Faculty surgeon Myriam J. Curet hopes the lessons she can learn and apply as SHC’s newest at-large Medical Board member will benefit all of the usual constituencies - patients, doctors, staff, the institution - but she has a special interest as well:

An innovator in laparoscopic surgery who arrived at Stanford only five years ago, Curet believes that what she can learn and apply can help fulfill a central professional goal of improving the education of medical students and surgical residents.

An associate professor of surgery since 2002, Curet serves as director of the Minimally Invasive Surgery Program and associate director of the General Surgery Residency Program. She is also Director of Clerkship Education for the Medical School.

“My involvement here at Stanford is pretty young,” Curet said. “I’m still on the ground floor, but I’m pretty excited about some of the changes we’ve already been involved in,” including a course in applied biomedical sciences which integrates basic science into the clinical curriculum. Curet and Elizabeth Stuart, the clerkship director in pediatrics, have put together a tutorial for faculty, notably clerkship directors, to help them become better teachers and better evaluators of students.

Students and Research

Curet has involved students in her practice and clinical research. For example, a medical student is listed as an author of a groundbreaking study she published in the Archives of Surgery in August about a safe and efficient method to use a surgical robot to perform gastric bypass operations.

Curet shares an interest in education with another Medical Board member and longtime medicine faculty member Kelley Skeff, whose faculty teaching course Curet took shortly after her arrival at Stanford from the University of New Mexico in Albuquerque in 2000.

“Kelley is fabulous, and now I’m trying to expand the teaching agenda he’s fostered for many years to surgical residents and to medical students,” Curet explained.

Appointed to the Medical Board

Curet was appointed last September to fulfill the term of longtime community anesthesiologist Bryan Bohman, who was elected vice president of the staff in an election comprising five candidates, including Curet.

Faculty anesthesiologist Kent Garman, then president-elect and now president of the Medical Staff, said he encouraged Curet to get involved on the Medical Board because she has “great people skills and an active, ongoing involvement and interest in leadership, including skill development.”

“I was extremely excited about the opportunity,” Curet said. “It was a real honor that people thought I was ready to do this. It’s not something that typically you get to do so early on at an institution,” Curet said.

The Medical Board serves as the staff’s executive committee and consists of the president and vice president of the Medical Staff, five at-large officers and members, as well as chiefs and chairs of SHC’s clinical services, and the chief of staff.

Learning Curve

Right now, Curet said she is very much on a learning curve. “I really want to understand the intersecting goals of the hospital and the medical school, not only to be an effective board member, but also so that I can be a more effective surgeon and educator. For example, knowing the realities of what the hospital can and cannot afford to do in terms of education is obviously useful.”

The new board member is also participating in SHC’s physician leadership development program, joining a group of 26 colleagues in five-day workshop sessions of a-day-and-a-half each. “I really am impressed with the investment the hospital and medical school are making in programs such as this.

“Although I’m learning, I also do think I have some perspective to contribute to the Medical Board and staff discussion. I came from two institutions - the Indian Health Service (surgical chief at the IHS’ Gallup, NM, medical center) and as a faculty member at the University of New Mexico at Albuquerque - where resources are incredibly thin.

Resource Allocation

“I learned a lot about resource allocation, and I think some of that can be effectively applied here where the opportunities are deeper. For example, at Stanford we have two rapid CT scanners right next to the emergency department that we use routinely to screen patients with abdominal pain for appendicitis. In Albuquerque, where we saw four times the volume of trauma, the lone CT scanner was always tied up, and using it for routine screening wasn’t an option.

“I’m hoping my background can help when discussions about utilization resources come up in the Medical Board. For example, how can we use our resources optimally to develop a rational plan to decide which ER patients should be selected for a CT scan.

So Many Constituents

Curet believes that the Medical Board’s overarching issue is to help find ways to balance all of the needs of so many constituencies - students, residents, faculty, community physicians, researchers, patients, staff, financial managers.

“A decision that the Medical Board makes will affect all of these groups in different ways. So one question becomes, How can we do the most good for the most number of people and minimize costs? In some ways this is easier at the less wealthy institutions I came from. When you really don’t have many resources, it’s easier to tell someone they can’t have what they want. Here we have enough to do most of what we want but not everything, so in a sense that makes decisions more agonizing.

”Curet took a leave of absence from New Mexico in 2000 to accompany her surgeon husband, Tim McAdams, on his one-year fellowship at Stanford. Afterward, both McAdams, who specializes in upper extremity surgery in the Division of Sports Medicine, and Curet, decided to stay at Stanford.

Place for Growth

“I stayed because I thought there was potential for tremendous growth here. I thought Dr. [Thomas] Krummel, my chair, would be a wonderful mentor, along with my division chief in general surgery, Dr. [Ralph] Greco. I thought there was an opportunity to do some innovative things clinically. For example, I don’t think I would have had the opportunity to develop the totally robotic gastric bypass surgical procedure anywhere else. That’s Silicon Valley.”

Curet discovered her educational aspirations could be fulfilled at research-oriented Stanford based on what she learned at the more education-oriented University of New Mexico.

“Stanford is a great place to bring together technology and education,” Curet said. We have a number of people who have pioneered and developed simulators “not only for developing technical skills, but also for improving communications, interpersonal and team management skills. But beyond that students and residents need real life experiences, including case conferences, and I’d really like residents to work in the outpatient clinics interacting with patients and a broad range of physicians, including community practitioners.

Community Physician Role

“Clinics are just one place where community physicians along with faculty can and do play a vital role. We could not teach our students without the help of community physicians. They’ve been invaluable in training, offering our students and residents opportunities to see medical practice from different perspectives, to see there are choices and options when they finish their training here.

“I was really pleased when I came here, and also when I joined the Medical Board, to see that the community physicians were integrally involved. There is a lot of respect and communication among the practice communities, and I think that bodes well for good medicine, good education and a successful medical center,” Curet said.