Feature
Transitions
Dr. Tracy Lower, '88, has seen the evolution of education and clinical care in pediatrics at SIU
Written by Karen Carlson • Photography by James Hawker
During just her second week of medical school at SIU School of Medicine in Carbondale, Tracy Lower had to interview her first patient. A certain biochemistry professor, Dr. Kevin Dorsey, was behind the simulated patient exam room window to give feedback. Dr. Lower remembers the trepidation of the experience. “I was a nervous wreck,” she now recalls. “I was thankful I could remember the questions to ask.” 
Although nerve-wracking, even then the medical student knew how valuable it was to see patients so early in her medical school education. “My friends who went to other schools didn’t touch a patient until their third year.” Dr. Lower graduated in 1988 and completed a pediatrics residency at SIU in 1991, when she joined the SIU School of Medicine faculty.
Two decades later, Dr. Lower still understands how valuable the educational experience is at SIU School of Medicine, and she has done her part to further enhance the experience. She is director of pediatric undergraduate medical education and curriculum director for the fourth-year.
“There are so many things we can do to help improve students’ skills,” Dr. Lower says, sitting in her small office at the St. John’s Children’s Hospital (SJCH), where she can often be found in the early hours of the morning, studying the needs of the pediatric patients. She is associate professor and medical director of the Inpatient Unit at the children’s hospital and is currently chief of the hospitalists. “The most important thing — this is a team sport. That’s something that’s changed in medicine.”
Dr. Lower has seen a lot of change in medicine during her time at SIU, from the curriculum to her own career. She graduated from SIU under the traditional, lecture-based curriculum that was experimenting with some pockets of problem-based learning. “When SIU offered students a choice of learning through either the lecture-based or
problem-based curriculums (offered from 1990-2000), I could tell from their communication and thought processes which curriculum students were taking.” Those in the problem-based curriculum she found to be more intuitive. “They talked to patients rather than ‘checklisting.’”
Directing the pediatrics clerkship for third-year students, Dr. Lower transitioned it to an all case-based curriculum. “It’s more of a discussion to stimulate thinking. Students do well no matter what we do, but I really appreciate the self-directed learning and setting their own goals so that I can be a facilitator rather than a lecturer.” Today’s revamped clerkship includes new initiatives such as students evaluating the educators.
Dr. Lower, students and residents discuss baby Chase's condition during family-cntered rounding at St. John's Children's Hospital.
Dr. Lower herself transitioned professionally to a full-time hospitalist and helped evolve the pediatrics department. “At the beginning of my career, I had a traditional setup: I saw patients in clinic at St. John’s Pavilion, then I came to the hospital and saw my own patients. I realized that I liked in-patient work a lot. I often did rounds for the group on inpatient service.” Around 2005, she shifted to more in-patient care and worked with the student clerkship. “As a hospitalist, I thought I’d miss the continuity of patient care. It was hard at first, but there’s actually a lot of continuity in this, because children with chronic illness may need to be hospitalized often.”
As a hospitalist, Dr. Lower was the only pediatrician caring for SIU patients and out-of-town referrals, about 500 patients a year. That service expanded with more pediatricians assisting her — including department chair Dr. Mark Puczynski — and soon they were caring for most of the family physician admissions in town. “As of June 2011, we now care for all the pediatric patients admitted to St. John’s Children’s Hospital from all the primary care physicians in town, and we admit pediatric patients who come from out of town.” Dr. Lower and two fellow SIU pediatric hospitalists, assistant professors Dr. Jody Lack and Dr. Lynn Kink, now share responsibility for inpatient care for an estimated 4,500 children a year. On a typical 12-hour day, Dr. Lower says she sees anywhere from a dozen to up to 20 patients a day at the hospital.
Jennifer DeLuka, M.D., a 2010 graduate of SIU School of Medicine, is the chief resident of pediatrics. She considers Dr. Lower a wonderful mentor. “Dr. Lower can see a patient 50 times, and she can always teach us something new about the patient.” 
Dr. Lower instructs Jeffery Hassenflug, MSIII.
Dr. Lower also instituted quality improvement measures at the children’s hospital, including developing order sets and putting procedures in writing. “By having these in place, patient care becomes more efficient and safe. All members of the team are clear about plans of care. They also make us compliant with national guidelines and measures that are reported publicly.”
In 2005, Dr. Lower helped transition learning and pediatric patient care to a national movement called family-centered rounding. “In the old days, students, residents and attending physicians would do rounds in a conference room, where they would talk about every patient, what the plan was. This was OK, but the patient wasn’t there; the family wasn’t there. It’s too easy to lose focus on the family when you’re sitting in a conference room.”
Most importantly, she says, students and residents weren’t experiencing that family interaction — understanding what the family needs and learning how to answer the tough questions a mom asks. There was potential for miscommunication, with the patient hearing reports from different nurses, residents and attendings. “We moved all that into the patient room and include the family. Ideally nurses are involved, and everyone hears the exact same thing.”
Dr. Lower leads the group of residents and medical students, a petite figure among some of the new generation who tower above her. She takes a firm, guiding hand, ensuring participation by all. She includes the parents and patients in the discussion with one simple query: “What questions do you have for us?” She ensures the patient and family members understand the medical terminology and sometimes reviews the test results with them on an iPad®.
Family-centered rounding reflects the SIU School of Medicine philosophy of treating the patient, not the illness. “It’s how it should always have been,” Dr. Lower says. “When I first brought the ideas of family-centered rounding, people said, ‘Of course that’s how we always do it.’ But once we started doing it, it was clear that we weren’t really doing it before.”
The technique also highlighted the differences in how SIU School of Medicine teaches students. “Most of our pediatric residents didn’t train here, and it was hard to convince them that family-centered rounding was a great teaching opportunity. They couldn’t imagine how they could learn outside of a conference room and its academic discussion. It’s a different focus.”
For the SIU third-year medical students on clerkship, however, it was a different story. “They loved it,” Dr. Lower says.
Teaching those students has become as dear to Dr. Lower as caring for her young patients. “My focus now is about transitions and getting the students ready for residency.”
To help with that transition, this academic year Dr. Lower has implemented a unique variation on the fourth year, which traditionally is filled with electives. This year, for students passing the Year Four Committee’s requirements — including the challenge of passing all 14 cases of the senior clinical competency exam — students can design their own curriculum for the year. “It sounds crazy,” Dr. Lower admits, “but you would be amazed at how much better they are at designing a curriculum that means something to them than we are.”
Fourteen students met the tough criteria this year, and eight decided to change their schedules. With guidance from Dr. Lower and others in medical education, the students can make the final year of medical school a true gateway to their future. “I call them the superstars. These are highly motivated people,” Dr. Lower says. One student is studying for a master’s degree in education, one is working on a research project and one is designing an elective to practice writing admission orders. “You have to be self-directed as a physician,” Dr. Lower says. “This experience will let them do that.”
Her SIU friends would agree that, like these students, Dr. Lower is a superstar in her own right. She has worked for decades with local and state organizations to prevent child abuse. “The word is out,” she says. “We’ve found that abuse goes up when the economy goes down. Studies have shown that nurses who visit high-risk homes in the first few weeks of life helps prevent child abuse.”
She notes that Pediatrics Chair Dr. Mark Puczynski was an incredibly supportive advocate for her transitions, and she received great support from St. John’s Children’s Hospital.
With her career at its apex, Dr. Lower looks toward more personal time to engage in writing projects both about her career experiences and possibly a fictional work. Among other professions, she once considered becoming a concert pianist. “I want to play piano in a bar when I retire,” she says.
Dr. Lower is thankful for the opportunity SIU has given her to make a difference in patient care and teaching. “My greatest joy is the kids,” she says. “When they get better, and you’ve had a part in it, nothing can beat that. But there are also the students who might be having trouble, and when they succeed, well, maybe I had a part in that, too.”