The Spear Fellowship is a unique award given annually to a UC Irvine medical student who excels in pathology. The recipient will participate in a one-month elective in the Department of Pathology at Johns Hopkins.
Johns Hopkins Hospital, the alma mater of Dr. Gerald S. Spear, was founded to challenge the medical standards of its day. Medical education in the late 19th century had more in common with a trade school than the academia known today. Medical practice relied in part on empiric rather than evidence-based traditions.
At the forefront of the effort to change this at Johns Hopkins were four men, architect John Shaw Billing and the four original leaders of the institution: gynecologist Howard Kelly, internist William Osler, surgeon William Halsted and pathologist William H. Welch.
While each of these men began to shape the future of medical training prior to the opening of the hospital in 1889, it was Dr. Welch who had a vision of the hospital’s mission and eventual culture.
At an early age, Dr. Welch rejected the American approach to medicine and moved to Germany to study the more scientifically rooted methods of Rudolf Virchow and other forward-thinking German pathologists. Even in its infancy, the Johns Hopkins pathology department and Johns Hopkins Hospital set forth a history of firsts.
Throughout the next 120 years, Johns Hopkins pathology continued its tradition of innovation and leadership in medicine. Dr. Welch was succeeded by Dr. W.G. MacCallum who was known for his discovery of the malaria life cycle and cardiac changes in rheumatic fever. Dr. MacCallum was followed by Dr. Arnold Rich, world famous investigator of tuberculosis, serum sickness and the vasculidities.
It was during Dr. Rich’s tenure that Gerald S. Spear graduated Johns Hopkins School of Medicine in 1952. Dr. Spear began his residency training first in medicine and later in the Department of Pathology. In 1958, he became Dr. Rich’s last appointed chief resident and remained on faculty until 1977 at which time he came to UC Irvine.
During his time at Johns Hopkins and UC Irvine, Dr. Spear was celebrated for his contributions to renal and perinatal pathology as well as his innovations in describing the genetic origin in Alport’s syndrome.
Dr. Spear was also committed to his role in medical education. He was involved in the pathology course at UC Irvine during his entire tenure, acting as course director for over 20 years.
Following his retirement in 2005, a collaboration was formed between the UC Irvine and Johns Hopkins Departments of Pathology to establish the Gerald S. Spear Fellowship.
Johns Hopkins Experience
During the clinical portion of the fellowship, students are assigned to the "outside slides" rotation. The outside slides team is responsible for reviewing and interpreting cases that are sent to Johns Hopkins from all over the world. These cases can be of any tissue type, and thus, the rotation offers a wide breadth of pathology.
Cases are of two types: Confirmations and true consults. Confirmatory cases are generally sent from both private and large university pathologists who have a specific question. For instance, there may be an issue on invasion or grade that would change clinical management for a particular disease.
Alternatively, true consults are similarly from private and large hospitals alike, but these generally have a more general question regarding a difficult diagnosis or rarely seen presentation/disease. True cases are often sent directly to a faculty member who is an expert in diseases of a specific tissue.
Finally, all cases with a particularly interesting feature are presented to a daily consensus conference. This conference is a sort of “coming together of the minds” in which all the attendings discuss the day’s difficult cases until consensus is reached for each case. The result is a collaboration between different specialties and disciplines ensures that no professor, regardless of stature, is allowed to stagnate in his or her learning.
In addition to addressing consults on outside slides, Spear fellows are able to attend several conferences throughout the week. These include a daily resident teaching conference in which a specific topic is discussed (similar to a pathology class lecture), weekly grand rounds where visiting professors from all over the country speak to a filled auditorium and an “Unknowns” conference where interns are quizzed about difficult cases.