Little did Daniel Harrington know that a chair hurled at his head would launch a new trajectory in his medical career.
At the time, more than three decades ago, Harrington was a third-year medical student undertaking a clinical rotation in psychiatry at the West Virginia University School of Medicine. "One patient, a middle-aged woman who had just lost her husband, was deeply depressed," Harrington recalls. "She was also terribly obese, and her chocolate binges were preventing her doctors from being able to control her diabetes. She had been admitted to the psychiatry ward for her depression and self-destructive behavior."
During a group therapy session, Harrington decided to take a direct approach. "I thought it would be smart to confront the patient -- to really get in her face about how she was endangering her health. But when I challenged her, she became so enraged she picked up a chair and heaved it at me," he says, with a slight chuckle.
Harrington can tell the story with a smile now, because he knows how it ends. "Several months later, I got a call from the lobby: someone wanted to see me. When I went down, I found the chair-throwing patient waiting for me." With this, Harrington's voice softens. "She said, 'I just want you to know you changed my life.' And with that, she changed mine."
The experience both humbled and inspired Harrington. Before his clerkship rotations, he had thought he wanted to be a pediatrician. After the incident, he zeroed in on psychiatry and internal medicine, a rotation he had also enjoyed.
Now, in his role as senior associate dean at the Virginia Tech Carilion School of Medicine, Harrington is drawing on his own experiences as he helps design the third- and fourth-year curricula of the Virginia Tech Carilion School of Medicine. During those two years, students will rotate through clerkships within various medical specialties.
"Carilion Clinic has a long history of clinical rotations with medical students from other schools, so it's not entirely new for us," says Harrington. "Now, though, we need to think about teaching our students clinical medicine in a different way. With the Virginia Tech Carilion School of Medicine's problem-based learning, students begin seeing patients during their first few weeks. They're involved in outpatient clinics, and they're trained to think as clinicians from the start. When our students enter their third year, they'll already have many of the skills they need to succeed in their clerkships."
Students will rotate through a range of core competency areas, such as internal medicine, surgery, obstetrics and gynecology, family medicine, pediatrics, and psychiatry. They will also gain experience in emergency medicine, radiology, intensive care medicine, and other subspecialty electives. "We need to provide a breadth of experiences," Harrington says, "so students can decide what specialty to choose for their residency training."
Harrington understands well the critical role that clerkships play in a doctor's career. "My own clerkship experiences defined the specialty I wanted to pursue," he says. From the furniture-flinging patient in his psychiatry rotation, to the internal medicine cases that fascinated him, Harrington found his niche combining both specialties. "That combination appealed to me," he says, "because almost all internal medicine patients have some kind of psychiatric component to their illness."
At the West Virginia University School of Medicine, Harrington was influenced by a mentor who developed the country's first combined residency program in internal medicine and psychiatry. Harrington ended up following that mentor to the University of Virginia, where he completed a combined internal medicine and psychiatry residency. During his final year, Harrington was selected as chief resident in psychiatry, and he stayed at the University of Virginia as a faculty member. After almost a decade there, Harrington moved to Roanoke in 1990 to develop a psychiatry residency with Carilion. He was appointed vice president for medical education about the same time as the announcement of Carilion's transition to a clinic model.
"Carilion began evolving into a more academic organization and needed to grow through the addition of new residencies and fellowship programs," Harrington says. "In the past three years, we have increased growth from a baseline of eight residencies and fellowships to 17. We're now developing several other residency and fellowship programs that include podiatry, general dentistry, gastroenterology, and adult reconstructive orthopedics."
When leaders from Virginia, Carilion Clinic, and Virginia Tech announced plans for the Virginia Tech Carilion School of Medicine, Harrington was asked to help plan and execute a vision for the school by exploring the problem-based learning curriculum model. He found it both exciting and astounding to start the project from scratch.
"How do you start a medical school?" he asks. "During the previous three decades, only one medical school had been started in the United States, so there weren't many experts we could turn to as resources. We really had to think about what kind of school that we wanted to build. Our mission was daunting, yet exciting."
The planning committee included research in the curriculum from the start because of Virginia Tech's commitment to being a top research university. In addition, Carilion Clinic had recently announced that it would move to a clinic model of care. With that change, the planning committee looked closely at how other medical schools that were associated with clinics operated. The planners made site visits to several schools, including the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
"By the end of that visit," Harrington says, "Carilion and Virginia Tech leadership decided that the Virginia Tech Carilion School of Medicine would use problem-based learning in small groups. At first, leadership wanted a research-focused five-year curriculum, as Cleveland Clinic was doing."
Yet several factors--including student debt--led the planners to opt for a traditional four-year education plan. "Students entering medical school already have significant debt," Harrington says. "If we added a fifth year, we would be delaying their entry into practice and adding to their financial burden."
After discussion with faculty and leadership, the planning committee recommended threading research throughout the curriculum, to allow students to meet the original research goals in four years rather than five.
"Most students who attend medical schools -- even schools with a research focus -- want to take care of patients," Harrington says. "With our strong research component, our goal is to train students to be physician thought leaders who integrate clinical excellence and inquiry with leadership skills."
The Virginia Tech Carilion School of Medicine's charter class will get a taste for what doctoring is really like when they begin clinical rotations next summer. With his experience, vision, and thoughtful planning, Harrington will prove an inspirational guide.
"I never envisioned a career in academic medicine, just as I never imagined I would become a psychiatrist," Harrington says. "But I happened into academic medicine 25 years ago, and I've thoroughly enjoyed the opportunity to help grow new generations of doctors."