Beyond Sterling Hall

To the YSM Community:

A few weeks ago, I had the opportunity to attend the Yale Medical Symphony Orchestra's winter concert. The orchestra played to a packed Harkness auditorium. Every time I witness the transformation of committed scientists, clinicians, and students into passionate artists, and the uncomplicated enthusiasm of the audience, including children, for the musicians, I am reminded of the amazing creativity, conviction, and power of our community. This winter’s concert was a particularly poignant reminder that even when faced with uncertainty, we can respond in the positive.

In academic medicine, we are living in a time of unprecedented challenge and change. During this time, it is important that we not lose focus on our missions of education, discovery, and improving health. As many across the school and university tirelessly advocate for discovery and health, share the impact that you are having, and challenge threats to our core missions, we must not only react but also continue to look forward.

Many of our recent emails have focused on the reactive—simple measures to ensure that faculty can continue and pivot their research without interruption, for example. Here I will focus on the proactive. Over the last five years we have developed strategic plans for research, education, and diversity within Yale School of Medicine (YSM) and a joint clinical strategic plan in collaboration with Yale New Haven Health System. We have realized many goals—such as the enhanced resources to promote professionalism and leadership, new resources to promote mentorship, the creation of advising houses, increased financial aid for medical and PA students, increased investments in predoctoral and postdoctoral trainees, execution of transparent funds flow model between the school and health system, creation of an aligned clinical enterprise, the creation of a new department of Biomedical Informatics & Data Science, new investments in support of the science strategic plan, build-out of space, and improved core support. These changes have enhanced our ability to attract outstanding students and future leaders, to make transformative discoveries, and to offer care to more patients.

But not all initiatives have been successful. In town halls, faculty continue to articulate the desire for more cross-departmental interdisciplinary collaboration. We have not made sufficient progress in removing frustration over administrative inefficiencies for either our research or clinical faculty. We have opportunities to better engage staff so critical to all we do. We have much work to do in improving the health of our population, not just individual patients. We must double-down on our efforts to diversify funding sources. As we look forward, we must also listen to and learn from the concerns of the public and leverage this understanding to think in new ways while preserving what differentiates YSM—excellence and rigor in a collaborative environment.

Over the coming months, we will begin work to refresh our strategic plans as a single, overarching strategic plan. We envision a process much like the one we used when we wrote our mission statement together. We will start by surveying the community about priorities, challenges, and aspirations across all missions. Based on those surveys we will hold focus groups, engaging stakeholders across YSM, the university and health system, and the community. Based on the input from these focus groups, we will identify strategic priorities for the next five years. As we do so, we will circulate drafts for iterative input from the community.

As we complete this strategic planning, we will also continue to respond in real time to input from faculty, staff, and students in town halls. To this end, we will soon introduce a series of gatherings called “Fifth Fridays,” to promote interdisciplinary collaboration. We envision inviting faculty from a different basic science department and clinical department or section each fifth Friday of a month, approximately four per year, to lead a rapid-fire presentation survey of opportunities for collaboration. We hope these gatherings will stimulate ongoing conversation and collaboration among faculty at a grassroots level. At the same time, Deputy Deans for Research Koleske and Smith will soon be announcing changes intended to improve the effectiveness of the Office of Team Science.

As evidenced by the Yale Medical Symphony Orchestra, there is no shortage of creativity at Yale School of Medicine. Let’s leverage this to work in new ways and amplify our impact.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

To the YSM Community:

Earlier today, President McInnis and Provost Strobel communicated regarding my reappointment as dean. I am grateful to President McInnis, Provost Strobel, and the Yale Corporation for the privilege of continuing to serve in this role.

I am also grateful to the Yale School of Medicine (YSM) community. I so admire your commitment to this school, to our patients, to advancing knowledge, and to each other. It is a joy to be surrounded by brilliant people who are passionate about our teaching, research, and patient care missions.

We have been on an extraordinary journey and we have accomplished much. As we look forward, we must remain focused on our core missions. The details of our strategic goals should evolve, but we will continue to emphasize four key themes:

• Create an environment of inclusive excellence where all members of our community can thrive and to which we can continue to recruit the best talent in the world
• Nucleate cross-disciplinary team science to advance creativity and innovation; promote interdisciplinary research to increase our impact
• Build and steward resources necessary to serve as a biomedical discovery powerhouse of the 21^st century
• Realize our potential as a premier academic health system through alignment and partnership with Yale New Haven Health System (YNHHS)

These align with the themes President McInnis has articulated as emerging from her listening tour.

There are many to acknowledge: the deputy deans, chairs, and center directors who tackle tough issues with humor and grace; our staff who keep the school running, often behind the scenes; our students and trainees who inspire growth and learning and bring energy to the school; faculty who identify both opportunities and creative solutions with a commitment to improving YSM and the world; our alumni who share their passion for the Yale System with future and current students; our partners in YNHHS; and fellow deans and cabinet members who generously provide support and share ideas.

As we look forward, we will have opportunities to refresh strategy. We also face critical challenges. In this regard, let me share a few priorities that are front of mind:

• During a time of uncertainty, we will continue to emphasize support for research, educational, and clinical programs. This may require sacrifices in other areas, but our decision-making must be driven by our values.
• At the same time, we will engage national leaders and our fellow citizens to highlight the impact of YSM.
• We will continue to address gaps in knowledge and patient care by diversifying funding for our work, through a renewed emphasis on development and novel partnerships.
• We must continue to attract and nurture outstanding leaders, faculty, staff, and students to ensure a robust future for the school.
• We will continue to strive to enhance bidirectional communication.

The last five years brought significant change as we faced unexpected tests, but we are well-poised to thrive in the face of new challenges.

Let us proceed on this journey with kindness, courage, and imagination.

Sincerely,

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

To the YSM Community:

During the last few days, reports from federal agencies regarding pauses in travel, communications, and grant reviews have raised uncertainties and may create confusion or anxiety among members of our community. Faced with incomplete information, human beings naturally create stories to fill in the blanks. As we gather more information, we will keep you informed. In the meantime, I write to articulate our basic principles and processes.

Yale School of Medicine remains anchored by its fundamental missions: “Yale School of Medicine educates and nurtures creative leaders in medicine and science, promoting curiosity and critical inquiry in an inclusive environment enriched by diversity. We advance discovery and innovation fostered by partnerships across the university, our local community, and the world. We care for patients with compassion and commit to improving the health of all people.”

The leadership of the school will be meeting frequently during the coming weeks to evaluate information as we receive it. We remain committed to our core values: Building an Engaged and Productive Community; Integrity, Reflection, and Communication; Generativity; Inclusion; and Discovery, Innovation, and Scholarship. We will continue to abide by the law.

We will cascade communications from the dean’s office. We ask that individual faculty, staff, and students share concerns or questions with their section chiefs/department chairs, supervisors, or deans so that we can respond effectively and in an organized manner. You can also refer questions to the office of the cognizant deputy deans–questions related to research to the deputy deans for clinical/translational and basic science research, questions related to clinical practice to the deputy dean for clinical affairs, etc.

We also ask that members of our community adhere to our policies and guidelines around communication.

• YSM Social Media Guidelines & Best Practices
• YSM Website Guidelines & Best Practices
• Report of the Committee on Institutional Voice

In this time of uncertainty, it is important that we focus on our work, support each other, and act with discipline. During COVID-19, we faced health fears and financial uncertainty. We learned that we are resilient, we can together tackle challenges through creativity and value-based decision-making, and we became stronger. We will apply the same principles moving forward. As we do this, we will continue to save lives, educate the next generation of leaders in science and medicine, and advance knowledge and human health.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

To the YSM Community:

Near the end of my residency, my beautiful, talented, and irreverently witty mother-in-law developed an expressive aphasia and was diagnosed with an inoperable grade IV glioblastoma multiforme. She was referred to a world-renowned neurooncologist at our academic hospital. When my father-in-law called for an appointment, the office did not call back for a few days (an eternity at the time), but he persisted and was able to schedule an appointment. They arrived promptly on the day of the appointment, but the physician did not. The nurses were very kind and explained to my in-laws, not to worry, Dr. XX, often wandered over late from his laboratory. He was very good, however, and could provide access to cutting-edge therapies. The neurooncologist arrived an hour and a half later.

Over the next 15 months, the family went on an odyssey in pursuit of hope. Eventually we found another neurooncologist who was compassionate and attentive and earned the respect and gratitude of the entire family. However, the encounter with the first neurooncologist left my father-in-law feeling disillusioned with medicine for several years and left me feeling embarrassed by my profession.

In this context, I note with gratitude the extraordinary commitment of our faculty, trainees, and students to patient care. Almost weekly, we receive notes about the impact you have had on someone’s life. And whenever a patient reaches out because he or she is having trouble getting an appointment, our clinicians respond generously, sometimes heroically, to see them.

Nevertheless, we have systems issues that make access to our world class clinicians unreasonably difficult. These systemic barriers create inequities, as the patients most likely to be able to navigate our complex and dysfunctional system are the most familiar with medicine. In our early town halls, many of you expressed moral angst over the difficulty both patients and referring physicians face in scheduling appointments. To address this need, we have embarked on a three-year journey to fix access with the Access 365 project, which requires a collaboration among leaders, faculty, non-faculty clinicians, staff, and outside experts. Waves 1 and 2 of this project launched with orthopaedics, radiology, primary care, neurosciences, heart and vascular, and urology, and we are now in Wave 3 of 8, with active work ongoing in digestive health, rheumatology, endocrinology, dermatology, and ophthalmology.

Untying the Gordian knot of patient access requires engagement, openness to change, and a committed focus on the needs of our patients. We currently have three asks of our clinical departments and faculty:

• First, we ask that our specialists and subspecialists agree on the appropriate appointment duration necessary to see their type of patients, considering national benchmarks. Over the years, we have developed hundreds of personalized templates within individual specialties, making it extraordinarily difficult to schedule patients.
• Second, we ask that specialists work with access leaders to revise templates to accommodate new patient visits in accordance with best practice for their specialty. We have learned that a few of our specialists could do better at returning patients to the referring physician as their condition comes under control.
• Third, we ask that clinicians adhere to standard hours. This is necessary as bespoke start and stop times can wreak havoc on staffing and operating a clinic. We have heard that this is a hardship for some. In the long-term we will examine the feasibility of developing staggered start times at our larger clinic sites.

Because change can initiate urban legend, it is probably worth saying what Access 365 is not. The access work does not require clinicians to change their number of clinics or meet some quota. The number of clinic sessions they hold is still determined by their section or department according to their track and clinical effort. Sections and departments assign faculty to clinic periods and can work to balance needs for morning or afternoon clinics, in the same way they distribute inpatient call schedules.

The efforts to improve access and clinic flows is enhancing the ability of clinicians to focus on patients while in clinic. The introduction of ambient AI (Abridge) enables physicians to spend more time face-to-face with patients, and less time on the computer. Increased levels of support staff and better coordination of staff schedules enable physicians to spend less time scheduling tests or making sure that they are performed and more time teaching and learning. Investments in clinical triage are routing patients to the most appropriate level of care and markedly improving warm handoffs, positively impacting patient outcomes. Further plans this year include initiatives to support in-basket management and prescription renewals, reducing administrative burden on our clinicians.

We are already seeing the benefits of this work in patient access. In Orthopaedics, we reduced the number of visit types from 38 to 21 and improved capacity by 24% without adding clinics. Redesign of imaging templates increased MRI capacity by 11,000 – 13,000 additional scans per year, providing important support to clinical program development in areas such as Alzheimer’s disease treatment. Positive patient satisfaction comments with our internal medicine primary care group rose from 68.2% before to 88.7% after the access work, with overall improvement driven by the categories Care Provider and Access to Care.

We are on a journey that began with conversations about access in listening sessions and town halls. We are now engaged in difficult work, but we must remain focused on the goals of enabling patients to access our world-class care and enabling clinicians to dedicate their clinic time to doing what they love—caring for those patients. I am grateful to the leaders in Wave 1 who have shown how this can be done with grace and whose teams are starting to reap the benefits. I appreciate those leaders who will continue to improve on the process over the next year and the teams who are in the trenches making this work happen. You embody the best of our profession

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

To the YSM Community:

Since 1839, the thesis requirement has been the capstone of a Yale medical education. Through the thesis process, students learn the importance of observation and formulation of a question leading to the expression of a testable hypothesis. They learn the importance of study design, and rigor, validity, and reproducibility. They come to understand the impact of bias on the interpretation of observations. Most importantly, they learn the value of curiosity and how to pay attention to the outlier.

The thesis serves as a way of inculcating curiosity and an appreciation for the scientific method and reflects a fundamental belief that only through science will we make progress in improving human health. Yet, the Sars-CoV-2 (COVID) pandemic unmasked a skepticism among some in this country about the value and reliability of science, even as scientists, industry, and patients came together to develop vaccines against Sars-CoV-2 in record time. The proportion of Americans who express “at least a fair amount of confidence” in medical scientists has dropped from 89% in the spring of 2020 to 77% in October of 2023 (Kennedy and Tyson, Pew Research Center, 2023).

To reestablish trust in science, we must change how we communicate with and engage communities in the scientific process, and we will need to double down on our commitment to unbiased hypothesis testing, rigor, and reproducibility. As scientists, we must recognize that we are also human beings who often fall in love with our hypotheses. We forget that our job is not to prove hypotheses but to test them, and that falsifiability is a crucial element of rigorous science. Science and advocacy do not mix well. In addition, we too often conflate technology with science and lose sight of the fact that some of the most impactful discoveries have been made when investigators apply simple, elegant methods to address profound questions.

As physicians and practitioners of medicine, we often take comfort in “evidence-based medicine,” without understanding the quality of the evidence or gaps in our understanding. We confuse observation and correlation with causation. Yet, over the course of my lifetime and career, our assumptions about the etiology of numerous diseases have been stood on their head by questioning the evidence to admit new observations and formulate and test new hypotheses. Consider the case of peptic ulcer disease. In 1974, authors of an epidemiological study published in New England Journal of Medicine affirmed an association between smoking and peptic ulcer disease but noted that studies of the effect of smoking on acid secretion and gastric motility had produced conflicting results (Friedman et al., 1974). Just 10 years later, Marshall and Warren systematically identified the presence of a new species of Campylobacter in the stomachs of patients with gastritis and peptic ulcer disease and went on to demonstrate the ability of H. pylori to produce gastritis (Lancet, 1984 and Australian and New Zealand Journal of Medicine, 1984). Through careful observation and experimentation, they disrupted gastroenterology.

We must guard against confirmation bias by taking an agnostic approach to understanding mechanism. This has been driven home in recent years by paradigm-shifting studies related to health disparities. For example, in the last year a group of investigators performed a combined ancestry genome-wide association study to identify single nucleotide polymorphisms associated with diabetic retinopathy ( Breeyear et al., Nature Medicine, 2024 ). They discovered a powerful association with a variant in the glucose-6-phosphate dehydrogenase (G6PD) gene that causes G6PD deficiency and hemolysis but also protects against malaria, resulting in increased prevalence in individuals of African descent. Because the variant leads to a shorter half-life of hemoglobin, levels of glycosylated hemoglobin (HbA1c) are lower in carriers of the variant for any given level of glucose. In a health system in which HbA1c is the primary metric for diabetic control, the authors estimated that 12% and 9% of diabetic retinopathy and neuropathy cases, respectively, in individuals of African ancestry are due to underdiagnosis of poor glucose control in carriers of this variant. This one discovery could dramatically reduce retinopathy and neuropathy if we change how we screen patients for this variant and alter diagnostic criteria in carriers of the variant.

Times of change present wonderful opportunities to conduct an agnostic and constructive appraisal of our hypotheses and processes. As we face skepticism about science in the coming years, we must approach it with the same curiosity that we ask questions in science. This requires us to listen with humility. We will win over doubters by demonstrating unwavering commitment to rigor and the scientific method and by communicating the impact of our discoveries in clear and transparent ways.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

To the YSM Community:

“If you build it, they will come.” So is the line from the 1989 movie, “Field of Dreams” often misquoted. In the film, the character Ray Kinsella, played by Kevin Costner, hears a voice whispering, “If you build it, he will come,” referring to the baseball player “Shoeless” Joe Jackson. In any case, the line speaks to the necessity of believing and taking risks to accomplish something worthwhile. When faced with adversity or obstacles it can be easy to give in to negativism. Yet, as one of my former chairs used to say to faculty when we were feeling daunted about designing a new clinical or educational program or achieving a fundable score on a grant, “You have to plan for success.”

Each year in the spring, we create a budget for the coming academic year. Each fall, we prepare a long-range, 10-year financial projection in which we forecast expected trends in revenue as well as expected expenses in the context of our strategic goals and investments. As part of this exercise, we project our revenues over the next 10 years based on historical growth rates, the impact of changes such as funds flow, and environmental factors. We also model expenses based on recent investments and anticipated rates of growth in our academic missions, as well as continual efforts to enhance efficiency. Lastly, we model a crisis scenario and potential mitigation strategies—imagine planning for the financial consequences of the next pandemic. We present this projection to the provost and a faculty budget committee and review it with the Yale Corporation’s School of Medicine Committee in an annual presentation of strategy.

It was during the preparation of the long-range plan this month that the expression, “If you build it, they will come,” came to mind. Over the last several years we have made significant investments in physician-scientist development; supporting time for educators; supporting graduate students and postdoctoral fellows; recruiting rising stars and leading clinicians and scientists; revamping the Master of Health Sciences; creating a new department of Biomedical Informatics and Data Science; building resources in imaging (small- and large-scale), core technologies, clinical research infrastructure, and tools for artificial intelligence; and creating an aligned clinician enterprise, to name a few. We have much more to do as we realize our strategic plans in education, research, clinical care, and DEI, and we anticipate even bigger investments as we engage in the master space planning process, build out 101 College, and receive approval to solicit designs for a possible new Yale School of Public Health and Yale School of Medicine building at 35 College Place.

Each of these investments involves risk, yet we are already starting to see the return on these investments. YSM clinical revenues grew by 11.6% in FY24 (and those of Yale New Haven Health System by 8.8%) under the new funds flow model. Thirteen of 20 clinical departments realized an increase in clinical margin over the prior funds flow model or year-over-year, and we expect the remaining departments to thrive based on adjustments to the model. Growth in clinical volumes reflects enhanced access for patients and yields increased academic program support. In addition, income from grants and contracts grew 13.2% year-over-year in FY24, and faculty garnered support from exciting new sources, such as the Advanced Research Projects Agency for Health (ARPA-H) and the Chan Zuckerberg Biohub NYC. Support from the Starr Foundation, alumni, and other donors enabled the school to increase the number of medical students eligible for financial aid and the capping of their annual unit loan of $10,000, and the quality and diversity of our enrolling class remains high while applications have increased 12% this year.

We have great aspirations for the future. In addition to the initiatives above and as described in the July Beyond Sterling Hall, we are working to garner increased endowment funding for graduate students and postdoctoral fellow positions, expanding support for clinician-scientist development to incorporate proceduralist scientists, and enhancing the clinical practice environment to restore the joy in caring for patients. As we continue to build, it is gratifying to see our school come (together). No doubt there will be unexpected hurdles, but we will continue to plan for success.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

On August 5, we marked the “start” of the academic year with the White Coat Ceremony for the incoming Class of 2028.

We begin this academic year during a time of uncertainty, stress, and polarization regarding events in the world and in our own country. During this time, it is important to reaffirm our principles. Vice President for University Life and Secretary Kimberly Goff-Crews recently sent a message regarding the University’s commitment to free expression and intolerance of discrimination and harassment. The Vice President of University Life and Secretary shared a website that consolidates policies on free expression and peaceable assembly: https://secretary.yale.edu/free-expression-yale. The 1974 Report of the Committee on Freedom of Expression at Yale (the “Woodward Report”) conveys Yale’s policy on free expression.

Freedom of expression is sometimes conflated with academic freedom, but the two differ in ways that relate to our obligation to provide a robust and productive learning environment. Thus, the American Association of University Professors, forceful advocates for academic rights, notes in its Statement of Principles on Academic Freedom and Tenure: “Teachers are entitled to freedom in the classroom in discussing their subject, but they should be careful not to introduce into their teaching controversial matter which has no relation to their subject.” A student or faculty member in Yale School of Medicine who attends a seminar or lecture in the basic sciences or grand rounds on a clinical topic, for example, should have the reasonable expectation that topic will not wander into the speaker’s personal views on current events. Those conversations can and should go on in other settings consistent with the university policies on free expression. When the specific subject of a seminar or lecture touches on controversial topics or areas for which there is not a clear scientific underpinning, it is paramount that faculty and students engage in civil discourse and feel able to express their opinions without sanction.

As members of a school of medicine, we have additional obligations. Those engaged in clinical care commit to being present to our patients even when it is not convenient or there are competing events. We commit to caring for all patients regardless of their beliefs; we engender the trust of patients by treating them with respect as individuals and listening to their experiences. Patient-centered care requires that we provide advice based on the best rigorously tested peer-reviewed scientific evidence available and that we exercise restraint in expressing our personal views in the clinical setting. Outside the clinical setting, we enjoy the same rights of free expression as all citizens. Because we represent the profession of medicine, however, we must distinguish when we are expressing opinion, informed by our own expertise, and when we are presenting peer-reviewed scientific evidence.

During the recent White Coat Ceremony our students took a pledge “to communicate effectively, respectfully, and compassionately, and to conduct [ourselves] in accordance with professional and ethical standards” and they vowed “to recognize the influence of our biases and to challenge ourselves.” Let us all exemplify this behavior as we engage with each other and educate leaders in medicine and science, advance discovery, and improve the health of all.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

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:
  • Alignment Website
  • Executive Group Minutes
  • Faculty Advisory Committee Minutes
  • Beyond Sterling Hall
  • News and Recognition

Any medical school dean will tell you that the white coat ceremony, “Match” day, and graduation are highlights of the academic year. Days of joy, these rituals enable us to take time out from the routine and appreciate the talent, excellence, and ideals of our students. This year, listening to former director of the National Institutes of Health, Francis Collins, MD, PhD, do a riff on COVID-19 to the melody of Simon and Garfunkel’s “The Sound of Silence" added an additional therapeutic dose of perspective-setting humor.

Truth be told, there are many such moments and days at Yale School of Medicine (YSM). This spring has been rich with celebrations.

In April, President Salovey hosted the American Academy of Arts and Sciences, convened at Yale by Academy President David W. Oxtoby, to bestow the Francis Amory Prize on Haifan Lin, PhD, the Eugene Higgins Professor of Cell Biology, professor of genetics, of obstetrics, gynecology, & reproductive sciences, and of dermatology, and founding director of the Yale Stem Cell Center. The prize is given every few years to recognize outstanding achievements in medicine and reproductive physiology and acknowledged Dr. Lin’s discovery of the Argonaute/Piwi gene family and elucidation of their function in stem cell self-renewal and germline development. The award ceremony, which was held on campus, enabled Dr. Lin’s current students, past trainees, family, and peers to join him in celebration.

Just a month later, three new faculty members were elected to the American Academy of Arts and Sciences—Susan Baserga, MD, PhD, William H. Fleming, M.D. Professor of Molecular Biophysics and Biochemistry and professor of genetics and of therapeutic radiology, Marina Picciotto, PhD, Charles B. G. Murphy Professor of Psychiatry, and professor in the Yale Child Study Center, of neuroscience, and of pharmacology, and Karin M. Reinisch, PhD, David W. Wallace Professor of Cell Biology and professor of molecular biophysics and biochemistry.

We also gathered to recognize the extraordinary clinical service of Richard Antaya, MD, who was awarded the 2023 David and Cindy Leffell Prize for Clinical Excellence. Dr. Antaya is a pediatric dermatologist who founded the Yale Multidisciplinary Vascular Anomalies Program (VAMP) and directs a pediatric dermatology elective. His remarks relating his own practice to his experience as a father inspired and reminded many of the attendees why we joined medicine. We also honored Joachim Baehring, MD, Morton Burrell, MD, Josh Copel, MD, and Alyssa French, MD, MPH, that evening, who received Distinguished Clinical Career Awards.

Later in the same month, we celebrated a different milestone, the retirement of Brian Rebeschi, MHA, who has served the university and YSM over a career spanning 36 years. Brian has held many roles across the university, but most notably he served as the clinical administrator for the Child Study Center and Department of Neurology, senior director of business operations for YSM, vice chair for Finance and Administration in the Department of Medicine, and interim YSM deputy dean for Finance and Administration before co-leading the OneFinance Strategic Initiative.

Also this spring, Yale MD-PhD students and physician-scientists convened in Chicago for the annual joint Association of American Physicians (AAP), American Society for Clinical Investigation (ASCI), and American Physician Scientists Association (APSA) meeting. Three faculty were inducted into the American Society of Clinical Investigation on Friday night and the students, trainees, and faculty rocked the dinner. Saturday night five additional faculty members joined the American Association of Physicians.

On our own campus, the corridors of Sterling Hall buzzed as 190 admitted students joined us from across the country for Second Look weekend. The Class of 2024 roasted our faculty in a musical mystery centered on the death of an LCME site visitor. We assembled in the Historical Library in the Sterling Hall of Medicine for the unveiling of the portrait of former dean Robert J. Alpern, MD, Ensign Professor of Medicine (Nephrology), professor of cellular and molecular physiology, to express our gratitude.

School of Medicine and university friends joined together to applaud the newly designated Department of Biomedical Informatics. There were symposia on Parkinson's disease and the new Chan Zuckerberg Biohub NY Immune Cell Engineering to name just two. There were the celebratory emails to say, “We got the grant,” “My paper was accepted,” or “Thanks to the outstanding care of Yale faculty….”

As dean, I am privileged to have a vantage point from which I can see all we have at Yale School of Medicine. Rituals such as graduation help us to separate the sublime from the mundane. Many of the events above took place because someone took the time to express gratitude or to sponsor or nominate someone. At times when we get lost in the details of getting things done, or when the events of the world overwhelm, rituals allow us to pause and to reflect on how privileged we are to do meaningful work in this community we call Yale School of Medicine.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

As described in yesterday’s and this afternoon’s messages from President Salovey, and the university statement regarding campus protests, over the weekend a peaceful protest on Beineke Plaza devolved into an event that compromised campus safety and was marred by reported acts of intimidation and harassment.

Even as our Yale School of Medicine community has modeled respect and civil discourse, we suffer when acts of hatred affect our larger community. When we bear witness to the darker aspects of humankind, we must pause to regain perspective and to live according to our highest values. As members of Yale School of Medicine, our commitment to the pursuit of discovery, as well as our student and professional oaths, require that we engage in inquiry, acknowledge each person’s humanity, and honor life. As a school, we will not tolerate any form of hatred.

As I wrote in November, “I have been buoyed by the civility of dialogue with our students. In one-on-one and group conversations, our students have expressed compassion for us and for each other, while articulating personal distress about events in the Middle East and often expressing opposing perspectives.” I continue to admire our students in this regard. In mid-December, we held back-to-back events in support of our Jewish and Muslim community members. What was most striking to me was that there was at least one-third overlap in the attendance of the two events.

We will be holding student gatherings over the next several days to provide ongoing opportunities to come together, listen, and support each other. Let us all continue to sustain each other in this way.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

In July 2023, we introduced a new funds flow model between the Yale New Haven Health System (YNHHS) and Yale School of Medicine (YSM).

To recap the elements of our new model, I share this excerpt from the March 28, 2023 Beyond Sterling Hall, with tenses updated: “In the new model, clinical departments are paid for clinical work based on either a ‘dollar per Relative Value Unit (RVU)’ model or a staffing model. An RVU, developed by the Centers for Medicare and Medicaid Services, is the generally accepted measure of the value for clinical services or procedures, and is commonly benchmarked by clinical specialty. In the “dollar per RVU” model, the payment rate is based on well-established national benchmarks for faculty salaries divided by benchmarks for median RVUs, multiplied by the number of RVUs the clinicians in a department generate. The model provides support for structural deficits, departmental overhead such as staffing costs, and deficits related to start-up in a formulaic way based on well-defined national benchmarks. For “hospital-based” departments (e.g. Anesthesiology, Emergency Medicine), the formula is based on staffing requirements and national benchmarks for hours or shifts per clinician. Hospital-based departments can garner additional funds through incentives for achieving pre-determined goals. Purchased services such as medical directorships, support for graduate medical education, and call coverage still flow directly from YNHHS to departments.”

Many of our peers have adopted this type of formulaic approach to funds flow and have found that aligning incentives between the school and health system results in increased revenues to both. We are seeing the same pattern. Through January 2024, RVUs are up 10.4 percent from prior year and about 3 percent over budget cross YSM clinical departments, whereas clinical effort is up 6.4 percent. In other words, for the individual clinician RVUs increased 3.8 percent per person. Support for the academic mission is projected to increase 8.3 percent. For YNHHS, revenues are up 9.8 percent compared to the prior year through January.

In this transition year, we are tracking the results of our old and new funds flow models simultaneously. This has allowed us to learn where we need to tweak the model and departments how to manage differently. Chairs and department business leaders meet with finance team members weekly to review issues.

While the clinical department margin increased 11.4 percent on average, the impact of funds flow on individual departments has varied, with 12 departments experiencing an increase in margin compared to the legacy funds flow model and ten experiencing a decrease as of the end of January. This is not unexpected, and we are using this transition year to troubleshoot. In five departments clinicians see fewer patients (as measured by RVUs) than average compared to their academic peers and four of our departments are at or below the 40th percentile. We are working to understand and address barriers to seeing patients in those departments. Some departments learned the sensitivity of the model to over- or under-budgeting clinical volumes, and we will revise the model to reduce this sensitivity. In rare cases, we have identified a section that may have been in the RVU model but should have been in a staffing model, or vice versa. In such cases, we are honing the review process through the Funds Flow Implementation Advisory Team (FF-IAT). We will refine the model as we continue to learn and as we adapt to anticipated changes, such as movement from RVU-based to value-based reimbursement.

Changing from a funds flow model in which the health system covered departmental deficits to one that rewards seeing patients, providing high quality care, and working efficiently incentivizes us to work together to ensure patient access and to optimize clinical operations. It also creates discomfort–perhaps even the five stages of grief*–as we work through the process of learning how to solve problems together and in different ways. For individual departments, the new model may require shifts in funds flow within departments. The work ahead requires prioritization; engagement of chairs, faculty, and staff; making sure we have the “right people on the bus;” and constant communication. The alternative is to blame others and settle for mediocrity.

Providing better care to more patients cannot be about asking our already hard-working clinicians to work harder. Rather we must remove roadblocks and allow clinicians to focus on caring for patients. Upcoming innovations such as “ambient digital scribing” using Abridge should reduce screen time, while Access 365 will enable more quality time with patients.

So, how’s it going? The answer is “not bad.” We are making a significant change, and while that naturally causes anxiety, there have not been any major surprises. Our teams are working hard together with grace to remove obstacles and to make sure that the funds flow system can provide sustained support for all our academic missions in the years to come.

With gratitude,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

*Kübler-Ross, E. (1969). On Death and Dying. New York, The Macmillan Company.

On Jan. 17, 2024, Provost Strobel shared university-wide efforts “to explore and consider strategic opportunities for AI at Yale.” The provost invited deans to convene panels of faculty from diverse disciplines who are engaging in artificial intelligence (AI) to brainstorm on school-specific approaches to develop and harness new AI technologies to have an impact on discovery, education, and practice.

Yale School of Medicine was invited to convene two faculty panels–a clinical research panel and a basic science panel. Deputy Dean for Clinical Affairs and CEO of the YSM/YNHHS Aligned Physician Enterprise, Margaret McGovern, and Yale Health CEO, Jason Fish, are co-chairing a panel on clinical practice. In addition, Assistant Dean for Education, Jaideep Talwalkar, is participating on a university-wide education panel.

Members of the clinical research panel include: Sanjay Aneja, Melissa Davis, Annie Hartley, Rohan Khera, Daniella Meeker, Wade Schulz, Hua Xu. Members of the basic science panel include: Kristen Brennand, Hyunghoon Cho, Peter Gershkovich, Ira Hall, Steve Kleinstein, Yuval Kluger, Smita Krishnaswamy, Xenophon Papademetris, Zeynep Erson Omay, and Steven Reilly.

The two YSM panels have been meeting to identify our strengths and differentiators as a school and university; needs within the school; opportunities for collaboration; transformative questions; risks; and the role for Yale School of Medicine, Yale University, and academia in general in addressing these questions. The panels will provide their initial insights to the Yale Task Force on Artificial Intelligence (YTAI) in February and early March.

The work of these panels and YTAI is just the beginning of the conversation on AI at YSM, the university and in collaboration with our clinical partner, YNHHS. As a premier school of medicine whose mission is to educate and nurture creative leaders in medicine and science, advance discovery and innovation, and care for patients and improve the health of all, we must lead in considering questions such as how do we:

• Leverage AI to educate future clinicians and scientists while promoting curiosity, critical thinking knowledge, and skill acquisition?
• Ensure rigor and reproducibility of data and discoveries generated using AI?
• Guarantee privacy and avoid bias in applications using AI?

In both basic science and clinical research, our faculty bring unique domain knowledge that can inform the appropriate use of AI. We benefit from growing computational expertise in the Section for Biomedical Informatics and across the university in the Departments of Computer Science and Statistics and Data Science, as well as other centers and institutes.

We must also partner with ethicists, legal scholars, patient advocacy groups, and others to define best practices. It will be imperative that we continue to engage our faculty with clinical and basic science domain expertise as we consider the role of AI. We must partner with other academic institutions, foundations, and even commercial entities who bring strengths and resources that complement those in academia.

How can you engage in this conversation? In a recent survey from Deputy Dean for Biomedical Informatics, Lucila Ohno-Machado, many of you expressed interest in learning more about AI. Please watch for announcements of opportunities to participate during the next phase of this work. In addition, consider attending the AI in Medicine Symposium in the Harkness Auditorium on Friday, Feb. 2, 2024. Lastly, the committees will be sharing recommended reading at this link. This site will be updated regularly. We will learn and lead together.

Sincerely,

Nancy J. Brown, MD

Jean and David W. Wallace Dean of Medicine

C.N.H. Long Professor of Internal Medicine

Robert Rohrbaugh, MD
Deputy Dean for Professionalism and Leadership
Professor of Psychiatry

The last two months have highlighted the importance of tending to the well-being of our community. This Beyond Sterling Hall provides an update on recent progress in developing and supporting a culture of well-being at Yale School of Medicine (YSM).

Over the last several years, the Office of Academic and Professional Development (OAPD) has been working in collaboration with Yale Human Resources, Yale Health, Yale Medicine, and Yale New Haven Health System (YNHHS) towards this goal. While these efforts also impact our students, specific resources related to student well-being may be found at the following links: MD Program , PA Program, and GSAS Program.

Developing a culture to support wellness centers on three domains of activity: enhancing organizational culture, improving the clinical practice environment, and supporting individual resilience and personal well-being. To be truly effective, we need to work at multiple levels, from the school to departments, sections, teams, and individual level interventions. We also need to be able to address issues across institutional boundaries, as many of our faculty and staff work in YNHHS as well as YSM. Dr. Rohrbaugh works in collaboration with Dr. Kristine Olson, chief wellness officer at YNHH, and many departments sponsor wellness initiatives.

A cornerstone of enhancing organizational culture is recognizing and addressing professionalism issues early and strengthening expectations across the medical school and academic health system. Early detection allows for the recognition of patterns of behaviors by individuals or within a unit. It also enables interventions such as coaching or counseling to help individuals or groups address barriers to professionalism and thereby prevent future events. Sometimes effective interventions require systems improvement. OAPD provides a central portal through which anyone can share concerns about professionalism.

Strong leadership and career development opportunities also contribute to enhancing organizational culture. OAPD has organized career and leadership development programs to support faculty throughout their careers at Yale. Recent programs include OAPD’s series of faculty workshops offered during the academic year to support assistant professors and research rank faculty, a Coaching Skills for Senior Leaders, and the YSM Healthcare Leadership Program , a monthly full-day program that focuses on leadership skills in the YSM/YNHHS context. YNHHS has developed a leadership program for medical directors under the leadership of Dr. Robert Fogerty. YSM provides additional career and leadership development offered by the Office of Physician Scientist Development and the Center for Medical Education. Yale University’s Emerge Program offers leadership development for staff.

Building a positive culture is facilitated when we celebrate exceptional professionalism, bestow accolades and awards, and promote inclusion. The Program for Humanities in Medicine and the Program for Biomedical Ethics sponsor seminars that promote critical reflection, help us understand perspectives different from our own, and promote compassion in medicine. Affinity groups, including Yale’s affinity groups, YSM’s medical student affinity groups, and the YSM six-college system, provide additional opportunities for faculty and trainees to come together to support one another and create community.

For active clinicians, inefficiencies related to documentation and administrative work negatively influence well-being. To improve our practice environment , Dr. Peggy McGovern, Dr. Lee Schwamm, and Lisa Stump, MS, have recently initiated an Epic Optimization Program, in which IT staff are working with departments, sections, and teams to better understand the challenges they face. This initiative will facilitate changing the Epic interface to address clinician concerns and conduct training sessions to ensure these changes are disseminated and adopted. In a very exciting development, YSM/YNHHS Digital Transformation Services (DTS) is also spearheading the introduction of generative artificial intelligence (AI), which has the capability to generate notes after a patient visit and to draft responses to patient inquiries received through the Epic portal. These efforts will prioritize time spent with patients and their families rather than with the electronic health record.

In efforts to support individual resilience, OAPD is partnering with human resources to increase awareness of personal benefits available to Yale employees (parental leave, childcare, college tutor program, tuition assistance, eldercare, financial well-being, retirement options) through a series of wellness webinars . In addition, the university has partnered with a third-party vendor to improve access to Optum’s Live and Work Well, our Employee Assistance Program (EAP). These resources include information on family caregiving, relationship challenges, financial wellness, legal consultation, mental health and substance use disorder, suicide prevention, and crisis support.

EAP provides eligible staff, faculty, post-doctoral associates, and their household members up to six free confidential counseling sessions and can also assist in making referrals for ongoing behavioral health treatment. Dr. Amy Sceery, a licensed clinical psychologist working in our EAP, provides solution focused counseling sessions; you can schedule directly with Dr. Sceery here. Recently the university has recruited an additional full-time social worker to increase access for in-person appointments on-site at the medical school, effective January 1, 2024. More information about well-being and mental health resources is available on the OAPD website.

We understand the profound impact that the events of 2023 have had on many members of our community and will continue to offer opportunities to support one another. The efforts outlined above will contribute to our culture of well-being, but we are still at the beginning of this journey. We will continue this work with ongoing commitment and resolve.

Sincerely,

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

Robert Rohrbaugh, MD
Deputy Dean for Professionalism and Leadership
Professor of Psychiatry

We had planned this Beyond Sterling Hall as an update on several initiatives aimed to promote well-being among the members of our Yale School of Medicine. We will do so soon, but instead I feel compelled to pause and to consider how we support each other as a community in the wake of heinous acts by the terrorist group Hamas, even as we acknowledge that members of our community hold widely disparate views on the response to those acts. We share a common grief over the loss of innocent lives.

Over the last few weeks, I have been buoyed by the civility of dialogue with our students. In one-on-one and group conversations, our students have expressed compassion for us and for each other, while articulating personal distress about events in the Middle East and often expressing opposing perspectives.

There have also been many common threads in conversations with all members of our community—students, staff, and faculty. Many are worried about the safety of family members in the Middle East. Others have shared fears that they will be marginalized or worse, targeted, if they express their opinions. Still others express fear for their own safety as anti-Semitic attacks and Islamophobia mount.

As a school engaged in “promoting curiosity and critical inquiry in an inclusive environment enriched by diversity,” we value discourse and freedom of expression. The university commitment to freedom of expression is codified in the Woodward Report. Individuals must feel safe to share their positions. At the same time, freedom of expression must never cross the line of “speech that meets the definition of harassment or discrimination, including threats of violence, or, under certain circumstances, threats that constitute intimidation or coercion.”

Let us commit to learning from each other and to expressing kindness and grace while recognizing the magnitude and impact of events in the Middle East. And let us continue to learn from our students.

Sincerely,

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

I live in New Haven. One of the joys of returning to Yale in 2020 has been the unexpected pleasure of living in New Haven. I often walk to and from work or to after-work events. An evening constitutional clears the mind. My husband and I love dining al fresco in one of our city’s many eateries. We “jog” the Farmington Canal Greenway. Having lived in the South for 33 years, I brought stereotyped perceptions of Northerners when I arrived. The people of New Haven would be gruff and aloof. Nay, not so. Other walkers nod along the pathway. My dry cleaner greets me by name. The folks at the firehouse indulge our grandson’s interest in their trucks. And I have many times experienced the kindness of strangers.

Why am I sharing this? Because as a citizen of New Haven and the dean of our school, I feel it’s important to reflect on a recent caricature of New Haven as a perilous place to live. Like many post-industrial cities, New Haven has wrestled with crime, but data from the New Haven police department indicates that violent crimes have declined 37.8% from 2019 to 2022 (the last full year for which there are data) and property crimes have declined 26% over the same period.

To be clear, the safety and security of our community are of the highest priority to Yale School of Medicine (YSM). Urban healthcare environments present unique safety and security risks. YSM and Yale New Haven Health System (YNHHS) have not been exempt from this national trend, and a spate of events on or near the medical school campus a few months ago heightened concerns about safety. As we have shared in messages and town halls, YSM, YNHHS, the Yale Police Department (YPD), the New Haven Police Department, and the New Haven Parking Authority have been collaborating extensively to increase safety and security near the medical school campus and in clinical settings. YPD has increased its staffing around the medical school, and in coordination with Yale’s security team, has expanded the visibility of security in the area. It has also deployed more mobile video technology in the medical school and Science Park areas, including in and around offices, garages, and parking areas. The university is installing additional blue “emergency” phones in the vicinity of YSM. The Yale Shuttle system has added a “to door” service from the medical school during evening and night hours, and a walking escort service is available to pedestrians. The university’s LiveSafe app provides an effective and immediate way to communicate with YPD via a mobile device. These prevention efforts have already and will continue to enhance the livability of New Haven.

I am not alone or astute in my observations about living in New Haven. The New York Times touted New Haven as having “the cuisine and culture of a major metropolis, but the laid-back vibe of a smaller place” and lists the city among the top 50 places to visit in 2023. U.S. News & World Report also ranked New Haven among the top 100 places to live in the U.S. for 2023–2024. Here are a few things our students enjoy about New Haven and its neighborhoods: the running/walking trails, East Rock Park, West Rock Ridge State Park, museums, art galleries, historic buildings, bookstores, coffee shops, and a wide variety of restaurants (including favorite pizza places, of course!). If you would like to share what you love about New Haven, you can do so here.

YSM is of New Haven. Our faculty, staff, and students are having an impact by fighting addiction, promoting healthy child and adolescent development, providing care to those who need it, partnering to address environmental risks of disease, and more. Our faculty, staff, and students also live here and feel proud of our city.

As a reminder, a number of helpful resources are available on the Safety & Security page on the MyYSM site.

Sincerely,

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

The last two years have seen dramatic progress in our alignment efforts. In January, Dr. Margaret McGovern assumed leadership of the Aligned Clinician Enterprise. Effective July 1, we launched a new, formulaic, and rational model for funds flow between Yale New Haven Health System (YNHHS) and Yale School of Medicine (YSM). Today, we write to provide an update on joint strategic planning efforts.

In March 2022, leaders from YNHHS and YSM began working with the consulting firm, Chartis, to articulate our shared aspiration to achieve extraordinary gains in individual, community, and global health as one of the nation's premier academic health systems.

To the YSM Community:

Department chairs, deputy deans, Yale New Haven Health System (YNHHS), and university leaders once again gathered in June to reflect on the direction of our school and academic health system. Although we will share the content of many of the talks in departmental meetings and town halls later in the year, the discussion was so rich that I wanted to provide a summary and links to relevant resources here.

John Tsang, inaugural director of the Yale Center for Systems & Engineering Immunology (CSEI), opened the retreat with an overview of his research and this nascent center. The center will recruit both existing and new faculty and trainees from diverse disciplines to develop systems and synthetic biology approaches to study and engineer the immune system, with a major focus on connecting the state of the immune system to physiological function of organs in health and disease. By understanding how immune cells act as sensors, John envisions that one can “engineer synthetic immune cells with homing, signal detection, recording, and actuation capacities for disease detection and modulation.” Stay tuned and reach out to John if you are interested in learning more and collaborating with CSEI.

David Coleman, interim director of Yale Center for Clinical Investigation (YCCI), shared ongoing work to enhance the efficiency and service offered by the center. Faculty advisory groups are providing critical input, and the center will soon be issuing a request for application (RFA) for new deputy and associate directors. YCCI is participating in efforts to realize the vision for a single IRB across YSM and YNHHS and is planning to implement a prospective protocol feasibility review process to improve the successful completion of research studies. With this process, studies of trainees and junior faculty would be prioritized for funding support. Those of you who are interested in becoming more involved in clinical and translational research leadership, watch out for that RFA.

Lucila Ohno-Machado, deputy dean for biomedical informatics, updated the group on efforts to enhance research data access and information services at YSM. She emphasized the need to develop better data governance to remove barriers to researchers while enhancing efficient, secure, and compliant ways to analyze sensitive data. She is working with department leadership to embed informatics directors in departments, who have domain-specific knowledge of research and clinical concepts, data, and workflow, and who will partner with biomedical informatics faculty who have expertise in predictive analytics and other AI methods. Lucila is also working with the library to streamline data collections and develop training and self-service tools for simple data summarization.

Amy Blanchard, director of Research Cores, gave an exciting presentation on efforts to advance core services and quality, which include standardization of core positions. Faculty advisory committees and user satisfaction surveys have led to new equipment and expertise in mass spectrometry and proteomics, and investments in new technology. Research cores and services are listed here.

Jessica Illuzzi, deputy dean for education, reviewed the YSM Strategic Plan for Medical Education. The school has identified the first 18 longitudinal coaches from among more than 50 faculty nominees, who will assist medical students in establishing their own goals and in tracking their progress in reaching the milestones for each of the nine YSM competencies in each new phase of the curriculum. To foster community among our students, we are launching six new advising colleges in the fall. Each college will include advisors and coaches, medical students, PA students, faculty, trainees, alumni, and community liaisons.

Keith Choate, associate dean for physician scientist development, summarized the experience with the Faculty Development Annual Questionnaire (FDAQ) during its first year of full implementation. As of June, 86% of faculty had completed their FDAQ and 72% of those had met with their chair or section chief. Faculty rated the quality of the feedback they received 4.54 on a five-point scale.

Darin Latimore, deputy dean for diversity, equity, and inclusion, shared departmental progress in meeting their goals related to the DEI strategic plan. Seventeen clinical departments measured their outreach efforts by tracking the proportion of residency and fellowship applicants who were underrepresented or women. Fifteen clinical departments and seven basic science departments tracked the proportion of faculty search applicants. Several departments have developed a catalogue of career advancing national leadership positions and honorifics for which they will sponsor faculty. Others tracked career development opportunities to which they were nominating faculty.

I hope this summary conveys that there are many good things happening. I also hope you will explore the embedded links related to your interests. We will continue these and other discussions throughout the year during departmental meetings, town halls, and ongoing meetings of the Faculty Advisory Committee (FAC) and YSM Executive Group. As a reminder, FAC minutes and summaries of Executive Group meeting discussions are available to the YSM community online. Please feel free to reach out with your thoughts about these or other issues of strategic importance to our school.

Sincerely,

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

To the YSM Community:

I recently had the opportunity to speak with participants in the Advanced Emerging Leaders Program, a leadership program developed through a collaboration between Yale Medicine (YM) and the Yale School of Management. The group asked many insightful questions, but one echoed a common query from faculty—how can faculty interested in contributing to the school identify opportunities for involvement and leadership?

For the individual faculty member, it is important to identify citizenship (and later leadership) roles that are aligned with your passions, career developmental stage, and the needs of the institution. An intention of the new Faculty Development Annual Questionnaire (FDAQ) is to provide you with the opportunity to reflect on your goals and aspirations, share them with your chair or section chief, and have a robust conversation about how you can best contribute while advancing those goals.

Early in one’s career, a faculty member best contributes by mastering their chosen discipline. For the clinician, early leadership skills may include leading clinical teams, conflict resolution, quality improvement, and patient advocacy. Clinical excellence, command of these skills, and passion for a particular clinical problem or disease state may lead to the building of destination programs or participation in the operational leadership of outpatient and inpatient clinical programs. For an early researcher, even as they are learning to ask impactful questions and test hypotheses with rigor and novel approaches, they must also learn how to run a laboratory, determine priorities, develop a team, integrate learners, and hold others accountable. The mastery of these skills can lead to increased leadership roles in the school, such as serving on thesis committees, developing programs, or performing national service on study sections and committees. For the educator, the maturation of early skills in teaching, clinical precepting, and small group facilitation may give rise to leadership roles in designing new pedagogies or curricula, assessment methods, course directorship, and advanced mentoring and advising.

For those who aspire to contribute more broadly to shaping the future of the school, uncertainty about how to participate and seek leadership opportunities may pose a barrier. Here again, conversations with mentors and the annual conversation with your section chief or chair are critical to identifying the right opportunities. I would also like to ensure that you are aware of other specific opportunities to participate in strategic decision making.

The dean’s office publishes an online recommendation form (including self-nominations) whenever we are filling a leadership position: Current Searches Yale School of Medicine. Expressing an interest in a position, even if the fit or time is not right, serves to make others aware of your interests and talents.

The Faculty Advisory Council (FAC) plays a critical role in ensuring the insights and ideas of our faculty are heard and influence policy and strategy. Faculty members who wish to serve on FAC may self-nominate or be nominated by their peers. Chairs, vice chairs, deputy chairs, associate chairs, section leaders, and faculty members with a formal role in YSM administration may not serve as representatives. The number of representatives per department is determined by the size of the department with one representative per 50 faculty members. There are also three elected representatives from among our associate research scientists. The dean’s office chief of staff solicits nominations from the constituents in each department, with constituents then voting for their representative.

Our faculty affinity groups provide advice and guidance on ways to make YSM a more inclusive community. They include the: Minority Organization for Retention and Expansion (MORE), Committee on the Status of Women in Medicine (SWIM), and Dean’s Advisory Council (DAC) on Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) Affairs. Faculty who wish to become more involved in advancing the school’s diversity strategy may want to review the school’s Diversity Strategic Plan (Faculty Section) and may also speak to Deputy Dean Latimore about the school’s Diversity Advisory Council.

For faculty developing careers as educators, Faculty Engagement Opportunities provides contact information for those who want to become involved in admissions, curriculum, mentorship and advising, student research, and global and community health activities with our students. The school seeks broad representation of the general faculty on our committees for admissions, curricula, education policy, student progress and strategic initiatives. Faculty members may be nominated or self-nominated in response to an annual call for nominations sent out each summer by the Office of Medical Education. Selected faculty are recommended to the dean and deputy dean for education, who approve the appointments.

There are numerous opportunities for clinicians to become engaged in citizenship. Full-time YM faculty may serve as one of four at-large YM Board members. The board chair issues a call when a term is up, and eligible candidates submit an expression of interest and curriculum vita to the chair of the board’s Nominating and Governance Committee, which recommends candidates for full board vote. In the new aligned physician enterprise, faculty may serve on consensus committees for the development of clinical pathways to promote a consistent enterprise-wide approach to driving quality. Over the next year as we stand up a physician-led Clinically Integrated Network (CIN), a call will go out for faculty to participate in committees related to quality, technology, contracting strategies, and coordination of care and case management approaches. In addition, faculty engagement in patient safety initiatives and risk reduction, such as service on committees of our malpractice carrier, Medical Center Insurance Company (MCIC), provide additional opportunities for faculty to develop leadership skills.

YSM attracts highly motivated, innovative thinkers who bring novel perspectives to solving problems and identifying unique opportunities. There are many opportunities for you to help shape the future of our school. I encourage you to consider and pursue these opportunities as they align with your professional and personal career goals.

Sincerely,

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

To the YSM Community:

During our recent Yale School of Medicine (YSM) department town halls, we have been discussing the progress on our journey to closer alignment between YSM and Yale New Haven Health System (YNHHS).

In January we launched a newly aligned physician enterprise, under the leadership of Chief Physician Executive Peg McGovern, MD, PhD, that will allow us to provide better access for patients, ensure consistency of the highest quality care across YNHHS, and reduce duplication and inefficiencies that not only frustrate our patients but also increase frustration and administrative burden for our faculty and staff.

A growing group across the school and health system is engaged in joint strategic planning focused on five pillars: leading-edge clinical and translational research; leading system-wide service lines and destination programs; unparalleled access, patient experience and care network; exceptional value; and continuous learning and innovation. As the plan takes shape, there will be opportunity for input and refinement.

We have also been working diligently to revise the funds flow model between YNHHS and YSM, to make it transparent and formulaic, and to align incentives with our aspiration to be a premier academic health center. We have discussed the principles of funds flow at a high level in town halls. Because rationalizing funds flow is critical to the long-term success of YSM and YNHHS, and because not everyone had the opportunity to attend a departmental town hall, I wanted to further review here the rationale, objectives, and outcomes of this work.

What drives clinical funds flow?

A substantial proportion of funds flowing from academic hospitals to their affiliated medical schools covers structural deficits in salaries related to how payments are made for clinical services by commercial and government payors. Payors remit professional fees to clinicians, e.g., our faculty practice plan, Yale Medicine (YM), but technical revenues for services in our system primarily flow to the YNHHS hospitals. Professional fees often do not cover clinician salaries, and so, academic hospital systems fund the structural gaps. Because it often takes time for new physicians to build a practice, academic hospital systems also support the “startup gap.”

An additional portion of funds from academic hospitals is used to purchase services from the affiliated school, such as the time of medical directors, call coverage for certain services, or the development and leadership of training programs in graduate medical education.

Lastly, academic hospitals understand that what differentiates them from community hospitals or large for-profit hospital systems is the ability to attract exceptional trainees and faculty and to offer access to innovative therapies. Support for the academic mission of the school serves as an investment in this differentiating edge.

Why should we change our funds flow model?

In short, because the current system is broken. Today, funds flow agreements between YNHHS and YSM are negotiated as a series of one-off Program Development and Deficit Offset (PDDO) agreements between each clinical department and individual YNHHS hospitals. We have hundreds of agreements, each one different from the next, ranging in size from support for clinical programs to support for individual physicians. Department chairs, YM leaders, and YNHHS hospital leaders spend considerable time and energy negotiating each agreement, and negotiations can end in paralysis. Decisions about hiring and program growth may be based on the prowess of the individual negotiators or on relationships rather than on an overarching strategic plan, resulting in inappropriate investments in some areas and insufficient investments in others of strategic importance.

In addition, our current agreements often do not distinguish between deficits due to structural gaps (the gap between professional fee revenues and salaries for certain specialties) and deficits due to inefficiencies. They do not align incentives between YSM and YNNHS.

What are the components of the new funds flow model?

In the new model, clinical departments will be paid for clinical work based on either a “dollar per Relative Value Unit (RVU)” model or a staffing model. An RVU, developed by the Centers for Medicare and Medicaid Services, is the generally accepted measure of the value for clinical services or procedures, and is commonly benchmarked by clinical specialty. In the “dollar per RVU” model, the payment rate will be based on well-established national benchmarks for faculty salaries divided by benchmarks for median RVUs, multiplied by the number of RVUs the clinicians in a department generate. The new model will provide support for structural deficits, departmental overhead such as staffing costs, and deficits related to start-up in a formulaic way based on well-defined national benchmarks. For RVU-reimbursed departments (e.g., Surgery, Medicine, Pediatrics), the payment to departments for any structural deficit will be calculated based on a blended Medical Group Management Association/Association of American Medical Colleges (MGMA/AAMC) benchmark for salary and the University Health Consortium (UHC)/Vizient academic benchmark for wRVU per clinician. For “hospital-based” departments (e.g., Anesthesiology, Emergency Medicine), the formula will be based on staffing requirements and national benchmarks for hours or shifts per clinician. Departments will be able to garner additional funds through incentives for achieving pre-determined goals. Purchased services such as medical directorships, support for graduate medical education, and call coverage will still flow directly from YNHHS to departments.

Funds related to clinical operational expenses such as the cost of staffing will flow directly to Yale Medicine Administration from YNHHS.

Support for academic programs, currently funded through a “dean’s tax,” will be funded as a percentage of YNHHS revenue directly to YSM. The percentage has been calculated based on current enterprise revenue to be equivalent to the current amount funded through tax but will be expected to grow as revenues grow, enabling greater investments by the school in the academic enterprise. As YNHHS returns to a positive margin, departments and the school will also receive a percentage of positive net operating income.

What does the new funds flow model mean for YSM and our academic mission?

Revenues from the clinical mission support our research and educational missions.

The type of funds flow model described here has been adopted by many peer research-intensive institutions, such as University of California, San Francisco, University of Pennsylvania, Stanford, and Washington University. The net effect of implementation of this type of formulaic approach has consistently increased resources for all academic missions. (Kennedy, D., et al, (2007). Aligning Academic and Clinical Missions Through an Integrated Funds-Flow Allocation Process. Academic Medicine 82(12):p 1172-1177. and interviews.)

What does the new funds flow model mean for clinical departments?

During the last several months, the finance teams of YSM and YNHHS, together with our consultant Chartis, have been modeling the impact of the changes to funds flow department by department and refining the formula. The purpose of that analysis is to ensure that the new clinical funds flow model is as close as possible to revenue-neutral for all parties. The expectation, based on the experience of other institutions, is that the new model will have a favorable financial impact for clinical departments, the school, and YNHHS. The new model will require clinical and operational leaders to eliminate barriers to efficiency in the clinic and to ensure that compensation and the distribution of revenues within departments support the academic mission.

We are not considering changes to the flow of funds related to research funding or general allocation (GA) at this time.

What does the new funds flow model mean for faculty in clinical departments?

The funds flow model encompasses the flow of money from YNHHS to YSM, YM, and the clinical departments. It does not dictate the compensation model within departments or, therefore, compensation for individual faculty. Departmental plans will continue to determine a faculty member’s compensation based on that individual’s mix of responsibilities and performance. Departmental compensation plans are expected to adhere to the guidelines established by YSM and ratified by the Executive Group of the school.

Over time, aligned incentives to improve efficiency in the clinic, together with initiatives to reduce duplication through the aligned physician enterprise, will improve the clinical experience of our faculty and staff as well as our patients.

What does the new funds flow model mean for basic science departments and faculty?

A change in the clinical funds flow model has no direct impact on the basic science departments. Clinical revenues provide academic program support, and ensuring the alignment of incentives between YSM and YNHHS will ensure the stability of such support.

What are the remaining steps to implementation?

As we complete individual department modeling and refinement of clinical funds flow, we plan to “go live” on July 1, 2023. Together, leaders in YSM and YNHHS will follow a set of common metrics of clinical, financial, research, and educational performance. For the first year, YNHHS and YM will guarantee departmental clinical funds at the level that the department would have received under the old funds flow model. Again, we expect that the revenue to most departments, YSM, and YNHHS will increase under the new model. We also realize that there may be unanticipated consequences for some areas of YSM or YNHHS. We are committed to iterating the model to address such findings.

Change, particularly change that involves funding, provokes anxiety. The revision of funds flow is critical to the financial health of YSM and YNNHS. It is also critical to realizing the missions of YSM. Together with the creation of the aligned physician enterprise, rationalizing and simplifying funds flow will promote efforts to improve the experience of our faculty and patients. The work will require courage, trust, and communication. We will do it together.

Sincerely,

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

To the YSM Community:

In the coming months, we will learn the Supreme Court decisions regarding race-conscious considerations in undergraduate admissions in the cases of Students for Fair Admissions v. President and Fellows of Harvard College, and Students for Fair Admissions v. University of North Carolina. We need not wait for these decisions to reaffirm the strong commitment of Yale School of Medicine (YSM) to diversity and inclusive excellence. As a school charged with training future leaders in science and medicine, we believe that enrolling talented and hardworking students from diverse backgrounds promotes intellectual creativity and enhances curiosity, compassion, and care for all patients. We will continue to engage in career development and outreach programs to ensure that we mentor, sponsor, and attract students who, by virtue of their lived experience, might not believe that an education at YSM is within their reach.

Our admissions committee evaluates student candidates using a holistic approach and considers each applicant’s commitment to medicine, compassion, maturity, curiosity, and resilience, as well as measures of academic preparation such as grades and MCAT scores. We believe that these are qualities of the best physicians and physician-scientists. We further understand that the same characteristics that are underrepresented in medicine—Black race or Hispanic ethnicity, female gender (underrepresented in some fields), lower socioeconomic status, disability, sexual and gender minority, and history of military service—are often associated with experiences that lead to resilience, an important trait in medicine and science.

Importantly, with our intentional, holistic approach to admissions, YSM does not manage based on metrics, such as those used in the U.S. News & World Report (USNWR) or other rankings. Understanding that national rankings are unlikely to disappear, we and other schools have sought to influence information disseminated through USNWR, as exemplified by the recent piloting of diversity information. Most data presented by USNWR for research-intensive medical schools are publicly available through databases such as National Institutes of Health (NIH) RePORTER and through the Association of American Medical Colleges (AAMC) Medical School Admission Requirements (MSAR) report. Nevertheless, many students who have not had the opportunity to attend colleges with well-developed counseling programs, and their families, share that they value the accessibility of information published in rankings.

Lastly, one of the most important means through which we can promote diversity and inclusion among medical students is to make a Yale medical education financially accessible to all regardless of socioeconomic status. To this end, in 2018, former YSM Dean Robert Alpern, MD, began working to reduce the debt burden of our students with financial need. Consequently, the median debt of students graduating from YSM was $79,750 in 2022, compared to $200,000 nationally. Reducing medical student debt through philanthropy has been a primary goal of our ongoing capital campaign. The recent extraordinary generosity of The Starr Foundation and Chairman Maurice R. Greenberg will allow us to reduce debt for medical education to $10,000 per year or $40,000 total over four years for students in need of financial aid.

YSM is committed to inclusive excellence and to working in meaningful ways to advance the diversity and richness of our student body. I am so grateful for the generosity of our community members who invest time in outreach and mentorship, serve on the admissions committee, and provide support to applicants and students, as well as for our generous donors who help to make a YSM education accessible.

Sincerely,

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

To the YSM Community:

As I near my third anniversary as a member of the Yale School of Medicine community, I have been reflecting on all that we have accomplished, as well as all that we have yet to do. You–our students, faculty, and staff–amaze me every day with your intellect, your thoughtfulness, and your commitment to our missions.

During department town halls, we have discussed our cross-cutting goals. We are working to:

• Create an environment of inclusive excellence where all members of our community can thrive and to which we can continue to recruit the best talent in the world
• Break down silos to advance creativity and innovation and promote interdisciplinary research to increase our impact
• Build and steward resources necessary to serve as a biomedical discovery powerhouse of the 21st century
• Realize our potential as a premier academic health system through strategic alignment and partnership with Yale New Haven Health System

Actualizing these goals will, at times, require us to work differently.

For example, we recruit brilliant and talented students, trainees, and faculty. To retain them, we must be intentional in our efforts to mentor, sponsor, and proactively support these talented individuals by eliminating barriers to their success and providing the right resources at the right time. The conversations fostered by the Faculty Development Annual Questionnaire (FDAQ) process are intended to catalyze this approach.

We must be willing to take risks. Making change involves experiments or pilots, and we know as scientists that not all experiments succeed but that we can learn from the unexpected outcome. To continue with the example of career development, the working group that developed the FDAQ borrowed heavily from the best practices of others, piloted the process in a few departments, and will continue to iteratively improve on the tool and process with input from you. If, at some future date, we replace the FDAQ with a better tool or process, that will mark progress, not failure.

As I wrote in 'On Discipline' two years ago, we must learn to replace transactional interactions with innovative, strategic thinking: “In the coming years, we will work to develop a practice of strategic planning that engages all stakeholders, identifies our strengths and differentiators, recognizes potential weaknesses and obstacles, and articulates a common vision with a plan to achieve it.” “Strategic planning” is not an exercise in which independent individuals or units each advocate for their own needs, and whomever advocates most effectively “wins.” For those who would like to learn more about strategy, there are many rubrics developed for business that can be adapted for academia, such as the work of Hambrick, D. C., and Fredrickson, J. W. (2001). The NextGen research strategic planning conducted by Deputy Deans Tony Koleske and Brian Smith in 2021 applied many of these principles. Importantly, strategic planning should not involve a “top-down” approach, but one that encourages creativity and engages our rising stars, staff as well as faculty, and collaborators across the university and our broader communities. Our annual presentations to our newly constituted Scientific Advisory Board will provide a forum in which to identify additional cross-cutting themes.

As we develop priorities within our school as well as in partnership with the Yale New Haven Health System, we will have robust conversations about future directions. We must continue to create an environment in which all feel engaged and comfortable espousing different viewpoints. We need to address obstacles and problems openly and think creatively together about solutions. And when, after a vigorous conversation, we develop priorities, we must work together to realize them even if our individual preference did not reach the top of the list.

And, again from 'On Discipline:' “To hold ourselves accountable, we must also become comfortable with sharing data about our performance. This should include everything from metrics of clinical excellence and research impact, to measures of diversity and inclusion, to the functioning of cores and administrative operations such as contracting.” Here, we have made progress. For those interested in statistics on climate, diversity, and inclusion, we will continue to expand the data at our online archive. Leaders in the health system and school are working to develop better dashboards to enable individual physicians as well as departments to track measures of quality and performance. We must develop similar analytics around our research cores, contracting, and grants management to enable even greater discovery. Attention to routine processes will enhance the return on investments in predoctoral training, cutting-edge new cores such as FIB-SEM and MERFISH, the creation of a new biorepository, and biomedical informatics and data science. We have begun this work in the Yale Center for Clinical Investigation, and you will be hearing more about that in the coming months.

As we revise the flow of funds between the hospital and the school to align with strategic priorities and to incentivize desired behaviors, some may need to relinquish a “learned helplessness.” With agency comes responsibility. Support for departments and sections will be transparent and equitable. We will have the opportunity to grow funding for all missions, but that will require execution. We will have to challenge prior assumptions and analyze root causes. We are already beginning to see changes that we could not have imagined a few years ago. The creation of the aligned physician enterprise will eliminate inefficiencies, enhance clinical care and service, improve the lives of our clinicians, advance educational opportunities for our students, and better integrate our missions of discovery and clinical care.

Yale School of Medicine is an extraordinary institution where excellence and a collaborative culture coexist. We are making considerable investments and progress in realizing our overarching goals. We have some old habits that hold us back from time to time, but we are learning to work differently, and this will be transformative.

Sincerely,

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

Dear YNHHS and YSM Communities:

In March, we articulated our commitment to align Yale New Haven Health (YNHHS) and Yale School of Medicine (YSM) to realize our full potential as one of the nation’s premier academic health systems. The imperative for increased alignment stems from our recognition that we must put the needs of our patients first, above all other considerations. Today, our patients struggle to access our services and to understand and navigate our complex organizational structures. They deserve the best from us, and we are focused on creating and delivering this patient experience.

Accordingly, we are pleased to share with you a new aligned physician practice model that will enable coordination between Yale Medicine, the YSM faculty practice plan, and Northeast Medical Group (NEMG), the YNHHS-employed practice plan with its affiliated physicians.

Dr. Margaret McGovern has been named chief physician executive of the aligned physician services, reporting jointly to the CEO of Yale New Haven Health as executive vice president and to the dean of Yale School of Medicine effective immediately. Dr. McGovern will continue to serve as CEO of Yale Medicine and deputy dean for clinical affairs in the School of Medicine. Dr. Richard Goldstein has been named as senior vice president for YNHHS, with responsibility for NEMG. Dr. McGovern will be advised by the Physician Enterprise Executive Committee comprised of physician and administrative leaders. NEMG, with its affiliated community physician groups, and Yale Medicine will remain separate legal entities, enabling us to provide an attractive professional employment environment for physicians with differing career aspirations.

The newly aligned physician enterprise will enable a coordinated strategy to enhance quality, service, and access. It will decrease fragmentation and increase communication and standardization across our physician practices. It will further improve operational efficiency and facilitate the implementation of a single point of entry for patients to access care.

Greater alignment will also result in better service and access for our physician partners in the community. Alignment will offer a seamless and timely experience to physicians referring patients and interacting with our health system. This is a critical first step toward the formation of a common quality platform with community physicians and surgeons through a clinically integrated network that will promote and promulgate best practices across the network and prepare us to be successful in value-based payment models.

Finally, alignment will increase our agility to grow to meet the needs of our region and build destination programs with national and international prominence. Our goal is to provide more patients with greater access to cutting-edge therapies across the system. In this way, our clinical research and educational missions will also be furthered.

We are truly excited about the opportunity to serve our patients and our physician partners in the community. Ultimately, this work will enable us to realize our full potential as a leading academic health system.

Sincerely,

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

Christopher M. O’Connor, FACHE
Chief Executive Officer of Yale New Haven Health

To the YSM Community:

As Thanksgiving approaches, I cannot help but reflect on how grateful I am to be part of Yale School of Medicine. We are surrounded by extraordinary people who come together to advance the most compelling mission of caring for people while advancing knowledge and health. I am reminded of this every day—by the patient or family member who sends an email to express their deep appreciation for the exceptional care they received, by the staff member who stops me in the hallway to introduce herself in person after months on Zoom, by the student who challenges us to think differently about the impact of our systems on the health of the underserved, or by the investigator whose life’s research has resulted in a newly approved treatment.

Thank you for all that you do and for being you. I wish you a restorative Thanksgiving.

Sincerely,

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

To the YSM Community:

Last week, Jewish members of our community marked Yom Kippur, the Day of Atonement. As someone who was raised in another faith and came to Judaism as an adult, I have often been struck by the power of the communal acknowledgement of shortcomings on Yom Kippur. Acknowledging one’s flaws together is intended to lead to a renewed commitment to repairing ourselves and our community. It is in this spirit that I share with you the results of a recent survey conducted at the medical school related to faculty, student, and staff engagement, inclusion, and belonging. The university will soon share the results of a university-wide faculty survey conducted in the fall of 2021.

The AAMC Diversity Engagement Survey was designed to measure and assess inclusion in academic medicine. YSM’s results were presented in comparison to data from 80,900 respondents from 50 other academic medical centers collected through October 2020. The survey questions addressed inclusion factors—common purpose, access to opportunity, equitable reward and recognition, cultural competence, trust, sense of belonging, appreciation of attributes, and respect; and engagement factors—appreciation, vision/purpose, and camaraderie.

Among 10,893 YSM students, faculty, and staff, 3,183 participated. The response rate was higher among staff (41%) than faculty (31%) and quite low among students (9%), clinical trainees (6%), and postdoctoral fellows (9%).

“Comparisons are odious,” and we note that YSM was benchmarked against peers who completed the survey largely before the pandemic. Nevertheless, it would be a mistake to ignore patterns. Due to limited space, I will highlight the three questions where we ranked lowest compared to our peers. For the “Factor: Appreciation of Individual Attributes,” 69.3% of YSM faculty or staff ranked this as favorable versus 75.4% among peers. For “Respect,” 74.3% answered in the positive versus 81.1% among our peers. For the “Factor: Trust – Confidence that the policies, practices, and procedures of the organization will allow the individual to bring their best and full self to work,” only 61.3% responded in the positive versus 72.7% among peer institutions.

Underrepresented minority (URM) faculty and staff scored lower in several areas than non-URM faculty and staff. For one group, this was relative to faculty and staff at peer institutions, while for another group, scores were comparable to those at peer institutions but lower than other groups within our school. The gap from benchmark was slightly greater for women than men in the appreciation cluster and vision/purpose cluster, as well as in the trust, cultural competence, and respect factors. Research rank faculty and social workers scored many areas lower than their colleagues. The survey revealed a few departments in which there are concerns about access to opportunity, equitable reward, recognition, and appreciation among staff.

How do we learn from this survey to make YSM all that we aspire to be? We have shared department or section–specific data with the chairs, who will review these data with department members so that together, you can reflect on the changes you would like to see within your departments. Department diversity vice chairs and champions are working together through the YSM Diversity Council to share best practices to inform departmental initiatives. For the rare department that consistently ranked lower in faculty or staff engagement, we have planned additional support to facilitate constructive change.

Deputy Dean Robert Rohrbaugh has been visiting with department faculty and staff to share the work of the Office of Academic and Professional Development (OAPD). OAPD has implemented a system for confidential reporting, a process for identifying patterns (at the individual or unit level), and an approach to addressing unprofessional, disruptive, or concerning behaviors. If you have not already done so, I encourage you to visit the OAPD professionalism concerns webpage.

To promote more effective mentoring within departments, we have developed the Faculty Development Annual Questionnaire (FDAQ)—a tool designed to provide faculty with opportunities to reflect on their career progression and to facilitate meaningful annual discussions with departmental leadership regarding their professional development goals. The FDAQ was piloted in 12 departments last spring and was formally adopted across the school in September.

Similarly, as I wrote about in a recent Beyond Sterling Hall, over the past year, a group of YSM faculty and leaders led by Deputy Dean Linda Bockenstedt has been considering the career development and trajectory of our faculty in the research ranks. The school is actively working to adopt the group’s recommendations to revise offer letters for faculty entering the research track to ensure a common understanding of expectations; to develop a dedicated research rank Faculty Development Annual Questionnaire; and to create resources that facilitate development along specific career trajectories and educational materials that enable candidates to compare the benefits of the research track versus professional staff positions.

In addition, the university kicked off the Emerge Program a year ago to develop a cohort of talented and diverse staff to serve as university leaders.

As a school we are committed to transparency. In the coming weeks, we will post the overall results of the survey online. Sharing our results will allow us to track progress over time as a community. We are also developing a repository that includes data presented each year at the State of the School, such as demographic data by faculty rank and professorships, as well as an annual summary of the number and types of behavioral concerns referred to the Office of Academic and Professional Development.

Lastly, although we learned a great deal from our participation in this survey, we recognize the need to reduce the burden of asking our community to complete multiple surveys. Survey fatigue is real. We ask faculty members to complete annual chair review surveys; the hospital asks clinical faculty to complete an annual wellness survey; and departments or others often send out targeted surveys. It is no wonder that our overall response rates hover around 30%. We need a bit of discipline to balance the imposition on our community with the value of the information gleaned. I have asked Deputy Deans Rohrbaugh and Latimore to review the schedule of surveys with the goal of decreasing their frequency and reducing the burden on our students, faculty, and staff. Going forward, we request anyone who would like to survey faculty and staff across the school to ask for clearance from Deputy Dean Rohrbaugh. We will be working closely with Yale New Haven Health to coordinate this effort as well.

We have taken an inventory of where we are as a community. We have paused for reflection. Now we must go forward and commit to becoming the community we would like to be.

Sincerely,

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

To the YSM Community:

Academic medicine is sometimes described as a three-legged stool, balanced on the legs of three missions–education, research, and clinical care. I would make the case that our stool has four legs, with the fourth being people development, encompassing not only the education of our students and trainees but also the career development of our faculty and staff. People development is about creating an environment where all can thrive, and it is the underpinning of our strategic plan for diversity, equity, and inclusion.

Over the past year, a group of faculty and leaders in Yale School of Medicine led by Deputy Dean Linda Bockenstedt has been considering the career development and trajectory of our faculty in the research ranks. Faculty on the research track play critical roles in advancing science within a laboratory or research group and, ultimately, within the school. Today our research rank faculty number 751 in total–573 associate research scientists (ARS), 142 research scientists (RS), and 36 senior research scientists (SRS). Forty-five percent of faculty in the research ranks in YSM are women, and 45%, 42%, and 8% of research rank faculty identify as Asian, white, or underrepresented, respectively.

The Research Rank Review Committee reviewed the history of research ranks at Yale since 1965 and surveyed our peer institutions regarding similar tracks. They identified other non-ladder track faculty, as well as staff positions, that support the research mission. The committee then surveyed our research rank faculty. The overall response rate was 53%, with response rates higher among RS (69%) and SRS faculty (78%). The survey revealed several important findings. First, there may be conflicting expectations for a faculty member on the research track. Many associate research scientists join the faculty after a trainee position with the goal of becoming an independent (ladder track) investigator. For them, the ARS position is a stepping stone to a ladder track appointment. Because the faculty appointed to this track “are engaged in scientific research in association with a faculty member or as a member of a research group,” they may become frustrated by a lack of autonomy to pursue their own work. Other research rank faculty aspire to a career as a critical member of a research team or of a vital resource, such as a core, without the pressure of garnering funding for their own program. Second, many research rank faculty would like to receive more mentoring or feedback. Related to this, faculty may be unclear on criteria for advancement and promotion. Lastly, because appointments and compensation for research faculty “are conditioned upon the availability of salary support from specified sources, including external research sponsors,” faculty may feel insecure about the stability of their careers.

To address these concerns, the committee recommends that offer letters for faculty entering the research track be revised to ensure a common understanding of expectations when a faculty member joins this track. They further recommend that we create a modified Faculty Development Annual Questionnaire for members of the research ranks, as regular conversations will help to align expectations. The YSM Executive Group, comprising chairs and deputy deans, has enthusiastically endorsed these recommendations.

Over the longer term, the committee recommends that we create resources to facilitate development along specific career trajectories. Examples of career trajectories might include a lab/project director with specific scientific expertise and direct research activities, a core member/director, and a research administrator. We plan to create a clearinghouse for research track faculty to learn about opportunities should they change laboratories. We will also create educational materials to enable candidates to compare the benefits of the research track versus professional staff positions so that candidates can choose the pathway that makes the most sense for them.

I would like to extend my thanks to the members of the committee, including Serap Aksoy, professor of epidemiology (microbial diseases); Kim Blenman, assistant professor of medicine (medical oncology); Richard Carson, professor of radiology and biomedical imaging and of biomedical engineering; John Elsworth, senior research scientist, Psychiatry; Jiankan Guo, research scientist, Internal Medicine (nephrology); Ruth Montgomery, professor of medicine and associate dean for scientific affairs; Lisa Petti, research scientist, Genetics; Lawrence Young, professor of medicine (cardiovascular medicine) and of cellular and molecular physiology; and David Zenisek, professor of cellular and molecular physiology, of ophthalmology and visual science, and of neuroscience.

Over the coming weeks, Deputy Dean Bockenstedt will be sharing the work of the committee with groups such as the Faculty Advisory Council. Our research track faculty contribute significantly to our research and education missions. I am grateful to the Research Rank Review Committee for ensuring that this group of faculty can thrive.

Sincerely,

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

To the YSM Community:

It’s been a quiet month in Lake Wobegon… not so much in Yale School of Medicine (YSM). Nevertheless, in the third week of June, department chairs, deputy deans, Yale New Haven Health System (YNHHS), and university leaders gathered off campus to reflect on the direction of our school and academic health system. Although we have convened before during the pandemic, this retreat felt different—like a homecoming and a new beginning at once. Let me share the conversations.

In the spirit of encouraging collaboration across departments and schools, in each of the last two years a university leader and collaborator from outside YSM has opened our leadership retreat. Last year, Dean Jeff Brock presented his vision for the School of Engineering and Applied Science (SEAS). This year, Nick Turk-Browne, director of the Wu Tsai Institute, reviewed milestones achieved over the institute’s first year.

Deputy deans for research Tony Koleske and Brian Smith led a robust discussion on future trends in research funding mechanisms such as the Advanced Research Projects Agency for Health (ARPA-H) and the Cancer Moonshot, as well as initiatives associated with the NIH’s commitment to Diversity, Equity, Inclusion, and Accessibility. Chen Liu, chair of Pathology, then updated us on the rapid autopsy program and the launch of the YSM Biobank, which provides general biospecimen intake, acquisition, processing, storage, and distribution; investigator or program-initiated tissue banking; clinical trials support, and existing biobank support.

Deputy and associate deans Bockenstedt, Latimore, and Choate led a discussion of career development. In January, we piloted the Faculty Annual Development Questionnaire (FDAQ), a tool to facilitate annual feedback and career development discussions between faculty and departmental leadership. Mentorship and sponsorship are critical to ensuring that all our faculty, regardless of track or seniority, thrive. Over 1,000 faculty from 14 departments participated in the pilot, and a follow-up survey indicated high satisfaction rates with the quality of feedback and impact on career development. This academic year, we have set the goal of departments completing annual meetings using the FDAQ for a minimum of 75% of their faculty. Departments will also choose among other goals aimed at promoting inclusive excellence, such as tracking the proportion of residency, fellowship, and faculty applicants who are women or underrepresented in medicine (URiM); sponsoring career advancing, national leadership opportunities; or tracking the number of faculty nominated for key leadership development opportunities.

Deputy Dean Illuzzi presented the strategic plan for education and preparations for our LCME reaccreditation site visit in October 2023. The group discussed the effective consideration of educational activities in the promotion process, noting a distinction between an extraordinary time commitment to educational activities and engagement in educational scholarship. This academic year, we have revised dean’s office funding to better support leaders in education and high intensity teachers. The group further identified the need to mentor innovators in education to enhance their scholarly productivity. Future work will examine renaming the Clinician Educator-Scholar and Academic Clinician tracks to appropriately differentiate and acknowledge educational scholarship and high intensity teaching.

A significant portion of the retreat was dedicated to our shared commitment to achieve greater strategic alignment between YNHHS and YSM. CEO Chris O’Connor and I reiterated the imperatives for alignment that we shared in our March 28 Beyond Sterling Hall. Specifically, we must be more aligned to realize our aspiration to become one of the premier academic health systems in the country. In addition, better partnership will enable us to flourish in the current difficult health care environment. As a first step, YSM and YNHHS leaders have been meeting to develop a shared strategic plan. This Joint Strategic Planning Committee identified priorities that will most differentiate us as an academic health system (national expertise, clinical research, personalized medicine, application of research, exceptional safety and outcomes, preclinical and clinical education), and those areas where we have the greatest opportunity to improve our performance (access, highly efficient operations, highly coordinated care, multidisciplinary care across the system). Emerging from this work will be a shared strategic vision, future direction, and major priorities. Surprisingly, YSM and YNHHS have never developed a shared strategic plan for our academic health system before.

As our joint strategic plan emerges, it will also guide decision making and coordination among our service lines, operations, and clinical teams. The plan will guide the rationalization of funds flow to support desired outcomes, including the growth of the academic mission. Executing on our strategy will require that we be disciplined, committed to each other and our goals, and data driven. As a first step, we have begun to identify potential shared common metrics—a “single source of truth”—that we can track together as we strive for excellence. We have begun the work to better harmonize Yale Medicine and Northeast Medical Group to coordinate services and provide the highest quality care and consistent service for our patients. Such alignment will also facilitate our academic missions by enabling research and teaching across the system and will further enhance the quality of life of our clinicians by reducing duplication of work. Importantly, joining the retreat (and now campus) were two new leaders who bring insight and experience to guide this work: Pamela Sutton-Wallace, YNHH chief operating officer, and Margaret McGovern, YSM deputy dean and chief executive officer of Yale Medicine.

The final session was led by David Berg, PhD, an organizational psychologist with special expertise in group and intergroup relations. Professor Berg presented a case study that illustrated how organizational events can be explained at the individual, interpersonal, group, and intergroup levels, with each level suggesting different responses and courses of action. The session provided a helpful framework with which to consider alignment and other organizational opportunities.

The retreat concluded with a sense of promise and optimism that I hope I have conveyed by sharing the conversations. Over the coming year, we will broaden these conversations through our regular meetings and through workgroups and town halls. Thank you in advance for your investment and engagement.

Sincerely,

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

To the YSM Community:

As we anticipate (and even preview) the Supreme Court's decision on Dobbs v. Jackson Women’s Health Organization, I want to take a moment to articulate the communication guidelines of the Yale School of Medicine (YSM) dean’s office and the rationale behind them.

When major events occur locally, nationally, or globally, YSM follows several basic principles in determining whether and how to respond. If an issue impacts the entire university community, we defer to university leaders to speak first. We also respect that, as part of the larger university, YSM does not comment on political issues and should not comment on issues about which other schools harbor greater expertise. Finally, while we appreciate there is often a desire for an immediate response, it is important to pause and ensure we engage in the necessary due diligence to understand the facts and to garner input from leaders and experts. This includes deciding if it is appropriate for the school to issue a public statement.

As a school of medicine, we sometimes lead most effectively by creating a venue in which our community can learn from varied perspectives through honest and difficult discussions. With respect to Dobbs v. Jackson Women’s Health Organization, a recent poll from the Pew Research Center indicates that citizens in our country hold nuanced views on abortion. In the coming weeks and months, we will collaborate with colleagues across the university to create opportunities to discuss Dobbs v. Jackson Women’s Health Organization. We will discuss the importance of access to health care, the disparate impact when access is denied, and the privacy of the physician-patient relationship. We may consider the medical history of abortion or the extensive changes in reproductive medicine since the 1973 Supreme Court ruling in Roe v. Wade. We will learn from the experiences of individual women. We will hear from colleagues in law about constitutional issues and from scholars in religion and ethics. And we will wrestle with the inadequacies of our current scientific understanding of what it is to be human.

Many of our faculty have expertise directly relevant to the questions under consideration and may participate in the writing of statements or guidelines by professional groups. Faculty often write opinion pieces in the media. We value freedom of expression highly at Yale. Best practice requires that we distinguish among rigorous scientific scholarship, news, opinion, and school policy as we publish materials. In general, we do not publish personal opinions on school websites. Individuals who identify themselves as Yale faculty or staff in an editorial or on social media should note they are expressing their own opinion and not the opinion of Yale (and, if applicable, Yale New Haven Health System). Many of our faculty and students will express themselves through protest. We ask that you do so safely and follow the guidelines of the Woodward Report.

We understand that many current events cause stress for members of our community. One of our major priorities is to ensure that every member of our community feels supported and is aware of and has access to the array of institutional resources available to them (e.g., Yale Health, Yale University Employee Assistance Program, Student Mental Health and Wellness Program, the Office of Education, Student Affairs, DEI, affinity groups, and other university offices). Students sometimes ask us to communicate regarding attendance of classes during stressful times; under the Yale System our students have the flexibility to take time out from pre-clinical classes. However, for those who provide clinical care, including students in the clinical clerkships, showing up to be present for patients defines professionalism.

During the coming weeks, months, and years, we will encounter other issues that invoke strong reactions. We are at our best when we model respect in discourse. As clinicians and scientists, and as a community, we must commit to listen, to learn, and to lend our insights to the dialogue.

Sincerely,

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

Christopher M. O’Connor, FACHE
Chief Executive Officer of Yale New Haven Health System

To the YSM Community:

Today, as we mark a leadership transition at Yale New Haven Health System (YNHHS), we write as dean of Yale School of Medicine (YSM) and chief executive officer of YNHHS, to affirm our shared commitment to align further our two institutions to realize our full potential as one of the nation’s top academic health systems.

In 1965, a formal affiliation agreement codified the long-standing relationship between YSM and Yale New Haven Hospital (YNHH). In 1999, a second affiliation agreement further established the relationship between YSM and YNHHS. Since then, the health system has grown significantly, adding delivery network hospitals, each with its own history, board, and culture.

We recognize that the relationship between YSM and YNHHS has not always been easy. It has often been transactional. Yet, we also believe that a more robust partnership—one based on trust and shared strategic decision-making—will benefit not only the school and health system, but also our patients and our communities.

When we come together as an academic health system, we provide better routine care, diagnostic accuracy, and cutting-edge therapies to our patients. Never was this more evident than during the COVID pandemic, when YNHHS achieved one of the country’s lowest mortality rates among COVID patients. In addition, together we serve those who may not otherwise have access to care. Academic health systems comprise five percent of hospitals in the United States but provide 30% of indigent care.

YNHHS hospitals and care venues serve as clinical medicine learning sites, providing training for our medical students, as well as 900 residents and 400 fellows affiliated with YSM’s clinical departments. YSM provides infrastructure for research, including clinical trials, informatics using the electronic health record, and research in genetics, precision medicine, and drug development through the creation of biorepositories of clinical samples.

To achieve our goal of being one of our nation’s premier academic health systems, we must:

• Create an environment in which the chairs and chiefs of the clinical departments work collaboratively with service line leaders and hold responsibility and authority for the quality of care in their specialties and subspecialties across the system
• Develop a common strategic plan that we can implement with agility and efficiency
• Capitalize on the excellence and expertise that our faculty bring, not only to the care of critically ill patients, but also to the assurance of care consistency and the reduction of health inequities
• Embrace the lessons of teamwork, collaboration, and spirit of innovation that we learned during the COVID-19 pandemic

During the coming weeks and months, we will be restructuring meetings to enhance shared strategic decision-making and execution at all levels of our YSM/YNHHS collaboration. We also recognize the need to eliminate duplication and competition between our two institutions, including between our practice plans. We must standardize and rationalize funds flow between and within our institutions, make financial transactions transparent, tie decision-making regarding investments to our joint strategic goals, align incentives with desired outcomes, and promote our academic mission. As we embark on rethinking our future, we have engaged the Chartis Group, a consulting firm that has worked with many of our peers to increase alignment. They have been meeting with leaders and gathering data as they prepare to advise us.

The path ahead will not be easy. It will require a change in our current culture and an investment in the development of real trust. It will require a willingness to take risks for the betterment of our academic health system. It will require constant communication. We will make mistakes, and when this happens, we need to allow each other some leeway.

Our aspiration to be one of our nation’s premier academic health systems mandates better alignment and we cannot afford to fail. External forces, including health care consolidations, workforce shortages, and increased emphasis on value and access, require that we think strategically and creatively and then rapidly and nimbly execute.

We are committed to transparent and frequent communication, and we welcome your questions and feedback. Please reach out to either or both of us to share your thoughts and ideas. We thank you in advance for your support and leadership.

Sincerely,

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

Christopher M. O’Connor, FACHE
Chief Executive Officer of Yale New Haven Health System

To the YSM and YSPH Communities:

Earlier today, President Salovey, Provost Strobel, and I met with the faculty, students, and staff of Yale School of Public Health (YSPH) to share the plans for the search for a new dean and the decision to transition YSPH to become an independent, self-supporting school. We anticipate this transition will occur within a year of the appointment of the new dean.

To launch YSPH as an independent school and replace the current annual Yale School of Medicine (YSM) subsidy to YSPH, Yale University is providing YSPH with a one-time increment to its endowment. At the same time, the University is making available $50 million each in matching endowment to YSPH, YSM, and Yale School of Nursing, a remarkable investment in health care education and in the advancement of human health. We will leverage these matching funds as we raise philanthropy to support scholarship and training.

Yale School of Public Health was founded in 1915 as the Department of Public Health under the leadership of Charles-Edward Amory Winslow. In 1946, the school was accredited as a School of Public Health. Since then, YSPH has existed as both an accredited school with a dean who reports to the president of the university and as the Department of Epidemiology and Public Health within Yale School of Medicine.

For more than 100 years, YSPH has contributed to the field of public health through innovation and collaborative science, learning, and action. From groundbreaking research on infectious diseases like HIV/AIDS and Ebola, to a myriad of contributions during the COVID-19 pandemic including test development, vaccine hesitancy messaging, contact tracing and policy development, and modeling and forecasting, the school has helped to shape Yale’s—and the world’s—public health response.

The experience with COVID highlights the value of cross-disciplinary collaboration not only within the university but across our community. Our efforts to combat this common enemy has led to new collaborations among the schools of engineering, medicine, arts and sciences, and law, among others. Going forward, faculty in YSM and YSPH will continue to collaborate extensively and share resources to avoid duplication or competition. We will have opportunities to create structures that cross school boundaries, as exemplified today by the Yale Institute for Global Health.

Over the last several months, the university has solicited input from members of the YSPH community. I have also had the opportunity to speak with deans of schools of public health and schools of medicine around the country, and with chairs of departments in both YSPH and YSM. The deans carefully outlined the pros and cons of an independent school of public health. “It will enhance Yale’s ability to recruit the highest caliber of new leadership.” “Your NIH ranking may drop as NIH funding for YSPH is no longer attributed to YSM.” To a person, however, our chairs recognized that both YSM and YSPH will grow stronger together as independent partners. Advancing human health through scholarship, education, and care is not a zero-sum game. Please join with me as we celebrate a milestone in the history of our sister school.

Sincerely,

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

To the YSM Community:

February 1 marks my second anniversary at Yale. Two years ago, we published the first Beyond Sterling Hall, “Listening.” Since then, I have been buoyed by our listening sessions and continue to learn from you. I am humbled by your excellence and your commitment to your work. I am also continually reminded how difficult it is to communicate effectively. As I quoted George Bernard Shaw two years ago: “The biggest problem in communication is the illusion that it has taken place.” For this reason, I thought I would feature some of the ways faculty, staff, and students can stay abreast of what is happening in the school.

Beyond Sterling Hall is published monthly and provides background on strategic conversations and initiatives in the school.

During the State of the School each June, I highlight past accomplishments and events and review the goals for our school for the coming year. I will continue to present the State of the School twice by Zoom each year to enable as many as possible to attend. If you cannot make one of those presentations, you can find the recorded talk online here.

Each year, we hold departmental town halls after the State of the School to provide you with the opportunity to probe topics and to raise new issues. At times, we have held a shared town hall for two departments. Beginning next year, we will meet separately with each department to facilitate open conversation.

There are several important resources that provide current information about plans for the school:

The minutes of the monthly Faculty Advisory Council (FAC) meeting with the dean are posted online. Your FAC representative likely shares this with you in departmental meetings, but you can delve more deeply by reading the minutes.

The minutes of the weekly meeting of the YSM Executive Group, comprised of the chairs and the deputy deans, also appear online. If you were to peruse the minutes of the last several meetings, you would find that the Executive Group approved the extension of paid time off for faculty child-rearing leave from eight to 12 weeks. You would also learn that YSM is contributing money to increase the number of three-year predoctoral slots available. You would read about Deputy Dean Illuzzi’s plans to provide specific effort support for key roles and high intensity teaching in the medical school. Your chairs communicate much of this information to you in their newsletters and faculty meetings, but reading the minutes of the Executive Group may add another layer of understanding.

We publish announcements of searches and requests for nominations. We request nominations for internal positions to ensure that we cast a wide net and do not miss any potential candidates. This also enables faculty to share with us their specific interests and capabilities.

Each week, we publish two digital newsletters: News and Recognition is a recap of the week’s top news stories and recognizes the accomplishments of faculty, students, and staff. YSM Events highlights the week’s activities and includes announcements of funding opportunities, training, and more. If you don’t already receive these publications, you can sign up here.

Our communications can always be improved, however. For instance, two websites that have been recently revised are the Office of Academic and Professional Development (OAPD) and the Office of Diversity, Equity and Inclusion (DEI). Overall, we recognize that our web pages are too numerous and hard to navigate, and we are in the planning stages of a major project to transform our web presence to be more audience-focused and user-friendly. You will be informed as we move forward with the work, as it will affect us all. Look for more communications about this project throughout 2022.

Sincerely,

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

To the YSM Community:

The SARS-CoV-2 pandemic has reminded us of the power of rigorous observation, critical thinking, and scientific discovery. We have witnessed how the application of basic discoveries made over many decades can culminate in the rapid development of vaccine technology. Lessons we have learned about the immune response to SARS-CoV-2 have shifted our understanding of chronic diseases such as diabetes, obesity, and hypertension.

The pandemic has also highlighted the need for continued investment in infrastructure for discovery. Even as we focused on keeping laboratories open and supporting individual investigators, we also engaged in strategic planning to ensure that we can continue to lead discovery in the future. Today, I would like to highlight work in two areas intended to enhance our research capabilities.

Space — the Final Frontier

Even prior to the pandemic, YSM was space constrained. This has been exacerbated as construction projects were delayed during the spring of 2020 and as the hospital has attempted to create more capacity for patient care. Fortunately, laboratory construction is back on track and we will be expanding our laboratory footprint within two to three years. Approximately 143 new workstations will come online in 100 College Street in 2023. Additional workstations are projected in 101 College in 2024. In 300 George, 110 new workstations will become available on the third and sixth floors in late 2023 with an additional floor opening in 2024 or later. In addition, we anticipate opportunities to create office space capacity as some workers continue to work remotely.

Nevertheless, until these construction projects come to fruition, we must be smarter about how we use space if we are to continue to grow our research programs over the next few years. While research funding per square footage of laboratory space is high at YSM compared to our peers, this density of funding is not consistent across departments. Among basic science departments, the ratio of facilities and administration (F&A) dollars to workstation in wet labs ranges from $16,102 to $41,330. Among clinical departments, the range spans from $97 to $46,364 per workstation. There is similar variation in the ratio of F&A dollars per dry lab space. Likewise, departments vary widely in their allocation of office space to faculty and staff.

To enable uninterrupted recruitment of faculty and program growth, we must rationalize space allocation and be more disciplined and efficient in our processes for assigning space. To this end, about six months ago, I tasked a group of chairs, deputy deans, and administrators to develop a policy for space allocation for the next few years. This policy was reviewed by the Faculty Advisory Council and ratified by the YSM Executive Group. It is designed to rationalize space allocation and ensure an equitable and transparent process. Departmental lead administrators will coordinate the administration of the policy. At times we may have to take difficult actions, such as downsizing the laboratory footprint of investigators who have a significant and sustained decline in or loss of funding. This work is not easy, but it is essential. Demonstrating discipline in this area will also resonate with the philanthropists who may consider investing in our missions during the capital campaign.

A “Central” Biorepository

During the pandemic, we saw the power of coordinated sample collection in a biorepository linked to our robust data warehouse. YSM investigators have collected genetic samples and tissues from patients with rare and common disorders over many years. Today, over 160 laboratories or investigators at YSM have active tissue banking protocols; however, these protocols are not coordinated, and procedures are not standardized. The result is that samples may not be collected to optimize their use for such organoid cultures, cell lines, or molecular studies, and opportunities for collaboration may be lost.

In April, I asked a task force led by Chen Liu, chair of Pathology, to develop a plan to establish an institutional biorepository that would allow for coordinated collection of tissue, plasma, serum and genetic samples, and clinical data, using common processes and information systems. The group surveyed leading institutions with centrally coordinated institutional biorepositories. They developed a plan for a College of American Pathologists (CAP)-accredited biorepository that would facilitate rigorous phenotyping of samples, and coordination of proteomic, metabolomic, and genomic analyses to enhance the identification of therapeutic targets and diagnostics. It is envisioned that the biorepository will function as a core that will provide standardized biospecimen acquisition, processing, storage, and distribution for investigator-initiated or programmatic tissue collection. While some investigators may wish to continue to collect and store samples locally, we have identified freezer farm space in the Temple Medical Building. We have committed funding to initiate development of this biorepository and the group will move forward with implementation. In a closely related development, we have received philanthropic support for the development of a unique biobank of brain tissue. We anticipate that investment in these resources will catalyze discovery for many years to come.

As we look forward, we have amazing opportunities to make discoveries that will transform our understanding of human health and disease and lead to innovative strategies of prevention, diagnosis, and treatment. It has never been more important to create and to shepherd the resources that support this work.

Sincerely,

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

To the YSM Community:

During this month of Thanksgiving 2021, I am drawn to reflect on the meaning of philanthropy. On October 2, Yale University unveiled the public phase of a $7 billion capital campaign. The title of the campaign, For Humanity, may seem like hubris to some. Rather it is meant to convey that the work we do here must have impact far beyond Yale. It captures the meaning of the word philanthropy, from the Greek “phil,” love, and “anthro,” human.

The campaign pillars—Science for Breakthroughs, Collaboration for Impact, Arts and Humanities for Insight, and Leaders for a Better World—are extraordinarily aligned with the priorities of Yale School of Medicine. Investments in neuroscience, inflammation, biomedical informatics, and cancer will all contribute to Science for Breakthroughs. Efforts to promote multi-disciplinary team science and to invest in shared resources such as biorepositories support the priority of Collaboration for Impact. Our goals to make medical education debt-free, expand support for graduate students, invest in physician-scientists, and promote diversity and belonging advance the priority of Leaders for a Better World.

A campaign with specific goals may seem to exclude important areas for investment. On the contrary, when philanthropists make investments in one area, it frees up money to invest in others. All boats rise. In addition, some donors energized by the campaign may identify specific areas in which they are motivated to invest. The campaign creates the opportunity to introduce that donor to faculty and programs and often leads to long-term relationships. Thus, the role of leaders at Yale School of Medicine is to articulate a vision, impart confidence to donors, steward their investments, and engage our faculty and staff. We benefit from a relationship of mutual trust and respect with our development colleagues.

How can you contribute to philanthropy efforts for Yale School of Medicine? First, be prepared to articulate what makes us truly unique. What are those things that differentiate Yale School of Medicine—the science we pursue, the education we offer, the clinical care we provide—from others? Develop your “elevator pitch,” a succinct statement about your work and why it is important. In that way you will be ready when a donor asks you to describe your vision and needs. Next, recognize when someone is inviting you to suggest a need. Those of us who are physicians often experience discomfort when a patient or family member asks “how can I help?” We understand the importance of avoiding conflict of interest in the physician-patient relationship. In those moments, the physician-patient relationship is paramount, but it is also important to recognize that for many of our patients and their families, philanthropy serves not only as a means to express gratitude but also as a way to exert control over an illness and to prevent others from suffering. We can honor that need by acknowledging the desire, articulating our own commitment to the physician-patient relationship, and referring them to a third party in development who can work to understand and enable their vision, allowing us to remain focused on care.

Lastly, it is important that we “walk the walk,” and give back to our community. Some may feel that we give to the community through our work, but it is important to differentiate citizenship from work. Many of our faculty and staff give to the community by contributing their time. For those developing their careers or with young families or elders for whom they care, time is a precious commodity. Still, many of you manage to find ways to give of your time in a way that is aligned with your family obligations, such as volunteering at a school, making volunteer work a family outing, or participating in support groups where you help others by sharing your experience.

With continued gratitude and amazement for all that you do,

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

To the YSM and Alumni Communities:

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.

Another thing that I loved about this story was how many people forwarded it. I imagine that was in part because the story reminds us that what differentiates the academic health system is our ability to attract committed and curious people. The ways in which our faculty and trainees save lives are not always as dramatic as in this case, but no less worthy. Indeed, the celebration of heroic saves should not detract attention from the need to attend to the day-to-day tasks that routinely prolong life. To provide the highest level of care and optimize the health of all, we must standardize routine tasks and introduce systems that minimize error across the Yale New Haven Health System. As our clinical mission statement reads, “We care for patients with compassion, and commit to improving the health of all people.” We need to apply the same commitment and energy that we devote to the care of our individual patients to the endeavor of optimizing health across the system and our community.

Achieving this level of care requires that the chairs of our clinical departments, as physicians- and surgeons-in-chief, have authority and responsibility for standards of practice across the system. It requires that chairs work closely with nursing, service line, and delivery network hospital leaders to operationalize best practices across our operations. It requires that each of us is invested in realizing these best practices. To this end, a task force of Yale New Haven Health System and Yale School of Medicine leaders, chaired by Murat Gunel in collaboration with Chris O’Connor, spent the better part of the last year developing a document that codifies the role of chairs across the system. It was particularly meaningful to me that one of the people who forwarded the Sanders column was a participant in the task force—Patrick Green, president, and CEO of L+M Healthcare.

Achieving the highest level of care also requires that our patients can access us. We must address barriers to timely appointments in the clinic. Under the leadership of Dr. Paul Taheri, Yale Medicine made progress in this area, and under interim CEO Babar Khokhar, we will work with the system to advance this work. In the hospital, we must address inefficiencies that prevent us from discharging patients who are ready for release. In the last few weeks, high occupancy rates and staffing shortages have prevented us from providing access to some patients in a timely fashion. What would have been the outcome if we had had to deny transfer of the patient in the story because the hospital was too full? To address this crisis, we must employ the same creative strategies and teamwork that we utilized during the pandemic. With this in mind, we are reconvening the group of school and hospital leaders that met weekly during the height of COVID-19 to tackle these challenges.

To provide the very best care of which we are capable and to make clinical research more accessible, we must also align strategic planning and decision-making across our academic health system. This will require careful delineation of responsibilities and elimination of duplication between the school and the health system and within each of our institutions. This in turn will require that we reimagine our coordinated leadership structures. Over the last 18 months CEO of Yale New Haven Health Marna Borgstrom and I began early work in this area. Chris O’Connor, recently designated as the incoming CEO of Yale New Haven Health, and I are committed to continuing this work and will be engaging many of you in the months to come.

The case described by Dr. Sanders gives us hope and reminds us of the fundamental reason we are here—to care for and sometimes cure individual patients and to advance human health. Let us carry that with us as we do the work with which we have been entrusted each day.

Sincerely,

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

To the YSM and Alumni Communities:

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.

As a dean now interested in knowing that our faculty are receiving annual feedback, I feel as if I am experiencing, to quote Yogi Berra, “déjà vu all over again.” During Listening Meetings, a hunger for regular feedback has emerged as a common theme among faculty members. In leadership meetings, department chairs invariably report that they provide feedback to faculty in their department.

Annual reviews serve as a forcing function for both the faculty member and the section chief or chair. They require faculty members to reflect on their aspirations and develop goals, contemplate their progress, and identify and communicate obstacles. They provide the opportunity to “manage up,” share their successes and ensure that the section chief or chair is aware of their vision for the future. For the section chief or chair, the annual meeting provides the opportunity to appreciate hidden talent, detect problems early, remove barriers or provide lacking resources, recognize patterns in an area under their leadership, understand better how to sponsor each faculty member, and retain rising stars proactively.

Annual reviews are as valuable for senior faculty members as they are for younger colleagues. The review provides the same opportunity to pause for reflection, highlight programmatic successes, identify obstacles, share the vision for the section or department, provide feedback to leaders, and promote junior faculty under their supervision. To this end, the chairs and deputy deans and I meet each year. In turn, I meet with President Salovey and Provost Strobel to review the success and misses of the last year and articulate the school’s goals for the coming year.

Why don’t annual reviews happen, then? For starters, they take time. For large departments, it may not be feasible for a chair to meet with every faculty member. In many cases, it is more appropriate for section chiefs to meet with faculty, and an hour a week is not too much to ask of a leader. Faculty further may not appreciate that they can initiate the process by requesting a meeting. In fact, in the case of the residency review mentioned above, the strategy that was eventually effective in increasing the proportion of responses was empowering our residents to ask for mid-rotation feedback.

As we return to campus, I would like each of us to renew our commitment to ensuring that all faculty meet annually with their section chief or chair. For the latter, this will require a determined commitment to meeting with each faculty member and the engagement of administrative support. For faculty, it will require the initiative to ask for what you need – that is to request a meeting if you have not had one in the last year. If you do, you will likely be surprised to hear a thank you. To support this work, the Office of Academic and Professional Development will disseminate several templates to assist faculty with reflecting and preparing for the meeting and to facilitate thoughtful discussion and feedback.

Sincerely,

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

To the YSM and Alumni Communities:

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.

On April 6, an invited speaker gave Grand Rounds at the Child Study Center (CSC), with the provocative title “The Psychopathic Problem of the White Mind.” After the event, faculty members from diverse backgrounds expressed concern about the content of the talk through the reporting system of the Office of Academic and Professional Development (OAPD) and to the Office of Diversity, Equity & Inclusion.

I reviewed the video along with Deputy Dean for Diversity and Inclusion, Darin Latimore. We found both the content and the tone of the talk to be antithetical to the values of our school. Because Grand Rounds are typically posted online after the event and in consideration of Yale’s commitment to the right of free expression, we sought the guidance of university experts on freedom of speech and reviewed the Report of the Committee on Freedom of Expression at Yale.

In deciding whether to post the video, we weighed our grave concern about the hostile speech, imagery of violence, and profanity expressed by the speaker against our commitment to freedom of expression. Even hateful speech is protected under the First Amendment in our country. We ultimately decided to post the video with access limited to those who could have attended the talk—the members of the Yale community. To emphasize that the ideas expressed by the speaker conflict with the core values of Yale School of Medicine, we added the disclaimer: “This video contains profanity and imagery of violence. Yale School of Medicine expects the members of our community to speak respectfully to one another and to avoid the use of profanity as a matter of professionalism and acknowledgment of our common humanity. Yale School of Medicine does not condone imagery of violence or racism against any group.”

Since the Grand Rounds, the CSC has begun to wrestle with several fundamental questions. Why was a speaker without an academic affiliation invited to give Grand Rounds and did the inviters understand the nature of the talk? Once the speaker sent the title of her talk and the learning objectives, why was the talk not cancelled? Why did no one intervene when the speaker began to use images of violence against a specific racial group? And most importantly, how do we ensure that our discourse is always civil? Deputy Dean Latimore has been engaged in these conversations. The CSC has already made changes to its processes for vetting speakers.

Until Friday, these conversations and deliberations have taken place in the department where the event occurred. On Friday, however, a news site published an apparent soundtrack and excerpts from the talk. In response, Yale School of Medicine posted a statement on the CSC website.

In the coming weeks and months, we, as a school, will continue to engage in self-reflection and dialogue about how to create a safe and inclusive environment and how to live our core values. We must continue to have zero tolerance for racism. Some who heard the April 6 Grand Rounds interpreted it as an expression of frustration and anger, but the speaker crossed the line when she spoke about imagining violence against others. As physicians, students of medicine and science, and staff engaged in patient care, education, and discovery, we value human life above all else.

As we review this specific event, we must hold ourselves accountable and look for and correct system failures. We must continue to demonstrate the behaviors we expect of others and listen to and treat each other with respect. Importantly, we cannot let others define us or obscure the good work we are doing every day to realize our mission:

Yale School of Medicine educates and nurtures creative leaders in medicine and science, promoting curiosity and critical inquiry in an inclusive environment enriched by diversity. We advance discovery and innovation fostered by partnerships across the University, our local community, and the world. We care for patients with compassion, and commit to improving the health of all people.

Sincerely,

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

To the YSM and Alumni Communities:

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.”

We will finish this year in the black and better than anticipated, largely due to two positive outcomes. First, clinical volumes increased earlier than expected in the beginning of the year. When we developed our budget for FY21, we anticipated that we would see a second wave of COVID-19 patients, although we did not expect it to have as great a financial impact as the first, because we would now have adequate testing capability and personal protective equipment, and we had become better at treating patients with COVID-19. This has proven to be true. Second, interest on our reserves exceeded expectations due to a stronger than anticipated financial market. In addition, through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, we received some funds that offset a portion of our clinical losses.

Throughout the past year, we have worked to become more efficient and to reduce expenses. Integration of our business offices has allowed us to leverage resources across departments. Our travel and entertainment expenses were, as expected, dramatically lower during the pandemic. These savings allowed us to invest in gap funding for our younger researchers and to invest in our strategic goals, including advancing diversity, equity, and inclusion; supporting mentorship and career development; and enhancing our research infrastructure.

We still face long-term economic challenges that pre-date the COVID-19 pandemic. For example, the current funds flow model within the school is overly complex and not always aligned with the academic mission. Clinical revenues and grant revenues accrue to departments, but educational and research expenses are often centralized. Over the years, we, like other schools of medicine, have developed a complex series of taxes and rebates that make it difficult to attribute revenues and expenses or link them to outcomes. In fact, we have created an administrative burden and new expenses.

Second, even as we work to control expenses in YSM, the cost of University services (i.e., grants management and IT costs) rose sharply last year, and this is not sustainable. We are working with the Provost’s office to develop a methodology to enable the school to have more control over these expenses, and I am very grateful to Provost Strobel for his support.

A group of leaders in YSM has begun the task of examining our internal funds flow model with the goal of simplifying it and aligning funds flow more readily with our missions. The group includes chairs, lead administrators, and leaders of the clinical, research, and education missions. We expect that the group will offer recommendations in late summer. We will model any suggested changes for the remainder of the fiscal year before implementing them.

As when we faced the financial impact of COVID-19, we will follow a set of guiding principles as we pursue this work. Our financial models must reflect our strategic goals. We must share data in a transparent way and without shame and hold each other accountable for reaching our goals. We must respect the autonomy of departments, while eliminating duplication, competition, and siloes. Change is not easy, particularly when money is involved. We are committed to an iterative process to ensure that we do not create unintended consequences.

We will make value-based decisions that will make Yale School of Medicine stronger for many years to come.

Sincerely,

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

To the YSM and Alumni Communities:

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.

When we consider medical education, we often conceive of the integrated medical student curriculum that covers fundamental science, physiology, anatomy, pathology, pharmacology, epidemiology, and health equity as well as professionalism, ethics, and clinical skills. Importantly, all YSM faculty members have the opportunity to teach even when teaching is not a focus of their appointed track (as is the case for the Investigator and Clinical tracks). Teaching distinguishes us as faculty at a school of medicine, rather than scientists in a research institute or clinicians in private practice. Teaching also enriches our professional lives. Any busy clinician has had the experience of gaining a new understanding of a patient after seeing that individual through a student’s or resident’s eyes and taking the time to discuss the differential diagnosis, pathophysiology, and factors influencing therapeutic decision-making. Similarly, what investigator has not become reinvigorated or shifted their research direction because of the novel observation and enthusiasm of a student or fellow?

The variety of teaching opportunities at Yale School of Medicine exceeds that of an undergraduate campus, where classroom lectures and seminars are the usual settings for teaching. At YSM, teaching just as commonly takes place at the bedside or the laboratory bench, in small groups, in simulation centers, and often involves mentorship and coaching. Many of our faculty devote hours as thesis advisors or serving on educational committees, such as the admissions, clinical assessment, and curriculum committees. For this reason, it is paramount that we develop effective ways to evaluate and communicate the educational activities of our faculty. The Teaching and Learning Center offers many resources here. For faculty under consideration for promotion to associate professor with tenure or professor on any track, the TLC provides the teaching summary letter—a standardized summary of faculty members’ teaching activities, including educational leadership, curriculum development and scholarship, mentoring activities, evaluation of teaching by students and residents, and other educational contributions.

How then do we value education? Education is not a commodity for which one can pay a unit price. In fact, commodifying educational efforts can reduce creativity. As Daniel Pink notes in his book Drive, what motivates our educators is autonomy, mastery, and purpose. For this reason, in our recently revised Guidelines for Faculty Compensation Plans, we do not attempt to define a unit of teaching, but instead characterize the effort that is expected to be dedicated to educational and scholarly activity on each of our faculty tracks.

At the same time, we must develop new strategies to provide protected time for leaders in medical and graduate education. In undergraduate medical education, examples of leadership positions include clerkship directors, course directors, and thread leaders. Today a few key positions are supported centrally. In addition, some monies supporting the education mission are conveyed to departments based on a formula set in 2007 and not tied to any specific educational roles within the department. During the coming weeks, Deputy Dean for Education Jessica Illuzzi and her team will be defining specific roles in undergraduate medical education that will be supported through those funds. A similar model is already in place for graduate medical education where residency program directors, for example, receive specific support. We must also standardize support for fundamental roles in PhD programs, such as directors of graduate studies.

Ultimately, those who teach do so because they find reward in learning anew and in developing others. Through teaching we express one of our core values, generativity.

Sincerely,

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

To the YSM and Alumni Communities:

“Judge Smails: Ty, what did you shoot today?
Ty: Oh judge, I don’t keep score.
Judge Smails: Then how do you measure yourself with other golfers?
Ty: By height.”

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.

In the last few weeks, the Blue Ridge Institute of Medical Research rankings for National Institutes of Health (NIH) funding were released. Yale School of Medicine moved from 6th to 4th in the rankings with a 13% increase in NIH funding to $512.1 million. This is a reflection of the creativity, talent, and hard work of our investigators and of the commitment of our staff who support the submission of grants and management of the research enterprise. It is not, however, the only measure of our research enterprise or even necessarily the best. Others include bibliometric measures, such as publications in high impact journals or the number of collaborative publications or citations per publication; the number of careers launched; numbers of Howard Hughes Medical Institute investigators; members in the national academies and other national honor societies; Lasker awardees; Nobel laureates; and drugs or technologies developed. Like NIH funding, many of these are measures of inputs when what we would like to measure is an output—the impact of our discoveries on human health.

Sharing data creates transparency and illuminates areas that need attention. Tracking and sharing turnaround times for contracting and similar performance metrics for cores, for example, will provide useable information that anecdotes cannot. Data do not elucidate etiology but can direct us to areas that require deeper analyses of root causes. Providing data year-over-year also permits the recognition of trends. At the State of the School I shared information regarding the proportion of women and those traditionally underrepresented in medicine at each rank among ladder track faculty. We will review these data every year so that we can follow our progress.

The faculty portion of our Diversity Strategic Plan now appears on the Office of DEI website and includes the measurement and annual reporting of many metrics. Understanding that 27% of our students belong to underrepresented ethnic or minority groups and that our students often go on to become faculty, the plan focuses on inclusion, mentorship, sponsorship, and proactive retention. The plan emphasizes leading indicators, those in which one can readily assess year-over-year progress, because we believe that improvement in leading indicators will drive improvement in lagging indicators, the ultimate outcomes. The plan does not set annual goals for any of the leading indicators yet, because we must first collect baseline data. We hypothesize that making data visible alone will drive change.

In cases where national benchmarks exist, we must decide to what extent these benchmarks should define our goals. For example, in the clinical arena, benchmarks for metrics of quality and service such as central line-associated blood stream infections (CLABSI), surgical site infections (SSI), or time to third-next available appointment are well-defined, and we should exceed them. In some spheres, such as education, we may lead the development of novel new ways for students to assess themselves. Where national benchmarks suggest that no institution is performing optimally, such as benchmarks for faculty diversity, we will need to create goals that make us stretch. What we choose to measure speaks to our values.

Lastly, data must never be used to shame. If we are to create a culture in which we leverage data to identify and address problems, we must create safe spaces where we can share our challenges and speak honestly about areas where we are underperforming. Such true transparency requires courage. The task should be to remove obstacles, not to place blame. This does not mean that we do not hold ourselves accountable. Rather, we should understand that each of us is responsible for the success of others and for the whole.

“So [we] got that goin' for [us], which is nice.”

Sincerely,

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

To the YSM and Alumni Communities:

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.

As we start a new year, I have been thinking about discipline. We have accomplished much during the last year, but we aspire to achieve even more. To execute on our plans to develop our talent, grow transformative research programs, enhance accessibility to cutting-edge clinical care for all, and increase diversity and inclusion, we will need to be disciplined.

In academic medicine, we value autonomy and often equate it with creativity. An overemphasis on autonomy can create duplication, however, whereas efficient, well-documented processes and clearly defined boundaries can paradoxically provide groups with the time and the freedom to discover and to innovate. In addition, autonomy sometimes conceals narcissism or tribalism that undermines our ability to reach common goals. “Strategic planning” becomes independent individuals or units advocating for their own needs. In the coming years, we will work to develop a practice of strategic planning that engages all stakeholders, identifies our strengths and differentiators, recognizes potential weaknesses and obstacles, and articulates a common vision with a plan to achieve it.

In the absence of discipline, academic communities often create redundant structures. We tend to love committees. Committees are generally effective at identifying issues and in giving stakeholders a sense that they have been engaged, but less effective at implementing solutions. In fact, cynical administrators have sometimes utilized committees to slow progress. In her book Yale Needs Women, Anne Gardiner Perkins, YC ’81, relates that President Kingman Brewster often appointed committees to stall actions.

Many of our standing committees such as the Faculty Advisory Committee (FAC) and our faculty and student affinity groups are vitally important as venues for bidirectional communication. To execute on our goals, however, we will tap task forces with specific objectives, such as the recent task force on Physician Scientist Development led by Peter Glazer and the Wellness Task Force led by Bob Rohrbaugh. We will delegate responsibility, commit to timelines, hold ourselves accountable for meeting those timelines, and communicate our outcomes. Only then, will our community gain trust in our ability to deliver.

To hold ourselves accountable, we must also become comfortable with sharing data about our performance. This should include everything from metrics of clinical excellence and research impact, to measures of diversity and inclusion, to the functioning of cores and administrative operations such as contracting. We must create a culture in which we respond dispassionately to data to identify problems and address them. We must also understand that to reach our goals, we must take risks and we will sometimes fail; we must make YSM a safe place to share our failures, as well as our successes.

Lastly, as a highly functioning organization we must also be disciplined about taking breaks. During the COVID-19 pandemic, we have developed bad habits. We jump from Zoom meeting to Zoom meeting without time for reflection. Our work hours have expanded as we have responded to each challenge. Yet, functioning at a high level requires taking time to reflect, process, plan, and rejuvenate even when it does not seem convenient or possible. This concept underlies our triennial and sabbatical leaves policy. This is the reason that, while faced with a larger than usual number of faculty coming forward to take leaves following the COVID-19 pandemic, we are committed to honoring the ability of faculty to take well-planned leaves to the extent that clinical responsibilities permit. I would propose that we also commit to a weekly pause and agree to minimize email communications during a 24-hour period from noon on Saturday through noon on Sunday.

We have extraordinary talent at YSM. There is no end to what we can achieve with discipline.

Sincerely,

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

To the YSM and Alumni Communities:

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.

Similarly, in the last year investigators at Yale Cancer Center led clinical studies that led to new FDA approvals of four anti-cancer therapies. Those therapies were grounded in scientific discoveries made decades ago. As an example, the approval of osimertinib for the treatment of advanced non-small cell lung cancer with certain EGFR mutations is grounded in the discovery of EGF over 60 years ago and the identification of driver mutations in EGFR 16 years ago.

Yet today science is under siege. Anti-vaccination campaigns undermine science-based approaches to infectious diseases. Deep and appropriate concern over racial constructs has led to distrust of genetic studies and has undercut efforts to advance understanding of the molecular basis for diseases. Skepticism regarding scientific reproducibility and the expertise of “elites” in academia challenges support for research funding. Pressures to realize early returns on investment particularly disadvantage fundamental research.

Challenges to science are sometimes driven by well-meaning instincts. Recently a student asked me if we should eliminate all science requirements for entrance to medical school. Implicit in the conversation was a concern that training in science might compete with selection for compassion. That is a dangerous false dichotomy. A lack of understanding of the mechanism of disease(s) or response to therapies can kill our patients. Compassion for our patients must drive us to understand each of them as an individual and the factors that affect their care but must also drive us to make discoveries and increase knowledge.

Similarly, a mechanistic understanding of pathophysiology advances public health. In the 1970s my grandfather suffered from peptic ulcer disease. I remember his lying on the floor after dinner until the pain went away. His doctor told him to stop smoking and drinking and to eliminate stress. Indeed, a large epidemiological study published in the New England Journal of Medicine in 1974 confirmed an association between cigarette smoking and peptic ulcer disease. Had investigation stopped with that observational study, however, our approach to peptic ulcer disease would be very different today. Instead, the discovery by Marshall and Warren of curved bacilli in the stomach of patients with peptic ulcer disease, followed by hypothesis-testing (self-) experimentation, transformed our understanding of peptic ulcer disease, gastritis, and gastric cancer. Today we recognize that H. pylori causes widespread chronic infection and contributes to cancer risk worldwide.

Fundamental to the scientific method are critical thinking and review of the literature, hypothesis generation and testing, and agnosticism about the outcomes. (The most exciting experiments are those with unexpected results.) Yet how often during the SARS-CoV-2 pandemic have we seen leaders and citizens anchor on a media report or embrace data that has not yet undergone peer review to support an emotionally held view? A commitment to science and the scientific method underlies the Yale System of Medical Education. It is embodied in the words of our new mission statement. As members of Yale School of Medicine, I ask that we recommit to the pursuit of scientific ideals.

Sincerely,

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

To the YSM and Alumni Communities:

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.

As Thanksgiving approaches, I feel compelled to share a few examples of how we continue to move forward despite the pandemic and to express my gratitude for all you are doing to make this possible.

The history of our school will record the extraordinary efforts of our clinicians and the health system to move whole wards to create capacity and to care for over 5,000 COVID-19 patients to date. The “front line” included not only physicians and nurses, but also clinic, hospital, laboratory, facilities, and security staff who facilitated our ability to provide care for these patients. A team of IT and clinical staff rapidly developed and implemented new Telehealth platforms so that patients could safely receive care in their homes. The Phyllis Bodel Childcare Center kept its doors open, enabling parents to come to work. Our virologists developed the first test for COVID-19 approved in an academic medical center, setting the stage for the later development of SalivaDirect as an economical screening test. Creative innovators manufactured and tested personal protective equipment (PPE) and ventilator valves. I learned recently that one of our senior leaders (with the initials FB) rendezvoused with a supplier at a rest stop on I95 to purchase PPE. Our community partners advised us on how best to keep our patients informed. Teams of volunteers from psychiatry, psychology, and social work tended to the emotional needs of our caregivers.

Behind the scenes, YSM Communications stood up the covid.yale.edu website in record time to provide a platform for people across the university and the world to collaborate in understanding and fighting the virus. Clinical trial staff from many departments supported COVID trials and became the backbone of these efforts. The IRB worked rapidly to vet and approve protocols. The development team adapted quickly to a virtual platform and pivoted to raise much needed funds to support COVID-19 research, as well as needs for PPE. Our colleagues in Environmental Health and Safety (EHS) worked tirelessly to enable labs to reopen safely in June. Staff of the Yale Animal Resources Center (YARC) maintained animal colonies so that work could progress. Our custodial team has kept the school spotless. The Office of Faculty Affairs staff converted processes to an electronic system to expedite critical hires, moved Appointment and Promotion and Board of Permanent Officers meetings to a virtual format, and collectively facilitated the promotion of over 175 faculty.

This summer we brought medical students back to campus for clinical clerkships and electives, as well as hybrid education during the first and second years. While many schools held virtual White Coat ceremonies, we convened in person to welcome our first-year students to the profession. This was all made possible through the diligent work of medical education staff and members of the Yale Office of Facilities. Over the last 11 weeks I have learned so much from the Class of 2024 as we met in small groups—that we could attract this extraordinary class speaks to the creativity of those who orchestrated our virtual Second Look weekend. Many of our pre-clinical students have come to campus every day throughout the fall and have appreciated the ability to study in the Cushing Whitney Medical Library, thanks to the commitment of library staff to keep it open and available to students. I am grateful to the leaders in medical education who have met oftentimes daily to troubleshoot everything from training our faculty to use virtual platforms for medical education, to ensuring adequate supplies of PPE, to navigating travel policy; to our clinical department leadership who have worked creatively to make preceptorships and shadowing opportunities available to physician associate and medical students; and to the staff in medical education who have arranged for rooms and meals and kept the wheels turning.

Today our physicians and nurses are caring for COVID-19 patients while maintaining the pace of care of non-COVID-19 patients. Our clinical staff have worked tirelessly to facilitate patient testing and scheduling to enable this. Our Coordination, Appointment, Referral & Engagement (CARE) team has adapted to new protocols after moving their operation off site. These efforts are not limited to New Haven. In the last few months, I have had the honor of visiting and witnessing extraordinary work at Greenwich, Bridgeport, and Lawrence + Memorial hospitals, as well as at the West Haven Veterans Administration (VA) Hospital.

Throughout the summer and fall, we rewrote the mission statement of our school. Over 1,500 of you contributed to this process led by Ayaska Fernando, Mary Hu, and Cynthia Dwyer. In January, Dr. Jessica Illuzzi will succeed Dr. Richard Belitsky as deputy dean for education, and I am grateful to the search committee and numerous interviewers who invested so much time in identifying the right person for this important role. No search would be possible without the administrative prowess of Rowan McWade and our administrative team in the dean’s office.

As the inaugural associate dean for health equity research, Dr. Marcella Nunez-Smith is already making an impact as a co-leader of President-elect Biden’s COVID-19 Advisory Board. I am grateful for our faculty, led by Drs. Michael Schwartz, Nancy Angoff, Beverly Sheares, and Douglas Shenson, who have transformed the Introduction to the Profession course and in October convened an annual curriculum retreat focusing on “Approaching racism through science, knowledge, and pedagogy.” With input from students, faculty, and experts from within and outside YSM, the Health Equity Thread will provide a longitudinal curriculum that extends across all years of medical training. At the same time, faculty, staff, and students throughout the school have gathered to engage in honest dialogue about diversity, equity, and inclusion. The Office of Diversity, Equity & Inclusion, led by Dr. Darin Latimore, has worked tirelessly to advance the conversation and provide resources.

YSM scientists continue to make important contributions throughout the pandemic. This includes not only high impact publications related to immunobiology and COVID-19, but also seminal papers regarding novel cancer therapies, neurosciences, behavioral health, cardiovascular disease, obesity and diabetes, and the microbiome, to name a few. Grant funding from the National Institutes of Health (NIH) has increased approximately 8% in the last year. To date, our faculty have garnered $20.2M in COVID-19 related funding from the NIH. None of this could have happened without the dedication of our laboratory staff and the support of our pre-award and post-award teams. Joe Vellali and the stockroom staff reworked their business model and creatively sourced materials to keep labs supplied. Construction of a new vivarium at 300 George and on the renovation of laboratories continues, and work will soon begin at 100 College. Approximately 115 research-focused faculty members have applied for and received COVID-19 gap funding to date to support their nascent research programs. I am grateful to the departments for contributing to this funding and to mentorship committees for advising faculty. By finding efficiencies, our lead administrators have enabled us to continue to invest in faculty and research. Drs. Jonathan Grauer and Sam Ball, associate deans for faculty affairs, are developing resources to support the careers of our clinician educators. Effective December 1, Dr. Keith Choate will assume the position of associate dean for physician-scientist development.

While the sight of the food trucks this summer on Cedar Street conveyed some return to normalcy, other changes to our physical environment convey a departure from the status quo. The hall outside the Dean’s office glistens with a new coat of paint. The portraits on the I corridor have been put in storage or distributed to departments, and those of the former deans cleaned and hung in their place. A team of graduate students in the History of Science and Medicine program and the History department, working under the leadership of Professor Naomi Rogers and in partnership with the YSM Program for Art in Public Spaces, has created two exhibits for the C corridor with the intent of making our school feel inclusive. One will feature the history of the HIV epidemic in New Haven and the role of YSM faculty. The second will celebrate the accolades of YSM faculty.

Much work remains to be done but pausing to reflect on all you have done over these last months reminds me how truly fortunate we are. This reflection is far from complete and I ask your forgiveness for the inevitable omissions. Understanding that it is impossible to recount the multitude of contributions, I encourage each of you pass this forward and find a way to share your gratitude for the people who contribute to your experience of our YSM community. Please enjoy a well-deserved and fulfilling Thanksgiving.

Sincerely,

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

To the YSM and Alumni Communities:

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 would like to propose that we, as members of the Yale School of Medicine, can exert control over our future.

As private citizens, we should exercise our right to vote. We can encourage others to vote. We may wish to exercise our rights to freedom of expression and to peaceful assembly. As physicians, scientists, health care workers, and trainees, I ask that we do so in a way that is mindful of our commitment to our patients, colleagues, and the health of our community. We must promote mask wearing and social distancing measures even while exercising our rights.

We must also commit to demonstrating the behaviors we expect of others, and listen and treat each other with respect. Our responsibilities as physicians, aspiring clinicians, and members of the academy require us to model this behavior. Many of us have taken an oath to treat our patients with respect. The World Medical Association Declaration of Geneva reads “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient … .” As professional students, our MD and PA learners have likewise committed to professionalism during their white coat ceremonies.

Times like this remind us that we may be required to care for patients who not only disagree with us, but whose ideas we find reprehensible. In 2018, after Robert Bowers opened fire and killed eight men and three women during a Shabbat service at Tree of Life Synagogue in Pittsburgh, Ari Mahler cared for Bowers as his nurse in the emergency department of Alleghany General Hospital. Bowers was spewing anti-Semitic hatred when he arrived in the emergency department. Mahler chose not to reveal that he was Jewish but to treat his patient with “empathy and compassion,” because he felt this was the best way to honor the victims.

Nurse Mahler chose to assert control by rising above the hatred. Not everyone has the autonomy to make that choice. For this reason, I ask that we also commit to keep each other safe. Our duty to care for patients does not require that we tolerate mistreatment of students or the members of the care team. In such situations, it is important to call out offensive behavior even as we treat our patients with compassion.

I also ask that we recognize differences of opinion among our colleagues, mentors, and trainees. Darin Latimore, deputy dean and chief diversity officer, recently noted “During these times, it is important that we remember that just because someone has a different political view, that alone does not make the individual bad or evil. In fact, this is the very moment that we should strive even harder to see the other person’s humanity.”

We at Yale School of Medicine can shape our future, one-by-one, together. As anthropologist Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

Sincerely,

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

To the YSM Community:

Our second son, Isaac, was born just about two months after I joined the faculty as a brand new assistant professor in the Division of Clinical Pharmacology at Vanderbilt. I found the transition from one to two children harder than the later transition from two to three, but at the time I was certainly not going to speak about it with anyone at work. That would have revealed weakness and a lack of seriousness about my career. I was invited to submit a career development grant (a predecessor to the KL2) while I was home on maternity leave and came in to present to the institutional selection committee just two weeks after Ike was born. At around this time, I received a two-paged single-spaced letter from Lee Limbird, chair of the Department of Pharmacology, my secondary academic home. Dr. Limbird was the first woman basic science chair at Vanderbilt and later went on to become the associate vice chancellor for research. Her course on receptors was a famous rite of passage for graduate students, post-docs, and junior faculty in the department. Dr. Limbird’s unsolicited letter addressed the art of juggling a career and family and let me know that I was not alone. It also impressed upon me that the journey on which I was embarking was possible.

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.

As was noted in a recent town hall of women in medicine, in our society, women often serve in the primary care giver role in families. The distribution of responsibilities in a family is at once a societal question, a highly personal choice, and the product of a negotiation in a relationship. Most women in academic medicine achieve a precarious balance between commitments at home and aspirations at work. There is no doubt that the COVID-19 pandemic has upset this balance. The disruption of child care and school during the pandemic has disproportionately affected the productivity of women faculty.

We have much work to do to support our working women and families. Based on a recent survey of the YSM community about child care needs, an estimated 30% of faculty and staff may need child care in order to return to work or study. Today, I would like to highlight the first steps that the medical school and university have taken in increasing support for child care and elder care:

• The University has expanded COVID-19 Childcare Resources, for faculty, staff, post-doctoral associates and fellows, and medical students. Twenty emergency back-up care days are now available. Importantly, the Crisis Care Assist offers the alternative option of $100/day reimbursement for 20 days for those who are using their usual caregiver network. Many are using this benefit to offset costs associated with the closure of daycare centers and schools. Resources for elder care are available here.
• The Phyllis Bodel Childcare Center has announced that it will provide on-site care for school age children who are engaged in distance learning. Bodel also has openings for infants, toddlers, and preschool children. The Bodel Center functions independently of the medical school but is led by an able and dedicated board of YSM faculty.
• YSM is continuing to work to identify partners to provide additional resources with a focus on developing on-campus options for school age children.

We are also focused on the need to decrease the impact of COVID-19 on career development:

• We have extended the tenure clock and time-delimited terms by one year.
• We recently announced the availability of COVID-19 gap funding for faculty on the investigator and clinician scholar tracks. The deadline for receipt of applications is October 31, 2020.
• The Doris Duke Fund to Retain Clinical Scientists will also leverage this gap funding to increase the reach of its funds.
• Faculty who are eligible are strongly encouraged to apply for NIH continuity supplements NOT-OD-20-054 or NOT-OD-20-055.
• We will continue to work through the AAMC and other national organizations to increase resources available from the NIH and other funders.

For me, Dr. Lee Limbird’s support at a time of transition meant the world. Our mentors and sponsors need not look like us, however. With women and underrepresented groups currently comprising 35% and 6% of our senior faculty respectively, they cannot. Two of my most influential sponsors were men. John A. Oates, chair of medicine at Vanderbilt appointed the first woman chief resident in the Department of Medicine. When I joined the faculty, he made it clear that he believed in me and had high expectations. Alastair Wood has remained a sponsor over many years. He brought the perspective of having watched his wife, Margaret Wood, chair of Anesthesiology at Columbia for 20 years, navigate academic medicine, and often encouraged me to look at jobs that I would not have considered otherwise.

For our faculty, students, and staff, in the words of the poet, Maya Angelou, the “mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style.” So while we work to shore up resources for our faculty, I ask our senior faculty to reach out to our junior faculty, and to remind them that they will not only survive but thrive.

Sincerely,

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

To the YSM Community:

In 2018, the University Science Strategy Committee (USSC) recommended five priority ideas for investment (Data Science and its Mathematical Foundations; Quantum Science, Engineering, and Materials; Neuroscience, from Molecules to Mind; Inflammation Science; Environmental and Evolutionary Sciences) and four cross-cutting areas for investment (Graduate Student Support in STEM Fields; Diversity throughout the STEM Pipeline; Instrumentation Development; Core Facilities). Since then, Yale School of Medicine has been actively engaged in addressing several of these priorities. We are investing in the build out of neuroscience research space in 100 College and conducting a national search for the new chair of Neuroscience. A cross-university group has begun to consider our needs in data science. We have leveraged the public interest in COVID-19 to promote research in inflammation. We are creating career development programs that will enhance diversity, and piloting tactics to promote multi-disciplinary research. Still, we need school-specific strategies to advance these goals, address additional scientific priorities identified by the USSC (Conquering Cancer; Precision Medicine; Regenerative Medicine), and shape vital cross-cutting investments in health equity.

Today I would like to review the research strategic planning process ongoing at Yale School of Medicine. Shortly after assuming his position in April, Deputy Dean for Scientific Affairs (Basic Science Departments) Anthony Koleske launched a listening tour of our scientific enterprise. He met with over 75 junior and mid-career faculty identified by chairs or center directors, Deputy Dean for Scientific Affairs (Clinical Departments) Brian Smith, and others.

On July 2, Deputy Deans Koleske and Smith invited all our faculty and trainees to participate in a survey on the school’s research goals and priorities. The survey addressed three of the five major elements of Donald C. Hambrick and James W. Fredrickson’s seminal “Strategy Diamond” model. (Hambrick, D. C., & Fredrickson, J. W. (2001). Are you sure you have a strategy? Academy of Management Executive, 19(4), 51–62)

They asked what differentiates Yale School of Medicine: “existing and emerging research strengths?” They asked respondents to identify arenas where we need to be active: “… currently underdeveloped areas of research at YSM that you would like to see strengthened?” They inquired about the vehicles that will enable us to get where we want to go: “Are there major partnerships that you would like to see developed between disciplines and departments in the medical school and across the university, and between basic, translational, and clinical research efforts?” “What infrastructure would need to be further developed to support the priorities?”

Recognizing that our missions and values must guide our research strategy, Deputy Deans Koleske and Smith further asked: “How could our basic, translational, or clinical research better address health disparities and inequities in our patient population and local community?” and sought feedback on research strategic planning relevant to “all aspects of our educational, clinical, and community outreach missions.”

Almost 200 people responded. Based on these responses and the earlier conversations, themes emerged regarding our research mission, our differentiators, the arenas where we should be active, and the vehicles that will enable our strategy.

We have now tasked working groups to address these themes, listed in alphabetical order below and with group leaders identified in italics. The groups are comprised entirely of Next Gen leaders—energetic, innovative, and committed members of our community. We hope that the strategic planning process itself will bring together colleagues from multiple disciplines across the School of Medicine and the University. We expect that their ideas will inspire us.

When the groups have finished their work, we will integrate their ideas and ask leaders and the community to weigh in on priorities. We will then consider the final two elements of strategy in the Hambrick and Frederickson model, economic logic and staging.

I am grateful to Tony Koleske, Brian Smith, and these Next Gen leaders for guiding all of us on this journey. I cannot wait to see where it leads us.

---

Biomedical and Biological Imaging
Joerg Bewersdorf, Gigi Galiana, Katie Politi, Walther Mothes, Hesper Rego, Yong Xiong, Shawn Ferguson, Rick Torres, Jaime Grutzendler, Chi Liu

Clinical Trials
Miriam Treggiari, Stuart Weinzimer, Uma Reddy, Daniel Petrylak, Eric Velazquez, Stephanie O'Malley, Onyema Ogbuagu, Eugene Shapiro, Gerard Sanacora

Developmental Brain Disorders/Autism/Schizophrenia
Yong-Hui Jiang, Jess Cardin, Ellen Hoffman, Mike Higley, Jamie McPartland, Tom Fernandez, In-Hyun Park, Tony Koleske

Health Equity
Marcella Nunez-Smith, Saad Omer, Emily Wang, Andrea Barbieri, Megan Smith, Suzi Ruhl, Kieran O'Donnell, LaRon Nelson

Inflammation, Metabolism, Cancer, and Disease
Rachel Perry, Marcelo Dietrich, Yajaira Suarez, Deep Dixit, Andrew Wang, Ranjit Bindra, Stephanie Eisenbarth, Andy Goodman, Carla Rothlin

Matching Researchers with Collaborations Across Disciplines/Clinical/Basic Divide
Stephanie O'Malley, Ed Kaftan, Nik Joshi, Jeanne Hendrickson, Kasia Lipska, Lauren Sansing, Sam Katz, Paul Aronson, Robin Whittemore (YSN)

Nuclear Cell Biology/Epigenetics/Single Cell Biology
Qin Yan, Shangqin Guo, Peggy Myung, Yajaira Suarez, Andrew Xiao, Steven Wang, Patrick Lusk, Christian Schlieker, Zachary Smith, Brian Hafler, Lauren Sansing

Technology Development, Bioengineering
Noah Palm, Erica Spatz, Mark Saltzman, Rong Fan, Chenxiang Lin, Kathryn Miller-Jensen, Tarek Fahmy

Translational Medicine
Uma Reddy, Mustafa Khokha, F. Perry Wilson, Charles Dela Cruz, Jeanne Hendrickson, Jon Leventhal, David Assis, Serena Spudich, Peter Gruber, Miriam Treggiari, Cary Gross, Monique Hinchcliff

Sincerely,

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

To the YSM Community:

During my first State of the School presentation, I committed to working with you to address discrimination and racism, promote diversity and inclusion, and eliminate inequities in health care. 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.

Since the first week in June, 16 departments and centers have held listening sessions and workshops, many facilitated by Deputy Dean Darin Latimore, and five additional sessions have been scheduled to take place over the next several weeks. I have had the privilege to be part of several of these frank conversations. For the last several months, Dean Latimore has led the development of a strategic plan for the Office of Diversity, Equity & Inclusion. While still a work in progress, I can share that this plan will include education in unconscious bias, micro-aggressions, ally-ship and bystander training, crucial conversations/dialogues, and leading across differences; provide strategies to enhance recruitment, retention, and inclusion; delineate goals and measurable outcomes; and hold us accountable to achieving these outcomes. This work cannot fall to one office, but requires our commitment as a school and as members of a community. Our actions must be real and sustained. I would like to elaborate on this vision.

To address behaviors such as racism, gender discrimination and harassment, and bullying, we must hold people accountable, regardless of rank or position. Accountability requires a system for confidential reporting, tracking patterns (either at the individual or unit level), and a standardized approach to behavior. This approach should include both counseling and behavioral interventions but also consequences for repeated and egregious offenses. In February, we developed such a standardized approach, and Deputy Dean for Professionalism and Leadership Linda Mayes has presented this process to department chairs and other members of senior leadership, FAC, SWIM, and MORE. Since February, we have completed climate reviews of seven departments, sections, or labs where there were perceived patterns of concern and have developed plans for intervention. We are also working with YNHHS to develop processes for sharing information to enhance pattern recognition. Our efforts to address racism and promote diversity and inclusion must span not just the medical school but also the hospitals and clinics where residents and fellows train, and the communities where our faculty, staff, and students live.

Accountability also requires that we select value-driven leaders and that we provide them with the training and tools to hold others accountable. In the last four months, we have revised our search processes for senior leadership. Importantly, this includes the constitution of search committees that are inclusive. We are developing onboarding tools and have expanded leadership coaching for new chairs and directors.

We must measure and report desired outcomes regularly. In the State of the School, I presented data on the proportion of URiM and women faculty by rank. In 2019, 9.4%, 6.2%, and 5% of assistant professors, associate professors, and professors, identified as URiM. While these numbers are unfortunately typical of our peers, Yale School of Medicine should lead in this area. Forty-seven percent, 41%, and 26% of assistant professors, associate professors, and professors were women. The proportion of faculty in these groups is a “lagging indicator,” but we must also track and report “leading indicators,” such as the proportion of candidates interviewed who come from these groups. Only by moving leading indicators will we move lagging indicators.

We must continue to build the pipeline. Today, approximately 28% of our students are URiM. Increasing the representation of these groups among our residents, fellows, and faculty requires that we nurture the career development of our students. We have opportunities to enhance the recruitment of URiM candidates in our graduate medical education programs. Similarly, we must continue to invest in programs that expose K-12 students and undergraduates to careers in STEM and medicine in particular.

In order to retain our best and brightest, we must develop a strong culture of mentorship and work proactively. A recurring theme in my listening meetings with faculty and staff is the need for career development. In March, I appointed a task force to make recommendations about an institutional infrastructure for career development for physician-scientists. At the same time, Deputy Dean Linda Bockenstedt has tasked Associate Deans Samuel Ball and Jonathan Grauer with surveying our departments to develop best practices for career development for clinicians. It is our intention to create centralized resources. In my experience, attention to career development and mentorship particularly benefits women and URiM faculty. For example, the observation that faculty of color carry a disproportionate share of citizenship duties (committee membership, etc.) reflects a failure of mentorship. We have begun to conduct exit interviews of faculty who have left Yale in the last three years. Going forward, we must also conduct “stay interviews” in which we identify the needs of our faculty proactively. In our Strategic Plan for Diversity, Equity and Inclusion, we will propose the creation of modules within our career development programs that address the unique challenges faced by URiM faculty. With the support of the YSM Office of Diversity, Equity & Inclusion, Professor Valentina Greco has created similar resources for women. We will measure the outcomes of these programs.

We must address inequities in health care in partnership with our community. The COVID-19 pandemic has highlighted yet again the effect of inequities in health care. In response to COVID-19, we developed coordinated collaborations across the university and health care system. We can leverage these collaborations to address health inequities. Together with Tesheia Johnson, deputy director and chief operating officer of YCCI, and Marcella Nunez-Smith, founding director of the Equity Research and Innovation Center, as well as other leaders of YCCI and colleagues in the Department of Sociology, we have expanded conversations with leaders of the Connecticut AME Zion Churches, Junta for Progressive Action, and local community-based organizations to prioritize and address health inequities and the needs of our community, including those areas where more research is needed. These conversations and others will serve as the basis for strategic planning and investment in community-engaged research.

We have much to do. Every member of our community has a role to play in changing our culture, and I ask you to consider what role you will play. I look forward to working together with you on this important undertaking.

Sincerely,

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

To the YSM Community:

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.

As physicians, students who aspire to be physicians or physician associates, and staff engaged in patient care, education, and discovery, we hold our responsibility for human life above all else. Our oaths recognize that we are also members of the community. The Hippocratic oath includes the language, “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” The Declaration of Geneva includes the language, “I will not use my medical knowledge to violate human rights and civil liberties, even under threat …” How then do we respond?

First, we must acknowledge what we have seen and call out racism. Second, as private citizens we must exercise our right to vote and hold those entrusted with public safety accountable. Some may wish to exercise the right to peaceful assembly.

As physicians, students, and staff, we must examine our own biases that prevent us from delivering the best quality care to every individual. We must also speak up when we witness bias against members of our own school. To this end, I have asked Deputy Dean Darin Latimore, MD, to accelerate education on unconscious bias within Yale School of Medicine.

As a medical school we must take responsibility for our role in health care inequities. In recent months, we have seen the disproportionate effect of COVID-19 infection on African Americans and Hispanics in our community. Public health measures to “flatten the curve” have also disproportionately affected the economic security of these members of our community. Common diseases such as diabetes and hypertension have a disparate impact on these groups every day. We must and will increase our investment in health disparities research.

We must listen to our patients and our community to understand their needs. As scientists, we must apply rigorous hypothesis-testing to understand the etiology of health disparities. Over the last few months, I have had the privilege of meeting a group of community leaders who are working closely with investigators at Yale School of Medicine to guide research, the Cultural Ambassadors, leaders of the African Methodist Episcopal (AME) Zion Church and the Junta for Progressive Action. The COVID-19 epidemic has afforded us the opportunity to strengthen the influence of this extraordinary group and I look forward to continuing these conversations.

Our response to the events of this week must begin at home.

Sincerely,

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

To the YSM Community:

“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.

It has been a difficult road and much work still lies ahead, but now it is time to prepare for the return. This past week President Salovey and Provost Strobel shared the work of six COVID-19 contingency planning committees tasked with making recommendations on how we escalate the activities of the University in preparation for its reopening. Many YSM faculty are serving on the Research in the Natural Sciences and Engineering Subcommittee to advise on how we resume laboratory operations. A group of clinical leaders from both the school and the health system have convened to consider how we will restart outpatient medicine and elective procedures, as well as clinical research. We anticipate that we will adopt innovative practices developed during this COVID-19 pandemic in ways that will forever change how we practice medicine. Our colleagues in medical education are planning intensively to reintroduce clerkship students on the wards after a brief period of online didactic preparation, and to welcome the Class of 2024 and all our classes to campus.

Through early spring, we have not been dormant, however. In my message dated March 20, Beyond COVID, I shared some of the ways we have been continuing our efforts to realize our vision for the future of YSM. These include reorganizing the Office of Academic and Professional Development; vetting a standardized process for addressing faculty behavior; revising our search processes for senior leaders to make searches more inclusive and to select for value-based leadership qualities; creating a task force on physician-scientist development; appointing Professor Anthony Koleske as deputy dean for scientific affairs (basic science departments); launching the search for the chair of Neuroscience under the leadership of David Schatz; and asking the Program for Art in Public Spaces to create a physical environment that conveys our commitment to inclusivity. More recently, we have revised our policies on endowed professorships to make them more equitable and transparent.

These activities have maintained our forward momentum, even as we have been focused on the pandemic. Now as we emerge from the winter of COVID-19, our return offers a time for regeneration. Over the next few years we will engage in strategic planning around each of our core missions. I propose that we prepare for this by first considering the school’s mission statement, which we can do as a community even while meeting by Zoom.

The mission statement of Yale School of Medicine was last reviewed in 2004 and reads: As a preeminent academic medical center that supports the highest quality education, research, and patient care, the Yale School of Medicine will:

• Educate and inspire scholars and future leaders who will advance the practice of medicine and the biomedical sciences,
• Advance medical knowledge to sustain and improve health and to alleviate suffering caused by illness and disease, and
• Provide outstanding care and service for patients in a compassionate and respectful manner.

We will shortly be distributing a survey to the community to collect input on the current mission statement. We will then host a series of online focus groups, including faculty, students, staff, alumni, and community members to review this feedback. Based upon these focus groups, we will charge a writing group with redrafting the mission statement. We will then invite public comment on this draft and incorporate this input into the final statement. In this way, we will join together in renewing ourselves as we prepare for the return.

Sincerely,

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

To the YSM Community:

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.

On Sunday, I had the opportunity to round in the emergency department and ICU, including the newly opened 15th floor of Smilow. Our teams are adapting in real time to an unfamiliar disease, to resource constraints that require creativity and innovation, and increasingly, to difficult ethical dilemmas. Still, you are stepping up to support each other. For instance, the Yale Department of Psychiatry is offering virtual Stress and Resilience Town Halls over Zoom that are open to all faculty, residents, and staff at the school and Yale New Haven Health. Since introduced a week ago, over 350 participants have dialed in.

On Thursday and Friday of last week, our admissions team hosted a Virtual Second Look Visit for over 150 prospective medical students. Many of our faculty presented their work, and participated in “speed-dating” sessions, as well as sessions on the curriculum, financial aid, student organizations, research, and more. Director of Admissions, Ayaska Fernando, and Associate Director of Admissions, Barbara Watts, coordinated this tour-de-force. The student videos are worth watching.

Earlier this week, the Office of Communications launched a comprehensive new website to provide data resources, pre-prints, connections with investigators, access to clinical protocols, and much more in our fight against COVID-19. On Tuesday, over 1,000 people attended a virtual Dean’s Workshop on COVID-19 in which clinicians, epidemiologists, geneticists, and immunobiologists shared their work. This Friday at 1:00 p.m., Ruth Montgomery and Gina Della Porta will host a grant-writing workshop.

All that remains to say are two words: thank you.

Sincerely,

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

To Yale School of Medicine Faculty, Students, and Staff:

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.

First, our response to COVID-19 has brought out the best in our school—the caring, collegiality, and creativity of our people. I provide here just a few examples. Faced with a shortage of clinical tests for COVID-19, Dr. Marie Landry has developed a test in the clinical virology laboratory to increase dramatically our testing capabilities. Researchers in immunobiology have extended the test for research purposes. Dr. Chen Liu and the molecular pathology laboratory will further increase our capacity for clinical testing. Professor Daniel Colón-Ramos facilitated the sharing of reagents with colleagues in Puerto Rico to make testing available there. Students at Yale School of Public Health are performing contact tracing and students at YSM, faced with the cancellation of their clerkships, are engaging with faculty to stand up a new course on COVID-19 and pandemics. They have also volunteered to conduct literature searches for our teams, just as they would on the wards. Our education leadership team has created a virtual Second Look visit for our applicants, calling upon the collective efforts of our faculty to participate not only in this important admissions event, but also post-Second Look recruitment efforts. Clinical leaders huddle every morning to make tough decisions to ensure that we have the capacity to care for patients while protecting the safety of our faculty and staff. Earlier this week, Dr. Murat Gunel facilitated a call among over 20 Yale participants and colleagues in China to learn from their clinical experience and enhance our protocols for caring for COVID-19 patients. Our clinical researchers are pursuing hypothesis-driven treatment studies, just as our basic scientists and geneticists are studying the mechanism of viral infectivity and host susceptibility. Others such as Dr. Naftali Kaminski and Professor Carla Rothlin, co-chairs of the YSM Faculty Engagement Committee, have shared resources for our faculty and staff around faculty wellness. Our psychiatry team, led by Dr. John Krystal, is offering virtual stress and resilience town halls over Zoom that are open to all faculty, residents, students, and staff at the school and health system. These meetings, which take place twice daily, are designed to provide a way to connect, decompress, and reinforce skills to promote resilience in coping with the stress of supporting patients with COVID-19 and their families, as well as in dealing with the increased work and personal demands of the pandemic.

These are just a few of the efforts. Over the coming weeks, we would like to continue to share your good work. For this reason, we ask that you send additional examples and opportunities to this link.

At the same time, we are continuing our strategic efforts to realize our vision for the future of YSM. As you know, in February we reorganized the Office of Faculty Affairs as the Office of Academic and Professional Development. We have established a standardized process, coordinated through this office, for addressing faculty behavior and have begun to vet this process with such advisory groups as FAC (Faculty Advisory Council), SWIM (Committee for the Status of Women in Medicine), and MORE (Minority Organization for Retention and Expansion). The Program for Art in Public Spaces has submitted a draft plan for modifying how portraits are permanently displayed at YSM to better convey the richness and complexity of our history. We have revised our search processes for senior leaders to make searches more inclusive and to select for value-based leadership qualities, as well as for excellence. We recently announced the search committee for the chair of neuroscience, led by Professor David Schatz. I am also interviewing candidates for the role of deputy dean for research (basic science) to succeed Professor Michael Crair. In a meeting with chairs and center directors, we affirmed expectations around mentorship and career development for all faculty. In the last week, I have charged a task force with developing a plan for how we might implement institutional infrastructure to support physician-scientist development. I continue to (virtually) meet with small groups of faculty and staff who signed up for listening groups. These are incredibly uplifting meetings, as I get to know you and understand how talented and committed you are to our missions of discovery, teaching, and patient care.

We have much to do to combat this virus and to moderate its effect on our community. As we gird ourselves for the coming battle and its aftereffects, we will discover new ways to work together to advance discovery, learning, and health. Through your resilience and creativity, we will emerge a stronger school and community.

Sincerely,

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

Dear Alumni and Friends:

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. There is much to do together, including advancing the work of the Academic Leadership, Faculty Engagement, and Clinician Well-Being committees; addressing alignment in the clinical enterprise to enhance patient care and restore joy in the practice of medicine; capitalizing on unique opportunities to grow and better coordinate across our research enterprise; and continuing to leverage the Yale system to enhance the education and training of physician scientists and leaders.

We have already begun to institute some changes. The Office of Faculty Affairs has been restructured as the Office of Academic and Professional Development. Dr. Linda Mayes has assumed the position of deputy dean for professionalism and leadership development. She will co-lead the restructured office with Dr. Linda Bockenstedt, who will continue in her role as deputy dean for academic affairs. We will implement several leadership development initiatives, including enhancing our processes for identifying and nominating faculty to leadership positions, expanding opportunities for our rising stars to participate in leadership development programs, and honing and training faculty leaders in standardized approaches to behavioral and disciplinary interventions. We are expanding our research footprint with new space at 100 College Street, and we are in the early stages of enhancing our infrastructure to promote the careers of physician-scientists.

I imagine, however, that at the moment what is most on your minds is the COVID-19 pandemic, and I would like to share with you some of what we are doing to meet this challenge. We are taking proactive measures to ensure the safety of our faculty, students, staff, and patients. We are working closely with University, YSM, and Yale New Haven Health leadership as we implement such social-distancing measures as moving preclinical classes online, cancelling or postponing larger events, moving to virtual meetings, and providing travel guidance. The current situation provides a unique learning opportunity for students and as a community we will be discussing how physicians and other clinicians can balance the responsibilities of caring for ourselves and our families with our duty to care for our patients.

Our experts in public health, basic and clinical research, and clinical care have been working around the clock to monitor the developing situation, coordinate our activities and response, and to advance knowledge. Our laboratories have developed new methods to increase the availability of testing for our patients, as well as our faculty and staff. We are pioneering telemedicine strategies to care for appropriate patients. Our outstanding infectious diseases experts, microbiologists, immunobiologists and geneticists are studying mechanisms of infection and susceptibility to infection.

Whether in caring for patients, modeling the epidemiology of the virus, approaching possible treatments, or exploring the genetics of COVID-19, the YSM community is responding with expertise and innovation. Although too numerous to mention here, faculty have been featured on news programs, in articles, on social media, and as authors of op-ed pieces about the pandemic. They are lending thought leadership to such topics as minimizing the risk of transmission, mitigating outbreaks among older adults and other vulnerable populations, reducing anxiety about the pandemic, what parents should know about COVID-19, pregnancy-related COVID guidance, and forecasting the impact of the virus.

I could not be prouder of our community for its thoughtfulness and commitment to our core values as we plan for the unknown. I look forward to sharing periodic updates on ongoing initiatives. I have had the opportunity to meet some of our alumni but am eager to get to know you and engage with you in meaningful ways to strengthen our core mission of training tomorrow’s physicians and scientists.

Sincerely,

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

To Yale School of Medicine Faculty:

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. Commitment to these values will lead not only to the effective implementation of the strategies proposed by the Faculty Engagement and Clinician Well-Being Committees but also to a more explicit focus on the behaviors and skills that reflect these values.

Realization of value-driven leadership requires an institutional investment in leadership development. To this end, we will be restructuring the Office of Faculty Affairs to become the Office of Academic and Professional Development (OAPD). I have asked Dr. Linda Mayes, co-chair of the Academic Leadership Committee, to assume the position of deputy dean for professionalism and leadership development, and to co-lead the restructured office with Dr. Linda Bockenstedt who will continue to oversee faculty affairs as deputy dean for academic affairs. In her expanded role, Dr. Mayes will continue those activities that were previously under the purview of the special advisor to the dean.

In addition, Dr. Mayes will work with members of the Academic Leadership Committee and others to implement several leadership development initiatives. These will include continuing work with recently appointed chairs and center directors and an additional focus on section chiefs and new program directors through trainings to be offered on an annual basis, as well as opportunities for ongoing support to reinforce effective leadership development. In complementary work, we will develop a transparent institutional process for nominating mid-level faculty for the Emerging Leaders and Advanced Emerging Leaders program run jointly with SOM and will work with departments to expand opportunities for faculty to participate in these programs. We will also develop trainings for leadership search processes to assist committees in assessing leadership capacities grounded in the values put forward for YSM.

At the same time, we recognize that effective leaders hold themselves and others accountable for their behavior and that attention to wellness and early intervention or remediation of unhealthy behavior can prevent more serious harmful behavior. When misbehavior does occur, leaders need to have the tools to handle it in an agile and consistent manner. In the next weeks and months, we will be honing standardized approaches to behavioral and disciplinary interventions for faculty serving in leadership roles across the school. We will develop coaching resources to support this work as well as clarify lines of reporting when concerns arise.

Dr. Linda Bockenstedt will continue to oversee those functions within the scope of the current Office for Faculty Affairs. This includes those activities related to setting faculty policies, hiring and promotion procedures, and career development. Beginning January 1, Associate Deans Samuel Ball and Jonathan Grauer have begun assisting Dr. Bockenstedt with career development activities for faculty in non-procedural and procedural departments, respectively. In addition, Dr. Bockenstedt will be examining strategies to streamline processes for hiring and promotion.

This restructuring to create the OAPD is a first step to implementing the recommendations of the Academic Leadership Committee and, subsequently, the recommendations of the Faculty Engagement and Clinician Well-Being Committees.

Finally, I recommend the book Learning to Lead in the Academic Medical Center: A Practical Guide by Jeffrey L.L. Houpt, Roderick W. Gilkey, and Susan H. Ehringhaus for insight on being an effective leader.

Sincerely,

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

Dear Colleagues:

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. Thank you as well to Michael Hoepp and Lisa Egan for orchestrating these meetings and to Dean Alpern for his leadership and graciousness in the time leading to our transition.

There is much to do together, including advancing the work of the Academic Leadership, Faculty Engagement, and Clinician Well-Being committees; addressing alignment in the clinical enterprise to enhance patient care and to restore joy in the practice of medicine; capitalizing on unique opportunities to grow and better coordinate across our research enterprise; and continuing to enhance the education and training of physician scientists and leaders.

My commitment to you is that I will work to communicate effectively. This is not easy across a large organization such as a medical school. As George Bernard Shaw said, “The biggest problem in communication is the illusion that it has taken place.” To this end, I want to share with you the types of communication you can anticipate. First, at least once a month you should expect a communication from me on an ongoing initiative that includes a discussion of the rationale and underlying values driving it.

Over the coming weeks and months, I will continue to meet one-on-one with leaders throughout YSM. In the late spring, I plan to present the State of the School at several larger gatherings across the campus to permit us to use our time in subsequent department meetings for conversation. In addition, we will be starting a new monthly lunch and breakfast series to allow me to meet with members of the staff and faculty in small groups in order to get to know you and to listen to your ideas. These meetings should not supplant communication within departments but will provide me with another venue for listening. We will develop other settings for me to meet with students. In the spring and summer months, we will be scheduling additional meetings at our network hospitals for faculty who practice there.

I am excited to be joining the YSM community and look forward to getting to know you and working together.

Sincerely,

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

Dear Students:

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.

There is much to do as we continue to enhance the education and training of physicians, scientists, and leaders and work to ensure that ours is an environment where students, faculty, and staff thrive. My commitment to you is that I will work to communicate effectively. This is not easy across a large organization such as a medical school. As George Bernard Shaw said, “The biggest problem in communication is the illusion that it has taken place.” To this end, I want to share with you the types of communication you can anticipate. First, at least once a month you should expect a communication from me on an ongoing initiative that includes a discussion of the rationale and underlying values driving it.

Over the coming weeks and months, I will continue to meet one-on-one with leaders throughout YSM. In the late spring, I plan to present the State of the School at several larger gatherings across the campus. I am also eager to hear from our students. Beginning in March, I will host a series of meetings, where you will have an opportunity to share your thoughts about our school over a meal. Details will be circulated in the coming weeks.

I am excited to be joining the YSM community and look forward to getting to know you and to hearing your ideas.

Sincerely,

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