Yale Psychiatry Grand Rounds: January 22, 2021

January 22, 2021

Information

"Dean's Address: State of the Medical School"

Nancy J. Brown, MD, Jean and David W. Wallace Dean of the Yale School of Medicine; C.N.H. Long Professor of Internal Medicine

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00:00Before we get started, I just
00:04wanted to share news that we
00:07have some sad news that we just learned
00:10this week last day or so that Bob Ross,
00:14who was a resident in our program
00:17and an MD PhD from Yale and very
00:20talented young investigator who
00:22has all of those who knew him.
00:28Struggled throughout his residency
00:31with a neurodegenerative disorder,
00:34and sadly he succumbed to that
00:39disorder this weekend and passed away.
00:44Really fine young man.
00:47Very talented scientist. And.
00:51We are always so sad to see someone
00:54so young and talented struggle.
00:58Last so mightily against
01:02an irrevocable outcome.
01:04Um? On let me change.
01:11Change the tone abit.
01:13We're really thrilled today to
01:15have us at Grand Round Speaker
01:17Ardene for a year so far.
01:22Nancy Brown, she's the
01:23gene and David Wallace,
01:25Dean of the medical school and the CNH
01:28Long Professor of Internal Medicine.
01:30She's a graduate of Yale College.
01:33And then, remarkably went
01:35to Harvard afterwards.
01:37Forgiven for that.
01:40Completed her residency in internal
01:43medicine at Vanderbilt and did a
01:46fellowship in the famed clinical
01:49pharmacology program there.
01:51Roger Prior studied molecular
01:53mechanisms of common medications are
01:55used to treat high blood pressure,
01:58and particularly the implications
02:00of those treatments,
02:01and in the context of the pathology
02:05for both heart and kidney disease.
02:09She's throughout her career,
02:10been a very strong supporter
02:12of physician scientists,
02:14development development.
02:15She initiated the Allen
02:17Newman Society at Vanderbilt,
02:19established the Masters
02:20Program in Clinical Science,
02:22and then also served in a
02:25variety of leadership roles,
02:27including the Associate Dean
02:29for clinical and translational
02:30Science Scientists Development,
02:32the director of their Division
02:34of Clinical Pharmacology was
02:36first Robert Williams professor
02:38and then the Hugh Morgan.
02:41Professor and chair of the
02:43Department of Internal Medicine
02:44are recipient of numerous honors
02:46member of the National Academy and
02:49other prestigious organizations
02:50and became Ardyn in last year.
02:53So Nancy,
02:54thanks so much for coming in
02:56to speak to us today about the
02:59state of the medical school,
03:01where we're thrilled to welcome you
03:04to the Department of Psychiatry.
03:07Thank you and really,
03:08this is intended to be a town Hall.
03:10I do have a few slides that I
03:13would refer to as the Cliff notes
03:15for the state of the school,
03:17just to remind you of some of the
03:19things that we talked about in
03:21June and update on a few of those
03:24and then really opened it up for.
03:26For questions and I'm very
03:28grateful to be here with you,
03:30and I have to say it's been a.
03:34A tough year for this Department.
03:36With some you know losses that are
03:39just hard to understand and bear.
03:42And yet you have remained a support
03:44for others in the institution.
03:47And I'm very grateful for that.
03:50Let me share my screen.
03:56And.
04:00Talk a little bit about the school,
04:03but let me start with leadership.
04:07You know, since I've been here,
04:10we've appointed Tony Koleski as
04:13Deputy Dean for basic science.
04:17We recently named Jessica Illuzzi
04:20as deputy for medical education
04:24and she officially started Jan 1.
04:27Several in this Department are
04:29taking critical leadership roles,
04:31and I'd like to highlight the
04:33work of of Sambol with Jonathan
04:35Grauer in the Office of Academic
04:37and Professional Development,
04:39and also Bob Rohrbach,
04:40who's been doing some work on
04:43how we promote Wellness in the
04:45clinical side and many others.
04:47And I forgive me if I forget
04:50to call out specific.
04:52Folks.
04:55One of the things that we would like to
04:58do is a is do a better job of shouting
05:02out the work of our faculty and I'll
05:05talk about that a little bit more,
05:07but I but I will say that this Department
05:10in particular is extraordinary and
05:12regularly ranked number one in among
05:15departments of psychiatry and NIH funding.
05:19Clinically, this year,
05:21in addition to what you normally do,
05:24you were accessible to faculty and
05:26staff who had a disproportionate amount
05:29of stress related to covid and made
05:33yourselves available on a voluntary basis.
05:36And it's really quite extraordinary.
05:40Want to turn to culture and climate
05:43and before I came before I arrived
05:46I was aware of some high profile.
05:50Cases that suggested and that I became
05:54more convinced of as we as I arrived that.
05:58Um? We had some work to do in creating
06:02the infrastructure to promote
06:04our best behavior and that work.
06:06I would place in three buckets.
06:09The first is identifying and
06:11selecting leaders you know in academic
06:14medicine we tend to select.
06:16People based on their excellence,
06:18their performance in research,
06:20and the clinical arena,
06:22but not often as often for
06:24their leadership attributes.
06:25And it shouldn't be either
06:28or it should be both,
06:30and so we have spent some time revising
06:33our search processes to standardize them
06:35and emphasize those qualities of leaders.
06:39In addition,
06:39once we tap leaders,
06:41we tend to throw them in and say good
06:43luck and and but the skill set required
06:46for leadership is quite different
06:48necessarily from that of running a
06:50lab or a large clinical enterprise,
06:52and it requires the ability to have difficult
06:55conversations and make hard decisions,
06:57and to be courageous and so.
06:59Helping people develop those
07:01skills is another area,
07:03and we've been working to
07:05to establish leadership,
07:06development and coaching.
07:07And then Lastly putting in place
07:10systems that help us detect issues as
07:13an early warning system and intervene
07:15when people are struggling and that's
07:18manifest in bad behavior or in micro
07:21aggressions or whatever it is and
07:24help them change behavior but also
07:27hold people accountable for their
07:29behavior and so this is the work.
07:31That's being done in LAPD.
07:34And if you haven't looked at
07:36their newly revised website,
07:37I would encourage it,
07:38but but one of the key things is
07:41just closing the loops for all
07:43the different points of entry.
07:45When somebody expresses a concern,
07:47because that may be expressed in
07:49the hospital and yet never get
07:51back to the school.
07:52Or it may be expressed in a
07:54Department and not be centralized,
07:56but also surprise supporting our chairs.
07:59And other leaders as they face difficult
08:01situations because for anyone chair,
08:03it might be the first time
08:05someone has dealt with it.
08:07But for a centralized office
08:09they can provide expertise.
08:12So I've mentioned this in our
08:14work to standardize pathways
08:15and not only accountability,
08:17but I would say closing the loop.
08:19We too often don't go back to our
08:21faculty and staff and say something
08:23has been done and we may not be
08:25able to say what has been done,
08:27but we can at least.
08:30Close that loop.
08:31We've done work to review our
08:33mission statement and I'll mention
08:35that in a minute we have now
08:38close to finalized a strategic
08:40plan for diversity equity,
08:42inclusion for faculty,
08:43and we have a draft for students.
08:47This really focuses on mentorship and
08:50sponsorship and creating an inclusive
08:53environment and promoting retention.
08:58And part of creating an inclusive environment
09:00is creating space that is inclusive,
09:02and if you haven't been outside
09:04the Deans Office lately,
09:05I would encourage you to walk by there.
09:08We've we've moved to the portraits.
09:10One haulover we've sent back some
09:12of the portraits that were clearly
09:14just there because someone had
09:16cleaned his or her addict and now
09:18it's limited just to the Deans.
09:20We've cleaned them up a bit,
09:22but we've made space for two.
09:25Rotating exhibits in the
09:27first 2 will open soon.
09:29One is an exhibit on HIV in New Haven,
09:32and that history that involves our
09:35school and the 2nd is a exhibit related
09:38to the accolades of our current faculty
09:41who are of course much more diverse
09:44than the Deans hanging down the Hall.
09:47So I'm excited about those changes.
09:50We've also done some work too.
09:52Review our institutional guidelines
09:54around compensation plans.
09:56As you know, Dean Alpern and now I.
10:00Annually go through salaries to
10:02make sure there aren't outliers
10:04and to and to ensure equity,
10:06but we also needed to do some work to say
10:09why do we see outliers and what are the what?
10:13Are the areas in which compensation plans
10:15are not consistent across the institution.
10:17So we've just finished that work.
10:21We are enhancing our resources for
10:24mentorship and career development.
10:26I've tapped Keith Choate to become
10:28the associate Dean for physician
10:31scientists development,
10:32but again, Sam Ball.
10:34We're doing a lot of work in
10:38creating toolkits for our clinician,
10:41educator and clinician faculty in
10:44helping them develop portfolios
10:47and educational portfolios as well.
10:50And as I mentioned,
10:51we have to develop mechanisms to celebrate
10:54all that our faculty and staff are doing,
10:57and one of my favorite emails
10:59these days is the Wednesday morning
11:01email of news and recognition.
11:03And it's just great to see what all
11:06that is going on in in the school.
11:09And we're continuing listening meetings
11:11which I anticipate continuing for good
11:14just because they are very helpful for
11:17me to to hear from you and to meet you.
11:20Even if not in person.
11:22So this is our mission statement.
11:24It was an interesting process and one
11:27that I thought would be difficult to do.
11:29But it turns out that Zoom is a
11:31is a wonderful medium for focus
11:34groups and for surveys.
11:35And as you know,
11:37this was an iterative process
11:39with lots of feedback until until
11:41we got it where we wanted to be.
11:44Yale School of Medicine educates
11:46and nurtures creative leaders in
11:48medicine by promoting curiosity and
11:50critical inquiry in an inclusive
11:52and collaborative environment
11:54enriched by diversity.
11:55Those words promoting curiosity
11:57and critical inquiry,
11:58I think convey the Yale system of
12:01medical education and the notion
12:03that we treat our students and
12:06learners as adults and that they
12:09take responsibility for immersing.
12:11And we believe that that creates people who.
12:16Know how to go deeply and ask
12:18questions and notice the outliers,
12:20the words inclusion and diversity
12:22had not appeared in our
12:24mission statement before and
12:26that was very important to us.
12:28And we advanced discovery and innovation
12:30in the pursuit of scientific knowledge,
12:32fostered by partnerships
12:33across the University,
12:35our local community in the world.
12:37And this is an institution where
12:39the excellence of our scientific
12:41discovery is extraordinary.
12:42But it's important to acknowledge
12:44that we don't do that in a vacuum,
12:47and we benefit from being part of
12:50the larger University, but also from
12:52being embedded in this community.
12:54And we're not alone.
12:55And Lastly,
12:56we care for patients with compassion.
12:59And commit to improving
13:00the health of our people.
13:02Acknowledging both our own individual
13:05relationships with patients,
13:06but also our larger commitment
13:09to the Community at large.
13:12So on the clinical mission,
13:14you know,
13:15I think it's hard to look back on the
13:18last year without saying the word covid,
13:21but I think one of the Silver Linings
13:24of the pandemic has been the.
13:27Fact that when faced with a common enemy,
13:30we have worked collaboratively
13:32and together in ways that I think
13:34perhaps we didn't realize were
13:36possible and we need to learn from
13:39that in terms of realizing better
13:41alignment between the school and our
13:43partners in Una Haven health system.
13:46And to that end,
13:47we're doing a fair amount of
13:49work addressing governance and
13:51how we share decision rights and
13:54what the role of chairs are,
13:57and Chiefs across the system.
13:59And that's been very gratifying work,
14:01and one in which the delivery network
14:05presidents are engaged as well.
14:07Related to that,
14:08I think we have to develop improved
14:11analytics and we have to become
14:13comfortable with seeing how we're
14:15doing in terms of quality and service
14:18and then looking at them together
14:20and problem solving together.
14:21It's part of holding ourselves
14:24accountable for what we do and we
14:27need to include HealthEquity in that.
14:30And then as an academic Medical
14:35Center and system.
14:37Every patient should be enrolled
14:39in clinical research in some way
14:41and should be contributing to the
14:43discovery mission and we should
14:44be leveraging our discovery to
14:46enhance the care of every patient.
14:48And so I think we have work to do there.
14:52And then of course,
14:53spaces is a difficult problem for us.
14:56I think our our approaches to it will change.
14:59Post covid.
15:00In that we will have more people staff
15:03working off campus by preference and
15:06we will be able to open up office space,
15:10perhaps for clinicians.
15:11And we may use that space differently
15:14on the education front I mentioned
15:17the appointment of Jessica Lusion.
15:19She's already doing a terrific idea,
15:22perfect job and plans a some
15:24strategic planning work,
15:26not of the scope that we did when
15:29Richard Belitsky took the job.
15:32But really focused on pedagogy and and
15:35mentorship and support for our students.
15:37The Yale system is wonderful,
15:39but it does require that students
15:42know how to navigate and seek help.
15:45And so in the early days,
15:47providing a little bit of support for that.
15:51And then I think in the area of pedagogy we.
15:56I think can do a better job of
15:59using technology and learning from
16:01Kovit again in terms of how to
16:04engage students in a better way.
16:06I would you were aware that Dean
16:10Alpern successfully reduced the
16:12unit loan to $15,000 per student
16:14and that's been wonderful,
16:16but we're currently paying for that out
16:19of operations and I would dearly love to
16:23identify donors to invest in that work.
16:27We also have an opportunity to leverage
16:29our alumni I think to to help us in
16:32our recruitment and of students and
16:34residents and to help us get the
16:37word out about all of the things
16:39good things that are going on here
16:41and in particularly to help us with
16:44enhancing recruitment and retention
16:45of those who are under represented
16:48in medicine among our students.
16:50Both our medical students in
16:51our PhD students,
16:53approximately 27% are
16:54under represented medicine,
16:55but we need to retain.
16:57Those in academia in our residency
17:00programs in our fellowships,
17:02because those become those programs often
17:05retain folks as faculty subsequently.
17:09And then I mentioned leveraging our
17:12communications to get the word out a
17:15little bit better about what we're doing.
17:17In research we are.
17:19We have an going.
17:20We're in the latter stages of a search
17:23for a chair of neuroscience and I'm
17:26very excited about the work going on there.
17:29Um,
17:30we have held a strategic plan
17:32for research within the school
17:35in the context of the University
17:38Science Strategic Plan, so.
17:41Focused on how we realize some
17:43of those overarching priorities,
17:45but also what is unique to the
17:47school and one of the things that I
17:51think was particularly successful
17:53about this exercise was that it was
17:55not a top down exercise but one in
17:58which Tony Glowski and Brian Smith
18:01engaged many of the rising leaders
18:04in department's and and spent a lot
18:07of time talking with folks on on
18:09the phone and developing surveys.
18:11And then.
18:12Tapping those rising stars to
18:15lead strategic planning groups.
18:17And there were several overarching themes.
18:20One I would say was the desire to
18:23promote better collaboration across
18:25our basic science and clinical
18:28departments and to facilitate
18:31interdisciplinary research through
18:33large multidisciplinary grants.
18:36A second is a need for better
18:40resources supporting our researchers
18:42in terms of data science.
18:46And then a third was,
18:48I think,
18:49a desire to to coordinate better all of
18:52the work going on in HealthEquity research,
18:55and to that end,
18:57we appointed Marcella Nunez Smith as
18:59associate Dean for HealthEquity Research.
19:04I mentioned Keith Choate and Kisses
19:06has hit the ground running and
19:09establishing infrastructure to enhance
19:11the success of physician scientists.
19:13That will include some institutional
19:16awards for salary support,
19:17but also a lot of career development
19:20resources that will not be
19:23limited to physician scientists.
19:24But to all, such as a grants repository
19:28repository of successful grants and
19:30in career development networking.
19:33I mentioned this and we are developing
19:35an office that will support the
19:38administrative functions related to
19:40submitting multidisciplinary grants,
19:41but also provide pilot support and.
19:46And potentially studios and salons too.
19:50Help identify groups that can collaborate.
19:55We have work to do and this is I
19:57think not been adequately developed
19:59to improve the function.
20:00Our course and certainly our
20:02grant and regulatory support,
20:03and in that I include our contract ING,
20:06which is slow and cumbersome and Brian
20:09Smith is starting to engage in that work.
20:12I think we have an opportunity to
20:15do a better job of nominating our
20:17faculty for key honors and awards,
20:20and really sponsoring our faculty.
20:24We have done some work to increase the
20:26availability of endowed professorships.
20:28This includes making it possible to split
20:32an endowed professorship that has become.
20:35Very large and we have criteria
20:37for doing that and we are now for
20:41those appointed professorships.
20:42After 2020 those are appointed on a 10
20:46year renewable term and we expect that
20:4999.9% of those will be renewed each time,
20:52but it does give give us the ability to
20:55make professorships available if someone
20:58is it's not appropriate to renew somebody.
21:02And then work that we have not yet started.
21:05But I think we need to do soon is work
21:08on improving the quality of life and
21:12career development for our research
21:14track faculty who are often the platform
21:17in which our programs are built.
21:19And then we are probably about a year
21:22away from establishing a scientific
21:24Advisory Board that would help us work
21:27to diversify our funding portfolio,
21:29but also again, improve.
21:31Communication about the work here.
21:33So those are a few things and you
21:35know we've accomplished them,
21:36but we have a lot more to do and I
21:39just wanted to remind you of some
21:41of what we've talked about.
21:43And then I'm going to stop sharing
21:45and just open it up for questions.
21:59And I see Richard Belinski and I just
22:02want to give a shout out to Richard's.
22:05For all that he's done for medical
22:07education as we were talking about
22:09kudos and my gratitude for his work
22:11to break me in in the first year.
22:15Thanks Nancy, I appreciate that very much.
22:20John, I have a question.
22:23Ken thank you
22:25so much for that. Quick overview.
22:27Rajita Sinha. We've talked before.
22:29I was really interested in your point
22:32about support for research and the data
22:35science piece that's in intriguing.
22:37And, as you know,
22:38so much of of both basic and clinical
22:42science is moving in that direction.
22:44Just thinking about the amount
22:47the portfolio in psychiatry for
22:49clinical research and we bring in
22:51somewhere such a big Department
22:53after medicine being the second one.
22:56And we.
22:56There's so much clinical research
22:58going on and wondering how an
23:00obviously in medicine as well.
23:02A lot of times when we start thinking
23:05about resources across the school,
23:07it's hard to sort of think about
23:10how those would get access to Nan.
23:13People who need it can.
23:15It can can access them and really
23:17get get some benefit,
23:19so was wondering if you could
23:21elaborate on that some more.
23:23I've been involved in Yci so
23:25I know that's a platform,
23:27but oftentimes the.
23:28Mid and senior folks who may be
23:30involved in larger grants that could
23:33benefit from those kinds of resources
23:35tend to not have access to those.
23:38Yeah, so my view of this is that
23:42we need to establish really a core
23:46function for data science in the same
23:50way that we do for basic science and.
23:53It's it can be done and it can
23:56be done well. You need to.
24:01Make sure that it's accessible
24:02to young investigators as well
24:04as senior senior investigators.
24:06There may need to be a hub and spoke kind of
24:10model where you have centralized resources,
24:13but you have expertise within individual
24:15departments that that then leverage
24:17those resources and help investigators.
24:19And there are two kinds of data science.
24:22I think the one we're talking about here is
24:25what I would call bio medical informatics,
24:28and you know,
24:30access to electronic health records and.
24:32Imaging in those kinds of things, but.
24:35The other, of course, is the omcs piece,
24:38and those are probably different cores and.
24:41And we will have to make investments
24:43and I think we have to support these
24:46things with endowment, frankly.
25:03I just follow up since no
25:05one else is saying anything.
25:07I appreciate your recognition of
25:09the the support for the clinical
25:12studies and I'm wondering it is
25:15complicated and wondering if you
25:17anticipate there would be some sort of.
25:19Planning committee or way to sort of
25:22think about how really to structure that?
25:24Or would it use existing structures
25:27to come up with the best plan?
25:29I really appreciate you're talking
25:31about support for it 'cause so many
25:34larger ones and things just don't
25:35end up having their big enough
25:38for getting the data collected.
25:40They don't have the capacity to
25:42support those kinds of aspects,
25:43so
25:44you're talking about the multidisciplinary.
25:46Yeah which which may or may not
25:48be clinical, but. Yeah, so we.
25:54We have drafted and Captain who's doing
25:56this work with spores in the Cancer Center.
25:59He will not take the job permanently,
26:02but is helping us out, for example,
26:05with the grant we're submitting now.
26:08And. So these officers have to be able
26:12to do things like format, you know,
26:15the gazillion biosketches promptly
26:17and the things that are don't add
26:20to the quote science of the grant.
26:22The the other pieces that you've mentioned.
26:26Our besides the administrative
26:28support one is money and so we
26:33have budgeted for some pilots too.
26:37That would support specifically grants from
26:41investigators of different departments, and.
26:45But I think you also have to provide.
26:48Um? The.
26:51It would I would call the enter
26:54function right?
26:55How do you get people from different
26:57areas together to know what's
26:58even going on in the institution?
27:00And because we're siloed,
27:02I think we've probably all had the
27:04experience of being the visiting
27:06professor and being the vector from
27:08one group to another in an institution
27:10where they didn't know what each
27:13other you know was working on.
27:16So we've talked about putting together
27:18a studio system where an investigator
27:20could say I'm interested in this
27:22area and and actually one of the
27:24groups that's really interested in
27:26helping with this is the library
27:28because they love doing these
27:31kinds of searches and so a recent.
27:33Epiphany was that maybe they
27:35could help with this as well,
27:37and but then you can bring those
27:38people in a room together and say,
27:40OK, you know what's the hypothesis?
27:42What are the specific games and
27:44and who's who's who's not here?
27:46Who should be here and the other
27:47way to promote this is with the
27:50career development activities.
27:51The more young people we get in a
27:54room from different departments.
27:56Who are of the same cohort but
27:58in different Sciences?
28:00That better than networking
28:01happens and in my experience that
28:03then connects their mentors.
28:05They grow up and become senior faculty and
28:07it connects those those groups forever,
28:10and so I think that will also
28:12be a way of doing it, yeah.
28:19Besides Jerry Centocor I I know,
28:21along those lines there
28:23was plans for the clinical trial,
28:25Strategic Planning Committee and that
28:27was started early
28:28on. Is that still in process?
28:32So, um, the not sure.
28:37Which committee you're talking about,
28:38but I can tell you what we are doing.
28:41The. We're at this very exciting.
28:48Point in at Yale.
28:50In terms of neurosciences,
28:51there's we're about to have a
28:54neuroscience Institute that will be
28:57focused on cognitive neuroscience.
28:59We are building out space in 100 college.
29:03The hospital is looking at a tower
29:06that would be completed roughly
29:09in 2026 which will increase our
29:12capacity for clinical neuroscience
29:15and the one gap there I think is
29:19the clinical translational trials
29:21and so we have tapped a group
29:24including from this Department.
29:27Chris Pittinger an. Anne.
29:29But somebody from.
29:31Neurosurgery neurology.
29:35Etc to develop a strategic planning
29:37process to get all of the many
29:40stakeholders in the room and
29:42think about how do we develop
29:44that infrastructure to translate?
29:46Because I think that's that's
29:48the one gap in all of that other.
29:51And all of those other resources.
29:55And.
29:58It will be extraordinary if
29:59we can do this if we can.
30:00Take advantage of that and that
30:02will identify the resources
30:03that we need that are beyond
30:05what's available in the CTS A.
30:10Thanks.
30:15So this is as many petrakos from the
30:17VA just to switch gears a little bit.
30:20Speaking of being siloed,
30:21can you say a little bit about
30:23your vision? About the VA?
30:24You know we have a chief of staff
30:27turnover coming up and just just
30:29your thoughts about it,
30:30so my overall thought is that
30:32Villiers are very important too.
30:34Schools of medicine and.
30:36That were probably.
30:40Under collaborating,
30:41not so much in psychiatry, obviously,
30:44but in some other Department and that I am
30:47optimistic because I think the leadership,
30:50the current leadership as opposed
30:52perhaps to prior leadership,
30:54really values our partnership.
30:56And as I was very disappointed that
31:00that Mike is leaving 'cause I think
31:03he was a terrific chief of staff.
31:06But as example of how Al Montoya
31:09values are our partnership,
31:11if you look at the search
31:14committee for this position,
31:15it's really composed.
31:18Largely of Yale School of Medicine
31:21faculty who do a lot of work at the VA,
31:25and I have no doubt that the the person we
31:28tap will be committed to that partnership,
31:32and then we have things to think about,
31:35like space and.
31:38You know which is not optimal at
31:40the VA in terms of research basin,
31:42and whether there's opportunities
31:44you know West Campus is darn
31:45close to the VA and are there
31:47opportunities to collaborate there?
31:48But we have to get that leadership in place.
31:53Great, thank you.
31:58Thank you, Dean Brown.
32:00It's Diana for presenting I,
32:02you know you and I have talked before,
32:05but I think the weight of cobett 19 Ann.
32:09Just the the depth
32:11and breadth of anti black racism
32:13over the last year has. Um?
32:20Just fortify how
32:21difficult it is to be one
32:23of the only
32:25Zana, predominantly White Department,
32:26and I'm wondering like what
32:28are the strategic
32:29plans that you
32:31guys might be thinking of of
32:33how to retain URM faculty.
32:35I know you mentioned
32:37it but I'm thinking if
32:39there are actual
32:40like plan in place what is being done? Yeah.
32:45So there is a strategic plan and the grant
32:49that I mentioned that we're writing is.
32:52Is a newly released RFA
32:55from NIH for cluster hiring.
32:57But let me let me address. What I think.
33:04Where I think we should be focusing?
33:07So I mentioned the importance of retention
33:10an and mentorship and sponsorship.
33:12And when I say retention I mean something
33:15very different from how we traditionally
33:18have done it in medicine, which is.
33:22We tend to ignore junior faculty and
33:24then other people invite them to give
33:27talks and try to recruit them away,
33:29and then we wake up and realize that we
33:32need to invest in their programs and.
33:36And sometimes we lose them, and I think that.
33:41How I think we should be doing
33:45retention is by.
33:46Checking in early with our
33:48faculty and making sure that they.
33:52Have what they need and sometimes
33:54are younger faculty don't even know
33:56what they need and you need to.
33:58You need to help people figure
34:01that out it it includes.
34:03The type of sponsorship of sending
34:06people to national meetings and
34:08recommending them for things and not
34:10waiting until they've been invited by
34:12somebody else and you just notice that.
34:15That, gosh,
34:16I haven't been paying attention here.
34:20For example,
34:20there are some you know very simple things.
34:24Double AMC offers leadership
34:26development for minority faculty.
34:28It offers programs for women.
34:30We've been kind of passive about that.
34:33You know,
34:34we invite faculty to put their names
34:36in and we're doing that differently.
34:39Now we're we're asking or
34:42Department chairs too.
34:44Um,
34:44recommend people and put somebody forward,
34:46which is just a forcing function to
34:49make very busy people look at their
34:51team and say who who were my great
34:54people that I need to invest in and
34:57nominate that I want to develop.
34:59And so there are ways to promote
35:02that in everything that we do.
35:04There's there is.
35:06You know much fundamental work to be done.
35:10In terms of anti racism and education
35:13and then I would say in our searches
35:17we have for our leadership searches
35:20significantly changed our process
35:22to make sure that our search
35:26committees are truly representative
35:28and I think that has the impact of.
35:35In terms of our finalists and when you
35:37look at our finalists for the last couple
35:40of searches that we're engaged in,
35:43they are diverse and we those are the
35:45kinds of leading indicators you need to
35:48measure to get to the lagging indicator,
35:51which is increasing diversity
35:52among our leadership.
36:05Thanks for that. Is there a?
36:07Is there a like actual committee
36:09that's working on that or?
36:11On which on
36:12all of the things that you were
36:14talking about, like having the
36:16strategic plan like I, I'm I
36:17am aware of the. Cluster hire grant.
36:21Because anyway, that's
36:22something that I study and
36:24I know some people
36:25involved in that, but about
36:26the strategic plan around
36:28your IAM retention and all the different.
36:30Points you just talked about.
36:32If they're like, is it already in existence?
36:36Someone committee that's looking
36:37at there's there's there's a draft
36:40that's been presented now to lots of
36:44different groups. So for example.
36:49Starting with, you know the Executive Group,
36:52which is the chairs and and director
36:55center directors. Then you know,
36:57FAQ some of the student groups.
37:00More you know, it's the plan is
37:02to is to extensively bet that.
37:04But in terms of who's doing the work,
37:07the idea of this plan is that it's not.
37:11We're not. Putting this work in a silo right,
37:15this is work that we should be
37:17doing in everything that you know.
37:19It's not it doesn't.
37:20It doesn't just belong in DI,
37:22it's not owned by one group.
37:23It's something that we all
37:25need to be doing and so.
37:28Some of the measurements will be done.
37:30You know tracking things will
37:32be done in the Deans office
37:34are in Darren's office,
37:35but this isn't something that
37:37we delegate to others.
37:47I have a follow up
37:48question to that Jean Steiner at
37:50at CMAC, and it has to do with
37:53the Fetty funds and process. Um, you
37:56know the funds are are terrific and
37:59it's it's really helped us support
38:02some of our
38:03junior faculty. You
38:04are M and I think one
38:06of the. Challenges is
38:09that we can't submit an application
38:11until the search is completed and
38:14we have a signed offer letter.
38:17You know, and and use that to
38:20support the application and then
38:21there is of course a Ilagan time
38:24as it gets processed within
38:26medical school and University.
38:27To find out whether.
38:29We can use those
38:31funds or whether they're
38:32going to be available,
38:33which makes it a little complicated.
38:36As we initiate searches and and really
38:39do our best to recruit diverse faculty,
38:41I'm I'm just wondering what your
38:43thoughts might be. Yeah so.
38:48It is something we've been advocating for,
38:50I think, but but I would. Suggest that.
38:56Um? These are recruits that we should make.
38:59Um? Even you know whether
39:03or not we have fed funds,
39:05and so I view very funds as kind of
39:07you know it's it's great to get them,
39:10but we just need to do this work.
39:13And and if you view it from that perspective.
39:18It's it's a little bit less problematic
39:20that we get them after the fact.
39:25Thank you.
39:30There's a question in the chat
39:32clarity on plans for initiatives
39:34for recruitment support and
39:37advancement of clinician educators.
39:39So thank you that Jonathan
39:42and Sam have spent the last.
39:46I don't know a long time,
39:48six months or longer.
39:50Going around every Department learning
39:52about what resources currently exist
39:54and then developing resources Ann,
39:57and if again I would encourage you to.
40:00Look at the the web page.
40:03So even the simplest things of.
40:06Developing the chart and posting on
40:08the web page 4 what are the criteria
40:11for promotion in each of these tracks?
40:14Which it's hard to believe,
40:15but we didn't have that previously,
40:17so so it's out there now.
40:20Developing workshops on Mentor ship
40:23and on how to prepare your CV and your
40:28CV two and so one of the things that.
40:32I've learned over the years is that you.
40:36It's actually harder to centralise
40:38some of those things because
40:41of the very different.
40:45Profile of clinician educators.
40:47Depending on the Department
40:48and even the subspecialty.
40:50So, as an internist I use medicine.
40:53You, a clinician educator in oncology,
40:56looks very different from
40:57a clinician educator in ID.
40:59For example,
41:01in terms of the portfolio of there.
41:05Research or education the
41:06way they spend their time,
41:08and so you can't create one size fits all,
41:11but you can create modules and then
41:14partner with those departments or
41:16sections to offer them in a way
41:18that specific to their faculty.
41:20So that's the work that they're doing.
41:25To follow up on that point, my name
41:28flamingly at Yale, New Haven
41:30and you know I was just
41:33curious in terms of support for early career.
41:37You know clinical educators
41:39especially because
41:40you know a lot of the challenges are
41:43around balancing time and then being
41:46able to do work on education. In
41:49addition to doing, you know.
41:51All of your clinical work,
41:53so I'm curious about whether
41:55or not there is small funding
41:57mechanisms to help with preserving
41:59sometime for the junior faculty.
42:00I mean, I'm already noticing some
42:03of my colleagues leave because
42:05of that and not having as much
42:07protected time to work on education,
42:09so I'm just curious about that piece
42:12and sort of small grants that can
42:14support educational initiatives
42:16that aren't necessarily funded by
42:17the NIH or an IMAJ grants, sure.
42:21Um? So couple things one is.
42:27I think it's one of the things we
42:30did when we revised our guidelines
42:33for the Department and compensation
42:35plans is state specifically what?
42:38R. Expectations were around
42:41distribution of effort.
42:43You know, I think.
42:47Faculty are disappointed if there's a.
42:50If there's a difference in expectation
42:52between the chair and the faculty
42:54member in terms of how much time is
42:57spent on educational activities,
42:59for example so. That is one thing and.
43:10And I haven't. I studied the Department
43:13of Psychiatry Compensation Plan
43:14to look at what's you know what's
43:17protected in terms of education time?
43:19One of the things in terms of Central
43:22E for education rolls, the conversation
43:24that Jessica and Richard and I have had,
43:27is the notion that. We should. Um?
43:35Be pretty specific about effort requirements
43:37for those major roles in medical education,
43:39and we've done that with some things,
43:42course directors and others.
43:44But we should do that with clerkships
43:47and tie effort to those things.
43:50So that's something that we
43:52will work on doing. Um?
43:54An with respect to grants.
43:59My understanding was that
44:00there were some through TLC,
44:01but I may be wrong about that.
44:02And Richard, I should just shut
44:04up and let you answer this.
44:09No, that's right,
44:10there are limited grants
44:11available for these kinds of things,
44:14But the teaching and Learning Center can
44:17be available for consultation around
44:19educational scholarship and looking
44:20for those kinds of opportunities.
44:31Nancy, it's Chris Pittenger.
44:32Thank you for being here this morning.
44:35And for the overview,
44:36you focused on initiative to develop clinical
44:39clinician scientists in their careers.
44:41And that's an area that this
44:43Department has a long and rather
44:45successful history in bringing up
44:47clinician scientists internally.
44:48But I wonder if you could speak it.
44:51It's hard because of you know,
44:54the complicated role that successful
44:56clinician scientists fill and the multiple
44:58sort of failure points where we lose.
45:01People. From that pipeline,
45:04both during training and during
45:05the early faculty period,
45:06I wonder if you could speak a
45:08little more to how you envision
45:10trying to bolster that yeah,
45:11development process.
45:13Um, so, as I mentioned,
45:1611 aspect of this is.
45:19Is providing some internal funding
45:22for the transition from T to K.
45:25As it were. On a competitive basis and
45:29there won't be a lot of positions,
45:32but it it has, it serves the function
45:35of making department's decide who
45:37they want to invest in because to get
45:40that funding you have to commit and.
45:43It also allows for better
45:45coordination of the various career
45:46development programs that already
45:48exist and and so if you do that,
45:50you can you can create.
45:54A collection of funding
45:56mechanisms and obviously,
45:57ultimately the Department has to
45:59say I'm investing in this person,
46:02but the other piece of it,
46:04and the reason for appointing a Keith
46:07Choate is is the idea of having some
46:10oversight of mentorship and having
46:12someone who is meeting regularly.
46:15With our junior faculty who have K awards,
46:18for example, where we've said
46:21they have 75% protected time,
46:23or if you know for some of
46:25the surgical specialties,
46:27now 50% protected time and
46:30ensuring that they do.
46:33And.
46:35That that role can can really identify
46:39areas where their problems and mentors
46:43were their problems and and then giving.
46:48Faculty the tools to protect their
46:50own time at one of the things that
46:53happens quite frequently as a
46:55faculty member may not be in clinic.
46:58But may have trouble.
47:02Not doing certain activities because
47:04they're comfortable, you know.
47:05I mean, we are.
47:06We all know how to take care of patients
47:09or patient calls and our partner,
47:11who's on call could take that call.
47:13But we do.
47:14And you know,
47:15so helping people figure out how
47:17they want to spend their time in
47:19an intentional way so that when
47:21they are five years down the road,
47:23they have become what they
47:25thought they were becoming and.
47:27Whatever that is, there's not a right answer,
47:30but that it's intentional, so.
47:33And then, as I mentioned,
47:35resources to help people.
47:38Submit better grants.
47:41Offer support through.
47:42There are many gaps in funding that
47:44happened along that trajectory.
47:46We've addressed the first gap,
47:48which is getting you to the K.
47:50We can increase our kata.
47:52Our conversion through these
47:53things that I'm talking about,
47:55but you're still going to have
47:57some gaps and but you can.
47:59You know that that oversight
48:01of mentorship ensures that the
48:03mentor and trainee happen.
48:04Young faculty member.
48:06Haven't lost.
48:07Lost sight of the timeline, you know?
48:09I mean, how many times does a?
48:12The best mentor,
48:13say Oh my God,
48:14you're in your 4th year of your
48:15K and we haven't started thinking
48:17about your are you know and and
48:19just having those things be a
48:21little more systemized can help
48:22people it it's it's so mundane
48:24and yet it works quite well.
48:31Tim Brown this is Mike Norco.
48:34I wanted to ask you about the
48:37changes that are going to occur
48:40to the triennial leave process.
48:42Understand that for
48:44starting next academic year,
48:46our faculty will likely experience
48:48substantially reduced time
48:50availability and I'm worried
48:52that this will limit people's
48:54abilities to enhance experiences
48:56as well as to maintain or expand
48:59their scholarly activities.
49:01And this will
49:02be particularly important for people who
49:05are working toward academic promotion.
49:06Could you please explain the changes in
49:09the reasons that they're being made? Yeah,
49:12there shouldn't be any changes.
49:15There were changes, so there's a.
49:20A residual funds that have just sat in
49:23department's but not been able to be
49:25touched by department's for many years.
49:28And we centralized those in the summer.
49:33But the until forever departments
49:36have funded triennial's out of the
49:40annual funds that come through taxes.
49:43And this year we have more than we
49:47predicted an increase in the request for
49:51triennial's and sabbaticals based on our
49:54modeling of what happened during Covid.
49:58But we think we're hearing.
50:00Some department's that it may
50:02be even higher than that,
50:04and so the concern that some Department
50:06have had is that they will have.
50:09A shortfall and what I have said
50:13to Department's is track that
50:16let us know look at.
50:18Eligibility look at your need
50:20to cover clinical practice,
50:21which is always part of the.
50:25Always part of the decision-making look to
50:27make sure that people have adequate plans,
50:29but then if you have a shortfall,
50:31will work with you.
50:32So we think there's a one time pressure
50:35on trying isn't sabbaticals and we
50:37will do what we need to help with that,
50:40but we don't.
50:40There's there's not been any
50:42change to policy.
50:54There's a question in the
50:56chat from Matthew Goldenberg.
51:01I think we got that one. Sorry it's OK.
51:20Hi, this is Elise. I have a
51:22question about. I appreciate
51:25all the the plans to make it more clear
51:28and transparent what the requirements
51:30are for promotion and different tracks,
51:33and I guess this is more of
51:36as a question comment like.
51:39I recommend you consider including
51:43associate research scientists as a
51:46default whenever you're in addition to.
51:50Assistant Professor and up.
51:52When you're kind of providing the
51:55information about these tracks because.
51:59And then there's sometimes
52:00you can just sort of.
52:05Um?
52:08The this Department has a reputation
52:11for people getting stuck. Certain.
52:16Right, so it's the research scientist,
52:18as in it makes it difficult,
52:21Sittard independent provided so
52:22the formal mentorship about moving
52:25up the track can start as an
52:27assistant professor and leave the
52:29people that haven't transferred
52:31over in a little bit of the dark.
52:34And it can also.
52:36I think there's also,
52:37I think there are a lot
52:39of positive things about.
52:44You know every mentor I've
52:46interacted with here is given me
52:48great advice in a lot of time,
52:50but there's a lot of fractionation of
52:52the advice because it's so personalized,
52:55so sometimes I talk to my colleagues
52:57and we find that we are all being
52:59told different things about what the
53:02expectations are and what the standards are.
53:04So if it were really centralized
53:06and written concretely,
53:07I think it would be easier for
53:10people to take ownership of
53:11their own direction and have it.
53:14Be less dependent upon the directions,
53:16instructions of their mentor.
53:18And actually,
53:19this was what I refer to about
53:21work that we needed to start,
53:23which is putting together a
53:25task for us on this track,
53:27and I think there were. He and I've.
53:31Done that elsewhere and I think
53:33there are two issues that.
53:35Come to the four.
53:38One is when there are differences
53:41in understanding about the.
53:43Career trajectory for the
53:45for the track member.
53:47So if a track Member believes he or
53:50she is on a career trajectory to be
53:54an independent investigator, but the.
53:58Department doesn't,
53:59that's a problem.
54:01And then the second is for those who.
54:04So I think the piece about how
54:07do you move when you move.
54:10And for those who stay on the track.
54:15What is the defined career pathway?
54:17What does success look like?
54:19How do we make sure that people?
54:22Can progress and move I think is
54:25a second piece and so we are.
54:29Linda Barkhamstead is working on
54:31putting together a task force to
54:33look at this in a little more detail.
54:54Nancy Chris Pittenger again.
54:56Another thing I was very happy to hear
54:59you emphasize is trying to cultivate
55:01cross departmental collaborations,
55:03and I think this Department
55:05has a great history of that.
55:08With some Department child study,
55:10genetics, psychology, neuroscience,
55:11and there are other opportunities
55:14that haven't been as well developed.
55:16Neurology and Immunobiology spring
55:17to mind where where they've been,
55:20you know attempt,
55:21but it's not as robust across
55:24dependent departmental.
55:25Collaboration and my impression is
55:26that when those are successful,
55:28it's often been because of individual
55:29people who are sitting at the interface
55:31and bridging, and that's great.
55:33If those people come along.
55:34If you can find them,
55:35and if you can cultivate them.
55:37But there's a certain amount of happenstance,
55:39and whether that that happened,
55:40so I wonder if you could speak
55:42to what can be done.
55:44Sort of structurally,
55:44systemically to to make it
55:46easier to build those bridges,
55:47and in particular,
55:48if you could speak to sort of
55:50institutional and structural
55:50issues that make it harder,
55:52like the fact that you report to one
55:54Department or another for promotion,
55:56like the fact that the indirect
55:57tend to go to one Department or.
55:59Various in structural things that.
56:02They tend to reinforce our silos even
56:04when we want to break out of them,
56:07yeah.
56:08I think it's more.
56:12Historical and cultural and and to be honest.
56:19Financial, right? You know,
56:20funds flow drives a lot of
56:22decision-making. There are lots of.
56:27I mean, I think every every academic
56:29institution in the world attributes
56:31grants to department's 'cause.
56:32You just have to do it somehow, right? But?
56:41But our incentives are
56:44not currently aligned for.
56:49Global success there,
56:50there and that's a big change and
56:52one that's threatening to people.
56:53And we're not going to get there overnight.
56:56But I think we can.
56:58Start to show people that. Um?
57:04Promoting things centrally.
57:05There all boats rise when you
57:08do that and you do it well.
57:11And. Anne.
57:18That's going to be the hardest.
57:22Pull over the next couple of years and one
57:24that we're going to work on really hard.
57:57I'm thinking we're
57:58we've asked our questions. OK.
58:03Well, thank you and thanks for
58:04all that you're doing and I look
58:07forward to the next conversation.
58:09Thank you for coming and
58:11answering your questions.
58:12Thank you very much. Thank you.