Yale Psychiatry Grand Rounds: "Dean's Address: State of the Medical School"

Transcript

• 00:00Thank you to those of you who did
• 00:03come in person and I'm actually not
• 00:05delivering the address so much as a
• 00:07Cliff notes really for the intention of
• 00:11tweaking your memory so that you will
• 00:13frame questions and things will come to
• 00:16mind that you wanted to to talk about.
• 00:18And so I'll start by just reminding you
• 00:21that with all the work that we're doing,
• 00:23they're really for cross cutting themes.
• 00:25And the first is about creating
• 00:30an environment where everyone can
• 00:32thrive that is inclusive and where
• 00:35we continue to recruit and retain
• 00:37the the best talent in the world.
• 00:41And I think this department embodies
• 00:46that in in the talent that's here.
• 00:49I'm looking at some of the honors
• 00:52that you have received and some
• 00:55of the national leadership.
• 00:58I'll point out, for example,
• 00:59that Marina is president of
• 01:02the Society of Neuroscience.
• 01:03As you know, Carolyn,
• 01:04Missouri is recently doing
• 01:05work for the White House,
• 01:07which is a pretty good gig.
• 01:10Charles **** president of American
• 01:12Academy of Psychiatry and Law,
• 01:13Regita Sinha, Vice President for
• 01:16Research Society and Alcohol,
• 01:18Annie Klee, American Psychology
• 01:20Psychological Association.
• 01:22So you know,
• 01:23that's the the kind of leadership
• 01:25that I think it differentiates this
• 01:27department and this school and
• 01:30something that we want to promote
• 01:32our junior faculty to grow into.
• 01:34One of the ways we've done that
• 01:36is the creation of this faculty
• 01:39Annual Development questionnaire,
• 01:41Development Annual Questionnaire,
• 01:43F DAC, which is you know,
• 01:45we piloted 2 years ago and
• 01:48did completely this year.
• 01:50Keith Choda is going to be
• 01:52showing to the chairs our data.
• 01:53These are out of date as of about,
• 01:56you know,
• 01:57the summer,
• 01:59but all but four departments
• 02:03completed virtually 100% of this.
• 02:07And the ideas really to frame the
• 02:11conversation to give our faculty
• 02:13better ways of thinking about
• 02:18what questions they want to discuss
• 02:20with their leaders and their chairs.
• 02:21And interestingly, we are just getting
• 02:24an early look at our university
• 02:26faculty survey data from this year.
• 02:28We now have a comparator for two
• 02:31years and the thing that showed the
• 02:33greatest improvement was our faculty's
• 02:35view of both formal and informal
• 02:36mentoring that they're getting.
• 02:37So it's really,
• 02:38I think starting to have an impact
• 02:40trying to get rid of that.
• 02:41What are we, what are we getting there?
• 02:44There's on the screen behind.
• 02:47Excuse me one second.
• 02:50OK, OK, great. I wasn't,
• 02:51I wasn't looking behind me.
• 02:55So lots of investments in career development,
• 02:59particularly in that period from training
• 03:03to independence if you're a researcher.
• 03:06And this is work that Keith is also leading.
• 03:08But one of the groups that we have,
• 03:12we often lose our our international
• 03:14trainees who are not eligible for training
• 03:17grants by virtue of their visa status.
• 03:19So we're putting some internal
• 03:21money into bridging that gap.
• 03:23We had four awardees this past year.
• 03:25It's really had an impact.
• 03:27We're also investing significantly in
• 03:30support for graduate slots and for gaps
• 03:34in the postdoctoral fellows and the
• 03:36graduates as those now with the Local
• 03:3933 are going up considerably this year.
• 03:42The long term play,
• 03:44I think it's got to be developmental
• 03:46support for these entities.
• 03:48Our research faculty,
• 03:49you know is a group that we have
• 03:51I think taken for granted and
• 03:53we are not alone in this.
• 03:54I think this is across all
• 03:57academic medical centers.
• 03:58And so this is some of the work that
• 04:00our recent task force recommended,
• 04:03including standardizing the offer
• 04:05letter so that there's clear
• 04:08expectations and my joining this track
• 04:10as a pathway to a different track.
• 04:12I'm joining this track because I want
• 04:14to be leading a lab and a core and
• 04:17differentiating in which case we need
• 04:20to provide those career pathways And
• 04:22then actually developing an F DAC
• 04:25equivalent for our research track faculty.
• 04:27The learning there has been,
• 04:30there are issues with trust and issues
• 04:33particularly because our research track
• 04:35faculty very much rely on the funding of API.
• 04:38And so being completely honest about
• 04:41what your experience and what your
• 04:42obstacles is is a little bit harder.
• 04:43So we may have to think about
• 04:46this differently.
• 04:47I mentioned our surveys,
• 04:48I think we've been well
• 04:50surveyed over surveyed.
• 04:52We're trying to get some discipline
• 04:53around this and now we'll be alternating
• 04:56the university survey which we just
• 04:57did this year with this survey,
• 04:59the double AMC survey.
• 05:00But to give you examples,
• 05:02this survey measures input from
• 05:04students and staff as well as faculty.
• 05:07So we get slightly different information.
• 05:09It allows us to benchmark around
• 05:12against other schools of medicine,
• 05:14whereas the university survey really
• 05:16allows us to benchmark against other
• 05:19schools in the in the university.
• 05:22And so these data are all the data
• 05:24from these surveys at a high level
• 05:25or all posted on our web page on
• 05:27the School of Medicine web page.
• 05:29I think that's really important because
• 05:33that transparency and in addition
• 05:35departments receive their data And
• 05:37so you know I think for you as a
• 05:40department to say what are our gaps,
• 05:42what are the things we need
• 05:43to do differently is is really
• 05:45an important exercise.
• 05:46The other data that are are posted,
• 05:49there is a high level annual survey
• 05:51of the types of things we come see
• 05:53coming to our office of Academic and
• 05:55Professional Development of course
• 05:56led by a member of this department,
• 05:59Doctor Robot.
• 06:00And this has been invaluable
• 06:02in seeing several things.
• 06:04One is an early warning when an individual
• 06:08is struggling with professionalism,
• 06:10often because there's something going
• 06:11on in their life and that they need,
• 06:13they need support for or they
• 06:16just need coaching.
• 06:17But also when there are systems issues,
• 06:18when we have a unit where there
• 06:20are particular things going on,
• 06:21you can see the vast majority
• 06:24of things that come to that
• 06:25office or around professionalism.
• 06:27And when we do a deep dive there,
• 06:29it's, I would say a lot of it falls
• 06:31into the category of anger management
• 06:33and just helping people figure
• 06:35out how to deal with frustration
• 06:37and stress in the workplace.
• 06:38But if we intervene early then we prevent
• 06:42the the the more serious episodes.
• 06:45Another group of not faculty,
• 06:48but extremely important to our
• 06:49future of course are our students,
• 06:51I mentioned earlier,
• 06:52graduate students we continue to recruit
• 06:55incredibly diverse and talented.
• 06:57This is, I think by the numbers,
• 06:59one of our most talented classes,
• 07:01but also the most diverse class
• 07:03that we've ever had.
• 07:04We've had lots of conversations about
• 07:07the potential impact of SCOTUS on
• 07:10our admissions process and I will
• 07:12admit to being a terminal optimist,
• 07:15but I will say the way our
• 07:18admissions process works,
• 07:19we have always had a very holistic process.
• 07:22And what SCOTUS says is you can't
• 07:25use a specific characteristic
• 07:27in the admissions decision.
• 07:29But what we do to increase
• 07:31diversity is really about outreach.
• 07:33It's about outreach before people
• 07:35get here and the work that many
• 07:37of you were engaged in,
• 07:38in going around the country
• 07:40and letting students know that
• 07:42Yale is accessible for them,
• 07:43that they're talented, they should apply.
• 07:45And then once we've admitted
• 07:48people making sure that they make
• 07:49the right decision and come here.
• 07:51And to that end,
• 07:53we've created a position with part time
• 07:56position of Director of Alumni Engagement.
• 07:58And this is partly to really allow our alums,
• 08:03some of you are are here to be more
• 08:07proactive in in involvement in the school.
• 08:11But it also with respect to admissions to
• 08:14enable our Lums out in the communities
• 08:18to call admitted students who have
• 08:21shared experiences come from shared areas.
• 08:24And so Anne Arthur,
• 08:25who's an alum herself,
• 08:26class of 1990,
• 08:28a practicing ophthalmologist in New
• 08:30York and I would say something of
• 08:32a force of nature is spearheading
• 08:34this work and and making sure that
• 08:36I don't go to any city where I'm not
• 08:39having a dinner or a luncheon with alumni.
• 08:41So thank you for all the work that many
• 08:45of you put into our LCME site visit.
• 08:49We are almost through the final stages.
• 08:52We will receive a a final report in February,
• 08:54but so far so good and this catalyzed
• 08:58a lot of important work including
• 09:00strategic planning and I won't walk
• 09:02through the entire strategic plan.
• 09:04I'll just highlight a couple
• 09:05of things that are going on.
• 09:07One is the the provision of coaches
• 09:10with our first year class, but it will,
• 09:12we will move through all four classes.
• 09:14Our students,
• 09:15you know,
• 09:16the Yale system allows them
• 09:18incredible autonomy that can be
• 09:21pretty frightening in the beginning.
• 09:24And we're a much bigger place
• 09:26than we were in
• 09:27the 1930s when the real
• 09:29system was put in place.
• 09:30So coaches are now available
• 09:32to our students to help them
• 09:34look at what they want to do,
• 09:35navigate the system and sort
• 09:37of measure their own progress.
• 09:39Still, you know,
• 09:41when winterness described the system,
• 09:43he said medical school should
• 09:44be like Graduate School.
• 09:45But we provide mentorship
• 09:47for graduate students,
• 09:48and this is about providing
• 09:50mentorship for our medical students.
• 09:51Another thing that's going on is the
• 09:53formation of colleges that allows for
• 09:55vertical integration of our students,
• 09:57not just across class,
• 09:58but with other classes,
• 09:59with faculty,
• 10:00with the community.
• 10:01We've had huge faculty engagement of
• 10:04this with this and the first dinners have
• 10:07been happening and a lot of enthusiasm.
• 10:09So the next set of cross cutting
• 10:11themes are around how we promote
• 10:14innovation and creativity discovery
• 10:15and what are the sort of cross
• 10:18cutting resources that are necessary.
• 10:20And I I will start with this slide which
• 10:25is our university science strategic plan.
• 10:28Superimposed on that in green is
• 10:30the results of our school specific
• 10:33strategic planning and highlighted
• 10:35in blue were the elements of the
• 10:36university strategic plan that
• 10:37are particularly relevant to
• 10:38the School of Medicine,
• 10:39right.
• 10:40So now I'll put red on there just
• 10:43to really make it a busy slide.
• 10:44But these are some of the things
• 10:46that we're doing to address
• 10:48these strategic initiatives.
• 10:50So for example,
• 10:52I'll go to neuroscience,
• 10:54which of course is most
• 10:56relevant to this group,
• 10:57but things like the creation of
• 11:01a clear potent stem cell core
• 11:04where you can generate neurons,
• 11:06recent philanthropically and and
• 11:10funded ventures related to neuro,
• 11:13inflammation and neurodegeneration,
• 11:17things like the Center for Brain,
• 11:18Mind Health,
• 11:19Chris is one of the leaders of
• 11:21that which is intended to bridge
• 11:24this basic science research that
• 11:26we're doing into the clinical
• 11:28arena so that any patient who
• 11:30gets admitted to Yale New Haven
• 11:31Health System has access to the
• 11:33most cutting edge therapies.
• 11:35So those are examples many,
• 11:37many others here central biorepository,
• 11:40Office of team Science,
• 11:43investments in precision medicine that are
• 11:46ongoing investments in cancer etcetera.
• 11:49So one of those investments is,
• 11:51is making sure that our cores are working.
• 11:55And Amy Blanchard,
• 11:56who's our Director of the research
• 11:59course has been a hero here in
• 12:02creating governance structures and
• 12:03input structures for our faculty
• 12:05to say this is what's working here
• 12:08are the cutting edge therapies or
• 12:10technologies that should be in the core.
• 12:12So updating equipment,
• 12:14introducing new software,
• 12:16trying to take the pain out of
• 12:18using cores and making sure that
• 12:19the service and the timelines are
• 12:21good and the sort of Uber core
• 12:23that we have is our Yale Center
• 12:25for Clinical Investigation and
• 12:26this is well known to to John.
• 12:29But you know one of the things
• 12:30about this as it's evolved over
• 12:32the years as we've tried to be
• 12:34all things to all people and
• 12:35sometimes are no things to anybody.
• 12:37And so we,
• 12:39we brought in Dave Coleman,
• 12:41who many of you know was here for for
• 12:44years and just retired from a gig as
• 12:47chair of Medicine at BU for like 16 years.
• 12:50Familiar with the institution,
• 12:52actually wrote the first report suggesting
• 12:54the creation of YCCI with Rick Lipton.
• 12:58And he's been getting under the hood
• 13:00in a way that only someone who's
• 13:03strictly focused on this work can
• 13:05do in collaboration with John and
• 13:07with Brian to to rationalize how
• 13:09YCCI works so that we're putting
• 13:11resources where they're most needed.
• 13:14So for example,
• 13:15closing studies that aren't
• 13:17enrolling and having some criteria
• 13:19for who should be funded,
• 13:21but then using that money to
• 13:22fund vouchers for young faculty.
• 13:23And so you'll be hearing more
• 13:26about those efforts.
• 13:27Another area of investment in terms of
• 13:32centralized resources is the faculty portion
• 13:35of our degree and Master of Health Sciences.
• 13:38You know,
• 13:39we have really have two degrees that
• 13:40were approved by the corporation,
• 13:41one for students and one for faculty.
• 13:44That was a single degree approved
• 13:46for faculty.
• 13:46It turns out we have,
• 13:47I don't know, count them,
• 13:4916 or 20 different programs.
• 13:52Everyone's different.
• 13:53Every department has created the
• 13:55different process for admitting training
• 13:58and it's incredibly inefficient.
• 14:00And I I would dare say that the students
• 14:02aren't getting the best possible education.
• 14:04So Lauren,
• 14:05Sensing has been doing this work
• 14:08in creating a a more unified
• 14:10structure with four tracks.
• 14:12Some of those tracks already exist of course,
• 14:145 tracks, sorry,
• 14:16medical education,
• 14:17no change there,
• 14:18National clinical scholars
• 14:20program no change there,
• 14:22but really codifying our track in
• 14:24informatics and a new track that Rob
• 14:27Rob Roy Herpes has been involved in
• 14:30developing in clinical investigation.
• 14:31So admission applications are being
• 14:33accepted right now and you probably
• 14:35saw an e-mail that went out from
• 14:38Jessica and Lauren yesterday.
• 14:42I won't get by without talking about space.
• 14:46This is a diagram of our
• 14:50beginnings of our master plan.
• 14:52You can see for orientation
• 14:54college turning into Congress.
• 14:55Here's Sterling Hall.
• 14:58We are you know neuroscience now has
• 15:01moved in largely into 100 college.
• 15:04Importantly, we now own 300
• 15:06George as of about a month ago,
• 15:08this was a lease to own building that
• 15:10will have so a lot of implications.
• 15:12It means eventually we will operate it,
• 15:14which I think is beneficial the
• 15:15university will operate it.
• 15:17It also means that as floors
• 15:19become available,
• 15:20we can build out more wet space there.
• 15:23One O 1 college will become
• 15:26available in roughly 15 months.
• 15:28That will decant people from
• 15:30TAC and allow for putting more
• 15:34inflammation research intact.
• 15:36But what I'm most excited about is this
• 15:39little the purple triangle that says
• 15:41site that's 35 to 47 college place,
• 15:44that one story.
• 15:45And that usually when I say this,
• 15:46somebody says that's where I park,
• 15:48I've got my office.
• 15:50They're good,
• 15:51but it's not being used well and it's
• 15:54going to become additional space
• 15:56both for the School of public Health
• 15:57and for the School of Medicine.
• 15:59For the medicine, it's wet lab space.
• 16:01It's going to go up many floors.
• 16:03They're doing the massing diagrams now
• 16:05and it will be a university building,
• 16:07not a least, which I'm really excited about.
• 16:11We have convened twice now a
• 16:15Yale Scientific Advisory Board.
• 16:17These are, you know, a Nobel laureate,
• 16:20Alaska prize winner,
• 16:21Breakthrough Prize winner, editor of science.
• 16:23All but one with a with a history
• 16:26with Yale from training to having
• 16:28been faculty here and we have
• 16:31slowly been in the presenting both
• 16:33sort of strong existing programs.
• 16:35So we did neuroscience the first year,
• 16:37inflammation this year,
• 16:39but also the things that we're building
• 16:41and getting input on that very,
• 16:43they're very interested in our
• 16:45trainees and what we're doing there.
• 16:46And so each year we'll be inviting
• 16:48trainees to meet with them as well.
• 16:52And then lastly before we get
• 16:54to lots of time for questions,
• 16:57just to address the work that
• 16:59we're doing with alignment.
• 17:01And you know we've had about a
• 17:03200 relationship year relationship
• 17:04with the health system and it's
• 17:07not always been a smooth one.
• 17:09I don't see any way forward for
• 17:12us without being better aligned.
• 17:13And the first part of that is
• 17:16doing joint strategic planning,
• 17:18which I don't think we've ever done.
• 17:20And so these are the sort of pillars.
• 17:24I'll point out on the far left,
• 17:28a pillar around clinical
• 17:29and translational research.
• 17:31This is this draft is written,
• 17:33it's posted online and the alignment website,
• 17:36you've all gotten a URL to that.
• 17:39It calls for things like a single
• 17:41IRB across the center so that
• 17:43if you're doing research,
• 17:45you're not applying separately in Bridgeport.
• 17:48It also calls for the appointment of a
• 17:52director of research in the health system,
• 17:54which would be shared reporting
• 17:56to the Dean and to
• 17:57the CEO of the health system,
• 17:59much as Peggy McGovern stands
• 18:01over the physician enterprise
• 18:03and that work is ongoing.
• 18:05And then work on what are the service
• 18:07lines that we need to develop that is
• 18:10has involved having chairs and service
• 18:12line leaders all in the room together
• 18:14each talking about their own programs,
• 18:17which is extremely useful because themes
• 18:19emerge like cross cutting themes that
• 18:22we all need support for these programs
• 18:25etcetera And then prioritizing them
• 18:26about what it what differentiates us,
• 18:28what are the national programs.
• 18:30And this is just a rubric
• 18:31that they've been using.
• 18:33You're familiar with this,
• 18:34which is the Align Physician
• 18:36Enterprise run by PEG.
• 18:37McGovern allows us to stop doing
• 18:40basically competing between the
• 18:42faculty practice plan and an EMG while
• 18:45maintaining separate economic structures.
• 18:47It also allows us to get rid of duplication
• 18:51and to #1 improve access so that we don't,
• 18:54you know,
• 18:55so we have coordination
• 18:56across all of these systems.
• 18:58And Peggy's doing God's work.
• 19:01The access work is fully underway.
• 19:05You know,
• 19:06it's about a three-year project.
• 19:07I think you're going to start to
• 19:09see improvements soon because we're
• 19:11about 8 months, nine months into it.
• 19:14We've also recently stood up,
• 19:16stood up a clinically integrated
• 19:17network which allows us to also
• 19:19create stickiness around the community
• 19:21positions with whom we work,
• 19:23where people who sign on are committing
• 19:25to a certain level of quality,
• 19:27but also committing to being
• 19:29part of this team.
• 19:31And that will have a huge impact.
• 19:34It allows us to create a
• 19:36network without having to,
• 19:38you know,
• 19:38dramatically increase our own
• 19:40faculty in areas where we may
• 19:42not want to grow faculty and then
• 19:45everyone's favorite funds flow.
• 19:48This is the sort of here's
• 19:50how the numbers flow.
• 19:51I think the important points
• 19:54here are it was designed so that
• 19:56the same dollars passed.
• 19:58If you did nothing differently,
• 19:59there was no change in the flow of money
• 20:03from the health system to the school,
• 20:05but that it also aligned incentives
• 20:07so that if we became more efficient.
• 20:11Improved faculty's lives so that
• 20:13you spent less time in front of the
• 20:15computer and more time seeing patients,
• 20:16all of those things we would both benefit.
• 20:18So it's got those efficiencies built into it.
• 20:22It also specifically acknowledges
• 20:24academic program support as a percent
• 20:26of the revenue to the health system.
• 20:28So it's a small percent of a big number,
• 20:31but it's not a,
• 20:32it's not dependent on the margins
• 20:34to the health system.
• 20:35So that's really quite important
• 20:38and and I'll stop there and take
• 20:42these down and show oops,
• 20:45did I just did I just turn everybody off?
• 20:50I didn't. OK.
• 20:55What are you guys seeing?
• 21:05Can I can we bring it up so
• 21:06I can see the people online?