At the start of a new year, a substantial to-do list

Planning for education, academic programs, an electronic medical record, and growth of the clinical practice are all in full gear; federal stimulus plan sparks an upturn in research grants.

On August 25, we welcomed 99 first-year students to Yale School of Medicine. At the start of each academic year, the entering class files into Harkness Auditorium in "civilian" attire and emerges, about an hour later, wearing one of the most recognizable symbols of the medical profession: the starched white coat. The ceremony both welcomes the students to the profession of medicine and underscores the responsibility that accompanies the public's trust in those who wear this particular garment. This is a tradition that came to Yale in the early 1990s and has become an automatic signal of the start of the new year.

Now the white jackets are everywhere—the hallways of Sterling Hall of Medicine, the corridors of Yale-New Haven Hospital, the study tables of the medical library. They dot the lines stretching from the food carts on Cedar Street, as well as the clusters of students sharing lunch inside Marigolds. The Class of 2013 has 99 members—52 men and 47 women. They are graduates of 46 undergraduate colleges, with Harvard and Yale leading the pack of alma maters (14 and 11 members from each, respectively), followed by Columbia, Dartmouth, Brown, MIT, and Cornell.

Academically, they are among the most gifted ever to attend Yale School of Medicine, with an MCAT mean/section score of 11.9, the highest in school history. The class has an average GPA of 3.78 (cumulative) and 3.76 (science). Its members pursued 126 total undergraduate majors; together they arrive with seven master’s degrees and one Ph.D.

This class arrives at an interesting time for medicine, for our country, and for Yale University. The past academic year witnessed several of the most momentous events of the last decade, certainly in economic and political terms. The fiscal crisis that began last fall, its impact on the Yale budget and endowment, and the need for strategic cost-cutting are all very apparent, as President Levin and Provost Salovey outlined in their message to the university on September 10. While the school is carefully monitoring its finances and trimming expenses, we are also expanding programs that address our strategic priorities. Along with the challenges, we see opportunities before us, and the school is moving forward to advance each of its core missions.

Advances in the academic realm

Nowhere is this more evident than in the area of education, which is midway through a strategic planning process led by Deputy Dean Richard Belitsky, M.D. The faculty have come together to ask, "What is the best way to teach medicine in the 21st century?" Across the country there is widespread call for reform, based on concerns that the current structure for medical education is outdated and fails to prepare our students for future medical practice. The explosion in biomedical knowledge, changes in the nature of clinical practice, and advances in pedagogy all need to be considered as we look forward and plan for the future of our curriculum.

The strategic planning process will map out a vision for addressing these challenges. In doing so, we will remain committed to preserving the values inherent in the Yale system of education, fulfilling our mission to educate and inspire future leaders in medicine and maintaining Yale’s longstanding reputation as a leader among schools of medicine.

Throughout the past year, we have also taken huge strides in the development of academic programs. James Rothman, Ph.D., who was recruited in 2008 as chair of Cell Biology, is focusing the department on cutting-edge technology for live cellular imaging, membrane transport, and nuclear biology. Michael Simons, M.D. '84, former chief of cardiology at Dartmouth-Hitchcock Medical Center, joined Yale last year as chief of cardiovascular medicine and is building a vibrant clinical and research program. In February, Thomas J. Lynch Jr., M.D. '86, former chief of hematology/oncology at the Massachusetts General Hospital Cancer Center, accepted our offer to become director of Yale Cancer Center. With the opening of Smilow Cancer Hospital next month and planning for a cancer biology institute on West Campus, Tom is moving the center forward.

In July the school had the pleasure of announcing that David A. Hafler, M.D., one of the world's leading researchers in multiple sclerosis, has agreed to head the Department of Neurology. David, formerly the director of molecular immunology in the department of neurology at Harvard Medical School, is building strength in both research and clinical neurology. John Krystal, M.D. '84, the McNeil Professor of Translational Research and a longtime member of the Department of Psychiatry took on leadership of the department in July and is opening a new chapter in its distinguished history. Gail D'Onofrio, M.D., who has led Emergency Medicine at Yale since 2005, became chair when the section rose to departmental status in July, making it the school's 28th academic department. Despite the economy, Yale is fortunate to have been one of the few medical schools recruiting aggressively during the past 12 months, and it has been a banner year, as evidenced by the appointments mentioned above and many others. With this growth in faculty comes the need for additional space, which we are leasing at 300 George Street, home to laboratories and offices for a number of medical school departments as well as several New Haven biotech firms.

Growth in research and patient care

Yale investigators across the university have been awarded more than 200 grants totaling $84.5 million since the federal stimulus package was signed into law in February. As we have not yet been notified about many of these applications, I anticipate that the number will increase in the next few weeks. Medical school faculty alone submitted more than 700 applications under programs funded by the American Recovery and Revitalization Act, which allocates $10.4 billion to the National Institutes of Health, $2 billion to the National Science Foundation, and $1.6 billion to the Department of Energy.

Space planning is a major focus of the clinical practice, Yale Medical Group. We engaged the consulting firm Kaufman Hall to provide a market assessment that will project the likely growth in demand for medical services during the next decade. These findings, coupled with a space plan, to be undertaken by the architectural and engineering firm HDR, will guide us in deciding where to expand programmatically and where to locate future clinical facilities. A second major YMG initiative now under way is planning for the adoption of an ambulatory electronic medical record, which will integrate fully with the inpatient system at Yale-New Haven Hospital. Stimulus funding applies to this equation as well, with incentives in the millions to have a new system substantially implemented by 2012.

The system will also integrate with a clinical trials management system and a clinical research data repository that will soon be in development. Clinical research continues to be a priority, especially clinical trials, and Yale has benefited enormously from the $57 million Clinical and Translational Science Awards grant we received under the NIH Roadmap initiative. We are continuing to expand the Yale Center for Clinical Investigation, which provides support to researchers in many areas, including infrastructure and data management, regulatory review, study design, patient recruiting, education, and career development.

At West Campus, which Yale acquired in late 2007, one of three new core facilities is up and running under the direction of Jim Rothman and Lars Branden, Ph.D. The Center for High Throughput Cell Biology is running high-volume customized siRNA screens for investigators across the Yale campus, using RNA interference to silence individual genes and thus determine their functions within a cell. Later this fall, the two other facilities will begin operations. One is a gene sequencing core led by Shrikant Mane, Ph.D., under the direction of Genetics Chair Richard Lifton, M.D., Ph.D. The other is a chemical screening core led by Janie Merkel, Ph.D., and overseen by Craig Crews, Ph.D., in the Department of Molecular, Cellular and Developmental Biology (MCDB).

London calling, and a Bicentennial

The school's international programs continue to grow, both in the number of individual initiatives by faculty and departments and in a major new relationship being created at the institutional level. Existing programs initiated by departments and individual faculty are in place with universities in Uganda, South Africa, Russia, China, and more than a dozen other countries. The school is now finalizing an agreement with University College London that will greatly increase the scope of our international activities. The UCL exchange encompasses both basic and clinical research in 10 distinct areas across the medical school, including cardiology, population genetics, health outcomes, and drug discovery, and it includes a significant educational component.

We are undertaking all of the above fully cognizant that this is a time of financial uncertainty. While we have been affected by the downturn and are weighing decisions cautiously, we remain in a sound position overall and are moving ahead in areas that support our institutional goals. We need to be discriminating in our investments, and solid, strategic decision-making remains the basis for all our planning.

In closing, I should mention that planning is in full swing for the observance next year of Yale School of Medicine's 200th anniversary. The Medical Institution of Yale College was chartered in 1810 as the nation's sixth medical school, and the coming Bicentennial provides a perfect opportunity to reflect on the past 200 years of American medical education and Yale's contributions to education, science, and patient care, and to contemplate what lies ahead. A full schedule of events throughout the 2010-2011 academic year will celebrate this milestone and put Yale in the spotlight both nationally and internationally. Further details will be forthcoming in a future letter. In the meantime, I wish you a good start to autumn and the new academic year.

Photos by Terry Dagradi