Public Safety & Justice

Medical Residencies Serve as a New Model for Police Training

One officer’s battle with cancer inspired him to take a new approach to policing.
by | July 2011
 

Growing up on New York City’s Upper East Side, Dean Esserman always knew what he’d be as an adult -- a doctor. His father, Paul Esserman, was a beloved primary care provider and a faculty member at New York University’s School of Medicine. He was also a physician with a strong sense of social justice. Although the Esserman family was Jewish, summers were spent working in hospitals run by the Catholic Missionary Service in countries such as Ethiopia, China and Guatemala. For young Dean Esserman, these were hands-on experiences. “I was 11 when we moved to Guatemala,” he says. “That was the first time I did surgery.”

But in college at Dartmouth, Esserman discovered an affinity for a very different profession -- policing. Instead of going into a pre-med program, Esserman started interning at the New York City Transit Authority police, the nation’s sixth largest police department. He went to law school, worked as a prosecutor and then returned to the transit authority as its general counsel. In the fall of 1991, he went to New Haven, Conn., to run the police department. There, he went through the New Haven police academy and joined the community of sworn police officers. (“A lot more push-ups than law school,” he says.) Stints followed as the chief of New York’s Metro North police force and as chief of police for Stamford, Conn.

In 2003, Providence Mayor David Cicilline asked Esserman to come head the Providence Police Department. (This April, the new mayor, Angel Taveras, reappointed Esserman to the position.) As chief of police, Esserman was a vigorous reformer. He divided the city into nine police districts and devolved power to district commanders, holding them accountable through the CompStat computerized crime-tracking system. He introduced the precepts of community policing to the department, forging connections with community groups and reaching out to other government agencies and nonprofits.

Then, on Oct. 3, 2005, at the age of 48, Esserman was diagnosed with colon cancer.

“Obviously since the days when I’d started doing surgery with my father in Guatemala, I’d been around mortality,” says Esserman. “But it’s different when it’s your own mortality.”

Esserman started radiation and chemotherapy treatment that fall. At first, he prided himself on not missing a day of work. Then, in February 2006, he underwent surgery to remove a tumor at the Miriam Hospital, a teaching hospital affiliated with Brown University’s Alpert Medical School. An infection and a second round of chemotherapy proved exhausting. Esserman lost 45 pounds; he was unable to get out of bed for several weeks. When he could, Esserman took to walking the hospital floors to rebuild strength, chatting with everyone from janitors to nurses to attending physicians along the way.

In the process, Esserman became fascinated by something he thought he’d put behind him -- the world of medicine. What interested him most was how “the Miriam,” as a teaching hospital, was organized to help medical students, residents and attending physicians learn. Soon, Esserman was sitting in on case conferences, where physicians talked about how to hand patients from one shift to the next. He even attended the weekly morbidity and mortality conference, where physicians discussed the most complex cases, areas for improvement and cases that had gone wrong.

For most of his adult life, Esserman had viewed his decision to enter the world of public safety as a step away from medicine. But now that he had re-entered the medical world, he noticed similarities between the two professions everywhere he looked.

“Here I am in a teaching hospital,” Esserman recalls thinking. “Maybe I could create a teaching [police] department.”

That’s exactly what he’s set out to do. It’s an intriguingly simple notion: Design a “residency” program for police officers similar to what hospitals require of medical students. But the implications of Esserman’s insight -- and his work in Providence to implement it -- could forever change the way police departments are structured, says Bernard Melekian, director of the federal Office of Community Oriented Policing Services (COPS). Esserman’s idea, says Melekian, “will revolutionize policing.”

A century and a half ago, both the medical and police professions were disorganized, lacking any real, coherent set of professional standards. In 1838, Boston organized the first paid police department in the United States, modeled on London’s recently created Metropolitan Police Services, also known as the Met. Other American cities quickly followed suit. But while London’s “Bobbies” (named after the prime minister who created the Met, Sir Robert Peel) quickly won the respect of the British public, American police departments struggled to define themselves as a profession.

In theory, policemen were responsible for a bewildering array of tasks. They apprehended criminals and then prepared the cases against them when they appeared in court. They picked up loose paper on the streets (blowing paper could spook horses), cleared weeds from abandoned lots, enforced foot-and-mouth disease regulations, notified businessmen of upcoming police auctions and enforced licensing requirements. Officers also responded to fires and floods. However, few seemed to apply themselves to their work with much zeal. A 1904 study of the Chicago Police Department found that police officers “spent most of their time not on the streets but in saloons, restaurants, barbershops, bowling alleys, pool halls, and bootblack stands.” The activities of detectives were more suspect still. Operating out of saloons and dives in plainclothes -- supposedly in order to better monitor the underworld -- it was often difficult to distinguish them from the men they were tasked with policing. Detectives routinely demanded cuts from the pickpockets, pimps, burglars and “bunco” men who operated in their areas, often at the behest of local elected officials who frequently insisted on a cut as well.

This wasn’t altogether surprising. Police jobs were treated as patronage positions by urban machines. Policemen received no training and very little support. After being hired, officers were required to supply themselves with the gear necessary for the job: typically two uniforms, hats, boots, a revolver, a gun belt and cartridges, and handcuffs and a billy club. For this, they were paid about $75 a month at the turn of the century -- less than a milk deliveryman.

At the same time, the medical profession also was struggling. In 1909, the Carnegie Foundation commissioned educator Abraham Flexner to investigate the condition of the nation’s teaching hospitals. What he found was horrifying: medical schools that would accept anyone who could pay the tuition, medical schools without laboratories and even a medical school where decaying cadavers were stored in an outhouse. Flexner’s report, Medical Education in the United States and Canada, recommended a different approach, one that called for higher standards for physicians and training that emphasized both biomedical research and hands-on training in a hospital setting.

At the heart of Flexner’s recommendations was the idea of a teaching hospital. “A hospital under complete educational control is as necessary to a medical school as is a laboratory of chemistry or pathology,” his report proclaimed.

The American Medical Association embraced the Flexner report, and it -- along with the great foundations borne of the Gilded Age -- funneled hundreds of millions of dollars into medical schools and teaching hospitals, creating an elite corps of some 400 teaching hospitals that are the center of the field of medicine today.

Policing attracted reformers too, most notably Chicago Police Superintendent O.W. Wilson and Los Angeles Police Chief William Parker, who in the 1950s and 1960s brought modern planning and research techniques to police departments, as well as modern technology, computerized records and radio patrol cars. Yet despite similar efforts, the police and medical professions developed in very different ways. Where the medical profession extended life spans, police departments presided over a crime explosion. In the 1970s, high-profile policing innovations, notably the practice of assigning radio patrol cars to patrol a geographic district and respond to calls for service, were found to be ineffective by a series of classic studies. “There was a sense that nothing worked,” says crime analyst George Kelling, whose research in Kansas City in the early 1970s first called into question the dominant paradigm of policing.

In the 1980s, a new generation of innovative police executives and academics developed a new approach that responded to these critiques: the community-policing model. William Bratton’s successes as police commissioner in New York City in the early 1990s unleashed new types of innovation that contributed to dramatic reductions in violent crime, returning many American cities to crime rates not seen since the early 1960s. Yet despite two decades of falling crime, there is a widespread sense of concern about the future of the profession, says Harvard University’s Christopher Stone, who directs the Kennedy School of Government’s program in criminal justice policy and management. “Police organizations have enjoyed a couple of decades of great innovation and great success in many respects,” says Stone. “But since the beginning of this century, policing has become so complex that to think in terms of community policing no longer helps police executives think through the most difficult challenges, whether it’s counterterrorism, organized crime or just dealing with the new surveillance technologies.”

Medicine offers a compelling model for dealing with these emerging complexities, says Stone. “I think medicine has embraced its own version of a new professionalism in recent decades, with a greater emphasis on communications, patient care and family practitioners. There’s been a lot of improvement in medicine that I think policing could learn from.”

Medicine also offers the law enforcement world strategies for dealing with the challenge of disseminating information to an incredibly decentralized field. No other country has anything approaching the 20,000-odd police departments the United States has, notes Stone. While such radical decentralization has upsides -- notably, democratic local control -- it also has a major downside: Police departments in the United States tend to be parochial. “We need a way of overcoming parochialism in American policing just as we do in medicine and education,” says Stone. “Medicine has done that through training, through accreditation, through standards. There are lots of devices that have made American medicine global in its knowledge base even as it remains local in its practice. Similarly, the education world has become much more sophisticated and less parochial.” Policing, he says, needs to go through that same growth process.

Esserman puts it even more bluntly.

“We are the old Detroit,” he says. “You joined the Providence Police Department; you didn’t join American policing. You joined a company and you stayed there until you retired. Period. That was the culture and education you got.”

Medicine was different. “I don’t think the cancer treatment I got was Brown University-Miriam Hospital’s cancer treatment. It was the medical profession’s best cancer treatment. The doctors at Miriam have been back and forth across the country. I got the best quality medical care that the profession had to offer, not what Brown medical school had to offer.” By contrast, he says, “in American policing, as soon as you cross the river to East Providence, it’s a different type of policing, for better or worse. There is no American policing.”

Esserman’s ambition was to change that.

Esserman’s surgery and subsequent round of chemotherapy were successful. By the summer of 2005, he was cancer free. (He remains so to this day.) But he didn’t leave his interest in teaching hospitals behind when he returned to work. In 2006, Esserman and Dr. Fred Schiffman, the oncologist who oversaw Esserman’s cancer treatment, collaborated on a program that sent doctors and police detectives into the Rhode Island School of Design Museum to hone their powers of perception and description. They named the program, which was inspired by a similar program at the Frick Museum in New York City, “Cops and Docs.”

Esserman sought to form other partnerships as well, reaching out to the Institute for the Study and Practice of Nonviolence and to Roger Williams University, which ran a police training program for departments across Rhode Island. Esserman began requiring newly promoted sergeants and lieutenants to participate in a two-week management development program there. But Esserman’s most important attempt to create a teaching police department comes directly from the world of the teaching hospital -- the concept of a residency.

Starting later this summer, all 17 of the department’s lieutenants will work with organizational psychologist Joan Sweeney and Robert McKenna, who directs Roger Williams’ justice systems training program, as well as outside consultants (all of whom are supported by a grant from the federal COPS office) to develop a residency program for command staff.

“Part of what we are hoping to do is shake up the notions in policing of what the competencies are that 21st-century police leaders really need to have,” says Sweeney. “Critical thinking skills, the ability to be a reflective practitioner, the ability to use a body of knowledge in the field to actively inform decision-making are not currently the emphasis of most training programs. We want to change that.” But not in a top-down fashion.

"This is not just an academic endeavor with academics teaching police officers,” continues Sweeney. “Nor is it cops visiting other cops and taking each other on ride-alongs and talking about what they are doing.” Instead, the goal is to develop a program that represents the best of both worlds -- and that the lieutenants buy into.

“They will inherit this place,” she notes, and changing their habits and their mindset “is a much deeper type of change than winning the heart and mind of a police chief who may be there two or three years.”

Just west of downtown Providence is Olneyville, the roughest neighborhood in the city and the poorest place in the state of Rhode Island. It and other tough neighborhoods make up the city’s Fifth District, currently under the command of Lt. Dean Isabella, a 24-year veteran of the Providence Police Department. If Esserman hopes to revolutionize the police profession, he’s going to need guys like Isabella.

Olneyville is a neighborhood Isabella knows well: He grew up there, in the top floor of a white triple-decker on the corner of Manton Avenue and Unit Street. “I remember there was a wiener joint at the front of the first floor and a mob social club in the back. I think they fenced stolen goods from back there.” There was heroin, too. Isabella recalls bounding out of his family’s apartment as a 5-year-old and encountering a man slumped over on the stairs, who’d just shot up. “Don’t step on a needle, kid,” the man told him.

When Isabella took command of the district in 2008, one area in particular near the Woonasquatucket River accounted for about 17 percent of his calls. Following in the footsteps of his predecessors, Isabella worked with the Local Initiative Support Corporation in an attempt to redevelop the area using what’s known as crime prevention through environmental design. Driving past a new playground, crowded with children after school, Isabella points out the features that have transformed the feel of the neighborhood. “The windows of all the houses are pointed toward the park, so [would-be criminals] there never know who’s watching them,” Isabella says. A bike path along the river is wide enough for police cars to drive on, and is set back from the river bank, closer to bystanders. Lights were left out of the playground, to discourage drug dealing and prostitution at night.

Isabella says the experience of partnering with the local community and the changes that resulted have been transformative.

“We could have put a police officer on every corner, and it wouldn’t have solved the problems,” he says of the old Olneyville. “What solved the problem was a partnership that changed the way people who lived in the neighborhood perceived it. They now feel that they live in a good neighborhood.” And they insist that the people in it behave accordingly, he says.

Isabella has presented his work to Providence’s other lieutenants and to police departments across the country. It’s exactly the kind of learning that Esserman hopes to encourage.

“People could perceive a teaching police department as something that is arrogant: ‘Come and learn from us; we will teach the world,’” says Esserman. “But I look at a teaching police department’s first concern as inward-focused, as what we teach each other. The first teaching is the teaching that goes on inside the police department, just like doctors teaching doctors inside a hospital.”

According to COPS director Melekian, it’s this kind of cultural change that makes the Providence experiment so exciting. Many departments offer training to the top executives, “the chiefs and sheriffs and possibly the seconds-in-command,” says Melekian. But it’s rare to emphasize to first- and second-line managers -- the sergeants and the lieutenants -- that their careers will involve ongoing education growth.

“If we can change the career officer or the career supervisor, if we can change his or her point of view to see this career as life-long learning,” says Melekian, “I think that’s the revolutionary part of changing the profession.”

Editor’s note: After eight and a half years on the job, Dean Esserman resigned as the Providence police chief on June 23. In his sudden announcement, Esserman cited the “distraction” caused by controversy over underage drinking at a party celebrating his daughter’s recent high school graduation.

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