One family’s century-long journey at the Medical School reflects changes in the profession — and in the culture at large.
In one of my first medical school classes, my genetics professor, Thomas Gelehrter, M.D., described the affliction of "M.D. (Medical Doctor): a chronic condition with significant physical, mental, emotional and financial consequences, with MD2B [pronounced 'M.D. to be'] as the early acute stage." He proceeded to ask the class how many students had at least a first- or second-degree "affected" M.D. relative, to which a sizeable portion raised his or her hand.
A 1990 study conducted by the University of Wales investigated this phenomenon, finding that the "risk" of first-degree relatives going to medical school was approximately 61 times that of the general population, providing strong evidence for "vertical transmission" of the practice of medicine. The idea of vertical transmission resonated with me because, for as long as I can remember, I aspired to be a doctor and follow in the footsteps of my parents: my father, a urologist, and mother, an internist. I yearned to be a part of their conversations, to learn the foreign languages of medicine and compassion for patients.
I believe this phenomenon also can be applied to the increased "risk" of attending the University of Michigan, an institution that embraces tradition to its fullest and has one of the largest living university alumni bodies in the world. My parents, in addition to many relatives, attended U-M; I grew up clad in Michigan apparel and yelled "Go Blue!" to anyone wearing even the smallest Block M.
During my medical school journey, I learned that I was actually the fourth generation of my family to be infected by both the medicine and U-M bugs, starting with my great-grandfather, Morris Bachman (M.D. 1925); my grandfather, Milton Goldrath (M.D. 1951); three great-uncles, Robert Goldman (M.D. 1956, Residency 1959), Milton Nathanson (M.D. 1960) and Harvey Komorn (M.D. 1961); and my father, David Goldrath (M.D. 1983). In homage of my family's deep roots in the Medical School, I sought to explore the evolution of life as a medical student from my family's perspective through archival research and personal interviews.
By the 1920s, the Flexner Report, which systematically ranked medical schools throughout the country, resulted in an exponential growth of medicine's prestige. World War I brought an influx of medical knowledge, techniques and students enrolling in higher education, which consequently led to higher qualifications for entry and the standardization of the internship for postgraduate education. U-M was charging about $740 total for medical school tuition ($1,075 for out-of-state) and was reveling in successes, including the discovery of iodized salt for goiter prevention and the completion of the new University Hospital (also known as the Main Hospital) in 1925.
Yet amidst the developing prosperity of the field, several populations were left disenfranchised. Though U-M was notable for being accepting, African-Americans, women and Jewish immigrants faced the most discriminatory admissions criteria through the establishment of quota limitations. In the 1920s, an overwhelming number of educated Jewish students, mostly Eastern European immigrants, applied for higher education (including my great-grandfather, Morris Bachman), but many were denied admission as they were perceived as "radical and abrasive," "invading" the educational system. Jews typically made up between 3 and 6 percent of the medical class. My grandfather's class had a transient increase in the acceptance rate at 10 percent (16 students).
Born in Odessa, Russia, 15-year-old Morris Bachman immigrated to the U.S. through Ellis Island to help his father, a cantor who had settled in Toledo, Ohio. Bachman didn't speak any English, but within three years taught himself the language, graduated high school and became an undergraduate at U-M. Because his father could only give him $25 for college, Bachman supplemented his tuition by working three jobs throughout his schooling. Eventually, he was admitted to the Medical School for his strong academic performance.
Here, he became a founding member and president of the Phi Lambda Kappa Jewish medical fraternity, as well as president of the Maimonides Medical Society, which sponsored scholarships for Jewish medical students. Bachman met his wife, my great-grandmother Clara Gussin, at a medical school party; when her original date could no longer take her, Bachman showed up as her alternative blind date.
He initially was a general practitioner through an apprenticeship, but, during the Great Depression, he decided to pursue a residency in obstetrics and gynecology. Bachman loved teaching and, during his career, he served on the staff of Hutzel and Sinai hospitals in Detroit and was an associate professor at the Wayne State University School of Medicine. Bachman excelled in bedside manner with his patients and valued the psycho-social conversations within his practice to the point that, when he could no longer practice obstetrics due to the physically demanding nature, he was preparing to train further in psychiatry before he died at the age of 71.
World War II brought changes in greater society. There was relatively more diversity in classes after the disappearance of quota limitations and the democratization of education due to the expansion of residency training. Admissions officials were forced to reconcile the expansion of classes with finite facilities and an unwillingness to lower standards to pre-Flexnerian times. By 1950, of the 24,000 candidates who applied to medical school in the U.S., 17,000 were rejected.
That same year, the University of Michigan celebrated the opening of its first women's hospital and the centennial anniversary of the Medical School. In coordination with this anniversary and the increasing media attention drawn to the competitive career path of medicine, Life magazine, one of the premier publications of the time, reported on medical students at U-M for the May 1, 1950, edition. The article regarded medicine as one of the most arduous and costly university trainings, with U-M exemplifying a successful program that had solid funding and top rankings. Alfred Eisenstaedt, a renowned photographer, captured the day-to-day life of medical school by following around a student in each class. My grandfather, Milton Goldrath, was selected as the third-year subject, deep in the action of formidable clinical rotations.
Milton Goldrath, who was born and raised in Detroit, captivated friends and family with his gregariousness, charisma and his chortle of a laugh. He had a photographic mind (I did not get this gene) and was known to place an open book on his face and fall asleep during exam periods, apparently absorbing the knowledge through osmosis.
The learning environment at this time was often confrontational in nature. Students feared flunking out on a daily basis. They were tested unexpectedly, notably in physiology class with "toilet paper" exams, so named because of the small pieces of paper upon which students had to answer questions. There was also "Junior Joy Week," which described periods during clinical rotations when students who finished a series of short rotations would take over 12 exams in one week. Despite all of this, Milton Goldrath somehow managed to enjoy his time in medical school. He even met my grandmother, Joan Bachman, the daughter of Morris Bachman, at the Michigan League.
Milton Goldrath completed a residency in obstetrics and gynecology and immediately began working at his father-in-law's private practice before serving in the U.S. Army. The favor was later returned when Morris Bachman finished out his career at Milton Goldrath's practice. Milton Goldrath would go on to become chairman at Sinai Hospital (now DMC Sinai-Grace) in Detroit for 12 years and an associate professor at Wayne State University. He most notably pioneered the use of lasers in surgery and invented the technology of hydrothermal ablation for gynecological surgery — still utilized universally within the field. He practiced medicine in metro Detroit for 53 years before dying in 2005 at the age of 77, and received an emeritus medallion from the University of Michigan for his service.
Between 1960 and 1980, the number of students entering U.S. medical schools dramatically increased from about 8,000 students to over 17,000. Simultaneously, medical knowledge expanded and evolved at an exponential rate. My grandfather would often tell my dad, David Goldrath (M.D. 1983), "Back when I was in medical school, there were 48 chromosomes — now you only have 46 to learn!"
Technological advancements, including the invention of the MRI machine and the first successful "test-tube baby," were being made almost daily. To streamline information, medical students at Michigan utilized an official note-taking service through the Phi Chi medical fraternity. They could purchase Xeroxed copies of "Phi Chi notes," which were distributed once a week and often included editorial comments of the lectures or cartoons. Preclinical years were not strictly pass/fail like today, and students became all-too-familiar with the difference between scores of 70.1 percent and 92.9 percent — "pass" and "honors." Assessments consisted of the now-defunct practice of concurrent exams: Students were tested every six weeks on a summation of all classes within that timeframe. "Concurrents" resulted in cramming sessions and heavy stress, followed by celebratory visits to Dooley's (now Scorekeeper's) or Rick's, subsequently achieving the lowest class attendance the following week.
My father's most meaningful clinical experience was being one of 35 students to complete all of his third-year clinical rotations at Henry Ford Hospital in Detroit. He also deviated from his predecessors by pursuing a career in urology — perhaps foreshadowed by his one-line performance in the 1982 Galens Smoker, "Oh, Diploma": "I can't believe how hard it was to get this Foley out," he said, staring at a balloon-sized Foley catheter. My father and mother, who were high school sweethearts and maintained a long-distance relationship at different medical schools, completed their residencies at the University of Wisconsin Hospitals and each transitioned to private practice in Illinois. My father has since devoted his career to his professional interests in robotic and minimally invasive urologic surgery and, like his father, has developed many innovative surgical techniques in renal and bladder cancer surgery. He serves as the chairman of robotic surgery at Advocate Good Shepherd Hospital in Barrington, Ill.
In 2013, Michigan was one of 11 schools selected by the American Medical Association for the Accelerating Change in Medical Education initiative. The school received a $1.1 million grant, in addition to institutional support, to innovate the medical education curriculum. The initiative aims to integrate scientific and clinical teaching from day one, defining a core basis of medical knowledge while exploring individual academic pursuits, and create a learning community infrastructure to foster professional development. By 2014, the school implemented the beginning of its several-year phase of the medical curriculum transformation, its most comprehensive in the last century.
My father, like his father before him, loves to compare his medical school experience to mine, reflecting on how easy I have it: a world where we can watch lectures from bed, not worry about preclinical grades and have access to unlimited digitized textbooks and online resources. Imagine his surprise when I told him about flexible quizzing.
The student body also has changed. Now a majority of my classmates are women (with twice as many female as male Alpha Omega Alpha Medical Honors Society inductees) and 15.3 percent are from underrepresented groups in medicine. My mother, Carol Kotzan Goldrath, M.D., the first female physician in my family, was a key influence on my decision to pursue medicine as a career, and I am grateful to establish a legacy as the first female in my family to graduate from the University of Michigan Medical School. In keeping with our family "gene" to pursue a pelvic region specialty, I will be entering my residency in obstetrics and gynecology at the University of California, Los Angeles.
As a recent Medical School graduate looking back at the history of medical education, I am humbled to be part of such a noble field, one full of evolving curiosity and discovery. And though the knowledge and practice is constantly changing, we still share commonalities — sometimes commiserations — with our predecessors. It is important to understand where we have come from to appreciate the advancements we have achieved, to explore the obstacles that still exist, and hopefully to validate the amount of money and time it costs to learn this vocation. Medical school is a rite of passage, and the challenges experienced here forever influence the type of doctors we become. Being at U-M, these challenges have been a source of pride for the institution, and we continue to be leaders in progressing the field. This institution and career path have left a profound impact on me and my family, as we are part of the force that has experienced the evolution of medicine here — and we know that U-M will continue to shape the field for future generations.
Many thanks to all of the people who helped me uncover my family's stories and make this article possible: My parents, Drs. David and Carol Goldrath; Janet Loeb and Charlie Loeb (another Goldrath MD2B); Dr. Harvey and Diane Komorn; Dr. Bob Goldman; Peggy Lakind; Dorie Miller; Dr. Edward and Roseanne Ehrlich; Dr. Howard Markel; Dr. David Howell; Brian Williams and the Bentley Historical Library; Lauren Crawford; Katie Vloet; and my Michigan Medical School family.