To the YSM Community:
In June, approximately two weeks after the State of the School, we held our annual Chairs Retreat. “Chairs Retreat” is a bit of a misnomer as the retreat includes chairs, deputy deans, Yale New Haven Health System (YNHHS) leaders, and university leaders. After a year focused on clinical strategic planning and implementing a new funds flow model, we turned to our goals related to education, research, and climate and culture at this year’s retreat. Leaders were preassigned topics and background material to review to optimize their time and participation.
In the first session, we concentrated on goals related to education and training. A workgroup led by Deputy Dean Jessica Illuzzi, MD, MS, and Senior Associate Dean for Graduate Medical Education Stephen Huot, MD, PhD, discussed improving formative assessment and feedback in undergraduate and graduate medical settings. Both LCME student surveys and ACGME data indicate significant variability by department in the quality and quantity of feedback in the preclinical period, and during clerkships, residency, and fellowship training. The group identified strategies, including leveraging the Center for Medical Education to train departmental faculty in best practices and developing better assessment tools, such as leveraging technology, optimizing clinical rotation schedules, and creating performance dashboards. The group will continue this work in collaboration with vice chairs and directors of Medical Education.
A second group led by Deputy Dean Anthony Koleske, PhD, and Chair Valerie Reinke, PhD, tackled the growing challenges of recruiting and supporting graduate students and postdoctoral fellows. Declining numbers of NIH-funded training slots and the end of the China Scholars program have significantly reduced the number of funded positions. Salaries for graduate students and postdoctoral fellows have increased dramatically over the last year, whereas the size of individual grants has not. In addition, the diversity of the entering class of predoctoral students decreased over the last year. YSM currently invests $15.9 million per year to support graduate students and postdoctoral fellows. Over the last few years, the school raised funding for predoctoral students and postdoctoral slots as part of science-specific or disease-specific proposals to donors. The group emphasized the importance of engaging successful alums in biotechnology in giving. They supported efforts to create new partnerships with countries that have strong foundational education in science as well as with industry. The group discussed best practices at other institutions, strategies to enhance relationships with Minority Service Institutions (MSI), which encompass HBCU, Hispanic Serving Institutions (HIS) and Tribal colleges, and various funding models. Anthony Koleske, PhD, will continue to advance this work in partnership with the dean, Dean Lynn Cooley, PhD, leaders in BBS and the development and postdoctoral offices.
Nita Ahuja, MD, MBA, and Keith Choate, MD, PhD, led a group on supporting physician-scientist development in the proceduralist specialties. Over the last several years we have made considerable progress in supporting protected time for physician-scientists and providing mentorship and resources to accelerate the transition to independence. Developing proceduralist surgeon-scientists poses unique challenges, including greater salary gaps between NIH salaries and clinical salaries as well as clinical time demands on those who provide highly specialized skills and must maintain proficiency. The group endorsed the value of surgical-scientists, pointing out that the current director of NIH exemplifies this phenotype. They discussed innovations in practice models and interdisciplinary collaboration to create economies of scale. A task force will make formal recommendations to the dean within the next few months.
A second series of workgroups addressed research priorities in artificial intelligence (AI) and in facilitating clinical and translational research across the health care system, building on the work of faculty panels who presented to the Yale Taskforce for Artificial Intelligence (YTAI), as well as on the joint strategic plan with YNHHS.Deputy Dean Lucila Ohno-Machado, MD, MBA, PhD, led a group focused on AI in clinical research. The group identified large amounts of multi-modal data, the diversity of our patient population, the development of a new secure computational infrastructure, and significant existing departmental strength in AI as differentiators. As an immediate next step, they suggested developing a nimble joint YSM/YNHHS working group to develop a request for proposals and process for seed grants, to maximize communication of our work (e.g. integration of the Medical AI Symposium into larger university events), and to develop and deliver AI training. They strongly encouraged continued investment in personalized precision medicine.
Chairs Valerie Reinke, PhD, and Chen Liu, MD, PhD, led a similar group on AI in basic science. The group lauded recent university commitments to substantial and ongoing increases in computing power and accessibility. They recommended that the Yale Center for Research Computing (YCRC) conduct a comprehensive needs analysis. The group emphasized the importance of recruiting, training, and retaining talent in this area, including the need to review and revise graduate training programs and to provide continuing education in the effective, ethical, and safe application of existing AI programs. They suggested greater collaboration with industry-facing foundations as well as strategic partnerships with venture capitalists and state government. Based on the work of the AI faculty panels reporting and the analysis of these workgroups, we will write a specific strategic plan for AI in the coming months.
David Coleman, MD, and Margaret (Peggy) McGovern, MD, PhD, chaired a workgroup on the strategic plan for Conducting Leading-Edge Clinical and Translational Research across the academic health system. The group discussion focused on four general topic areas outlined in the Joint Strategic Planning process. For the goal – create a governance structure to facilitate clinical and translational research across the enterprise, we recently established an aligned Clinical Research Advisory Committee and Clinical Research Space and Operations Committee. For the goal – create the infrastructure to facilitate clinical research across YNHHS, the group supported creating a single Investigational Drug Service and integrating clinical research in business planning processes. For the third goal – enhance discovery through biomedical informatics, data science, and precision medicine, the group recommended expanded capacity and resources for HIPAA compliant data access, curation, management, and analysis of internal and external datasets. They endorsed improved timeliness for approval of data use agreements and further expansion and coordination of programs in Precision Medicine (all “-omics). Deployment of artificial intelligence and digital technologies to improve processes generated interest among members of the group. For the fourth goal – enhance understanding of and engagement in the research mission across YNHHS, the group recommended heightened communication of clinical research to stakeholders, expansion of training programs for clinical staff, development of key performance indicators, and development of searchable databases to link a patient with clinical trials. Dr. Coleman will take point on this work.
The third session of workgroups focused on culture and climate within Yale School of Medicine. Deputy Deans Robert Rohrbaugh, MD, and Margaret (Peggy) McGovern, MD, PhD, led a group discussing wellbeing among clinical faculty. Data from 2022 show a wide range in the rate of faculty burnout across departments. In at least one department, rates of burnout are highest among those with the greatest clinical loads. A sense of loss of autonomy and the administrative burden of the electronic health record (EHR) contribute. The group discussed a three-prong strategy, including enhancing the practice environment, improving organizational culture, and supporting individual resilience. Epic optimization, use of ambient AI for note writing, and addressing space and staffing needs will improve the practice environment. The leaders will explore building central resources for clinically active faculty, analogous to the Janeway Society for physician-scientists and the Center for Medical Education for clinician educator-scholars. Interventions might include building a mutually supportive community through stronger mentoring programs at the departmental level and facilitated group coaching.
Deputy Deans Brian Smith, MD, and Arnim Dontes, MBA, led a group on the major pain points challenging the conduct of research. The group identified a need for more timely and consistent post-award support, space constraints, funding challenges highlighting the gap between expenses and grant funding, inefficiencies in pre-award and contracting, need for greater clinical trial support, challenges for faculty conducting research at the VA, and the need for more mechanisms to promote collaborative research. A research administration enhancement group is working to address training and processes related to post award. A biweekly review of contracting challenges and work to redesign processes in YCCI has begun to impact contracting and study initiation times. Master space planning is underway. The group advocated for a dedicated medical campus facilities team and for extending the work of the research enhancement group to include pre-award. Key performance indicators of timeliness and performance should be transparent. The deputy deans for research, the Research Administration Enhancement Group, YCCI, VA Relationship Steering Group, and the Office of Team Science will pursue these suggestions in the coming year.
Deputy Deans Darin Latimore, MD, and Linda Bockenstedt, MD, led a work group on achieving Inclusive Excellence. Over the last few years, we have codified strategic plans on diversity, equity, and inclusion that focus on recruiting-outreach and proactive retention through mentorship and sponsorship. We have made progress in enhancing diversity and excellence among students, trainees, and faculty; however, there is a long way to go. Deputy Dean Latimore, MD, led a discussion on how best to leverage vice chairs and diversity champions, as well as faculty affinity groups to achieve our goals. The group identified the need to standardize best practices for searches across departments, along with the development of a robust faculty sponsorship program, as major goals. We will be establishing a representative group to codify policies based on best practices and input from faculty affinity groups.
In reflecting on this year’s retreat, it is impossible to capture the engagement of the workgroups or the depth of discussion. This summary is necessarily superficial. Nevertheless, I hope this synopsis provides you with a sense of the priorities for the coming year. The topics flow from the annual goals outlined in the State of the School presentation.
To stay informed and contribute to the discussion, I invite you to review the following resources:
- Listening to the State of the School
- Participating actively in departmental town halls
- Reviewing these resources from time to time: