Teaching Tomorrow's Medicine Today: The Mount Sinai School of Medicine, 1963-2003

The History of the School

1 The History of the School IN THE MID-1950S, The Mount Sinai Hospital was at the pinnacle of hospitals in the United States. It had a reputation for attracting exemplary physicians who provided high-quality patient care and performed the clinical research that had made Mount Sinai’s name known around the world. It had state-of-the-art obstetric and research buildings , which had opened in 1952: the Klingenstein Pavilion and the Berg and Atran Laboratories. It was already looking forward to the creation of a new clinical building on Madison Avenue that not only would house the large psychiatry program but also would replace the outmoded ward beds in the older buildings. There were more than 200 research programs ongoing in the Hospital, funded, in part, by the largest amount of federal research dollars to go to any stand-alone hospital in the country. The Mount Sinai Trustees were very involved in the day-to-day operations of the institution and kept a careful eye on the quality of the care provided and the reputation of the Hospital. But when the medical leaders of The Mount Sinai Hospital surveyed the scene around them, it was apparent to them that the landscape was changing. This led to the beginning of a process whereby the leaders of the medical staff set out to educate and persuade the lay leadership that if Mount Sinai did not respond to these changes, the Hospital’s ability to provide high-quality patient care and research programs would be impaired. The solution proffered by the medical staff centered on the creation of an undergraduate medical school. The medical leaders most actively involved were the full-time Hospital department directors: Drs. Hans Popper, Chief of Pathology; Horace Hodes, Chief of Pediatrics; Alexander Gutman, Chief of Medicine; Alan Guttmacher, Chief of Obstetrics and Gynecology; M. Ralph Kaufman, Chief of Psychiatry; Allan Kark, Chief of Surgery; and Martin Steinberg , Director of the Hospital. 3 The physicians put forth many explanations for what had changed and why action was needed now. One was that hospitals were being eclipsed as elite institutions by academic medical centers that combined hospitals and university-affiliated medical schools on one campus. These large centers seemed to more easily attract young physicians because they could offer an academic title and environment. Also, the physicians feared that faculty members from these institutions were filling up the grant review agencies and specialty board panels and might be inclined to favor people at academic medical centers. One factor leading to the elevation of these university-based medical centers was the change in the nature of medical research. Mount 4 TEACHING TOMORROW’S MEDICINE TODAY The campus of The Mount Sinai Hospital, mid-1950s. The area shown is looking southeast, with Fifth Avenue in the right foreground, 101st Street on the left, Madison Avenue along the top left, and 98th Street at the top right. Sinai Hospital had thrived in the era of clinical research, where data was received at the bedside, analyzed in the laboratory, with the results coming in the form of a disease description or a treatment taken back to the bedside. After World War II, the basic sciences of chemistry, molecular biology, and physiology had assumed a much larger role in elucidating the underlying workings of disease. Biomedical research became based in scientific labs, often on a medical school or university campus. It took trained scientists to run these laboratories and to teach the techniques and science involved. It was becoming beyond the ability of practicing physicians to pursue molecular research because of the nature of their training and their limited access to modern laboratory facilities. Mount Sinai was becoming out of step with the evolution of medical research. There was another major change that had affected Mount Sinai’s ability to attract and retain house staff after their training, but this was not given much public airing. From the beginning, in 1872, when Mount Sinai first created an internship, the Hospital had benefited from the anti-Semitism that existed in the graduate training programs at other hospitals.1 While it was difficult for young Jewish men to gain acceptance to medical school, it was even harder to find a place in a high-quality postgraduate training program. This applied to many hospitals in New York City, making Mount Sinai Hospital the obvious choice for young Jewish doctors...