Striving for Quality and Balance
In the February 11th Dean's Newsletter I invited you to comment on some of the questions discussed at the January 31st-February 2nd Strategic Leadership Retreat. Based on the comments I received from you and the distillation and analysis of the discussions that took place at the Retreat, I now want to share with you some of the initiatives I will be bringing forth during the next year. It is important to note that these are not all of our high priority initiatives, but rather those that relate to the Retreat theme of achieving excellence while being attentive to sustaining quality and balance among our missions in education, research and patient care. There are several overarching issues as well as ones that are mission- specific.
Some Overarching Issues
- One of the most important overarching issues we will be addressing on "quality and balance" over the next year will be reconciling our plans for growth (especially in clinical care initiatives) with the size and scope of our faculty and the potential limitations that may be imposed if the current billet cap remains fixed. For reference, our faculty billet cap is set at 900 and we are now at just over 800 full-time faculty. This effort will be led by Dr. David Stevenson, Vice Dean and Senior Associate Dean for Academic Affairs, and David O'Brien, Director of Institutional Planning.
- Given the likelihood of continued constraints on research funding from the NIH and other federal sources, we need to develop new models for supporting and funding research in an era when federal funding is flat or declining. Included in this area is the need to better define financial support for graduate students and a different model for the use of endowed professorships. To do this I will appoint a task force led by Marcia Cohen, Senior Associate Dean for Finance and Administration.
- Because of the limitations of our size, resource restraints and the tensions that emerge from having missions in basic and clinical research as well as education and patient care, there is a continuing need to find ways to make all members of our community -- students, staff and faculty -- feel both engaged and valued. This is something we all need to be part of and I will personally seek ways to help assure that we each share in securing the "quality and balance" of our community.
- There is a need to continue to address academic and staff leadership succession planning, including an assessment of the impact of transitions of faculty and staff on resource consumption and strategic initiatives. The Dean's Office will take the initiative in working on this issue.
- One of the greatest and most distinctive strengths of Stanford is the opportunity for interdisciplinary research and education. With the Stanford Challenge now underway (a topic we spent time discussing at the 2008 Leadership Retreat), it is clear that we need to find better ways to engage faculty and students in the Initiatives on Energy and the Environment as well as the International Initiative and the Initiative on Human Health. The responsibility for this will lie with basic and clinical science chairs, Institute Directors and, of course, faculty and students. We will seek ways of making the opportunities that are available more broadly known and accessible to our community.
Quality and Balance in Education
Medical Student Education
- We need to address ways to assure diversity in our medical student body within the context of our New Curriculum and our focus on training and developing physician scholars, scientists and leaders. This will require addressing the alignment between our institutional goals, the criteria of our admissions committee and the expectations and goals of prospective and admitted students. In tandem with assuring diversity in our entering classes, we will also recommend ways to assure the success of minority students while at Stanford. I will appoint a Task Force led by Dr. Charles Prober, Senior Associate Dean for Medical Student Education, to address this issue.
- An observation and concern that emerges from various surveys and reviews is that we do not, as an institution, place sufficient value in clinical education (and, to a degree, in education overall) and the roles played by faculty in patient care activities in comparison with some of our peers. In tandem with this is the need to better determine the metrics by which to evaluate the clinical performance of medical students in a manner that is data driven and transparent. This is especially important as we seek to better define the tools used to evaluate student performance more broadly, including the official school letter (or "Dean's Letter"). A review of these important issues will be led by Dr. Charles Prober, Senior Associate Dean for Medical Education, in collaboration with Drs. Hannah Valantine, Senior Associate Dean for Diversity and Leadership, and Gabe Garcia, Associate Dean for Medical Student Admissions.
PhD Education
- To improve the quality of graduate student education, we will initiate a peer review of current graduate courses by students and faculty. The questions to address include whether we are really educating students for the jobs they will eventually hold and whether there is enough breadth of topics, including ones that extend to business and law and that provide a wider breath of experience including "PhD Internships." We also need to assess whether our graduate education programs are truly achieving the interdepartmental/interdisciplinary focus we espouse or whether they are really still more departmentally focused. This review will be led by Dr. John Pringle, Senior Associate Dean for Graduate Education and Postdoctoral Affairs, and Dr. Ellen Porzig, Associate Dean for Graduate Education.
- Without question, postdoctoral scholars and clinical fellows are among the most important members of our academic medical community but also among the most disenfranchised. We need to develop improved ways of integrating postdoctoral scholars into the broader missions and opportunities of Stanford and to assure mentoring and transitional appointments that better prepare them for faculty or other careers. These issues will be addressed by Dr. John Pringle, Senior Associate Dean for Graduate Education and Postdoctoral Affairs, and Chequeta Allen, Assistant Dean for Postdoctoral Affairs.
Graduate Medical Education (GME) and Continuing Medical Education (CME)
- We need to develop recommendations for programs that measurably improve the quality and diversity of GME programs. This effort will be led by Dr. Myriam Curet, Senior Associate Dean for Graduate Medical Education.
- We need to develop a fundamentally new approach to CME based on improving quality metrics of clinical performance and on more individualized education compared to traditional lecture formats. I plan to appoint a Task Force led by Dr. Rob Jackler, Associate Dean for CME, to develop new and novel approaches that can make Stanford a leader in CME.
Enhancing Quality and Balance in Research
- In addition to developing new financial models to support our missions in research during an era of constraint (see above) we also need to develop new models to support our research mission within Stanford, including how we use cores and shared services. This includes where they are located, how they are managed and funded, and how they can sustain a balance between service and innovation. This effort will be led by Dr. Daria Mochly-Rosen, Senior Associate Dean for Research.
- We have reached a critical phase in our planning for laboratory animal programs -- including space (both onsite and offsite), financing and a better delineation of which models should be employed. Given the transition of leadership in Comparative Medicine that will occur in the next year, these and related issues are timely and important. They impact the School of Medicine as well as the rest of the University. Accordingly, a review group will be led by Dr. Harry Greenberg, Senior Associate Dean for Research, and Dr. Ann Arvin, Vice Provost and Dean of Research.
- Although we have made "Making and Translating Discoveries" our overarching institutional priorities, we have work to do in better defining how the Medical Center can achieve success in clinical and translational research as well as research that results in improved quality of patient care during a time of resource constraint. In considering this issue we need to better delineate how hospital based clinical research is supported and funded and who will carry it out. A review of these issues will be assigned to Dr. Ken Cox, Senior Associate Dean for Pediatrics and Obstetrics Clinical Affairs, and Dr. Norm Rizk, Senior Associate Dean for Clinical Affairs.
- It has been observed that members of the Stanford community are often unaware of the research breakthroughs being made by their faculty and student colleagues. We need to develop better ways to communicate research discoveries and successes to our Stanford community. This review will be led by Paul Costello, Executive Director of Communications and Public Affairs.
Fostering the Highest Quality Patient Care
- During the past year several programs have been initiated to address quality performance at SHC and LPCH, and a Center for Quality and Efficiency is to be established. Because of this, we will not recommend new initiatives per se. That said, we need to continue to support these initiatives and also assess ways of better linking them to efforts underway by our colleagues at the Palo Alto VA Medical Center. In conjunction with these efforts, we also need to better define the important role that our Clinician Educator colleagues play in enhancing our missions in education, clinical research and patient care. Importantly, we need to delineate ways to make the role of Clinician Educators more valued and appreciated. This review will be led by Dr. David Stevenson, Vice-Dean and Senior Associate Dean for Academic Affairs.
It is important to note that these initiatives are a subset of those that we will be working on during the next year. There are other major tasks we face -- especially in the development and support for medical center facilities. But the outline above conveys the ways we will follow up on some of the important suggestions emerging from the 2008 Strategic Leadership Retreat. Again, if you have further questions or suggestions, please feel free to contact me.
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Concerns about Proposed Changes to the USMLE
At a recent meeting of the Council of Deans we discussed the efforts underway by the National Board of Medical Examiners (NBME) to review and potentially revise the USMLE (United States Medical Licensing Examination). While there is great merit in developing ways to better integrate basic science into the clinical medicine, my colleagues and I expressed great concern at the prospect that the USMLE would be potentially postponed until the third year and that there would not be specific assessment on student's knowledge of the basic science that underpins modern medicine (see: http://www.usmle.org/General_Information/review.html). Indeed, such knowledge will prove only more important in future years as the genetics, genomics, proteomics, and the biological behavior of complex physical and mental disease become better understood.
While we recognize that knowledge acquisition in medicine must be a life-long endeavor, there is great value in periodic assessments and cross learning. While we also recognize the stress placed on students by having to assimilate a vast body of knowledge across many basic science domains, such intense review allows them to make connections that would not otherwise be possible -- and helps set the stage for the evidence and science based learning that should help define the future of clinical medicine. With this in mind, the Council of Deans will join with numerous other organizations and societies to inform the NBME of the importance of having a USMLE testing at the completion of the preclinical years and as a focused assessment of knowledge in basic science. At the same time, we will also encourage the NBME to seek ways to better integrate knowledge in basic and clinical science and medicine in the USMLE parts 2 and 3 exams.
I want to share this information with you since it has not been as widely discussed as it should be. Thankfully the NBME is being attentive to the concerns being expressed about their earlier proposition to make the radical changes alluded to above. You may wish to bring this issue to your attention of your colleagues and related professional and scientific organizations and societies.
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I previewed in my recent newsletter the ways in which we were planning to commemorate the 100th anniversary of the establishment of the Stanford School of Medicine. Last week we began our activities virtually, with the launch of our Centennial website and the publication of an intriguing look at Stanford then and Stanford now as well as the posting of images from our past and present. In addition, this week banners will go up around our campus, and event planning continues for the coming months.
It seems to me that, beneath the banners and images, although certainly facilitated by them, the Centennial affords us the opportunity to be reminded of the deeper truth that we stand on the shoulders of those who came before us. None of us would be here at the Stanford School of Medicine but for the efforts and accomplishments of the thousands of men and women who have striven for 100 years to make the School excellent in every respect -- in education, in research and in the care of patients. The challenges our predecessors faced must have seemed as daunting to them as ours seem to us today, and we can look back with gratitude as their perseverance and success.
So I invite you to learn about the past hundred years of our School and participate in the celebration, even as we address our own challenges and find new opportunities for our own time -- and the future.
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Update on the Department of Obstetrics and Gynecology
At the Friday, February 15th meeting of the Executive Committee, Dr. Jonathan Berek, Professor and Chair of the Department of Obstetrics and Gynecology, gave an update on the progress that has been made in the department since he assumed the role of chair in December 2005. Below is his summary of what has transpired during the past two years.
The Department of Obstetrics and Gynecology is on a strong upward trajectory. Over the past two years, the department has experienced a substantial increase in the number of faculty and staff, in clinical productivity, in the vitality in each of its divisional education and research programs, and in the level of national recognition and stature. The clinical programs in the department have been invigorated and the reproductive biology research productivity is excellent and expanding. Each of the four clinical divisions--Maternal-Fetal Medicine (MFM) & Obstetrics, Gynecologic Specialties, Gynecologic Oncology, and Reproductive Endocrinology & Infertility (REI)--is formidable and has outstanding clinical and translational research components. The Division of MFM & Obstetrics combined with neonatology form the world-renowned and highly successful Johnson Center in the LPCH. The newly created Division of Gynecologic Specialties (renamed from General Gynecology) is functioning as a dynamic team with demonstrably improved academic and educational activities. Specialists in this reorganized division have nationally recognized expertise in urogynecology and pelvic reconstructive surgery, minimally invasive and robotic surgery, pediatric and adolescent gynecology, family planning and contraception, menopause, pelvic pain, infectious disease, and women's sexual medicine. The Division of Gynecologic Specialties is now one of the finest in the country.
Integrated across all divisions are the basic research programs, the Reproductive Biology and Stem Cell Research (RBSCR) Program, and the Women's Health Program (WHP). Departmental collaborations with the Institutes have been improved and strengthened--the Stanford Cancer Center, Stem Cell Biology and Regenerative Medicine (ISCBRM), and Immunology, Transplantation and Infectious Disease (ITI), especially with its Center of Clinical Immunology at Stanford (CCIS) and the Human Immune Monitoring Center (HIMC). Program Project grant funding for the Cooperative Ovarian Cancer for Immunotherapy (COGI), which is based at Stanford, has just been extended for an additional 5 years. The Women's Cancer Program has just been established, integrating the Breast Cancer and Gynecologic Cancer Programs in the Stanford Cancer Center, which will increase clinical and translational research collaborations. The department receives grant support for the Women's Reproductive Health Research (WRHR) Scholars and the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Scholars programs. Future strategies include the creation of an interdisciplinary Women's Center of Excellence under the aegis of the Department of Obstetrics and Gynecology.
Many outstanding new faculty members have been recruited during the past two years. By the end of this year, the total number of UTL, MCL and CE positions will have increased from 30 to 42, and of the 39 who are full-time, 59% are women. Key departmental recruitments are Dr. Renee Pera, one of the most prominent embryonic stem cell researchers, recruited to assume the role of Director of the departmental Reproductive Biology and Stem Cell Research Program and to lead the embryonic stem cell program in the ISCRM, Dr. Paula Adams Hillard from Cincinnati to become the new Chief of the Division of Gynecologic Specialties, Dr. Paul Blumenthal from Johns Hopkins to become the Director of Ambulatory Gynecology and the Kenneth J. Ryan Program and Fellowship in Family Planning and Contraception, Dr. Judy Lacy from Toronto as a specialist in Pediatric & Adolescent Gynecology, Dr. Meg Juretska from Memorial Sloan Kettering Cancer Center to Gynecologic Oncology, Dr. Valerie Baker in REI to help to expand and sustain the In Vitro Fertilization (IVF) program, and Dr. Lisa Rahangdale from UCSF as a WRHR Scholar in Infectious Diseases.
The educational programs for medical students, residents and fellows in each of the divisions are excellent. Maximum achievable 5-year accreditation renewals by the American Board of Obstetrics & Gynecology have just been received for both the residency and for the MFM fellowship programs, under the direction of Vice Chair, Dr. Maurice Druzin. The overall ratings of the medical student clerkship, co-directed by Drs. Kim Harney and Cynthia DeTata, have risen significantly over the past 2 years and the program is now in the top tier of Stanford clerkships. The department has taken a leadership role in the development of simulators in obstetrics and gynecology training through the CAPE (Center for Advanced Pediatric and Perinatal Education) program directed by Dr. Kay Daniels and through collaborations with SUMMIT and the Goodman Centers directed by Dr. Mary Jacobson. The department has a very active Quality Management program. Faculty and staff are deeply involved in international outreach activities, including those in Eritrea, Guatemala, Mexico, and in many other developing countries via the Global Alliance for Women with Cancer and the Aid for International Development programs. From 2006 to 2007, the department's ranking by the US News & World Report rose from 27th to 16th.
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The Office of Diversity and Leadership received a wealth of nominations for outstanding candidates for the 2008 Faculty Fellows program. The review committee was pleased to be able to select, in addition to a cohort of Faculty Fellows for 2008, an additional class of Fellows who will participate in this year long program beginning in 2009.
We are delighted to announce the selection of the following 2009 Faculty Fellows: Timothy Angelotti (Anesthesia), Juliana Barr (Anesthesia), Preetha Basaviah (Medicine), Helen Bronte-Stewart (Neurology), Kay Chang (OHNS), Waldo Concepcion (Surgery), Firdaus Dhabhar (Psychiatry), James Fann (Cardiothoracic Surgery), Lauren Gerson (Medicine), Jeffrey Gould (Pediatrics), Geoffrey Gurtner (Surgery), Michael Harbour (Medicine), Peter Kao (Medicine), Anna Messner (OHNS), Ruth O'Hara (Psychiatry), Stephen Roth (Pediatrics), Richard Shaw (Psychiatry), Rebecca Smith-Coggins (Surgery), Julie Theriot (Biochemistry), and PJ Utz (Medicine).
The Faculty Fellows program brings these faculty members together for monthly meetings featuring invited leaders who serve as role models by sharing their own leadership journeys, describing their own leadership styles and addressing specific challenges they have faced in their own careers. In addition, small mentoring groups led by senior faculty mentors meet once between each of the dinner meetings to discuss leadership challenges specifically and in general. Other topics, such as work/life balance issues, are also open for discussion.
Fellows also engage in a structured Development Planning process aimed at identifying opportunities for growth and development. The result is a personalized career development plan that they work with their chair or division chief to implement.
Candidates are nominated by their department chairs and other supervisors, and are ranked on the basis of leadership potential and demonstrated commitment to building diversity. A review committee consisting of Drs. Hannah Valantine, Julie Moseley, James Chang, Eric Sokol, and Claudia Morgan selected 16 fellows from a large pool of nominations.
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Memorial Service for Dr. Steve Leibel is on March 19th
On Wednesday, March 19th the School of Medicine and Medical Center will host a Memorial Service for Dr. Steve Leibel, the Ann and John Doerr Medical Director of the Stanford Cancer Center, who died unexpectedly on February 7th (see: http://med.stanford.edu/special_topics/2008/steven_leibel/). The Memorial Service will be held in the McCaw Hall at the Arrillaga Alumni Center at 3 pm and will be followed by a reception. All are invited to attend.
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- Dr. Marlene Rabinovitch, the Wight and Vera Dunlevie Professor in Pediatric Cardiology, has been selected to receive the 2008 Recognition Award for Scientific Achievement from the American Thoracic Society (ATS). The Recognition Award is "bestowed only upon those with lifelong outstanding scientific contributions to the understanding, prevention, and treatment of lung disease." She will receive the award during the ATS Annual Meeting this May. Congratulations to Dr. Rabinovitch.
Profile: http://med.stanford.edu/profiles/Marlene_Rabinovitch/
- Heidi Heilemann, Acting Director of the Lane Library, will be the recipient of the Murray Gottlieb Award from the Medical Library Association. Congratulations to Ms. Heilemann.
Profile: http://lane.stanford.edu/contacts/heilemann.html
- Dr. Paul Blumenthal, Professor of Obstetrics and Gynecology, is this year's recipient of the Kenneth J. Ryan Award to be presented by the American College of Obstetricians and Gynecologists. This award acknowledges Dr. Blumenthal's impressive leadership and contributions to women's health. Congratulations to Dr. Blumenthal.
Profile: http://med.stanford.edu/profiles/Paul_Blumenthal/
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- Laura D. Attardi has been promoted to Associate Professor of Radiation Oncology and Genetics, effective 2/01/08.
Profile: http://med.stanford.edu/profiles/Laura_Attardi/ - Kerwyn C. Huang, has been appointed to Assistant Professor of Bioengineering, effective 2/01/08.
- David Relman has been promoted to Professor of Medicine (Infectious Diseases) and of Microbiology & Immunology), effective 2/01/08.
Profile: http://med.stanford.edu/profiles/David_Relman/ - Bryan D. Thom has been promoted to Adjunct Clinical Associate Professor of Obstetrics and Gynecology, effective 3/01/08.
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