The latest Jaharis Family Foundation donation will lift the anatomy lab out of the basement into a bright new space and ease the debt burden on students who specialize in family medicine.
By Bruce Morgan
September 21, 2016
Students consistently rank the gross anatomy course as one of Tufts School of Medicine’s top classes. More than anything else that is a tribute to the superb teaching that goes on there—because as anyone who has visited the anatomy laboratory in recent years knows, the space could use some improvement. It’s a cramped, windowless room in the basement of the M&V Building that has been in operation, with some periodic updates, since shortly after the medical school moved to its downtown Boston location in 1950. Dean of Students Amy Kuhlik calls it “way past retirement.”
Now the outdated lab is about to enter the 21st century. Thanks to a $15 million gift from the Jaharis Family Foundation Inc., the anatomy lab will be enlarged, technically upgraded and moved to airy new quarters on the third floor of the M&V over the next two years.
“I know firsthand that the gross anatomy lab needs to be completely redone to bring it up to today’s standards,” says Steven Jaharis, M87, speaking on behalf of the foundation. “It’s the one laboratory that basically hasn’t changed since I was a student 30 years ago.”
There’s a less obvious change in the works as well. A $2 million portion of the Jaharis gift will be used to encourage students to pursue a career in family medicine by alleviating some of their indebtedness before graduation. “The need for primary-care physicians in America is growing,” says Jaharis, himself a longtime family medicine practitioner in the Chicago area. “I hope that this scholarship will help students who go into family medicine graduate with less loan debt.”
The Jaharis family is the School of Medicine’s most generous supporters. They made the cornerstone gift for the Jaharis Family Center for Biomedical and Nutrition Sciences, a milestone in the school’s development that, since it opened in 2002, has expanded research space and fostered greater collaboration among faculty. A few years later, they funded the wholesale renovation of the Sackler Building, transforming it into a handsome student learning center.
They didn’t stop there. The family’s foundation also helped create the Clinical Skills and Medical Simulation Center, enabling students to develop their physical diagnosis abilities. They endowed the Jaharis Family Chair in Family Medicine as well as the Jaharis Family Scholarship Fund, which provides more resources for financial aid.
“We feel grateful and lucky for all the help the Jaharis family has given us over the years,” medical school Dean Harris Berman says, noting in particular that the endowed professorship in family medicine “helped us build a robust Department of Family Medicine. In the same way, we are excited for everything that this latest gift means for our future.”
The importance of education to the Jaharis family prompted its patriarch, Michael Jaharis, M87P, H15, who died in February, to assume a leadership role in the governance of Tufts. He served as a university trustee from 1993 to 2003 and was a longtime chair of the Board of Advisors to Tufts School of Medicine and the Sackler School of Graduate Biomedical Sciences.
Tufts President Anthony P. Monaco says the Jaharis family’s philanthropy aligns with a core value of the university—to act as an engine for social good. “There’s nothing more noble than an investment in education and the health and well-being of our society,” says Monaco, an accomplished medical researcher and geneticist. “Family physicians trained at Tufts will play a critical role as we confront the obesity epidemic, opioid addiction and other great health challenges of our times and work to resolve them.”
The Importance of Dissection
Since the time of the Greeks, an understanding of anatomy has been basic to the effective practice of medicine. Robert Willson, a senior lecturer and director of the gross anatomy course, calls his field “the oldest and most fundamental of all the medical sciences.” How best to teach the subject has been a matter of some debate among U.S. medical schools as digital methods of representing the human body have been widely adopted. With the new anatomy lab, Tufts, on the other hand, has reinforced its commitment to hands-on physical dissection as a critical component of medical education.
“Overall, the trend has been for schools to go away [from physical dissection], although many have come back to it,” says Jeffrey Marchant, research assistant professor and associate director of the Division of Medical Education. “In our view, in order to learn the material, students have to go into the lab and physically dissect the parts of the body. Searching for structures is an important part of the learning process.” In other words, digital anatomy programs rely heavily on a standardized model of the human form, but in the real world, bodies vary considerably from one to the next.
Associate Professor Peter Brodeur, director of the Division of Medical Education, notes that digital images are limited in what they can convey, whereas the cadaver teaches students “what the textures are and the spatial relationships among structures.”
You can hear the passion in these instructors’ voices, but for the past half century, the basic challenges of the space in which they teach have posed a countervailing force.
In the early 1950s, when the lab was new, there were just 100 students in a medical class. Now the laboratory runs year-round, providing anatomical training for 200 medical students, plus dental and physician assistant students. With students and 15 faculty members all jostling for space, conditions have been challenging.
The acoustics in the basement aren’t ideal, so students often have to strain to make out what the teachers are saying. “Students would often ask us to repeat things,” says Rebecca Lufler, a senior lecturer in integrated physiology and pathobiology. “The new lab will be a much better learning environment for our students,” she says.
Additional improvements will include an expansion of the space, from 16 square feet per student to 30 square feet per student, consistent with the recommended anatomy lab standard of between 25 and 40 feet. And instead of six students per dissection table, there will be five.
The ventilation and lighting systems will be state-of-the-art, and with the new location on the third floor, anatomy students will be able to work in natural light. Gone will be the days when, as Sarah Ballatori, M19, recalls, students exploring the fine detail of head and neck dissection have to rotate their table toward the overhead lights to see what they are doing. A new adjacent classroom capable of holding 60 students will provide space for small-group learning to supplement the regular coursework.
“One of the best aspects of this gift is that it will allow us to modernize one of our oldest buildings on campus, the M&V building,” says Berman. A former garment factory, the M&V, now called the Biomedical Research and Public Health Building, has been used for myriad purposes since the university acquired it in 1946. “The M&V is a significant piece of our 20th-century history, and the gift from the Jaharis family will allow us to maximize its use in the 21st century,” Berman says.
An essential component of the modernization is the technology upgrades, which are so significant that Willson says they provide faculty members with “a great opportunity to change the way we teach.” For example, computer screens will be installed at each dissection table to supply online learning materials, perhaps in the form of videos made by Tufts faculty and aimed at providing more focus to the day’s assignments. The new technology will also allow for better integration of advances in medical imaging, including X-rays, CAT scans and MRI. “We’ve had these before, but we’ve not really had the space to use them most effectively,” Brodeur says. “Now we’ll have a separate classroom where we can bring the students in.”
For his part, Marchant couldn’t be happier with the plans for the new lab, scheduled to be completed in summer 2018. “There’s a big push to include radiology in anatomy courses,” he says, “for the simple reason that when students enter their careers, they will be looking at images. If they understand the 3D anatomy at the same time they’re learning the 2D representation, they’ll learn the material a whole lot better.” Kuhlik adds that once the new lab is completed and the instruction is going on right next door, “we’ll be able to say, ‘This is what that looks like on the X-ray, and here is what it looks like in the cadaver.’ ”
Of course, some of the improvements in the new lab will be on a more intimate scale. For the past 50 years, in keeping with the Tufts spirit of improvisation, male and female students have had to change out of their regular clothes into scrubs in a crowded hallway. “It wasn’t ideal,” Ballatori says. The new lab will include designated changing areas and locker rooms.
An Underserved Field
No matter how much the students enjoy their first-year anatomy class, some of them eventually will become interested in practicing family medicine. Unfortunately, family medicine pays less than other medical specialties. The Association of American Medical Colleges reported that a 2014 median first-year, post-residency salary in family medicine was approximately $187,000, compared to $285,000 for diagnostic radiology and $327,500 for general surgery.
This is where the second portion of the Jaharis Family Foundation gift plays a role. Tufts medical students graduate with a lot of debt. In 2015, their average education debt was more than $205,000, the eleventh highest in the nation, according to Tara Olsen, the school’s assistant dean of financial aid. “We were number two for a long time,” she points out, “so we’ve brought that ranking down significantly. We would like to get out of the top 20.”
The high levels of debt and the relatively lower pay in family medicine pose a likely deterrent for students when it comes to choosing a specialty. Fewer medical students nationally are entering primary care. “It’s our most underserved field,” Kuhlik says. “We have a critical need in this area, yet year after year, this is where we see the greatest number of programs go unfilled in the match.”
The trend has dire implications. To ensure that all Americans have access to health care, the American Academy of Family Physicians concluded in a 2014 report that the primary-care workforce needs to grow from 209,000 to 261,000 by 2025. “Since family physicians currently make up about 38 percent of the primary-care workforce, a conservative estimate is that an additional 21,000 family physicians are necessary to meet their share of the increased need,” the report said.
Kuhlik believes that at least part of the reason for the shortage of family medicine doctors is this combination of considerable debt and lower pay. Each year, as part of a broader survey, the medical school asks graduating students, How important was debt level in choosing the field you went into? In the most recent survey, 22 percent said debt was a “moderate” factor, and 9 percent said it was a “strong” factor in their decision. “So more than 30 percent of our students called debt a moderate or strong factor” in their specialty determination, Kuhlik sums up. “That’s significant.”
The $2 million from the Jaharis gift will translate into about $100,000 annually for eligible students who go into family medicine. The number of recipients will change from year to year. For some perspective: in the class that graduated in May, 16 students matched in family medicine, and of those, six had demonstrated financial need, the main criterion Tufts uses to award scholarships and other aid. “If we were to have awarded the money this year, we would have been able to offer more than $16,000 in a loan reduction award for each eligible student,” Olsen says. That amount would reduce both the principal and the corresponding interest charges on a 20-year education loan.
Any loan reductions will be timed to occur between Match Day in March, when students learn where they will do their residencies in their chosen specialties, and graduation in May, so that the Jaharis gift will alleviate eligible students’ overall indebtedness before they even walk out the door. “Every penny counts,” Olsen says. As a corollary benefit, the gift will help Tufts School of Medicine reduce its aggregate student indebtedness and possibly improve its national ranking in that area.
Creating room to move, whether in a lab or in a career, may be considered the animating spirit of the latest Jaharis Family Foundation Inc. gift. But of course it is not up to one family alone, or any single act, to paint a brighter future for the medical school. As part of the gift agreement, the medical school is seeking $10 million in matching gifts from its alumni, friends and other supporters. “When we make a gift, our family always wants to inspire others to do the same,” Steven Jaharis says. “We hope that the Jaharis Challenge for Medical Education will motivate others to follow our lead and make the medical school one of their charitable priorities.”
This story first appeared on Tufts Now.