Faculty of Health Sciences - Ben Gurion University of the Negev

Introduction
The Beer-Sheva Experiment
Training the New Physician
An integrated Medical Program for the Negev
The Academic World and the Community
Achieving the Goals
Experiment to Example
Looking to the Future
International Cooperation

Introduction

The Negev Desert comprises over 60% of the land of Israel. Its residents (numbering over 400,000) comprise one of the most unusual ethnic mixtures in the world. Who are the people of the Negev? They are immigrants from North Africa, Ethiopia, India, Europe, North and South America and the Republics of the former Soviet Union; they are Bedouin Arabs and Jews born in Israel.

In a small corner of this desert, the Medical School of Ben-Gurion University has become a beacon to countries throughout the world. The establishment of the Medical School in l974, located "temporarily" in Beer-Sheva's Soroka Hospital (which services the entire population of the Negev), brought major changes to the world of medical education and substantially improved health care in the Negev.

The orientation of this school ... provides the rest of the world with an extraordinary model for research, education and service. [It] brings a realism into the health and education system that we sorely lack in the United States.

Philip R. Lee M.D.
U.S. Asst. Secretary for Health, 1994

The Beer-Sheva Experiment

This extraordinary development in Israel is without parallel. It is most unlikely that the events which have taken place there could occur in any other country. ... It is the history of Israel, the culture of the Jewish people, with its emphasis on health and admiration for the medical profession, and the nature of Israeli society that have created the Beer-Sheva experience. No two countries are the same but no country has any greater claim to uniqueness than Israel has.

Willoughby Lathem, Editor
"The Future of Academic Community Medicine in Developing Countries"
Rockefeller Foundation, New York, 1974

Ben-Gurion University set out in 1974 to create a unique medical institution - a Medical School which was to be the major component of the new Faculty of Health Sciences. Created under extremely adverse economic and psychological conditions, the Medical School accepted its first students immediately after the Yom Kippur War.

Its program marked a dramatic departure from conventional institutions for medical education. In order to counter the trend toward training specialists who tend to focus on only the "sick" part of the patient, and whose services are rendered in large central hospitals, the new medical school presented a so-called experimental program. Its goals were:

To train its students to be aware not only of their patients' medical problems, but of their psychological and social backgrounds as well. The patient is regarded as a human being - part of a family, a community and a culture - factors which must be taken into account when treating the illness.
To assume responsibility for the health care of the population of the Negev by delivering medical services of the highest standards both in the hospital and in the community.
To hire and train first-rate clinicians and health-care professionals and to support continuing medical education programs for practicing physicians and other health professionals.
To conduct clinical and basic biomedical research of the highest standards as well as to establish programs for health economics and policy, health promotion and disease prevention.

The result of this effort has become a model of medical education and the Medical School of Ben-Gurion University is now a world leader in the field of community medicine. The "experiment" in medical education is, in reality, a radical return to its roots wherein the physician cares for the patient as well as the illness.

It is clear at this still early stage of the experiment that your reforms have had a significant impact on your own student body at Ben-Gurion as well as on the three other medical schools in Israel. Moreover, your reforms have provided an important model for a number of third-world nations. You have had marked success in selecting and educating medical students who are interested more in treating individuals than diseases.

Eli Ginzburg
A. Barton Professor Emeritus of Economics, and Director, Conservation for Human Resources
Columbia University, NY

Training the New Physician

Ben-Gurion University in Beer-Sheva, Israel remains the best example of a medical school methodically focusing on personal qualities. This small school, ... has from its beginning emphasized empathy, flexibility and responsibility in the admissions decision. Candidates complete an autobiographical form including three standard questions (on a moral dilemma, a significant experience and a major achievement). Interviews take off from these responses, focusing as much as possible on students' actual deeds. ... With particularly promising candidates, interviewers shift to more stressful questioning.

While Ben-Gurion's admission process is more time-consuming than most schools, ... the results are worth the effort.

Promoting Medical Student's Ethical Development:
A Resource Guide
American Association of Medical Colleges
Prepared by Janet Bickel, Oct. 1993

The new approach to medical education begins with the admission procedure at BGU, for student selection is the very first step in training a new kind of physician. Believing that doctors need compassion at least as much as a high grade point average, at BGU emphasis is placed on interviews designed to reveal the applicant's personality, motivation and sensitivity. Competition is keen. Over 1,000 candidates vie each year for the 50 available places in the Medical School.

The unique approach to medical education is symbolized at each commencement ceremony. When the time comes for the recital of the Physicians' Oath it is not the graduates who take the pledge. Instead, the freshmen rise to pledge themselves as new practitioners of medicine. The graduates stand with them, reaffirming their own pledge taken seven years earlier, and saluting the new generation of students who are about to begin their medical careers.

From the very start of their medical education the new students, under appropriate supervision, work in community clinics and hospitals throughout the Negev receiving a "hands-on" education that is singular in Israel and quite new in the rest of the world. At BGU medical students learn not merely from textbooks, case histories and lectures, but by personal interaction with patients.

The curriculum of the Medical School is unique. The integrated six-year program, followed by a year of internship, emphasizes the early acquisition of clinical skills in addition to the study of medical Sciences. Basic sciences, often studied in small tutorial groups, are oriented toward practical application. Teaching methods include fewer lectures and more group discussions, tutorials, clinical and epidemiological projects and field work. The entire process encourages independent study and the maintenance of high standards while it develops the ability to care for others which originally motivated the student to choose medicine as a way of life.

The Beer-Sheva Experiment has become institutionalized and the justification for the program - the integration of medical education and medical delivery - has been realized. ... The medical program at BGU embodies a philosophy of health care service as the overall mission with medical education as a means to this end. A combination of extraordinary leadership and esprit de corps among students and faculty seems to contribute to sustaining Beer-Sheva's viability, especially as shown in the numbers of graduates who remain in the Negev to practice.

Ronald E. Richards
The Kellogg Foundation,
Battle Creek, Mich.

An integrated Medical Program for the Negev

It seems incontrovertible that the establishment of the Medical School alone made possible the expansion and improvement of Soroka Medical Center into a major regional hospital with a broad array of sophisticated services. The placement of students, residents and faculty (part-time) throughout the Negev surely contributed to the improvement in the range and quality of medical care in the clinics of the region.

Eli Ginzburg
A. Barton Professor Emeritus of Economics, and Director, Conservation for Human Resources
Columbia University, NY

In partnership with Kupat Holim, the largest provider of health services in Israel, and the Soroka Medical Center, Ben-Gurion University participates in providing health care for the entire region. This is not a simple task, for the heterogeneous population of the Negev is scattered over 6,000 square miles. Its residents live in small cities, development towns, brand-new absorption centers, kibbutzim and other agricultural settlements. In addition, the health needs of 90,000 Bedouin, some still semi-nomadic, require special attention.

A great deal of emphasis has been placed on education and prevention, on the continuity of care through various phases of illness and on developing outreach programs to handle populations that are not effectively served in a traditional medical care setting.

Dialysis treatment is regularly available to distant kibbutzim and to Bedouin tents thanks to the mobile dialysis unit that travels throughout the region.
Special-cardiac preventive programs provide screening, testing, dietary advice and follow-up examinations for children who are at risk because one or more of their parents have heart disease. The service is available in Kupat Holim clinics throughout the region.
Medical students have developed a number of unique programs for school children of all levels, from first grade through high school. The medical students teach programs in basic sciences, medical ethics, smoking prevention and clinical sciences in regional schools and at the Medical School itself.

The Medical School of BGU does not operate in an ivory tower. It plays a vital role in planning and providing health care for residents of the Negev, and has developed creative models for other institutions in Israel and abroad.

Students at BGU's Medical School take an active role in community education. One after-school science program called Ofek (Hebrew for 'Horizon') has grown by leaps and bounds, thanks to the enthusiasm of both he Medical Students and their young pupils.

The children, 1st to 4th graders, work on projects geared to their age groups in a very interactive format . Medical students of the Ofek program emphasize biology, teaching the children about responsibility, animals, ecology - and humanity. There are well over 30 classes today (just 3 years after the program began!) - and the horizons are still expanding.

The Academic World and the Community

I had a number of discussions with your young graduates and was most impressed. ... You have instilled two significant ambitions into them. ... On the one hand you have succeeded in giving them a sense of the needs of their communities and their responsibilities to help meet these needs. I felt that you have achieved this more effectively than anywhere else I have encountered. ...

But on the other hand you have also instilled into them an ambition to practice medicine at the highest level of quality of which they are capable.

Sir John Brotherstone
University of Edinburgh, Edinburgh, UK
Excepts from his letter, June 1, 1982

The close cooperation between scientists and physicians at BGU and the regional responsibility for 400,000 people are factors which give unusual options for special investigations at the Medical School. Following are brief descriptions of some research projects designed to bring better health to the residents of the Negev.

Among the immigrants who came to Israel from the former Soviet Union, there are several hundred who were victims of irradiation from the nuclear accident at Chernobyl. Many of them have settled in the Negev. BGU instituted a unique program to study the effects of the accident and to treat the psychological as well as the physical illnesses of these victims. It is the first thorough investigation of the radiation-exposed population outside of the CIS.
The heterogeneous population of the Negev and the high number of births at Soroka Hospital have resulted in several singular programs. Research into genetic diseases, many of which are peculiar to specific ethnic groups, is an area of considerable importance and has expanded into pre-screening and counseling services. In another program, all pregnant women are routinely tested for gestational diabetes, which means students, scientists and physicians conduct unusually broad-based investigations into the cause and prevention of diabetes in various ethnic groups.
Other community related research projects, to mention a few, include the evaluation of new immunization programs; the study and treatment of infant diarrheal disease and malnutrition among different populations; the investigation of the quality of maternal/child care in the region; and the effect of Dead Sea baths on arthritic conditions.

The research facilities of the University contribute significantly to the success of the Medical School. Working together with physicians and scientists, medical students are part of a dynamic integrated program which combines education with medical care and research to order to bring better health to the community.

The students are key change agents in the organization of health services in the Negev. ...
That, to me, illustrates why the investment in the students is so extremely important.

John R. Evans, Chairman
Allelix, Inc. Mississauga, Ontario, Canada
Moshe Prywes Distinguished Lecturer, 1985

Achieving the Goals

This school ... is looked to as one of the boldest and most imaginative innovations in medical education in a very long time. The combining of service and educational activities in a truly integrated way, and the inclusion of services other than those that are hospital based are important efforts that are significant to all parts of the world.

Frederick C. Robbins, Former President
Institute of Medicine,
National Academy of Sciences,
Washington D.C. 1982

The Medical School of Ben-Gurion University has grown from fragile infancy to thriving maturity in its 21 years, exceeding the vision of its founders while fulfilling its basic principles:

Community Medicine: The orientation in this regard is represented by a strong Department of Family Practice as well as by Units for Sociology of Community Health, Health Administration and Management, Epidemiology and Health Care Evaluation, and Health Promotion and Disease Prevention. Some of these units are unique in Israel.
Improving Health Care in the Negev: Close ties with Kupat Holim, main health care provider in the Negev, the Soroka Hospital and community clinics has had a pronounced effect on raising the standards of medical care in the Negev.
A 'New Breed' of Doctors: A recent survey found that 80% of hospital department heads outside Beer-Sheva specifically cited BGU graduates as outstanding in doctor-patient relationships and as good or better than graduates of other Israeli schools in 14 other categories.
Research: Research programs in neuroanatomy and neurophysiology, immunology, microbiology, and molecular biology are excellent. The Epidemiology research program is the best in the country and one of the best in the world. Three major research centers were recently established - the Zlotowski Center for Neuroscience, the Daniel Abraham Center for International Health and Nutrition and the Center for Cancer Research.

Researchers attract impressive amounts of competitive research funding per scientist, while most physicians perform clinical or basic research, in addition to normal patient care.
Education: The Medical School is the focus for the development and growth in Israel of academic family medicine and in medical education research in Israel. It pioneered a number of programs for immigrant doctors from the former Soviet Union. Courses in continuing medical education have been conducted for medical professionals from the Gaza Strip and the West Bank. A new degree program in Health Care Management is the first of its kind in the country.

Thanks to the establishment of the Medical School, several hundred highly qualified physicians and health-care professionals have settled in the Negev. They are based in Beer-Sheva at the Soroka Medical Center and in the various community clinics throughout the desert, serving all its residents. For them teaching, research and service go hand in hand.

It seems to me that we did not discover America. What we did in essence was to shift the emphasis from exclusively hospital-based clinical education to primary care ... Consequently, population needs in health gain in value, and human and comprehensive medicine becomes a pattern of medical practice in health and diseases. The introduction of change in our own sound medical tradition created a new tradition for the medicine of tomorrow.

Moshe Prywes
Israeli Journal of Medical Science, 1987

From Experiment to Example

If one were to ask whether this model program is replicable elsewhere, I would have to answer affirmatively. ...Other institutions may well build on this experience in launching new programs.

John Beck
UCLA School of Medicine, University of California, Los Angeles
Israel Journal of Medical Science l987

"The Beer-Sheva Experiment" has made a bold imprint upon modern medical education with a reputation for excellence that has traveled from the Negev to all of Israel, to the third world, the developed world - and to the White House. The office of first lady Hillary Clinton requested information on BGU's program as a model for integrated Medical education and health care.

The World Health Organization (WHO) designated BGU as a Collaborating Center for Integrated Health Services and Manpower Development. Reports of the Center's diverse activities are disseminated by WHO throughout the world. The introduction of medical school curricula modeled after BGU's is helping to improve health standards in the developing world and to train qualified physicians. BGU helped to establish medical schools or health care programs throughout the developing world and has given several international courses in epidemiology, health care systems, pediatrics and perinatal medicine.

In highly developed countries there is growing interest in the Medical School, which was in the very vanguard of the trend toward increased emphasis on the individual patient's needs. Harvard, John's Hopkins and Columbia University have implemented features pioneered by BGU. The British Medical Council's recent recommendations for medical reform echo the principles of BGU's Medical School. Students from many parts of the world are eager to spend time in Beer-Sheva visiting the young Medical School to study the way in which it functions as part of the community and the region.

The Medical School is presently facing a number of exciting challenges. Israel's role in world affairs has grown significantly in the last two years (since the start of the Madrid Peace Talks, the number of nations that have inaugurated diplomatic relations with Israel has increased by 50%) and so has the role of BGU.

The Government of Holland and the Foreign Ministry of Israel asked the Medical School to prepare a continuing medical education program for physicians from newly independent republics of the former Soviet Union. The courses were taught by Russian immigrant physicians and scientists at BGU. The program was so successful that the Medical School has considerably increased its activity in the CIS and members of the staff have assisted several new Independent States in the building and design of health care and medical education programs.
After designing strategies for reorganizing the health services of Rumania and the Czechoslovakian Republic, the Medical School's Unit of Health Policy and Management was asked by the World Bank to advise the Russian Ministry of Health on the formulation of health system reform. The success of these projects is proven by the fact that the Russian government has asked for assistance in designing a community health care system for that country. The Hungarian government, as well, has requested assistance from BGU in developing a new community health care system.
BGU was recently invited to conduct workshops in Thailand on Evaluation and Student Performance in Medical and Health Professional Education. The medical curriculum developed at BGU serves as a model and has been adapted to specific local conditions by schools in the U.S., Sweden, Spain and Egypt.
As the reputation for excellence and expertise of BGU's Medical School spreads around the world, requests for assistance multiply. After playing an important role in establishing a new medical school in Kenya, recent requests for similar assistance have come from Costa Rica, Ecuador and Johannesburg.

Israeli medical education represents a highly sophisticated and well differentiated national effort which has achieved considerable successes but which is faced with significant challenges. ... In particular, the Ben-Gurion University program has become an acknowledged model for international reform in medical education.

David M. Mirvis
Medical Education in Israel: History, Structure and Current Challenges,
Jerusalem, 1993

Looking to the Future

The Medical School of Ben-Gurion University looks ahead to the 21st century anticipating an era of peace in our region and to playing an even greater role in the world of nations. It is launching new programs in clinical pharmacology, laboratory technology, emergency medicine and health care policy and management.. It is vigorously entering into collaborative enterprises abroad.

At the same time, the Medical School is preparing to move into a home of its own. The new campus, some 9,000 square meters in size, lies between the University and the Soroka Medical Center. Ada Carmi, one of Israel's most talented architects designed the new home of the Medical School. Her plans are splendid and the new Medical School is sure to be the architectural hallmark of Beer-Sheva, and one of the finest buildings in the land.

The future is full of promise. The Medical School of Ben-Gurion University will reinforce its existing achievements, augment academic resources, enhance research programs and expand its involvement in the local and world communities. Most important of all, it will do everything in its power to prepare the students of today to be the very best physicians of tomorrow.

While looking to the future of Beer-Sheva, I remember the story about Winston Churchill. As is well known, he liked French brandy and he enjoyed it quite frequently. When he was appointed Prime Minister, he continued for a while to work out of his office at the Admiralty, which had rooms with rather high ceilings. One day, a delegation of ladies from the Salvation Army came to visit him requesting him to limit his drinking habits and give a better example to the younger generation. They said "If we filled up this room with the boxes of brandy you drank, they would probably fill it up at least halfway." Sir Winston looked up, then looked down and said: "So much to do, so little done."

There is still a lot to be done in Beer-Sheva.

Moshe Prywes
Israel Journal of Medical Science 23, 1987