“How do you become a world leader in your own medical field?” Dr. Stephen J. Pomeranz probably did not even consider this question when he first started teaching courses to a small group of physicians in his home, but 20 years later he leads a one-of-a-kind education program with a global reach. Now that the current administration strongly supports the advancement of the sciences, physicians, researchers, and policy makers are trying to find ways to restore and maintain America’s role as a world leader in science and medicine. That role, however, is no longer as straightforward as a “space race” to the newest technologies and procedures. As Dr. Pomeranz knows, the most fruitful kind of leadership also involves a bit of sharing.
Dr. Pomeranz founded the ProScan Imaging Education Foundation (PIEF) in Cincinnati, Ohio, in 1988, and now physicians at the center read over 1, 000 MRIs and CT scans daily from all over the world. Physicians at PIEF study diagnostic imaging through year-long fellowships, visiting fellowships, DVD-based lectures, and 10 annual courses taught by Dr. Pomeranz.
For many years now doctors from foreign countries have traveled to PIEF to study, but the center has recently noticed increasing numbers of international attendees. Pete Huster, Director of Operations and Marketing at PIEF, makes a geographic splatter chart of students after each course and noticed that the usual one-quarter of international attendees had increased to about 32% to 35%. “We tried to sort out whether the international draw is for Dr. Pomeranz or just for the American training, ” says Huster. “After we looked at the escalation of international attendees in all our courses across the bar, it seemed to be related to Dr. Pomeranz and his expertise. They like to sit down and train with him. They bring their own cases, they can very specifically customize the type of training that they would like to receive, and then we form the program around what they would like to do.”
In the early 1980s, the first attendees of Dr. Pomeranz’s courses, however, may have been more interested in the food. Dr. Pomeranz explains: “I gave a course and my wife baked a cake. About 10 people showed up. She was an incredible cook, and the next time 30 people came and the next time 60 and then within a year I had about 250 to 300 people coming, holding meetings and teaching. Then my wife said, ‘Listen, there’s too many people coming. I can’t make any more cakes’ and I said, ‘well they won’t come if you don’t make the cakes.’ But they did come. That started over 20 years ago, and now we’ve trained probably on the order of eight to ten thousand folks. They come from all disciplines to learn about imaging.”
Part of the appeal of Dr. Pomeranz’s first courses on diagnostic imaging was the fact that the technology was so new and innovative. “I got started in the field because there were very few radiologists trained in MRI at the time, and it looked interesting, says Dr. Pomeranz. “I thought it would be a really valuable tool in the care of the patient, once I saw the technology in the early 1980s. So I was one of the first MRI fellows in the United States. And my interest in teaching really stemmed out of a passion to raise the bar of care and make other people better at it.”
Just as important as innovation is the ability to share that discovery with other languages, cultures, and countries. Dr. Pomeranz admits that his expertise is part of the international draw of PIEF, but he also points to other aspects of the center which make it work well on a global scale. For example, PIEF is a multilingual center where a number of physicians speak other languages, from Chinese to Hebrew to Spanish. Accommodating several languages inside one center opens up the possibility of new discourses on research around the globe which cannot always happen while only speaking English.
It is also becoming increasingly important for doctors to be able to send, receive, and read all kinds of data across international systems and file types. Dr. Pomeranz explains how PIEF accommodates electronic medical records from around the globe: “In terms of exchanging information, we’ve got very advanced technology here and some very unique and proprietary software. For instance, on any PACS system, we can take data and convert it into the receiving system. So our machines will take data from Italy or Japan from a Siemens machine on a PACSZ, and when it gets to us, it will convert it over to our PACS, which would be PACSX. And of course it does it for anybody, from location to location. It’s also really helpful in terms of data storage. We can store in one format and help others store in one format as well.”
In the end, allowing for this mix of information from around the world rather than solely concentrating on innovation in American medicine results in a richer, more comprehensive education for physicians. “On any given day in this building, ” says Dr. Pomeranz, “you could see diphtheria or polio, and you could see a meniscus tear. It’s very varied in terms of the pathology, and that’s very interesting to people from all over the globe. An orthopedic physician could see 400 to 500 cases on any given day from all over world, and that’s something that really isn’t available in many places.”
Dr. Salvador Trinidad, who is currently on a one-year musculoskeletal (MSK) fellowship at PIEF, likens the center to a total immersion foreign language study program. In many residency programs, complicated MRIs get sent to more specialized readers, and the residency physicians never see those cases. At a place like PIEF, MSK physicians can immerse themselves in all kinds of cases from head to toe.
Reading all these various types of images has given Dr. Pomeranz a case experience of over a million, but he is always eager to learn more from experts outside of his field. Dr. Pomeranz: “In terms of orthopedic imaging and MRI, the United States is at the forefront throughout the world, and a lot of that has to do with the way our system is structured. For instance, in countries like Australia, they are on a national rebate system, and it’s much more difficult to get orthopedic MRI. On the other hand, in Europe, they are very advanced and well-developed in terms of their body imaging, liver imaging, and abdominal imaging, but they probably haven’t had as much exposure to orthopedic imaging as in the States. So different parts of the world have areas in which they are more advanced and areas in which they are less advanced.”
When Dr. Pomeranz saw this opportunity for exchanging ideas and research, he started going to Munich every summer to teach a group of 300 physicians. “I did that for quite a few years until the German, Austrian, and Switzerland physicians got more and more comfortable with orthopedic MRI, ” says Dr. Pomeranz. “I learned a lot from my European colleagues about body imaging and I think they have learned a lot from me about orthopedic imaging.”
This mix of expertise and education is a good example of the kind of leadership role America could maintain in global medicine. Our country has always encouraged innovation, but the ability to share American research and technology and combine that with expert research from abroad is key to making advances in the medical field. The center that can provide a forum for exchanging ideas and data from around the world will have the biggest impact on global medicine. And the doctors who can effectively teach what they practice will draw the most attention.
Of course, it also helps to have a good chef. For Dr. Pomeranz, “It was carrot cake–extraordinary carrot cake, if I do say so myself.” He and his wife have been married for 30 years and have six children, and Mrs. Pomeranz still makes her famed carrot cake, just not for 300 people anymore.
