COLLEGE OF MEDICINE
History of the Medical College
|The Founding and Early Excellence|
Although the College of Medicine was not officially established until 1824, a young physician from Pennsylvania sowed the first seeds of formal medical education in South Carolina. David Ramsay, M.D., a student of one of the founders of the first medical school in the United States, played a pivotal role in establishing the Medical Society of South Carolina in Charleston in the late 1700s. In 1803, Dr. Ramsay successfully lobbied the Society to include lectures in Anatomy, Surgery, Midwifery, and Chemistry to benefit students in medicine. The Society agreed and the dream of a formal college began to grow. Nearly 20 years would pass before Thomas Cooper, president of South Carolina College in Columbia, called for the establishment of a medical school in 1821. Cooper most probably wanted the college for Columbia, but his speech inspired those in Charleston instead. The Medical Society introduced its own proposal and a three-year dispute ensued. It ended in December 1823 with an authorization from the South Carolina General Assembly for a college of medicine in Charleston. Less than a year later, the Medical College of the State of South Carolina was a reality. Two years later, the first class of five physicians was graduated.
Despite being proprietary rather than state-supported, the College flourished. Within eight years of its founding, it had a student body of 109, with 35 graduates. By 1856, the College’s first teaching hospital, Roper, was in regular use. On the eve of the Civil War in 1864, the College had 248 students, the fifth largest medical school student body in the country. The rapid growth in enrollment was due in large part to its exceptional faculty, a standard that still holds true today. One early dean, James Moultrie, Jr., M.D., is credited with improving medical education on state and national levels and was a founding member and later president of the American Medical Association. His concern for the quality of the practice of medicine was prescient, as quality care remains the foremost goal of physicians today.
|The Post Civil War Period|
The golden age of the College ended with the firing on Fort Sumter in April 1861. Some 698 South Carolina physicians, including 321 graduates of the College, joined the war effort. The College suspended teaching and classes did not resume until the end of the Civil War. There was a major challenge to reopening: the College’s building, its equipment and specimens had been destroyed. Armed with little but determination, all but one member of the faculty returned and by November 1865, classes had resumed. The dedication of Charleston’s physicians is credited with the College’s survival at that time. In 1872, when students were unable to find money to attend medical school, all fees were suspended and faculty and trustees assumed these financial obligations. The College’s operation had little to do with money; it was clear that the faculty, composed of highly capable local physicians, was acting in the public’s interest. More obstacles were yet to be overcome. In 1886, the Charleston earthquake ravaged the city, forcing the closing of Roper Hospital and severely damaging the College’s building. Alternate quarters were quickly found and classes were uninterrupted.
At the turn of the century, the College faced an uncertain future. Often referred to as the Flexner report, the 1910 publication Medical Education in the United States and Canada1 found that the College, despite its tradition and dignity, was sorely lacking in facilities, faculty, equipment, and money. Flexner wrote that it “pains him”1 to describe Charleston’s school without a dispensary and being a purely mercenary operation. In another place he says that teachers in Charleston after the Civil War rank with Philadelphia, New York, Boston, and elsewhere, and that “from them the really capable and energetic students got much.”1 And he summarizes well his apparent assessment about the College and several others like it: “The Medical College of the State of South Carolina, at Charleston, (and few others) are not without traditions and a certain present dignity.”1 However, Flexner found few redeeming features in the Medical College of the State of South Carolina. In designing his “reconstructed” national medical education plan, he left the entire state of South Carolina devoid of a medical school in his map of the future of medical education in the United States, believing it unlikely that Charleston’s Medical College could or would survive (see figure 1). In his own words, South Carolina’s school was among the 120 he “wiped off the map.”1
Flexner’s report was met locally with steely determination to reverse its impact, and a great number of people are responsible for the salvation of the Medical College. The dean of the College, Robert Wilson, M.D., led the effort to secure state funding. Using brilliant statesmanship, statewide lobbying of fellow graduates of the College, and a strong rapport with Governor Coleman L. Blease, Dr. Wilson succeeded, and in 1913 the General Assembly approved state ownership of the College, appropriating the grand sum of $10,000. The City of Charleston then raised $75,000 to construct a new building, which cemented the College’s future. The effort required to obtain State support is well chronicled by Dr. Curtis Worthington, who summarized this momentous accomplishment as “a fascinating pattern of political shrewdness, loyalty and devotion, artful maneuvering, hard work, goodwill, and, finally, luck.”2 Within a year, a grand, three-story building, the Medical College of the State of South Carolina, stood on Lucas Street. It was a tribute to physicians who led the fundraising drive, a beacon for present and future medical students, and a profound symbol of victory for Dr. Wilson, who went on to serve as dean of the College for 35 years. Other changes, very early after the Flexner report was published, and as a direct result of the damnation of the proprietary nature of the College, were led by Dr. Wilson. Entrance requirements were also almost immediately changed as a result of the Flexner report and the new dean. From high school “equivalency” as a requirement in 1909, admission requirements were strengthened by 1913 to conform to the newly created Council on Medical Education of the American Medical Association. A crucially important change was made in 1955 with the opening of the Medical College of South Carolina’s own Hospital, another delinquency reported by Flexner. This effort was led by Dr. Kenneth Lynch, who served as dean and then president of the Medical College from 1943 to 1960.3
Because of the solid foundation laid by Dr. Lynch, the institution continued to expand, and in recognition of this, the Medical College of South Carolina became the Medical University of South Carolina in 1969. The large and full-time faculty of the College is another important change initiated by Lynch that has occurred over time and continues today, as does the building of more and better facilities. The College in the new University Structure was finally prepared for a real renaissance.
The Years of Renaissance
The College was transformed beginning in the 1980s with the creation and reorganization of several University entities and the expansion of clinical and research activities. The appointment of James B. Edwards as President of the Medical University heralded a bright future. Edwards, an oral surgeon who had served as Governor of South Carolina and then Secretary of Energy under President Ronald Reagan, came to MUSC with a clear vision of establishing a “world class academic health science center”.
Over the next few years, reorganization at the top level of the University began to occur. Agreements were reached with the new School of Medicine at the University of South Carolina concerning the possibility of collaboration. In the late 1980s a Vice President for Research was added, recognizing Edwards’ intent to expand the research program. In 1990, Layton McCurdy was recruited to serve as the Dean of the College of Medicine and the first Vice President for Medical Affairs. This dual appointment had been developed through a reorganization effort recommended by a “blue ribbon committee” that came to Charleston in the late 1980s to provide guidance to Dr. Edwards and the new leadership. Edwards had called together leading medical education leaders from across the United States for this critical task.
Early in his tenure as Dean, McCurdy and Hospital Director, Charlene Stuart, determined that a strategic plan was essential to establish clear objectives that would achieve Edwards’ dream of a world class institution. The strategic planning process took more than a year. The plan identified three major areas for clinical and research emphasis: cardiovascular disease, cancer, and neurosciences. The process also established diversity with students and faculty as a primary goal. It was clear that major leadership recruitment among department chairs was critical to achieving these goals. It was also apparent that to realize the dream, significant philanthropic support was crucial. In those years the MUSC Foundation was strengthened and new leadership obtained to house the philanthropic program of the University.
On the clinical side, the physicians’ group organization (Professional Staff Office) was in essence a billing and collecting entity. Early in the 1990s, the University Medical Associates (a 501c3 organization) was formed and participated in the strategic planning process. Increased patient care income through the medical faculty was regarded as crucial. Further, the organized physicians group could prepare for managed care, as well as reach into other locales in the Lowcountry.
Also recognizing the critical importance of organized relationships with the pharmaceutical industry, another entity was created: The Foundation for Research Development. This organization followed the pattern of many outstanding academic health science centers in the country, and established the pattern of “bringing to market” discoveries made by research faculty. To further this aim, development of the Darby Children’s Research Institute was also initiated during this interval.
Crucial during these years was the importance of recruitment of department chairs and, from them, faculty members who embraced the concept of a strong teaching faculty partially supported by grants and patient income. In 1990 the university’s research portfolio was less than $18M. By the end of the decade, the research portfolio had grown to almost $100 million.
During these years, the Hollings Cancer Center was dedicated and opened. The Strom Thurmond Institute for Research was completed, including shared research space with Veterans Administration faculty, and the Gazes Cardiovascular Research Institute was completed as well. With the recruitment of key faculty, the strategic objectives of cardiovascular disease, cancer, and neurosciences began to be fulfilled.
In the mid 1990s the university obtained the building that had housed the downtown St. Francis hospital to be used as the ambulatory clinics building. A major renovation of the building was undertaken, with a goal toward creating an effective patient care center. The process included construction of a garage for patient use, and creation of linkages for inside transportation of patients from the university hospital to the center, which became known as Rutledge Tower. Under the leadership of Marion Woodbury, the University Medical Associates began to expand from Hilton Head to Georgetown, all along the South Carolina coast.
Following the example of several leading American medical schools, a significant revision in the student curriculum was also undertaken. For several years there was a parallel curriculum utilizing a self-instructional, small group learning approach. After four successful years it was determined that this approach needed to be applied across the entire class. Small group teaching and patient-oriented activities during the first two years, coupled with self-instruction, were some of the tactics utilized in this major curriculum revision. This effort was significantly facilitated by the increasing sophistication of internet information resources, as well as an automated online library. Included in this curriculum were new rotations in rural and small town South Carolina for students during their clinical years. This was done in collaboration with the USC medical school in Columbia. These “rural rotations” became very popular with the students, and enhanced linkages with alumni throughout South Carolina. Within the student curriculum, one of the additional major achievements was the organization of testing in blocks.
The Harper Student Center was opened during this time, providing state of the art physical fitness opportunities for students across the University, as well as the new education center for the College of Medicine. This center housed learning rooms for small group work and examination rooms for use with simulated patients. MUSC was a pioneer in the utilization of simulated patients for assessing clinical abilities and skills. This practice was subsequently adopted on a national level and incorporated into Part 3 of the National Board.
Operating under state regulations, the Medical University Hospital was disadvantaged in the increasingly competitive world of hospital care. With the concurrence of the South Carolina legislature, the Medical University Hospital Authority was formed during this period as well. This public interest authority permitted the hospital to utilize more appropriate administrative measures to achieve its mission-critical goals.
The New Millennium
The year 2000 brought the inauguration of a new president of the Medical University of South Carolina, Raymond Greenberg, M.D.,Ph.D., who had served as provost and Vice President for Academic Affairs of the university after being dean of Public Health at Emory. His first permanent appointment was a new dean of the College of Medicine to replace the retiring Layton McCurdy, M.D., in 2001. Jerry Reves, M.D., was recruited from Duke University to the deanship and Vice Presidency of Medical Affairs. The College was on a firm foundation and McCurdy’s people and programs were making enormous progress that mostly needed support and little meddling from the new dean. Nevertheless, some things were done that merit attention. A new strategic plan to improve research, expand clinical operations and to create and implement a new curriculum was developed in the first three years. Key elements were to improve interdisciplinary cooperation in these areas. In 2005, Neurosciences became a single academic department from three smaller ones, Neuroscience/Physiology, Neurology and Neurosurgery, making interdisciplinary program development a concrete example. This merged department has had spectacular success in student education, clinical care and research. More recently in 2009, a major restructuring of the basic sciences was undertaken, partially in response to the recession-driven budget crisis of the State and College, but also to create better opportunities for collaboration in education and research. The unified Division of Basic Sciences was created to break down barriers between the basic sciences of Biochemistry and Molecular Biology, Cell and Molecular Pharmacology and Experimental Therapeutics, Microbiology and Immunology. The College’s basic science expertise still exists in full force, but is now structured in a more cohesive and less bureaucratic form. Emphasis throughout the new Department continues to be centered upon performing world class research and providing state-of-the-art medical education, bolstered by innovation through collaboration.
The medical student curriculum was finally changed in 2009. It still resembles the four years that Flexner so strenuously supported – two years of basic science and two years of clinical science. However, beginning this very year, the Medical College is implementing a two year progression into an “integrated” curriculum, designed to acquaint the first and second year medical students with the relevance of the basic sciences to clinical care by placing the scientific underpinnings of medicine within the context of organ systems and patient disease. In other words, instead of having each of the basic science topics taught separately as parallel courses, the pertinent aspects of these basic sciences are integrated within a common set of underlying themes that horizontally run throughout the first two years. Overlying these themes, the curriculum is further organized vertically into a framework of the various organ systems of health and disease, and each module is introduced through the video presentation of a single patient. It is this patient’s biopsychosocial issues that provide context for all of the teaching that takes place within a given module.
The College now admits 160 students in each class. This is a 19% increase over the past 10 years when it was 135 in 2000. Notably the diversity is also greater with approximately 48% female now and about 20% underrepresented in medicine, most of whom are African American.
A university is a community of scholars whose work is learning and teaching. The University in its best sense is an environment where learners and teachers are seriously engaged in broadening the views and knowledge of all who interact: this means that the generation of new knowledge through scholarly research is a major activity. This is exactly what is happening today at the Medical College, which has taken its rightful place among the upper tier of schools of medicine in this country. The major research funds awarded to MUSC in 2009 by the National Institutes of Health included the approximately $20 million Clinical and Translational Science Award (CTSA), one of only 46 similar medical school awards in the country, as well as the $10.5 million award by the National Cancer Institute of “Clinical Center Status” for the Hollings Cancer Center, placing MUSC among only 65 institutions with this designation. Also, the National Science Foundation awarded MUSC $5.2 million for tissue engineering, placing the Medical College within a very elite group of academic medical centers at the forefront of this exciting realm of research. For the first time in its life the College of Medicine recorded grants totaling more than $100 million dollars from the National Institutes of Health in FY09 putting the College among the upper third in the nation in NIH funding.
The College of Medicine has a permanent faculty of 1089 physicians and scientists in 2010, compared to only 34 part-time physicians in 1909 when Flexner visited. The size of the undergraduate medical student body is 670 today compared to 213 in 1909.4 Today the College of Medicine is a robust academic institution that favorably compares with most in this country.
Many College of Medicine faculty, both basic science and clinical, mainly support their own compensation through grant awards and clinical earnings. The College has expanded its clinical mission, reaching out to more people in the Lowcountry of South Carolina than ever before, and also serving as the primary referral center for patients in the state and region in need of specialty services and tertiary-quaternary care. There are now multi-specialty facilities and outreach clinics providing clinical care, and assisting in the teaching and research missions of the College, located throughout the state.
As the first decade of the twenty-first century concludes, the College of Medicine of the Medical University of South Carolina remains faithful to its core mission of educating new generations of physicians, within an exciting environment that actively fosters the development and spread of new knowledge in medicine. The motto of MUSC is Auget Largiendo, which freely translated means, “She enriches by giving generously.” No truer words can be found to describe this venerable College over its long and productive lifespan.
Curtis Worthington, MD