“A medical school operates in an always-changing environment”

What does it mean to be resilient? While exploring this topic for this issue of Yale Medicine, we asked students and faculty (see excerpts), including Dean Robert J. Alpern, M.D. He shared his thoughts from the vantage points of an administrator managing a billion-dollar-plus budget, a faculty member interested in the work of colleagues, and a basic researcher who ran his own labs in California, Texas, and at Yale.

What is resilience?
The ability to survive is based on homeostatic mechanisms that maintain our bodies in a constant state, in spite of a variable environment. So the temperature outside goes up and down, but our bodies remain at about 98.6 degrees, as long as we’re healthy. That’s homeostasis.

When we talk about resilience, we refer to the ability of the homeostatic mechanisms to function within environmental extremes. This plays a role in health from so many perspectives: psychological resilience after trauma, the body’s ability to heal after an injury or severe infections, the resilience of communities and populations, just to name a few.

As a nephrologist, can you discuss how the kidney figures into this topic?
If you ingest a low-sodium diet, the kidney retains sodium. If you eat a high-sodium diet, the kidney excretes sodium. The kidney is all about homeostasis and resilience.

What about deans? Do they have a homeostasis mechanism?
A colleague once said to me that the reason there are more nephrologists serving as deans than from other specialties is because nephrologists understand that what goes in has to equal what comes out. So we’re very good at balancing budgets and addressing extreme homeostatic challenges to the institution.

What kinds of challenges?
A medical school operates in an always-changing environment, and we have to maintain our excellence in the midst of this—changes in health care law, the competitive environment, NIH regulations, NIH budgets. And sometimes they’re extreme: sequestration for example. You need to be resilient.