Robert Barbieri, MD, is the Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology and Chairman of the OBGYN and Reproductive Biology Department at Harvard University. Dr. Barbieri was appointed to be the Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology in 1993. Macy sat down with Barbieri and discussed the importance of endowed professorships to commemorate the 50th anniversary of the endowment.
Why do you think endowed chairs are important for institutions?
These positions allow the incumbent time to pursue a higher calling, and act as a building block to creating an environment of scholars. The National Institutes of Health has thousands of highly qualified scholars and their collaborations move the field forward. In medical education, there may not be enough individuals with enough discretionary time to collaborate on something that has a big impact.
Why is that critical now?
It used to be said that bullying and medical education were the same thing, but in the last five years there has been a huge shift to creating a supportive rather than threatening environment, to reduce the number of episodes of student mistreatment, and to implement intense reporting to find pockets of mistreatment and initiate positive changes. We’re bringing the ‘trial by fire’ era to an end. You see a lot more use of simulation which creates a safe environment for practice. There is also a bigger focus on more interactive, case-based learning, and on new topics like population health, justice and empathy. And there’s an effort to try to individualize the career path more.
Students are also so, so different now than 40 years ago; many of the students back then were highly capable scientists but with less ability to demonstrate a broad range of psycho-social skills. The modern student is incredibly capable of being a role model in the community and an empathetic advocate for patients and their families. Teamwork is in their DNA—they want to be good team members, to quickly form into a high functioning team and work collaboratively with other health professionals.
What has the Josiah Macy Jr. Foundation award allowed you to do that you might not otherwise?
Something I’ve had the privilege to tackle is the question: “If you wanted to influence and improve the clinical practice of 10 million physicians in the world, how would you do it?” A group of people led by Burt Rose have built a website called UpToDate— an online clinical decision support resource featuring over 10,000 clinical topics designed to give immediate answers to clinical questions at the point of care. It’s incredibly successful and is used throughout the world; providers in low-income areas in Africa, and other countries are given free access to it. It’s used by physicians, nurse practitioners, physician assistants and others who have the authority to diagnose and prescribe. Macy’s support helped free up my time to work on the OBGYN component of this site.
When you study doctors’ behaviors, you see that they often have a question about the best diagnostic or treatment approach, but most often they won’t check it out. If you can shorten the cycle time to look it up, there is a higher chance they will check out their query or uncertainty. If it takes 10-15 minutes, that’s too long. UpToDate is extremely quick and studies have shown hospital mortality rates decrease when physicians use it.
Another thing I was able to do under the endowment was to write a medical student textbook to be used in 3rd year clerkships. There are two main publishers of text books, but neither produces evidence-based books. I wanted to create an OBGYN text book that is more evidence-based, one that would, for example, provide underlying data about the effectiveness of drugs. I worked with a small German publisher to create the text book “Obstetrics and Gynecology: The Essentials of Clinical Care.”
Why do you think you were selected for this position?
Three people have held the Macy Chair at Harvard. Duncan Reid was the first and then Kenneth J. Ryan. My passion is medical student and resident professional development and helping to close practice gaps where clinicians are doing X but should be doing Y based on best practices, to get people to move quickly on deploying best practices.