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Beyond Sterling Hall

Beyond Sterling Hall is a regular message from Dean Nancy J. Brown about ongoing initiatives at YSM.

Write to Dean Brown at beyondsterlinghall@yale.edu.

Yale School of Medicine should be an academic home where women and underrepresented in medicine (URiM) faculty, staff, and students thrive, and where diversity and excellence are inextricably linked.

Dean Nancy J. Brown

A couple of weekends ago, several people sent me this column by our faculty member and NY Times writer Lisa Sanders. There is so much to love about this story. In its telling, Dr. Sanders captures what it means to be a teaching hospital and academic health system. She celebrates the commitment of our faculty, staff, and trainees to the value of human life and the tenacity with which they ask questions and apply their diagnostic acumen in the pursuit of saving lives.

This story further reminds us of the centrality of our clinical work to the realization of all our missions. I do not simply mean that revenue from the clinical enterprise supports our education and research missions, although this is true. Rather, the story highlights the critical role of the hospital and clinic in teaching analytical thinking as well as diagnostic and therapeutic strategies to our undergraduate and graduate medical trainees. Clinical observations inform discovery, and the partnership between Yale School of Medicine and Yale New Haven Health System enables us to offer our patients access to cutting edge diagnostics and therapies made possible by research.

Each year when I was chair of a Department of Medicine, the residency program director and I would shake our heads when we reviewed the resident survey and came to the question regarding how often residents received mid-rotation feedback. Whatever we tried, we struggled to increase the proportion of residents who answered positively. We developed courses in evaluation for core faculty. We conducted our own surveys, and there we discovered a disconnect. When surveyed, 80% of faculty said they provided feedback mid-rotation. Twenty percent of residents said they received feedback mid-rotation.
Last week the graduating Class of 2021 took an oath as they became physicians. They expressed the conviction that “all humans are deserving of our highest degree of care,” regardless of “ability, age, beliefs, ethnicity, gender, nationality, race, religion, sexual orientation, or socioeconomic status.” They vowed “to respect all patients, including those who hold beliefs that contradict our own.” Each day the members of our community live that oath, whether they care for patients, educate students, advance discovery, or create and maintain the infrastructure that makes this work possible. For this reason, it saddens me when an event appears to undermine our values.
A little over a year ago we faced an uncertain financial future. In the fiscal year ending June 30, 2020 (FY20), Yale School of Medicine had suffered a significant decline in clinical revenues, as we decreased the number of surgeries performed to create bed capacity for COVID-19 patients and reduced face-to-face outpatient visits due to a shortage of testing and masks. A year later, many of you have asked how we are doing. The short answer is, “We are okay.”
A recent conversation with colleagues in the Faculty of Arts and Sciences caused me to reflect on our education mission at Yale School of Medicine, and the significance that education and lifelong learning are embedded in all that we do, including our research and clinical missions.
In January, in a reflection on discipline, I shared that, “To hold ourselves accountable, we must also become comfortable with sharing data about our performance.” As I have been considering the many ways in which we measure ourselves, these lines from the Harold Ramus film, Caddyshack, came to mind (an occupational hazard of having raised three sons). In his glib response, Ty Webb (Chevy Chase) captures the pitfalls of comparisons, but also the absurdity of striving to improve without measuring progress.
Sometime during our training most physicians have experienced a “bad code.” Clinicians from four corners descend upon a room to resuscitate a patient, but it does not go as planned. Perhaps the leader does not communicate effectively. Others in the room deviate from their assigned tasks. Without coordination, despite their individual expertise and sense of purpose, the group never becomes a high-functioning team. In the research setting, an analogous lack of rigor or attention to detail, while not life threatening, can lead to wasted resources, irreproducible results, and misleading data that sets discovery back. In both cases, the culprit is a lack of discipline.
The SARS-CoV-2 pandemic serves to remind us of the importance of science. In the last week, clinicians and other health care workers began receiving mRNA vaccines against SARS-CoV-2. Such a strategy would not be possible without the basic science that defined the role of mRNA, elucidated the function of RNA polymerase, allowed for the isolation and sequencing of the viral genome, or identified modifications to make RNA less immunogenic.
As the days grow shorter and we face an increase in the number of SARS-CoV-2 (COVID-19)-positive patients in the hospital, our patience with this pandemic grows thin. Those who come to campus every day to care for patients, teach students, or conduct research may find some solace in human contact and witness progress in the environment around them. For our staff and faculty who are working remotely, however, it may be hard to appreciate how your efforts are contributing to the ongoing evolution of our school.
The fall is upon us and in less than two weeks the general election. In a time of uncertainty, anticipation of various potential outcomes can create anxiety. Some may feel that they do not have control over their future.
I hesitated to write about something this personal in Beyond Sterling Hall, but the value and importance of letting our faculty know that they are not alone and that they will succeed as they juggle work with child care or elder care through the COVID-19 pandemic compelled me to share my personal experience.
Today I would like to review the research strategic planning process ongoing at Yale School of Medicine.
Yale School of Medicine should be an academic home where women and underrepresented in medicine (URiM) faculty, staff, and students thrive, and where diversity and excellence are inextricably linked.
This week we have been confronted by the image of a white police officer holding his knee on the neck of a fellow human being, a Black man named George Floyd. The image invokes the most visceral of emotions, sickness, shock, anger, and for many in our community fear for themselves and for their loved ones. It follows on a series of disturbing events, including the shootings of Ahmaud Arbery and Breonna Taylor.
“Whan that Aprille with his shoures soote the droghte of Marche hath perced to the roote ... .” So wrote Geoffrey Chaucer in the prologue to The Canterbury Tales nearly 700 years ago. Spring has amazed and comforted us since the beginning of humankind. Yet, somehow the sight of daffodils and trees in bud has never seemed more startling and welcome than this year, as we experience the first downturn in the number of COVID-19 cases and anticipate our emergence from this long winter.
Pride, humility, gratitude—these are a few of the emotions I have been feeling lately as I witness the response of our faculty, staff, and students.
We named this monthly missive “Beyond Sterling Hall,” to convey that YSM extends far beyond an administrative building or our laboratories. Today I would like to convey the ways in which our faculty, staff, and students are rising above COVID-19 and share the work that is continuing to move us forward as a school of medicine.
The months leading up to my arrival and my first six weeks as dean of Yale School of Medicine (YSM) have been both exciting and eventful. The many meetings I have had with leadership, faculty, staff, and students—including a series of ongoing small group listening sessions with these groups—have given me a unique perspective on what makes the school so special, as well as some of the opportunities we have to excel even further.
As outlined in the three climate committee reports posted on January 23, 2020, the Academic Leadership Committee proposed that effective leaders are guided by the values of integrity, reflection, and communication; diversity and inclusion; generativity; discovery, innovation, and scholarship; and building an engaged and productive community.
Sixty-five meetings and 42,000 steps. Thank you to all who have welcomed me to your departments and offices over the last few months as I have begun to learn about Yale School of Medicine (YSM) prior to my arrival this week.
Sixty-five meetings and 42,000 steps. I have had the opportunity to meet with many faculty members over the last few months as I have begun to learn about Yale School of Medicine (YSM) prior to my arrival this week. I am grateful to Dean Alpern for his leadership and graciousness during our transition.