Yale School of Medicine: Reaching Our Vision

September 29, 2022

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00:00Doctor Brown served for 9 years
00:01as the chair of the Department of
00:03Medicine at Vanderbilt Development of
00:05infrastructure to promote the career
00:07success of physician scientists.
00:09She founded the Vanderbilt Master of Science
00:11and Clinical Investigation program in 2000,
00:13served as associate Dean for clinical
00:15and Translational Scientist development
00:17at Vanderbilt from 2006 to 2010,
00:19and is the director of the Division of
00:22Clinical Pharmacology from 2009 to 2010.
00:24Doctor Brown's NIH funded research
00:26focuses on cardiovascular pharmacology
00:28and vascular biology and humans.
00:31She's particularly interested in
00:32understanding the mechanisms of
00:34antihypertensive and antidiabetic
00:35drugs that are peptidase inhibitors,
00:37including the angiotensin converting
00:39enzyme inhibitors,
00:40dipeptidyl peptidase 4 inhibitors,
00:43and neprilysin inhibitors.
00:45Our group has a loose stated not only
00:46how these drugs decrease inflammation,
00:48enhance fibrinolysis,
00:49the breakdown of blood clots,
00:51and improve glucose homeostasis,
00:52but also how they interact with one
00:54another and sometimes cause side effects.
00:56This understanding leads to
00:58optimizing outcomes in patients
01:00with hypertension and diabetes.
01:01Doctor Brown received her AB in molecular
01:04biophysics and biochemistry from Yale
01:05and her MD from Harvard Medical School.
01:07She completed her clinical training
01:09at a fellowship in clinical
01:10pharmacology at Vanderbilt University.
01:12Doctor Brown is a fellow of the American
01:14Association for the Advancement of
01:16Science and a member of the American
01:17Society of Clinical Investigation,
01:19the Association of American Physicians,
01:21the National Academy of Medicine,
01:23and the American Academy of
01:24Arts and Sciences.
01:25She is a master of the American
01:27College of Physicians and a Fellow
01:28of the Royal College of Physicians.
01:29She has served on the
01:31National advisory Research.
01:31Resources Council and the National Heart,
01:33lung and Blood Advisory Council of
01:35the National Institutes of Health.
01:36Doctor Brown currently serves on the
01:38Visiting committee for Harvard Medical
01:40School and the External Advisory
01:41Board for the Harvard MIT Health
01:43Sciences and Technology program.
01:44Finally,
01:45she's a member of the Scientific Advisory
01:47Board for Alnylam Pharmaceuticals.
01:50Thank you very much, Dean Brown,
01:51and cheers to take away.
01:53Thank you. Ariel and I will
01:54share some slides here.
02:03Can you all see those? Great.
02:05So thank you for the invitation to
02:07speak and and for those of you who
02:10have seen the state of the school,
02:11there will be some repetition,
02:13but some some updates as well.
02:16And the title of this is really
02:18to think with you about how we
02:21become all that we can, we can be.
02:24And I will start by reminding
02:28of our mission statement because
02:30everything that I'm going to talk
02:33to about today really derives.
02:35From this Commission first,
02:37that we educate and nurture creative
02:40leaders in medicine and science by
02:42promoting curiosity and critical
02:44inquiry in an inclusive environment
02:46which is enriched by diversity.
02:48Also that we advanced discovery
02:50and innovation fostered by
02:51partnerships across the university
02:53and our local community as well as
02:55other institutions in the world.
02:57And that we care for
02:59patients with compassion,
03:00but also commit to improving
03:02the health of all people.
03:03So as I think about the strategic planning.
03:06That we've done over the last 2 1/2 years,
03:09often in specific areas like education
03:12or research or clinical enterprise.
03:14There are several cross cutting
03:16themes that I'd like to highlight
03:18as we talked today and the first
03:21is this creation of an environment
03:23of inclusive excellence where every
03:25member of our Community can thrive.
03:27And to which we can continue to
03:29recruit the best talent in the world.
03:31We have amazing people at Yale,
03:34and much of our investments over
03:37the last few years is creating a
03:40culture that enables people to
03:42reach their full potential.
03:44And I'll talk a lot about how we
03:46are working on climate and how we're
03:48working on career development.
03:51A second cross cutting theme is the
03:54notion of breaking down silos across
03:56departments between the school and
03:59our Yale New Haven Health system,
04:01between the school and our other
04:04collaborators and the institution
04:06in the university.
04:08And by doing this,
04:09how we promote interdisciplinary research
04:11to increase the impact of our science.
04:14Our science has always been excellent.
04:16But we can do higher impact
04:19science through doing this.
04:20Related to that is building resources
04:24that serve biomedical discovery.
04:26So as a a School of Medicine,
04:28we are always thinking about
04:31recruiting talent,
04:32but we also need to build the cross
04:35cutting resources that enable discoveries.
04:36And so we'll talk about some of
04:39our investments in those areas.
04:41And then lastly,
04:43you know our clinical mission
04:45is extremely important.
04:47We provide care often for underserved
04:49in our community and we do that
04:52in our partnership with the owner
04:54even health system and we are
04:56working a great deal on,
04:57on aligning to become the premier
05:00academic health system that we can be.
05:03So we'll talk a little bit about leadership.
05:04As I say we we are in the business
05:07of recruiting talent and that
05:09means both excellence in research,
05:11education and clinical work,
05:12but also people who share the values
05:15of our school and who are leaders.
05:18This highlights some recent
05:19recruitments over the last few years,
05:22most recently for example Eric Weiner and
05:25joined us in February as the director
05:27of our Cancer Center investments
05:29in some of our research centers.
05:32Leadership Anton Bennett in
05:34molecular and systems metabolism,
05:37Carlos Fernandez Hernando in
05:38vascular biology and Therapeutics,
05:40and Akiko Osaki leading a new
05:43Center for infection and immunity.
05:45We've also recruited leaders both
05:48internally and externally into deputy
05:52Deans roles and I would highlight
05:54these three Bob Rorbach who is leading
05:57our efforts in professionalism and
05:59leadership development and really
06:01establishing an infrastructure where
06:03we can recognize when a faculty
06:06member or a staff member or even
06:08a student are struggling with
06:10issues around professionalism.
06:12We can recognize that early
06:14make early interventions.
06:15To really change our culture overall.
06:21Dante's joined us a little over a
06:24year ago from UT Southwestern and is
06:27bringing new processes and analytics
06:30that enable efficiencies and less,
06:33I would say.
06:36Bureaucracy for our faculty and then
06:39most recently, doctor Peggy McGovern
06:41has joined us as CEO of Yale Medicine
06:44and is our Deputy for Clinical Affairs.
06:47And we'll talk about what that has
06:49enabled in terms of alignment.
06:51In education, of course.
06:53John Francis joined us about
06:55November a year ago as our associate
06:57Dean for Student Affairs.
06:58Veronica Chang assumed the position
07:00of assistant Dean for admissions,
07:02and Marietta Vasquez became associate
07:05Dean for medical student diversity.
07:07There are other things going on in the
07:09campus outside the School of Medicine
07:11that impact on the School of Medicine.
07:13And one is the creation of a freestanding
07:17school of engineering and applied
07:19science led by Dean Jeff Brock,
07:21who has been a tremendous partner,
07:22and I'll talk about that as I talk
07:25about biomedical informatics.
07:26And the other is the full separation
07:29of the Yale School of Public Health,
07:31anticipated after the recruitment
07:33of the new Dean to become a self
07:36supporting and independent.
07:38Right now the School of Public
07:40Health is something in an in between
07:42situation where it is has a Dean
07:44appointed by the President and
07:46sets many of its own policies.
07:48But financially is acts as a department
07:51in the School of Medicine and Melinda
07:54Irwin has recently chaired a search
07:56and and there are finalists for that
08:00permanent Dean's position and our
08:02interim Dean is Melinda Pettigrew.
08:05So one of the ways that we create
08:08an environment that is inclusive is
08:11by celebrating the accomplishments
08:12of our faculty.
08:13And we often do this with traditional
08:16academic accomplishments as shown
08:17here election into the American
08:19Society for Clinical Investigation,
08:21National Academy, etcetera.
08:23Or large awards like the awards
08:27garnered by Doctor de Camilli and
08:30Doctor Ruttle and Doctor Cruz last year.
08:34But it but.
08:35Also in the recognition by our peers
08:37and so I would highlight our faculty
08:40who were honored with distinguished
08:42Political career awards and Mike
08:45Katie who received the David Leffell
08:48Prize for Clinical Excellence.
08:50We are making an effort to be more
08:54intentional about recognizing our staff
08:57who enable that mission that we started with.
09:01So we had some who received the
09:03Linda Lorimer award last year in
09:05the Department of Psychiatry and
09:07we've had three members of our staff
09:10recently complete the Emerge program,
09:12which is a leadership development program,
09:15again emphasizing career development.
09:18And we further communicate about
09:21the accomplishments of our faculty,
09:23staff and students through our
09:25weekly news and recognition.
09:27This goes out to our school,
09:28but we also now send it
09:31to our peer institutions,
09:32the Deans,
09:33and to our alumni as a way of of
09:36really highlighting everything
09:37that is going on here,
09:39because I think we've often been
09:42a little bit shy to do that.
09:44We actually track our communications
09:46to to know are we getting the word
09:49out about the impact of our faculty.
09:52And so for example,
09:55if you Googled Ms and inflammation,
09:58we had the top hit based on our one of
10:01the sometime second hit.
10:03Our stories that related to COVID
10:05have brought many people to the to
10:07our websites who are patients who
10:09can benefit from our healthcare.
10:11And so these are some examples of efforts.
10:14Not area. Let me turn it now to
10:18education and this will look familiar.
10:21It's our incoming class,
10:23which is just outstanding.
10:25And we continue to recruit a diverse
10:29group of students with about 24%
10:31this year from groups traditionally
10:34underrepresented in medicine and
10:36slightly more women than men and with
10:38many of our students having been born
10:41outside the United States and roughly
10:43about 14% of our students being first
10:45generation first in their family.
10:47Complete a college education and as
10:49you can see outstanding stores scores
10:52and coming from the top institutions.
10:55I'm particularly pleased that our
10:57students also when they leave here,
11:00if they leave here,
11:01go to the top institutions as well.
11:04And this is the example of where
11:08our students went after this year.
11:10In the education room,
11:12we are leading in in some particular
11:14areas and and one is in the use of
11:17technology received again and annotation
11:20as an Apple distinguished school for
11:22the the period of 2021 and 2024 and
11:25you could see Mike Schwartz there.
11:27He's often led these efforts.
11:30Umm.
11:31Since Jessica Illuzzi came
11:33in January of 2021,
11:36we've had she's engaged in taking a
11:40look at our medical education programs
11:43and has recently led strategic planning
11:46that identified 3 cross cutting themes.
11:49The first is the.
11:52Engagement of our students in attaining
11:55competency and and by that we mean,
11:58you know,
11:59our medical students benefit from the
12:03Yale system in having a great deal of.
12:07Choice and the ability to tailor
12:11your education.
12:12And.
12:15How you think about whether you're
12:17achieving your goals is something
12:19that we'd like to work on.
12:20We don't have grades.
12:22We believe that you are adults
12:24and you need to be able to.
12:28Do self evaluation.
12:29It's part of lifelong learning
12:31and so developing systems,
12:33including coaching systems
12:34that allow you to do that is
12:37one of the strategic goals.
12:40Included in that, as I mentioned,
12:41our coaches and so a little more hands-on.
12:48Ability to to get input beyond what
12:51you have now with the advisor program.
12:54The second domain is enhancing faculty
12:56engagement in the educational mission.
12:58And Jessica and others have done a lot
13:00of work in the last year making sure
13:02that we're adequately rewarding our
13:04faculty for their educational efforts,
13:06including changing how we fund effort
13:10for education and most recently,
13:13changing our definitions of our promotion
13:16tracks in the faculty handbook that still
13:19has yet to be approved by the corporation,
13:23but to acknowledge.
13:24Work that is innovative in
13:27leading educational programs,
13:29even when that work does not
13:32result in a scholarly production,
13:36although I think we can do much
13:38better again in getting the word out
13:40about the innovation going on here.
13:42And then building an environment that
13:45is more inclusive and by doing things
13:49like creating colleges for the students.
13:51I know many of you have been engaged
13:54in this work and others of you
13:56will be engaged in the next phase.
13:58We are coming up just a year away on a
14:01visit from LCME and I'm very grateful to
14:05our students who have completed a self study.
14:08We've been working on our
14:10DCI and now of course the.
14:12The Self Study group is reviewing
14:14all those materials.
14:16This is a lot of work.
14:18I hope that it is a labor of love
14:20for those of you who are involved it.
14:23It is,
14:24you know,
14:25obviously important to be accredited,
14:27but it's more important in that it gives
14:30us time to reflect and think about
14:33where we can continue to innovate and
14:35and provide the best medical education.
14:38Turning to culture and climate,
14:41one of the hallmarks of our
14:45efforts to develop faculty,
14:47but also to develop in particular those
14:49who have been underrepresented in medicine,
14:52is to make sure that we are
14:55meeting with faculty early enough,
14:57identifying their needs,
14:59helping reduce barriers.
15:01One of the things that I've heard
15:03most often when I've had listening
15:05meetings with faculty is they.
15:07They feel like they don't always
15:10get as much input as they need.
15:13Many of our departments have annual reviews,
15:16but when you look at whether they're
15:19really happening and whether they're
15:21as useful as they need to be,
15:22in some cases they have not.
15:24So we've worked to standardize this.
15:26The group that's on the right
15:29there has been involved in an
15:31iterative process with input from.
15:33Departments that that piloted a
15:36form that can be used as part of
15:39the annual meeting and this we've
15:42had very positive feedback and
15:44that people really felt that they
15:46received input that was helpful
15:47in their career development.
15:49So we are going live with this as
15:52of this month for this this academic
15:54year and asking our departments to
15:57reach some goals in completing this.
16:00The formal diversity and inclusion
16:03strategic plans are online at the office
16:08of EI and they include many features,
16:11again focused on active retention
16:13of our faculty as well as recruiting
16:17retention of our students into
16:19trainees and our trainees into faculty.
16:22One of the things that we've wanted
16:24to do is have some discipline around
16:26this work so that everyone isn't
16:27reinventing the wheel and part of that.
16:29Is sharing best practices,
16:31and so we've gathered a committee of.
16:36University vice chairs and champions.
16:38It's led by Darren Matamore and the
16:41goals there are to collect data that we
16:44can use to make continual improvement.
16:47I present data at our state of the school
16:49such as this that I'm showing here.
16:52This just shows the growth in
16:54representation of those groups
16:55traditionally underrepresented in medicine
16:57in the school over year over year.
17:00It was at 5 year intervals in
17:02the first few bars,
17:03but now year over year showing that we
17:05are seeing progress in recruiting and in
17:09promoting to the associate professor.
17:11Now we have to work on promoting
17:13to the professor level and similar
17:16data for our women. In medicine.
17:18And starting to show new data that
17:22to to look at other things other
17:24than just numbers of faculty,
17:26but including things like among our faculty,
17:30among our professors,
17:32what proportion of our professorships
17:34are endowed shares are held by
17:37women or those underrepresented
17:38in minority and medicine.
17:40And you can see that for the
17:43underrepresented medicine,
17:43it's actually a higher portion than
17:46the than the denominator about the
17:48same for about equivalent to the
17:51number of women who are professors.
17:52So we're consciously looking
17:54at those sorts of things.
17:56We are also doing a lot of work,
17:59or as I said around.
18:01Our environment and how do we
18:04respond if someone is noted to have
18:08struggling with with behavioral
18:10issues or those kinds of things.
18:13Those of you haven't go to the LAPD
18:17website and and read the processes
18:20that we use were very dedicated
18:22to making it feasible for somebody
18:24to come forward without fear of
18:27retaliation and to follow up and to
18:29try to get follow up to those who have.
18:32Move forward,
18:32we're also tracking what kinds of
18:35things we're seeing and these are data
18:37from Bob Rohrbaugh over the last year.
18:40And you can see the pie chart there
18:42that 77% of the concerns that are
18:45expressed are around professionalism.
18:47And I'll go into more detail,
18:48about 13% are around what I would
18:51call climate within a within a unit.
18:54About 3% are related to sexual
18:56harassment or Title 9,
18:58I should say Title 9 issues
19:00and those sorts of things, so.
19:02Looking drilling down in the
19:04professionalism categories disruptive
19:06or inappropriate behavior is by
19:08far the that the farthest the most
19:11prevalent and this is sometimes you
19:13know things in the category of anger
19:16management those sorts of things and.
19:20Recognizing this early and and finding
19:23often that there are underlying issues
19:26either in somebody's personal life
19:29or frustrations that are ongoing
19:32in the environment.
19:34So correcting those things,
19:36but then also giving faculty
19:38coaching to help them improve and
19:41change before something more serious
19:44happens. Some of these happen in the
19:46student and training environment.
19:48Some of them are related
19:49to compliance issues. Few.
19:51Related to harassment or bullying,
19:53so you can see the categorization.
19:55I'll point out that there are some
19:57that are sexual misconduct and
19:59harassment that we're seeing but that
20:01are not in the Title 9 category.
20:03In other words, where the Title 9
20:05Office has said this is not has
20:07not reached a level for our office.
20:09So we will make efforts to start to to
20:13get this information out a little bit more.
20:18Again, creating an inclusive environment,
20:20paying attention to the needs of our faculty.
20:22A common need for our faculty
20:25is support for child rearing,
20:27and in the past year we have increased
20:30extended our time for a paid leave for
20:33child rearing from 8 weeks to 12 weeks,
20:36in part leveraging a new Connecticut law.
20:40This is not easy because it creates
20:43other stresses in the system,
20:45for example, making sure that.
20:47We can provide adequate clinical
20:51coverage when we have small units that
20:53have just a small number of faculty.
20:55So we are recently convening a committee
20:58of members of FAC and administrators to
21:01think through how do we have consistency,
21:05consistent policies around such
21:08issues across departments.
21:10And then we have for many years now since
21:142014 tracked gaps in salary between.
21:18Between our male and female faculty
21:20members and where we see this is in our
21:24clinical departments as you can see here,
21:27perhaps the closing gap,
21:28but we also changed our methodology
21:30in the last year.
21:31And you can see the variance variables
21:33that go into this multivariate regression
21:35analysis and see those things that
21:38have the biggest impact on salary by
21:40far and away it's your subspecialty.
21:42So what is the double AMC median
21:45salary for someone,
21:47but there are other things that.
21:49Obviously it you know how much
21:51political work you do have an impact
21:53and so these things are all controlled
21:55for and yet we still have a gap.
21:57What we do with these data are look
21:59department by department and what
22:01we've found is that when we do that
22:04we are able to bring a department that
22:07may have gotten out of line back into
22:10line back to zero and and we in the
22:13process often identify systemic issues
22:16that we can address across departments.
22:19And this is just the the example of
22:22how we look at this by department
22:25and you can see this department was
22:27one that we focused on this year.
22:30I would point out that one of these
22:33departments that is at around zero
22:34was one that had a very large gap
22:36in salary just a few years ago.
22:40Let me turn now to our research mission.
22:43You know one of the questions is how do
22:45you track your success in research and
22:48ultimately you want to track impact.
22:50It's the number of drugs that you bring to,
22:54to patients or the number
22:57of deaths that you prevent.
22:59Those are very long-term things to track
23:01and you know we are now have drugs
23:03coming to market that are based on basic
23:06science research that was done 30 years ago.
23:09So we often track leading indicators
23:11like NIH funding shown here
23:13and you can see we're in that,
23:15you know, tightly.
23:19Clustered group in the four to 8 range
23:22and we bounce around between there.
23:24I would say we tend to be very high
23:27in the number of single investigator
23:30grants and that's a hard way to.
23:33Have large, have as big an NIH budget as
23:37we have and so we've been emphasizing.
23:40Again, interdisciplinary large grants
23:42and then this just shows the data
23:44by department and I think you know
23:46you can see that about half of our
23:49departments are in the top ten in
23:51NIH funding and you know many are
23:53year over year in the top one or two
23:55such as psychiatry and medicine.
23:57Our faculty of course also do research
24:00at the VA and it's a it's not an
24:04insignificant amount and the VA
24:06research program is a really wonderful.
24:10Resource,
24:10particularly for new investigators to
24:13to maximize their chance of getting funded.
24:17There are pressures on our research program
24:20beyond just getting funding support.
24:22One of those has been a decline in
24:25the number of graduate students and
24:28and postdoctoral fellows who of
24:30course are the future of discovery.
24:32And there are several factors
24:34that have come to bear.
24:35One is the influence of recent
24:41governmental policies around certain visa
24:44holders and particularly from China.
24:47The other is that we had,
24:49we had a number of training grants
24:52going through an NIH institute that is
24:55decreasing the number of training grants.
24:57So as an interim solution,
24:59the School of Medicine along with
25:01the Graduate School is funding slots
25:03to maintain our ability to train
25:06graduate students and postdoctoral
25:08fellows while we come up with
25:11other solutions to fund slots,
25:13such as through endowment
25:15or through collaborations.
25:17With industry and those sorts of things.
25:21We are working to increase the diversity
25:24of our postdoctoral fellows as well.
25:26And one of the things that we
25:29appreciate is that often the best
25:31way to grow talent is to invest
25:33early and then retain that talent.
25:36And so you,
25:37fat Levy and Kristen Brennan are
25:39leading a new program called
25:41the Science Fellows Program,
25:42which creates the ability to recruit
25:46those superb postdoctoral fellows
25:48and groom them for transition to
25:51independence as faculty members.
25:53This is envisioned to be cluster hires,
25:55so that you're bringing in two or
25:58three or four fellows at the same
26:00time who are working in related areas.
26:03We are also spending a lot of effort
26:06on enabling our physician scientists.
26:09This effort has been led by Keith Tote,
26:12but also Nee Addy and Nick Click
26:16Light who have created huge resources,
26:19both salary support for people
26:22beginning their careers,
26:24mechanisms to make sure that mentorship
26:26is working,
26:26access to grant writing resources,
26:29and the creation of the Janeway Society,
26:30which brings together all of our
26:33junior faculty.
26:34To talk about how one starts a research
26:38program. What are the barriers?
26:39What? How?
26:40How does one navigate those barriers?
26:43We've created a successful grant
26:45library so that those who are
26:47submitting grants can can learn
26:49from others who have
26:51submitted successful grants.
26:52And this is just the types of grants
26:54that are included in that library.
26:56And it it could not happen without
26:58the generosity of our faculty who
27:00are willing to share their grants,
27:02including those that were not initially
27:04funded and then got funded so we
27:07can see how they responded to it,
27:09to the comments from reviewers.
27:13They have also developed mock study
27:16sections and again the generosity
27:18of many faculty who who participate
27:20in those and review grants together.
27:22And that ensures that when someone
27:25then finally submits the grant to
27:27the National Institutes of Health,
27:28it is the best possible grant
27:30that could go out the door.
27:31And that enables them to get be more
27:35likely to be funded the first time
27:38through and shorten that time to funding.
27:40Linda Bockenstedt has led an an effort
27:43to look at our research faculty.
27:45This is a track that is fundamental
27:47to many research programs.
27:49These are our faculty who have
27:52particular expertise in methods
27:54but perhaps don't desire to have an
27:57independent research program and
27:58the stresses of writing grants.
28:01And but the issue that we have with this
28:03track is that it's used in different ways,
28:05and there's often a disconnect
28:07between the expectations of a faculty
28:09member and the expectations of.
28:11Their principal investigator.
28:12So that committee has made
28:14a number of recommendations.
28:16One is to clarify those expectations,
28:18expectations at the outset of the
28:21standard offer letter to create
28:23individual pathways within this track
28:26to do a better job of mentoring
28:28this group of faculty,
28:29including using a form like the F
28:32DAC that we've developed and so
28:35that we're in the process of
28:37implementing those sorts of things.
28:39Again,
28:39as a way to increase the types
28:41of faculty we're developing,
28:43we have had an effort in biomedical
28:45data science.
28:46There's a real shortage of people
28:48who have expertise in this area.
28:50The students who are interested in this,
28:52I would encourage you to pursue
28:54those interests.
28:55But this is a program in collaboration
28:57with Burner Ingelheim where we have
28:59grown it actually more rapidly than
29:02anticipated because it's been so
29:04successful and each student has
29:06reach fellow has.
29:08Mentor within the university and
29:10a mentor within Barringer Anaheim,
29:12allowing them to cross fertilize.
29:16We have also recently recruited
29:18Lucilla Ana Machado,
29:19a member of the National Academy
29:21of Medicine to lead what will start
29:23as a freestanding section of
29:25biomedical informatics and data science,
29:27but evolve into a new department.
29:30And Lucilla has been on campus quite a bit,
29:34will be here today and tomorrow
29:37really working.
29:38And how we build better support for
29:41our faculty, our students,
29:43in terms of biomedical informatics.
29:45And I'm aware that our students are
29:47frustrated about access to J DAT,
29:49and this is something that we still
29:52will be able to help with.
29:54We are in in the realm of cross
29:58cutting research.
29:59We recently stood up a Yale Center
30:01for Brain and Mind Health.
30:03As you know, we have very
30:05strong neuroscience here.
30:06The Woosah Institute was created
30:08to study human cognition.
30:10Yale New Haven Health System
30:13is building a new neuroscience
30:15tower for clinical neuroscience.
30:17And there was a real need to create.
30:22Mechanisms to bring discovery
30:24into trials for our patients
30:26and to learn from our patients.
30:28And so this group of five faculty
30:32members representing neurosurgery,
30:34the Child Study Center,
30:36psychiatry and neurology.
30:38Interviewed all of the stakeholders,
30:40convened a retreat,
30:42strategic retreat and conceived
30:45of this center,
30:47which will create resources and bring
30:50people here to translate discovery
30:53into our into the clinical realm.
30:56We have some roadblocks in that area.
30:58One is that our our contracting
31:01and our time to initiation
31:04of clinical trials is slow.
31:07Just the goal is that this
31:08would happen within 90 days.
31:09You can see over this two year
31:11period that the vast majority of
31:13contracts and initiations took longer.
31:15We have a group that's working on this.
31:17We have some things that we need to
31:20tweak within the School of Medicine
31:22before we can really fix this.
31:24We're investing in, as I said,
31:27resources to enable everybody's research.
31:30One is a biorepository,
31:32where we're collecting samples
31:34from patients and keeping them
31:37stored appropriately,
31:38processed and stored appropriately so
31:40that investigators can access them.
31:42Two of the higher technology
31:45cores that we are just standing
31:47up is first A-fib SEM core,
31:50being led by Shanzu and song.
31:53Saying who we were very fortunate
31:56to recruit from Janelia Farm and
31:58who have developed mechanisms
32:01using fibs them to image cells down
32:05to the to the for Micron level
32:09incredible resolution leading them
32:11to be able to publish for example
32:14in a collaborative group the the
32:16connectome of the dress Drosophila
32:19brain so really impressive work
32:21and similarly a new Murphy.
32:24Multiplexed fish for transcriptome imaging,
32:27led by money dekmar that's
32:29available to all of our resources.
32:34Ironically, at this point our research
32:37enterprise is not constrained by money,
32:39but by space. We have a space plan.
32:44In in place, and I would say we have it.
32:48It's been somewhat frustrating because
32:51we are already behind schedule
32:54largely due to labor shortages and
32:56supply chain shortages post COVID.
32:59We just had a walk through of 300,
33:01George again this morning to think about
33:04what we need to do to improve this building.
33:07But you can see that after we
33:10complete renovations in this building
33:12and build out four floors and 100.
33:14College we will be building
33:16out floors in 101 college,
33:19the School of Public Health will
33:22be consolidating some of its.
33:24Classroom space.
33:25We will have backfill space related to
33:29this work that we can then renovate.
33:31This is the the.
33:34Preparation for another building,
33:36which is to move the School of
33:39public health classrooms into 300
33:42George temporarily so that we can.
33:46Plan for a new building in this
33:50strip mall area that's that's
33:52now used for classrooms.
33:53That will be very exciting.
33:54It will allow us to cross bridges
33:57here and what the students might
33:59observe is that then you start to see
34:02lines here over at Harkness Hall.
34:04I think all of us know that Harkness
34:07Hall is outlived its useful life and we
34:10have plans to to renovate that eventually.
34:13But you can see by the timeline that that's.
34:16Getting passed when you guys are here.
34:20Even I hope for the MD,
34:21PhD students who are on the call.
34:23So.
34:24We also this December will convene
34:27for the first time a scientific
34:31Advisory Board comprised of,
34:34you know, Nobel laureate,
34:36several Lasker winners,
34:38leaders in industry and interestingly I
34:41think all but one have a Yale association,
34:44maybe all of them do,
34:46which was not something we know.
34:48Charles Sawyers, I believe this is not,
34:50not something we intended to do,
34:52but happened by chance and and so we're
34:54looking forward to seeking their advice.
34:56On how we can do things a little bit better.
35:00Lastly, looking at the clinical mission,
35:03you know what academic health
35:05systems have traditionally done.
35:07Is offer access to cutting edge care,
35:11whether that's chemotherapy or at Yale,
35:14you know.
35:15Closed loop insulin pumps,
35:18transplant imaging,
35:20etcetera.
35:20But what increasingly academic health
35:24systems are able to do is also offer
35:28population health that increases
35:30the health of our entire community.
35:33And we have amazing physician nurses
35:37staff in our academic health system.
35:41One piece of evidence for that is that
35:44we were among all of the hospitals in
35:47the country in the top 24 for having
35:50the lowest mortality rate during COVID.
35:52And so I hold this out as an example of what
35:56we can do when we are all working together.
36:00It is not,
36:01however,
36:02always what we do,
36:03and although we offer excellent care,
36:07we often offer it in silos
36:09and not in a coordinated way,
36:11and we also often don't
36:14measure what we're doing so
36:16this. Slide which shows where we are in
36:19NIH ranking and has a number of NR not
36:22ranked and has a number of levels below
36:2510 is not what Yale School of Medicine
36:30or you only Haven Health should aspire
36:33to and the reason for this is that.
36:35As I say, we are not working together.
36:37We're still working in silos.
36:40We have tremendous opportunity when
36:42you look at where we are represented
36:45across the state of Connecticut.
36:48The state of Connecticut has demographics
36:50that mirror the rest of the country
36:53and we have both some of the wealthiest
36:56communities in the country as well as the
36:59largest disparities in income in the country.
37:03So as a.
37:04Place where we can have impact
37:07across a diverse set of communities.
37:10This is a wonderful place to be.
37:13And so we need to realize that ability to
37:16improve health across all of our communities.
37:19We also have a financial relationship
37:21with our clinical enterprise.
37:22We we support our research and our
37:26educational mission in part through our
37:29revenues from the clinical enterprise
37:31and those have been growing and we
37:34expect that they will not continue
37:36to grow at that same rate rate.
37:38So we have to work smarter.
37:40One of the reasons is that we have an
37:42aging population and and more of our
37:46older patients are shifting from commercial.
37:49Insurance tends to pay better to Medicare,
37:51where hospitals often lose money
37:54on the care of patients.
37:56We also have lost some patients that
37:59we think are the patients we should
38:02see that is the patients in in.
38:04Requiring tertiary and quaternary
38:06care to hospitals that we feel are
38:09less equipped to care for them,
38:10and so we need to reverse that.
38:13So we are engaging in a significant
38:16effort around realigning this,
38:18the School of Medicine and Neal New Haven
38:22Health system as an academic health system.
38:25Very grateful to have the
38:27partnership of Chris O'Connor,
38:29the CEO for Yale New Haven Health System.
38:32And a number of people have been working on
38:36this for the first time in memorable history.
38:40We are developing a shared strategic plan.
38:44And one of the things that I would
38:46highlight is these are the pillars
38:48that the group has identified and in
38:51the highest ranking both among our,
38:53our.
38:53With medicine colleagues on this committee,
38:56but also among our hospital members
38:59of this committee,
39:00leading Edge research was important
39:02and and and actually came out on top.
39:06But providing access to our patients,
39:09you know,
39:09you can provide the best possible care,
39:11but if a patient can't access it,
39:13it doesn't do them any good.
39:16Providing exceptional value that
39:18that allows all in the community
39:22to benefit and then of course
39:26cultivating our educational missions.
39:29And so you'll see some of the cross
39:32cutting foundational elements here.
39:34We also are doing some work,
39:36although I think this is an area
39:38that we have much more work to do to
39:41coordinate our operations where we have.
39:45We're not working in parallel,
39:47but we're working together.
39:48So once we have that strategic plan,
39:50we're following the same
39:52data we're following.
39:53We're not having duplication of
39:55things that will allow us to provide
39:58better service and also to be.
40:03To lower expenses, frankly and and
40:05these are some of the people that
40:07will be involved in that work.
40:09And then we're thinking about how we
40:12align the physician practice plan beyond
40:15medicine with the employed practice
40:17plan NE Medical Group so that we are
40:21working together and that a patient
40:23is getting care that is seamless and
40:26not fragmented and we have some very.
40:30Significant work that you'll hear
40:32about within the next two months
40:35or so in which we're going to do
40:37this and and stay tuned for that.
40:40Lastly, we have to.
40:43Make our funds flow between the hospital
40:46and the School of Medicine rational.
40:48This is a cartoon of the many,
40:51many agreements we have back and forth,
40:54which is crazy.
40:55And so we're thinking about how do we
40:58create a fund flow model that aligns
41:01incentives and where people get paid
41:03for their work and and it's not a one
41:06off negotiation where it's fairly
41:08formulaic and those things have a
41:10huge impact on our ability to fund.
41:13An educational system for example,
41:15and and fund our research,
41:17just say a little bit about finance.
41:20I mentioned that Arnie Donton joined
41:24in July of 2021 and discovered
41:29why we recruited him,
41:32which is that we have a lot of
41:34work to do around getting seamless
41:36processes in place and analytics
41:38to enable our core missions.
41:40And so this is his mission
41:43statement and vision.
41:44But when there's been
41:46failure of those processes,
41:48it has pretty dramatic consequences.
41:52And so some of you are aware that
41:54we had a $40 million theft over a
41:56period of about 10 years dating back
41:59to 2012 in one of our departments.
42:01That cannot happen unless you have
42:04failure in many places in the system.
42:07It's it's not unlike this,
42:09the safety analysis we do in the
42:12hospital when there's been an adverse event.
42:14And so it was everything from
42:17oversight of individuals to how we
42:19train people to how the controls work
42:22that some of which are centralized
42:24to how we could see the data.
42:26And one of the things that our work in
42:30correcting these has has highlighted
42:33is around climate and the fact that
42:36many of us don't feel like it's our
42:39job to to pay attention to these things.
42:41And it does seem mundane and.
42:44It doesn't seem like it's
42:46directly related to what you do,
42:47but I will tell you that it it is.
42:49And so you know,
42:50these are some of the things
42:52that we've heard from.
42:55Senior faculty sometimes.
42:57And my favorite is do you know who I am?
43:00And you know,
43:01there's an arrogance associated
43:02with that that should never be
43:03part of Yale School of Medicine.
43:05And it goes back to what we were
43:07talking about around professionalism.
43:09While we're talking about money,
43:10I will mention that we are in
43:13the midst of a capital campaign.
43:15One of the goals of that campaign is
43:18to raise money for financial aid to
43:21make our School of Medicine truly debt free.
43:25We have had a decline in our.
43:29That of our students are median
43:32debt of our students is around
43:35in this past year 79,000 compared
43:38to a much higher number.
43:40Average is more like 110,000 I believe
43:44compared to a national average of about 204.
43:47That should get the median should
43:49get closer to 60 as we start
43:52to realize the capping,
43:53the benefit of capping the unit loan.
43:55But of course we'd like to get
43:58that number down to zero and so.
44:00We we also have an opportunity to match funds
44:03and create a quasi endowment to do that.
44:06This takes time, but but it's a high
44:09priority in our capital campaign.
44:11And just to show you that we are starting
44:14to reap the benefits of that campaign.
44:16With an increase in in funding
44:19over the last three years.
44:21So I've talked about a lot of specific
44:24elements around the three missions.
44:27I would add the 4th mission,
44:28which is how we develop people,
44:30whether it's our students
44:32or trainees or our faculty.
44:33And I've shared with you some cross
44:35cutting themes about how we will
44:37do that to realize our vision.
44:38I think we've allowed plenty of time
44:40for questions and I will stop sharing.
44:46Thank you so very much, Dean Brown.
44:48If anyone has any questions, it's viewing.
44:51I haven't seen any so far, but there
44:52is an in the bottom part in the chat.
44:55There should be a question and answer
44:57area and people can put in their
45:00questions and we can try to answer them.
45:04Not seeing anything so far you.
45:07People may may want to take a a
45:09lunch break, so that's OK too.
45:22While we're waiting to see if
45:23anyone does have some questions
45:24that they'd like to submit,
45:25I'd just like to take the time
45:27to thank you, Dean Brown,
45:28again for coming and speaking.
45:29It's always a pleasure to get to work
45:31with you and to get to see all the
45:33fantastic work that you and everyone
45:34here is doing to try to further the
45:36training and the opportunities and
45:38the culture here at the schools.
45:39Very inspiring.
45:40So thank you very much.
45:41You have a great team. So.
45:44And and I and again thank you as you
45:47know because we meet in the MSC,
45:49but I I think that. You know,
45:52one of the philosophies of the
45:54old system is that you are future,
45:57future colleagues and you very much,
45:58the students are very much
46:00been part of this effort. So.
46:02Yes, that is. I very much felt that
46:04and experience that myself and I know
46:06many of my other classmates have,
46:08so we're very excited about.
46:11Question in the chat,
46:12do you have any thoughts on
46:14the future Yale Health CEO?
46:15So many of you may have seen the
46:17announcement that Paul Jennison is
46:19stepping down and there's now a
46:21national search for that position.
46:24I I and Peg McGovern, our CEO of your
46:28medicine is on that search committee.
46:29I think we have tremendous opportunity.
46:31It's a, it's a little bit
46:34unusual to have a separate.
46:36To have the the health plan for the
46:40university separate from the faculty
46:42practice plan to the extent that they are,
46:46and I think we can.
46:48We can work when the new leader
46:51is in place in ways that will
46:54increase efficiency and access
46:56again for our university community,
46:58at the same time making sure that
47:01we're providing the best value
47:03care about based care that we can.
47:24You don't see any more questions
47:26coming in at the moment,
47:27but for the MSC perspectives,
47:29our theme this year is equity and access
47:31and it's fantastic just how much of
47:33the schools principals align with that
47:35based on what you've been speaking about
47:37today and what our experiences have been.
47:39So would like to tune in in the future.
47:41We will be trying to continue on that theme
47:44and look forward to the future
47:45conversations. Thank you everybody.
47:46Thank you so much.