember what year that was, maybe early 2000s. I guess around 2004 or so, I was then department chair, and I moved the section chief to Margaret Row. She was one of the faculty and worked predominantly in the Emergency Center.Back then, all the faculty that work in the Emergency Center, just in the Emergency Center, was part of general internal medicine. We had a mix. We had faculty that were hired just to work in the Emergency Center, which had been different than when I initially was hired, where we worked in days, and the evenings and nights were covered by the fellows. As the area grew, we needed—the fellows weren’t as crazy about working as nights, and the care wasn’t to the same expectations during the day, and a decision was made probably in around 2000, somewhere around there, to hire faculty that would just work in the Emergency Center days and nights.So we began recruiting faculty that they were all internists that wanted to work and care for acute patients in an Emergency Center-type setting, and then I—
Tacey Ann Rosolowski, PhD:
Can I—I’m sorry. I just wanted to ask you, you said that the Emergency Center moved from the Clark Clinic. Where did it move to?
Carmen Escalante, MD:
It moved to the front of the main Lutheran Building, and I can’t remember, that was probably in around 2000, mid-2000s. And space was increased enormously. By that time, I may have been medical director for a year or two, and then it was transitioned to Margaret Row. So it was moved physically. And so we hired these physicians that worked just in the Emergency Center. Then I had a group of internists where we worked both. We did days in the Emergency Center and we worked in other areas, but we didn’t do nights, so we supplemented the Emergency Center group that worked only in the Emergency Center.
Tacey Ann Rosolowski, PhD:
Can I ask you, when you made the decision to begin hiring faculty only to work in this acute-care situation, was that a controversial decision to shift that away from fellows?
Carmen Escalante, MD:
No, I think it was—no. The fellows, we were still supplementing with some fellows because even today I think they still—well, I don’t think they use fellows anymore. They use outside consultants that can work extra shifts to fill in here and there. But it was a major change, because for years it had been—I remember when I was a student here—not a student, an intern here, Station 19 back then was just one big ward with beds, and during the day, the oncologists came in and saw their own patients, and after hours the fellows took care of them.So over time, as general internal medicine developed, there was a huge improvement in how acute patients were handled. So I was the second one here, and when I first started, even then a few oncologists would not let us touch their patients. They’d come down and see them. But after a while, once they developed the confidence in us, we saw all of them down there.And this continued, and it got busier and busier as the institution grew, and so it outgrew space. That’s when we transitioned over. We had a hard time in attracting fellows because after a while, you know, it’s hard work—
Tacey Ann Rosolowski, PhD:
Right.
Carmen Escalante, MD:
—to work at night and then go to day. And some groups needed the extra money, and others didn’t. And so over time, the decision was made we just need to start hiring people.
Tacey Ann Rosolowski, PhD:
Where’s the Emergency Service located now?
Carmen Escalante, MD:
It’s still in the new—
Tacey Ann Rosolowski, PhD:
Oh, it’s still there.
Carmen Escalante, MD:
—in the front of the Lutheran Pavilion on the first and second floor.
Tacey Ann Rosolowski, PhD:
Okay. I just wanted to make sure it hadn’t moved yet again. (laughs)
Carmen Escalante, MD:
No.
Tacey Ann Rosolowski, PhD:
Okay. (laughs)
Carmen Escalante, MD:
And so it grew and grew, and as we grew faculty, the department grew, and there was a lot of struggles trying to recruit people, maintain people, fill the night shifts, until about maybe three or four years ago, Dr. Gagel decided that general internal medicine was too big and that he wanted to split off the Emergency Medicine Group and make them a separate department. So I guess there was probably seven or eight faculty at that time, maybe, that were full-time Emergency Center, so they created a new department and hired—
Tacey Ann Rosolowski, PhD:
And that was in 2010?
Carmen Escalante, MD:
Yeah, somewhere in that range. I can’t—probably around four years ago, maybe, something like that. And they recruited a chair; Dr. Todd is the chair of Emergency Medicine. And I think it’s been a good thing. It’s allowed that group to focus on just emergency care. It’s given me a good reprieve, because, you know, I had an extra section then of emergency care, and they were going through growing pains, and, you know, I think it worked out well for everybody concerned. And now it’s off my radar, so I don’t have to worry about it anymore, and it takes a lot of time.
Tacey Ann Rosolowski, PhD:
I assume with the giving Emergency Medicine a department status, that also means that there will be research associated as well.
Carmen Escalante, MD:
Right. So Dr. Todd got resources when he was made chair. I’m not sure how much. But he has started to develop a research program focused on emergency medicine issues, and he was given a number of clinical positions so that he could hire more faculty. I mean, we got hit right about the time that the institution was having financial difficulties, and we had tried to hire two people, and then everything was frozen. It was a bad time. They were short-handed. We had verbally offered a couple positions. We couldn’t hire them. There was a lot of stress down there. We had to use consultants to fill in until the situation, the financial situation improved and everybody was able to hire. But I think with him getting a package, it gave more resources to that group so that they could develop, you know, individually. So I feel good that I got something started and was able to get it to a department status so that they could grow on their own.
Recommended Citation
Escalante, Carmen MD and Rosolowski, Tacey A. PhD, "Chapter 17: Developing Educational Initiatives in the Department of Internal Medicine" (2014). Interview Chapters. 775.
https://openworks.mdanderson.org/mchv_interviewchapters/775
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