In 2001, I took over as the program director. Tulane was a good program then, but it was not great. It has taken a few years, but now it has been re-constructed to be a truly excellent program. And while Hurricane Katrina was a rough time for us all, it has long-since passed. Tulane is 100% re-build, and what remains is a strong Tulane residency team, complete with 28 new interns, who are twice as resolved to make a difference in the lives of the people of New Orleans.

There have been many changes, and all for the better. Here are just a few of the improvement points that have defined Tulane’s Residency as a national program of excellence:

1. Mission Statement. Tulane is defined by its mission statement: this is what directs our every decision, and defines the physicians and people that we become. Life is full of unexpected events, and the greatest of a program is defined by how it approaches and overcomes any unexpected events, either good or bad. There is great comfort in knowing exactly how a program will approach future changes, and it is a strong mission statement that maintains a forward direction. Regardless of what might come our way, Tulane will remain committed to caring for those patients that no one else wants to acknowledge, and to giving back the dignity and universal right to health to those who have had these fundamental rights taken from them.

2. Program Size. In 2000, there were 15 categorical residents and 5 prelim interns per class. This grossly undershot the educational opportunities of the program, and because there were so few residents, elective time was sparse. The program has grown each year, largely as the word on the street has spread regarding Tulane’s renaissance. Following Katrina, we downsized a bit to ensure that quality would not be sacrificed in our intern class (we kept the same admission standards), and to ensure that patient volume would be appropriate for the size of the program. We elected to take 28 instead of our usual 32 interns per class. This year, with the patient volume beginning to swell in New Orleans, we will return to our standard 22 categorical interns and 10 prelim interns per class. Only 5 of 95 residents transferred out of the program following Katrina, so the upper-level classes remain as robust as always.

3. Recruitment. When I took over as program director, I had faith that if you built a program around a high-quality mission statement, and if you handed over control of the residency to the residents such that they could make that mission statement a reality, great applicants would come to Tulane. And indeed, this is what happened: over the past three years the quality of resident applying to and being accepted by Tulane has risen exponentially. Compared to 2000, the average board score is twenty points higher; twenty five percent of the current residents were ranked in the top 10% of their medical school class (AOA). All of this with no sacrifice on the personal qualities of the resident: our residents are athletes, artists, musicians, and writers. This fulfills the type of resident that gravitates to Tulane and New Orleans: “Quality + x,” where “x” is that extra talent outside of medicine. And the bonus is that the diversity of the program has also increased, with the 95 Tulane residents representing over forty different medical schools from around the country. The diversity of the program destroys the old dogma, opening the doors to the free thought and creativity necessary for the physician to practice his or her art of medicine.

4. Curriculum. Tulane has always enjoyed great patient diversity; it is likely that each disease on the internal medicine board examination will be encountered during a resident’s three-year training at Tulane. But without a curriculum to alert the resident to what he or she sees on the wards, many of the learning opportunities were lost. Again, the curriculum in 2000 was good, but it was not strategic and thorough. Take a look at the curriculum now, and I think you’ll see that it is smart: alerting the resident to his or her weakest areas and sequentially filling in the gaps. The proof of its quality is in the 100% Categorical board pass rate over the past three years. We highly recommend taking a look at the innovative Friday-School interactive format used to deliver the Tulane curriculum.

5. Firm System. The firm-system handed over control of the program to the residents in 2003. Tulane is about building leaders within the field of internal medicine, and developing leadership is not a passively-acquired skill. Becoming a leader requires active participation in leadership activities. See the Tulane Firm System for how this system will empower you to take control of your professional life, while still maintaining time for your personal life.

6. The Philosophy of Autonomy. Medicine is learned by active participation, not passively following along like a shadowing first year student. In 2001, morning report was moved back from 8 AM to 9 AM, allowing one hour for work rounds where all decisions for patient care are made by the resident. Attending round was shortened by an hour, leaving two hours of attending rounds for the purpose of checking resident decisions and teaching the resident team. Morning report was changed as well: the case presentation followed by a didactic lecture was discarded in favor of an active-participation graduate-level discussion conference.

7. Teaching Opportunities. To be exponential, you have to teach. Tulane is devoted to developing academic leaders, and that means training residents in teaching excellence. In 2001, a realistic and practical (i.e., none of the educational jargon and theory from the edu-crats) teaching-teaching course was designed for the residents. This has dramatically improved the quality of the residency; there is nothing quite like teaching a topic to discern what you do and do not know about the topic.

8. Research. Once the program grew in size, it was possible to guarantee each resident at least three elective months per year. This in concert with an exponential expansion of the Tulane faculty made it possible to provide research opportunites for residents. Residents have responded in force; check out the research performance of the past three years. Becoming the program with the most national resident presentations has expanded Tulane’s reputation, further improving the quality of residents that come to Tulane.

9. Hospitalist System. 45 of 48 attending months at MCLNO, and 24 of 48 months at the VA are staffed by hospitalists. This has allowed for greater supervision on the wards (for afternoon procedures and the like), and greater accessability of attending physicians for the residents.

10. Fellowship Placement. In 2000, the occasional Tulane resident would find fellowship placement; most residents, however, went into private practice following residency training. Now with the educational and research opportunities, the more aggressive mentoring program and the overall higher quality of residents, 60-70% of Tulane graduates will choose fellowship careers. Over the last four years, 100% of all Tulane residents seeking a fellowship position have obtained a position; in 2005, 100% of the Tulane graduates received their first choice of fellowships. Those not pursuing fellowship training have chosen academic careers as General Internists or Hospitalists. This has laid a national foundation for subsequent residents from the Tulane program. As past graduates display the results of their quality training while at Tulane, Tulane’s reputation continues to grow. If you have heard great things about Tulane from your colleagues on the interview trail, and you are wondering why your home-school residency director of dean of students is not as enthused, it is likely because he or she knows Tulane from the pre-2000 years. Based on the quality of the program back then, I wouldn’t argue. Based on the quality of the program now, however, there is no question that Tulane is one of the best programs in the nation.

Oh, and by the way, all of the quality that you see above has not diminished in the slightest bit following Hurricane Katrina. It’s only made our team stronger!