Yale Psychiatry Grand Rounds: "Dean's Address: State of the Medical School"

January 12, 2024

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January 12, 2024

"Dean's Address: State of the Medical School"

Nancy J. Brown, MD, Jean and David W. Wallace Dean of the Yale School of Medicine; C.N.H. Long Professor of Internal Medicine

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00:00Thank you to those of you who did
00:03come in person and I'm actually not
00:05delivering the address so much as a
00:07Cliff notes really for the intention of
00:11tweaking your memory so that you will
00:13frame questions and things will come to
00:16mind that you wanted to to talk about.
00:18And so I'll start by just reminding you
00:21that with all the work that we're doing,
00:23they're really for cross cutting themes.
00:25And the first is about creating
00:30an environment where everyone can
00:32thrive that is inclusive and where
00:35we continue to recruit and retain
00:37the the best talent in the world.
00:41And I think this department embodies
00:46that in in the talent that's here.
00:49I'm looking at some of the honors
00:52that you have received and some
00:55of the national leadership.
00:58I'll point out, for example,
00:59that Marina is president of
01:02the Society of Neuroscience.
01:03As you know, Carolyn,
01:04Missouri is recently doing
01:05work for the White House,
01:07which is a pretty good gig.
01:10Charles **** president of American
01:12Academy of Psychiatry and Law,
01:13Regita Sinha, Vice President for
01:16Research Society and Alcohol,
01:18Annie Klee, American Psychology
01:20Psychological Association.
01:22So you know,
01:23that's the the kind of leadership
01:25that I think it differentiates this
01:27department and this school and
01:30something that we want to promote
01:32our junior faculty to grow into.
01:34One of the ways we've done that
01:36is the creation of this faculty
01:39Annual Development questionnaire,
01:41Development Annual Questionnaire,
01:43F DAC, which is you know,
01:45we piloted 2 years ago and
01:48did completely this year.
01:50Keith Choda is going to be
01:52showing to the chairs our data.
01:53These are out of date as of about,
01:56you know,
01:57the summer,
01:59but all but four departments
02:03completed virtually 100% of this.
02:07And the ideas really to frame the
02:11conversation to give our faculty
02:13better ways of thinking about
02:18what questions they want to discuss
02:20with their leaders and their chairs.
02:21And interestingly, we are just getting
02:24an early look at our university
02:26faculty survey data from this year.
02:28We now have a comparator for two
02:31years and the thing that showed the
02:33greatest improvement was our faculty's
02:35view of both formal and informal
02:36mentoring that they're getting.
02:37So it's really,
02:38I think starting to have an impact
02:40trying to get rid of that.
02:41What are we, what are we getting there?
02:44There's on the screen behind.
02:47Excuse me one second.
02:50OK, OK, great. I wasn't,
02:51I wasn't looking behind me.
02:55So lots of investments in career development,
02:59particularly in that period from training
03:03to independence if you're a researcher.
03:06And this is work that Keith is also leading.
03:08But one of the groups that we have,
03:12we often lose our our international
03:14trainees who are not eligible for training
03:17grants by virtue of their visa status.
03:19So we're putting some internal
03:21money into bridging that gap.
03:23We had four awardees this past year.
03:25It's really had an impact.
03:27We're also investing significantly in
03:30support for graduate slots and for gaps
03:34in the postdoctoral fellows and the
03:36graduates as those now with the Local
03:3933 are going up considerably this year.
03:42The long term play,
03:44I think it's got to be developmental
03:46support for these entities.
03:48Our research faculty,
03:49you know is a group that we have
03:51I think taken for granted and
03:53we are not alone in this.
03:54I think this is across all
03:57academic medical centers.
03:58And so this is some of the work that
04:00our recent task force recommended,
04:03including standardizing the offer
04:05letter so that there's clear
04:08expectations and my joining this track
04:10as a pathway to a different track.
04:12I'm joining this track because I want
04:14to be leading a lab and a core and
04:17differentiating in which case we need
04:20to provide those career pathways And
04:22then actually developing an F DAC
04:25equivalent for our research track faculty.
04:27The learning there has been,
04:30there are issues with trust and issues
04:33particularly because our research track
04:35faculty very much rely on the funding of API.
04:38And so being completely honest about
04:41what your experience and what your
04:42obstacles is is a little bit harder.
04:43So we may have to think about
04:46this differently.
04:47I mentioned our surveys,
04:48I think we've been well
04:50surveyed over surveyed.
04:52We're trying to get some discipline
04:53around this and now we'll be alternating
04:56the university survey which we just
04:57did this year with this survey,
04:59the double AMC survey.
05:00But to give you examples,
05:02this survey measures input from
05:04students and staff as well as faculty.
05:07So we get slightly different information.
05:09It allows us to benchmark around
05:12against other schools of medicine,
05:14whereas the university survey really
05:16allows us to benchmark against other
05:19schools in the in the university.
05:22And so these data are all the data
05:24from these surveys at a high level
05:25or all posted on our web page on
05:27the School of Medicine web page.
05:29I think that's really important because
05:33that transparency and in addition
05:35departments receive their data And
05:37so you know I think for you as a
05:40department to say what are our gaps,
05:42what are the things we need
05:43to do differently is is really
05:45an important exercise.
05:46The other data that are are posted,
05:49there is a high level annual survey
05:51of the types of things we come see
05:53coming to our office of Academic and
05:55Professional Development of course
05:56led by a member of this department,
05:59Doctor Robot.
06:00And this has been invaluable
06:02in seeing several things.
06:04One is an early warning when an individual
06:08is struggling with professionalism,
06:10often because there's something going
06:11on in their life and that they need,
06:13they need support for or they
06:16just need coaching.
06:17But also when there are systems issues,
06:18when we have a unit where there
06:20are particular things going on,
06:21you can see the vast majority
06:24of things that come to that
06:25office or around professionalism.
06:27And when we do a deep dive there,
06:29it's, I would say a lot of it falls
06:31into the category of anger management
06:33and just helping people figure
06:35out how to deal with frustration
06:37and stress in the workplace.
06:38But if we intervene early then we prevent
06:42the the the more serious episodes.
06:45Another group of not faculty,
06:48but extremely important to our
06:49future of course are our students,
06:51I mentioned earlier,
06:52graduate students we continue to recruit
06:55incredibly diverse and talented.
06:57This is, I think by the numbers,
06:59one of our most talented classes,
07:01but also the most diverse class
07:03that we've ever had.
07:04We've had lots of conversations about
07:07the potential impact of SCOTUS on
07:10our admissions process and I will
07:12admit to being a terminal optimist,
07:15but I will say the way our
07:18admissions process works,
07:19we have always had a very holistic process.
07:22And what SCOTUS says is you can't
07:25use a specific characteristic
07:27in the admissions decision.
07:29But what we do to increase
07:31diversity is really about outreach.
07:33It's about outreach before people
07:35get here and the work that many
07:37of you were engaged in,
07:38in going around the country
07:40and letting students know that
07:42Yale is accessible for them,
07:43that they're talented, they should apply.
07:45And then once we've admitted
07:48people making sure that they make
07:49the right decision and come here.
07:51And to that end,
07:53we've created a position with part time
07:56position of Director of Alumni Engagement.
07:58And this is partly to really allow our alums,
08:03some of you are are here to be more
08:07proactive in in involvement in the school.
08:11But it also with respect to admissions to
08:14enable our Lums out in the communities
08:18to call admitted students who have
08:21shared experiences come from shared areas.
08:24And so Anne Arthur,
08:25who's an alum herself,
08:26class of 1990,
08:28a practicing ophthalmologist in New
08:30York and I would say something of
08:32a force of nature is spearheading
08:34this work and and making sure that
08:36I don't go to any city where I'm not
08:39having a dinner or a luncheon with alumni.
08:41So thank you for all the work that many
08:45of you put into our LCME site visit.
08:49We are almost through the final stages.
08:52We will receive a a final report in February,
08:54but so far so good and this catalyzed
08:58a lot of important work including
09:00strategic planning and I won't walk
09:02through the entire strategic plan.
09:04I'll just highlight a couple
09:05of things that are going on.
09:07One is the the provision of coaches
09:10with our first year class, but it will,
09:12we will move through all four classes.
09:14Our students,
09:15you know,
09:16the Yale system allows them
09:18incredible autonomy that can be
09:21pretty frightening in the beginning.
09:24And we're a much bigger place
09:26than we were in
09:27the 1930s when the real
09:29system was put in place.
09:30So coaches are now available
09:32to our students to help them
09:34look at what they want to do,
09:35navigate the system and sort
09:37of measure their own progress.
09:39Still, you know,
09:41when winterness described the system,
09:43he said medical school should
09:44be like Graduate School.
09:45But we provide mentorship
09:47for graduate students,
09:48and this is about providing
09:50mentorship for our medical students.
09:51Another thing that's going on is the
09:53formation of colleges that allows for
09:55vertical integration of our students,
09:57not just across class,
09:58but with other classes,
09:59with faculty,
10:00with the community.
10:01We've had huge faculty engagement of
10:04this with this and the first dinners have
10:07been happening and a lot of enthusiasm.
10:09So the next set of cross cutting
10:11themes are around how we promote
10:14innovation and creativity discovery
10:15and what are the sort of cross
10:18cutting resources that are necessary.
10:20And I I will start with this slide which
10:25is our university science strategic plan.
10:28Superimposed on that in green is
10:30the results of our school specific
10:33strategic planning and highlighted
10:35in blue were the elements of the
10:36university strategic plan that
10:37are particularly relevant to
10:38the School of Medicine,
10:39right.
10:40So now I'll put red on there just
10:43to really make it a busy slide.
10:44But these are some of the things
10:46that we're doing to address
10:48these strategic initiatives.
10:50So for example,
10:52I'll go to neuroscience,
10:54which of course is most
10:56relevant to this group,
10:57but things like the creation of
11:01a clear potent stem cell core
11:04where you can generate neurons,
11:06recent philanthropically and and
11:10funded ventures related to neuro,
11:13inflammation and neurodegeneration,
11:17things like the Center for Brain,
11:18Mind Health,
11:19Chris is one of the leaders of
11:21that which is intended to bridge
11:24this basic science research that
11:26we're doing into the clinical
11:28arena so that any patient who
11:30gets admitted to Yale New Haven
11:31Health System has access to the
11:33most cutting edge therapies.
11:35So those are examples many,
11:37many others here central biorepository,
11:40Office of team Science,
11:43investments in precision medicine that are
11:46ongoing investments in cancer etcetera.
11:49So one of those investments is,
11:51is making sure that our cores are working.
11:55And Amy Blanchard,
11:56who's our Director of the research
11:59course has been a hero here in
12:02creating governance structures and
12:03input structures for our faculty
12:05to say this is what's working here
12:08are the cutting edge therapies or
12:10technologies that should be in the core.
12:12So updating equipment,
12:14introducing new software,
12:16trying to take the pain out of
12:18using cores and making sure that
12:19the service and the timelines are
12:21good and the sort of Uber core
12:23that we have is our Yale Center
12:25for Clinical Investigation and
12:26this is well known to to John.
12:29But you know one of the things
12:30about this as it's evolved over
12:32the years as we've tried to be
12:34all things to all people and
12:35sometimes are no things to anybody.
12:37And so we,
12:39we brought in Dave Coleman,
12:41who many of you know was here for for
12:44years and just retired from a gig as
12:47chair of Medicine at BU for like 16 years.
12:50Familiar with the institution,
12:52actually wrote the first report suggesting
12:54the creation of YCCI with Rick Lipton.
12:58And he's been getting under the hood
13:00in a way that only someone who's
13:03strictly focused on this work can
13:05do in collaboration with John and
13:07with Brian to to rationalize how
13:09YCCI works so that we're putting
13:11resources where they're most needed.
13:14So for example,
13:15closing studies that aren't
13:17enrolling and having some criteria
13:19for who should be funded,
13:21but then using that money to
13:22fund vouchers for young faculty.
13:23And so you'll be hearing more
13:26about those efforts.
13:27Another area of investment in terms of
13:32centralized resources is the faculty portion
13:35of our degree and Master of Health Sciences.
13:38You know,
13:39we have really have two degrees that
13:40were approved by the corporation,
13:41one for students and one for faculty.
13:44That was a single degree approved
13:46for faculty.
13:46It turns out we have,
13:47I don't know, count them,
13:4916 or 20 different programs.
13:52Everyone's different.
13:53Every department has created the
13:55different process for admitting training
13:58and it's incredibly inefficient.
14:00And I I would dare say that the students
14:02aren't getting the best possible education.
14:04So Lauren,
14:05Sensing has been doing this work
14:08in creating a a more unified
14:10structure with four tracks.
14:12Some of those tracks already exist of course,
14:145 tracks, sorry,
14:16medical education,
14:17no change there,
14:18National clinical scholars
14:20program no change there,
14:22but really codifying our track in
14:24informatics and a new track that Rob
14:27Rob Roy Herpes has been involved in
14:30developing in clinical investigation.
14:31So admission applications are being
14:33accepted right now and you probably
14:35saw an e-mail that went out from
14:38Jessica and Lauren yesterday.
14:42I won't get by without talking about space.
14:46This is a diagram of our
14:50beginnings of our master plan.
14:52You can see for orientation
14:54college turning into Congress.
14:55Here's Sterling Hall.
14:58We are you know neuroscience now has
15:01moved in largely into 100 college.
15:04Importantly, we now own 300
15:06George as of about a month ago,
15:08this was a lease to own building that
15:10will have so a lot of implications.
15:12It means eventually we will operate it,
15:14which I think is beneficial the
15:15university will operate it.
15:17It also means that as floors
15:19become available,
15:20we can build out more wet space there.
15:23One O 1 college will become
15:26available in roughly 15 months.
15:28That will decant people from
15:30TAC and allow for putting more
15:34inflammation research intact.
15:36But what I'm most excited about is this
15:39little the purple triangle that says
15:41site that's 35 to 47 college place,
15:44that one story.
15:45And that usually when I say this,
15:46somebody says that's where I park,
15:48I've got my office.
15:50They're good,
15:51but it's not being used well and it's
15:54going to become additional space
15:56both for the School of public Health
15:57and for the School of Medicine.
15:59For the medicine, it's wet lab space.
16:01It's going to go up many floors.
16:03They're doing the massing diagrams now
16:05and it will be a university building,
16:07not a least, which I'm really excited about.
16:11We have convened twice now a
16:15Yale Scientific Advisory Board.
16:17These are, you know, a Nobel laureate,
16:20Alaska prize winner,
16:21Breakthrough Prize winner, editor of science.
16:23All but one with a with a history
16:26with Yale from training to having
16:28been faculty here and we have
16:31slowly been in the presenting both
16:33sort of strong existing programs.
16:35So we did neuroscience the first year,
16:37inflammation this year,
16:39but also the things that we're building
16:41and getting input on that very,
16:43they're very interested in our
16:45trainees and what we're doing there.
16:46And so each year we'll be inviting
16:48trainees to meet with them as well.
16:52And then lastly before we get
16:54to lots of time for questions,
16:57just to address the work that
16:59we're doing with alignment.
17:01And you know we've had about a
17:03200 relationship year relationship
17:04with the health system and it's
17:07not always been a smooth one.
17:09I don't see any way forward for
17:12us without being better aligned.
17:13And the first part of that is
17:16doing joint strategic planning,
17:18which I don't think we've ever done.
17:20And so these are the sort of pillars.
17:24I'll point out on the far left,
17:28a pillar around clinical
17:29and translational research.
17:31This is this draft is written,
17:33it's posted online and the alignment website,
17:36you've all gotten a URL to that.
17:39It calls for things like a single
17:41IRB across the center so that
17:43if you're doing research,
17:45you're not applying separately in Bridgeport.
17:48It also calls for the appointment of a
17:52director of research in the health system,
17:54which would be shared reporting
17:56to the Dean and to
17:57the CEO of the health system,
17:59much as Peggy McGovern stands
18:01over the physician enterprise
18:03and that work is ongoing.
18:05And then work on what are the service
18:07lines that we need to develop that is
18:10has involved having chairs and service
18:12line leaders all in the room together
18:14each talking about their own programs,
18:17which is extremely useful because themes
18:19emerge like cross cutting themes that
18:22we all need support for these programs
18:25etcetera And then prioritizing them
18:26about what it what differentiates us,
18:28what are the national programs.
18:30And this is just a rubric
18:31that they've been using.
18:33You're familiar with this,
18:34which is the Align Physician
18:36Enterprise run by PEG.
18:37McGovern allows us to stop doing
18:40basically competing between the
18:42faculty practice plan and an EMG while
18:45maintaining separate economic structures.
18:47It also allows us to get rid of duplication
18:51and to #1 improve access so that we don't,
18:54you know,
18:55so we have coordination
18:56across all of these systems.
18:58And Peggy's doing God's work.
19:01The access work is fully underway.
19:05You know,
19:06it's about a three-year project.
19:07I think you're going to start to
19:09see improvements soon because we're
19:11about 8 months, nine months into it.
19:14We've also recently stood up,
19:16stood up a clinically integrated
19:17network which allows us to also
19:19create stickiness around the community
19:21positions with whom we work,
19:23where people who sign on are committing
19:25to a certain level of quality,
19:27but also committing to being
19:29part of this team.
19:31And that will have a huge impact.
19:34It allows us to create a
19:36network without having to,
19:38you know,
19:38dramatically increase our own
19:40faculty in areas where we may
19:42not want to grow faculty and then
19:45everyone's favorite funds flow.
19:48This is the sort of here's
19:50how the numbers flow.
19:51I think the important points
19:54here are it was designed so that
19:56the same dollars passed.
19:58If you did nothing differently,
19:59there was no change in the flow of money
20:03from the health system to the school,
20:05but that it also aligned incentives
20:07so that if we became more efficient.
20:11Improved faculty's lives so that
20:13you spent less time in front of the
20:15computer and more time seeing patients,
20:16all of those things we would both benefit.
20:18So it's got those efficiencies built into it.
20:22It also specifically acknowledges
20:24academic program support as a percent
20:26of the revenue to the health system.
20:28So it's a small percent of a big number,
20:31but it's not a,
20:32it's not dependent on the margins
20:34to the health system.
20:35So that's really quite important
20:38and and I'll stop there and take
20:42these down and show oops,
20:45did I just did I just turn everybody off?
20:50I didn't. OK.
20:55What are you guys seeing?
21:05Can I can we bring it up so
21:06I can see the people online?