Deans' Report for 2007: Looking back and a look forward

Dr. David Guzick, M.D., Ph.D.

Dr. David Guzick, M.D., Ph.D.

January 11, 2008

2007 was a very busy and—I think—productive year in the Dean’s office. See if you agree.  Here is a snapshot of last year’s activities, as summarized by our Associate and Senior Associate Deans, along with their look ahead to 2008.

 

Undergraduate Medical Education—David Lambert, M.D.

Looking back

In the School of Medicine and Dentistry, 2007 was an exciting year.  The major event for the school was the site visit by the Liaison Committee on Medical Education (LCME) survey team as the final piece to the school’s reaccreditation.  The visit was extremely successful and while the final report will not be received for a few months, the team was impressed with all aspects of our educational program and the collegial atmosphere here in Rochester.  2007 saw the largest number of students participate in the Academic Research Track (ART)’s research year out.  Students in the 82nd URSMD class graduated in May of 2007 and are now interns in great programs across the country.  20% of them remain here at the URMC for training.  We welcomed the Class of 2011 whose talents, diversity and achievements were outlined in an earlier newsletter.  Our students continue to provide community service through Saturday School, U.R. Well and many other programs.  The class of 2010 did an all class project working with Rochester city seniors and assisting them in completing college applications. Faculty development programs grew tremendously in the last calendar year as we continue to maintain the excellence in our teaching and in individual faculty growth.

A look forward

The year 2008 promises to be no less exciting than those that preceded it.  We plan to take a look at our overall curriculum as we continue to make changes to keep our program innovative and balanced.  With this process, we will further define the presence of Domains of Excellence in each course and clerkship and indicate how they link to our overall educational objectives.  We expect to further grow the integration of technology and simulation in our teaching.  The Office of Admissions is well on its way in interviewing applicants for the Class of 2012 that will enter in August.  We will host a meeting of admissions, curriculum and student services leaders from 12 other research intensive medical schools in May.  Given the faculty, staff and student talent here at the URMC, we will have a year of outstanding teaching and innovative growth.

Graduate Medical Education—Diane Hartmann, M.D.

Looking  Back

With the addition of 4 new fellowship programs, Graduate Medical Education at the University of Rochester now encompasses 669 trainees in 75 Accreditation Council on Graduate Medical Education (ACGME) training programs (25 residencies,50 fellowships) as well as 7 dental residencies (54 trainees).  The importance of these programs in providing the next generation of Rochester’s clinicians is supported by data from 2007 graduates indicating that 28.6% of fellows and 43.9% of residents remained in the area to practice.

The high standard of excellence in our programs is evidenced by 2007 individual program accreditation statistics revealing that 65% of our training programs are on a 5-year and 12.5% are on a 4-year accreditation cycle as compared with a national accreditation cycle average length of 3.5 years.  In addition, this year the ACGME’s Committee on Innovation in the Learning Environment chose the University of Rochester as 1 of 4 sites nationally to be interviewed/visited as part of its Learning Innovations Project.  We were honored to be “studied” by this initiative designed to identify best practices in high functioning institutions and disseminate its findings nationally.

A Look Forward:

Our programs continue to develop and define their ability to skillfully teach and evaluate residents in the 5 physician core competency domains of patient care, medical knowledge, communication, professionalism, practice-based learning and improvement and systems-based practice.  Special emphasis during this year will be placed on systems-based practice—the domain that focuses on collaborative care models, medical economics and patient quality/safety.  Graduate medical education is partnering with the University’s quality improvement group to develop metrics to evaluate the link between educational quality outcomes and patient care quality outcomes.  Training programs will educate residents and engage them in promotion of excellence in the national clinical quality indicators that the hospital will be required to publicly report on in the near future.

Several of our residency programs have been chosen to enter new national medical education demonstration projects.  The family medicine programs was invited by the American Board of Family Medicine and Academy of Family Physicians as one of 14 family medicine programs nationwide to participate in the P4 (Preparing the Personal Physician for Practice) initiative.  This project is focused on the delivery of high quality care in an information-age environment.  Our internal medicine, obstetrics and gynecology and family medicine programs have been selected to be Beta test sites for the ACGME’s Resident Portfolio Project.  This initiative is the nucleus for what many expect to be a personal e-portfolio that each physician opens in medical school and maintains throughout his/her career to reflect attainment and maintenance of professional competence.

It is my pleasure to work daily with an outstanding group of program directors, program coordinators and GME staff who embody the essence of Meliora.

Graduate Education—Paul LaCelle, MD

Among the many activities of the Office of Graduate Education,  I will focus on a few programs for which there were significant developments in the past year and/or for which there are significant plans for the year ahead.

PhD in Translational Biomedical Sciences

This new PhD, approved by the Department of Education, New York State on December 6th is an outgrowth of a proposal in SMD’s initial CTSA application.  It emphasizes basic science foundations and provides dual basic and clinical scientist mentoring/advising and great flexibility for students to follow their interests in translational research. This degree concept was approved unanimously by the SMD Council on Graduate studies, which is perhaps the most meaningful endorsement. Three well recognized scientists and educators served as external site visitors and their very positive assessment certainly was significant in the ultimate approval process. The degree now is available for students beginning in July 2008 and strong interest already has been shown by several individuals.

Certificate Program in Translational Biomedical Science for Biomedical Engineering PhD Students

Because of great interest and practical utility of a certificate in the key topics of translational science, a new certificate program has been devised for BME PhD students, to permit them to take necessary translational science courses along with their regular coursework so that they have the basic knowledge and some experience during their PhD program. This will not require additional time or expense and will equip such students with unique backgrounds for future application in translational research. The certificate program has been reviewed by the Directorate for Education and training and will be presented to the SMD Committee on Graduate Studies on January 11, 2008. Subsequently it will be reviewed for approval by the Office of the Provost.

Ph.D.-M.B.A. Program

this program, started in 2005, has proven to be quite popular. Five PhD candidates have enrolled in the Simon MBA degree program and have proven to be outstanding students in both science and business.  Three students have completed both degrees. 

Online services

An online system to receive letters of recommendation and transcripts in connection with graduate student applications has now been implemented.    PhD applicants currently apply to our programs on line; up until now, however, it was not possible to receive verified letters of recommendation and transcripts on line. Working with ACS, we have developed a system for on line letters and transcripts, with appropriate safeguards.

PREP (Post-baccalaureate Research Education Program)

The PREP effort, designed to prepare minority undergraduates for graduate/professional study, was initiated by Stephen Dewhurst, PhD and was supported by NIH and SMD until August 2007. At that point, NIH discontinued its funding, i.e., no renewal applications were accepted by NIH. Reflecting the ongoing commitment of SMD to graduate education for under-represented minorities, the students enrolled at SMD in this two-year program have received support during the NIH funding hiatus. Fortunately NIH will now permit renewals and Edith Lord and Stephen Dewhurst are preparing such an application. As a part of the renewal preparation we had a site visit by Roger Chalkley, PhD, Senior Associate Dean for Graduate Education in the School of Medicine at Vanderbilt; this review was extremely laudatory and also gave some valuable suggestions for the new application. We are proud of our record:  77% of the diversity/minority students entering our PREP have been admitted to PhD programs; and additional nine are in SMD. This high success rate demonstrates the extraordinary value of the program.

Clinical Affairs (URMFG)—Kenneth DeHaven, M.D.

Looking back: General

The commitment of URMFG to embrace Quality Improvement for outpatient in addition to inpatient services.  A Quality Improvement Committee was appointed, chaired by Tom McInerny, MD, to work in collaboration with the SMH Quality program to improve patient safety and quality in URMFG faculty practices.

Contract Management

We set reimbursement targets for URMFG based upon a commissioned survey of peer academic health centers, which showed our academic practice should be reimbursed at approximately 153% of current Medicare.  URMFG successfully negotiated contracts with Excellus, Preferred Care and Aetna such that we are in line with this target, which is to be achieved by 2010.  URMFG was also able to negotiate additional “endangered specialty” enhanced conversion factors to assist those divisions to recruit and retain sub-specialists in these fields. 

Finance and Administration

URMFG was successful in passing the FY 2007 financial audit by PricewaterhouseCoopers with no current year management comments.  This confirms that all departments are completing cash reconciliations and following URMFG policies and procedures.  This also attests that management is testing and auditing financial processes across all departments and is centrally following all accounting standards.  URMFG ended the 2007 fiscal year with a positive change in net assets of $2.6 million.

Shared Services Organization (SSO)

A look forward: General

Initiate at least one URMFG Quality Improvement project and begin collecting data by the end of this academic year.

Contract Management

Continue to negotiate to meet the three year target reimbursement level set by Dr. Berk.  Monitor contract performance to ensure enhanced rates are appropriately paid. Confirm with departments that "endangered" providers are being retained and recruitment slots are being filled.   Continue to monitor payer initiated cost-cutting measures, such as CareCore imaging management program, to ensure patients have appropriate access to care and providers have appropriate control over their patient's care.

Finance and Administration

Work closely with University Audit to review all department billing offices to ensure appropriate controls and segregation of duties are in place to mitigate and minimize fraud.

Continue to convert the remaining Non-IDX sites to IDX, the common billing and accounts receivable system. Continue to roll out the Allscripts Electronic Medical Record.

Shared Services Organization

On a personal note, I have made the decision to step down from my role as SAD for Clinical Affairs and Director of URMFG on January 31, 2008.  It has been a pleasure to have the opportunity to serve in this capacity for the past four years.  After 32 wonderful years as a faculty member in the Department of Orthopaedics, and while my wife and I are still in good health, we have decided that we would like to spend more time traveling, and for me to have more time to pursue other interests, such as servicing and repairing old pendulum clocks and doing more non-professional reading.  Dr. Regis O’Keefe has graciously afforded me the opportunity to stay on part-time, seeing office knee patients a couple of days per week.  I look forward to maintaining my involvement in clinical medicine and making whatever contribution I can, including assistance in the transition to a new URMFG Director.

Basic Research—Steve Dewhurst, Ph.D.

Looking Back

NIH grant support to URSMD grew by 12% in FY07, rising from $134,809,734 for FY06 to $151,866,313 in FY07, and raising our ranking to #25 among U.S. medical schools.  Counting grants and contracts, our total funding from NIH in FY07 was $159,362,995. This remarkable growth, in the face of a flat national NIH budget, reflects the scientific creativity, drive and resilience of our faculty.  Opportunities for additional collaborative/multidisciplinary projects can be expected in the coming year and beyond as the new strategic plan is implemented, and begins to stimulate new initiatives and cross campus interactions.

A look forward Enhance core research services

Core services will be enhanced, to better support our scientific research base and to provide the infrastructure needed to propel URMC's strategic plan.  The past year saw the appointment of Dr. Sally Quataert as overall Cores Director, as well as the appointment of several new core directors and technical directors.  The Gene Targeting and Transgenic Core and has been reorganized under the leadership of Dr. Lin Gan, and the Flow Cytometry and Immunologic Assessment Core is under transition to the leadership of Dr. Tim Bushnell, who has already negotiated a new lease arrangement with BD that will give us two new analytical cytometers at minimal cost.  The Proteomics Center is expanding under the energetic direction of Dr. Alan Friedman, and will add a new Fourier Transform Mass Spectrometry (FTMS) early in the new year, while Dr. Linda Callahan is leading the effort to improve the Pathology/Morphology Imaging Core (PMIC) by adding a new, contemporary confocal microscope to better serve faculty needs.  Also in development are a number of additional core concepts, including a two-photon microscopy core, a high throughput screening facility, a cGMP facility, and enhancements to institutional imaging capacity for small animals.

Incentivize and promote shared equipment grant applications

The incentive plan has been revised to promote the submission of shared equipment grants, and Dr. Quataert will lead efforts to develop a coordinated application strategy for these proposals.

Continue strong support for the interim funding program

In 2007, the interim funding program received 21 requests for support, of which 12 were funded - most of them at levels between $35,000 and $50,000.  The total outlay on the program was $536,000, which included matching contributions from Departments/Centers in almost all cases.  Of the awards funded in 2007, 5 have already been successfully recompeted or funded as NIH R01s.  We will continue strong support for the interim funding program in 2008, when the national NIH budget will continue to be flat.

Develop international linkages

Drs. Brad Berk, Barbara Iglewski, Jian-Dong Li and Chen Yan recently visited three top universities in China, with a view to establishing educational and research linkages with the URMC.  We plan to build on these nascent relationships in the coming year, in collaboration with the School of Nursing which is also undertaking similar efforts under the leadership of Dr. Pat Chiverton.  Other efforts involve partnerships with institutions in the Province of Ontario, including the Ontario Institute for Cancer Research (OICR) and MaRS; these efforts are being led by Dr. Bob Sutherland (formerly of UR, and currently appointed at OICR) and by Peter Robinson.

Support collaborative scientific partnerships

Efforts are underway to help faculty investigators compete for large, collaborative projects supported by DoD/DARPA, and to develop new strategic alliances between the URMC and corporate partners. Debra Hafner in the Office of Corporate Alliances (OCA) is playing a key role in this process.

Promote technology development

The Office of Technology Transfer (OTT), under the direction of Marjorie Hunter, is working with the office of URMC Vice President and COO Peter Robinson and with OCA, to develop a more fully integrated process to move research projects along the development pathway into commercialization (where appropriate).  This effort involves the creation of new opportunities for access to early stage funding, business expertise and advice, and management mentoring, and is being enhanced by a closer relationship with High-Tech Rochester (HTR).  OTT has recently added a new Associate Director for Biological Sciences (Michael Rusnak) to further facilitate this process, as well as two senior licensing managers (David Wang and Zubair Mirza).  The coming year will see more emphasis on education and outreach including an enhanced marketing effort; a new technology development fund concept is also under consideration.

Clinical Research—Randy Rosier, MD, PhD (Interim)

Looking back

This past year has been quite notable for advances in clinical research on several fronts. Results of the most recent Research Resources Survey shows continued momentum in clinical research at SMD.  Tom Fogg, Senior Planner, was instrumental in creating a process that led to a complete assessment.  As a percentage of total sponsored research funding at SMD, clinical research accounted for 52% and basic research 48%.  These figures compare to 49% and 51% from the 2005 survey.  If we restrict the analysis to NIH funding, the percentages of clinical and basic research are 42% and 58%, respectively, which compares with 33% and 67% across NIH nationally.  These data demonstrate the entire philosophy and infrastructure of our institution with its clinical and translational orientation.  It is interesting to consider these results in light of the relative investments being made in basic and clinical research: Last year, SMD spent $24 million and $3 million in support of faculty conducting basic and clinical research, respectively. Complete results of the Research Resource Inventory can be found at: www.urmc.rochester.edu/ctsi.

2007 was the first full year of our NIH Clinical and Translational Science Award (CTSA).  During Dr. Pearson’s sabbatical this year, the CTSI Education, Training and Career Development key function is being supervised by Dr. Robert Holloway.  This key function is an umbrella that covers what used to be known as the K30 program (the Rochester Clinical Research Curriculum), the K12 career development program and the T32 predoctoral training program. The K12 program provided mentored career development awards to 6 faculty scholars, and the T32 provided support for the PhD phase of our MD-PhD program to 3 students and for year-out support for 11 medical students.  These experiences will no doubt pay great dividends for these faculty members and students in the years ahead.  Consistent with the goals of the CTSA, we have been able to also support a large number of pilot studies, novel methodology projects, laboratory costs, and epidemiology and statistical consultations.  Moreover, We were recently awarded a supplement to the CTSA to create the University of Rochester’s Research Associate Organization. This first-of-its-kind one year planning grant was awarded to only four CTSA institutions. The goal of the planning project is to develop the infrastructure for a Rochester Research Associate Organization (RRAO) to perform innovative practice-based research in the community.  As well, the Greater Rochester Practice-Based Research Network (GR-PBRN) is a collaborative network of primary care practices and health researchers established by the Community Engagement portion of the CTSI. The GR-PBRN brings together primary care physicians and academia to form the necessary bridge between practice and research.

A look forward

The new PhD program in clinical and translational sciences has recently been approved by New York State, and commencement of enrollment is planned for 2008.  This is the first program of its kind nationally and will be a model for other Universities.  This past month, we were pleased to announce the appointment of Eric Rubenstein, MPH JD, as our new Director of Regulatory Support, filling a much-needed position  in our research community—that of “investigator advocate.” Together with a small staff, Eric will be responsible for creating a process that ensures the efficient review and implementation of research projects.  During the first quarter of 2008, the Community Advisory Board, which was established in early 2006 to provide a community perspective on all four mission areas of the medical center, will hold a retreat to establish priorities for research to support community health improvement goals.  And perhaps most exciting development is the approval and initiation of planning for the new Clinical and Translational Sciences Building to house many of the programs of the CTSI.  This is again a one of a kind entity, and will be looked at nationally as a new model for co-localizing clinical and translational research, education, and administrative activities.  The strategic plan recently completed by the Medical Center includes a large number of planned clinician-scientist recruitments to further bolster our clinical and translational research activities into the future.  

Academic Affairs—Richard Burton, M.D.

Looking back

Faculty actions: We currently have 1423 full-time faculty (FTF), 1222 Part-time (PT) and Volunteer faculty, 115 Visiting and Adjunct Faculty, and 53 Departmental Fellows for a total number of 2813 current faculty. This year we had 286 new faculty appointments, and 138 terminations or retirements, for a net gain of 148 faculty.

73 Ad Hoc Committees were appointed to evaluate candidates for promotion to the ranks of Associate Professor or higher, including 12 for consideration of Tenure, all deliberated by Steering Committee and reported to MEDSAC.  These senior faculty action activities and those for reappointment yielded a total of 181 Senior Faculty Action items.

There were 6 new Chair or Center Director appointments, 6 Chair or Center Director reappointments, 3 Interim Chair appointments, and 12 new or reappointments of Named Professorships.  Three University of Rochester Trustee actions created two new Endowed Chairs, and two new Centers.  Thirteen of our faculty requested a sabbatical (leave of absence), and were acted upon favorably by the University Trustees.

All of the above generated more than 2000 hard copy letters of correspondence, and the processing of more than 3000 #510 forms for issues of salary, account numbers, and/or other adjustments for PERC.

Reports: Multiple reports were generated, including those required by the LCME, for Women in Academic Medicine, the UR Fact Book, and reports for the GME office.

Conflict of Interest (COI) issues and creation of COI management plans have been under the guidance of the Conflict of Interest Advisory Group (CIAG), chaired by the SADAA, and composed of selected senior faculty, the Director of ORPA, the Director of Technology Transfer for URMC, the Office of Human Subjects Protection, and legal counsel.  A new reporting form has been created, now being sent to all faculty at URMC.  There are now a total of approximately 80 approved COI Management Plans in place, 40 of these new during 2007.

A computer program has been developed to facilitate the initial development of COI Management plans and to monitor compliance with those plans.

Department/Center reviews: A formalized process has been put in place for systematic and standardized review of Departments/Center and the respective Chairs/Directors at the time of first and of subsequent reappointments.  The first review is a process internal to URMC, and the subsequent reviews involve external consultants.  During the past year, 6 reviews have been completed, and at present 2 more are in process.  Four additional reviews are planned for the coming year.

Guideline for searches:  A guideline document has been developed this past year to standardize the national search process for Chairs/Directors.  At present there are 3 active Chair searches.

Two new Associate Dean positions have been created.  Dr. Denham Ward is the Associate Dean for Faculty Development/Medical Education, and Dr. Vivian Lewis is the Associate Dean for Faculty Development/Women and Diversity.  Several new programs in these areas are being implemented.

Mentoring awards: Improvements have been put in place for the very competitive process for the selection of Two Mentoring Awards, one for mentoring of junior faculty, one for mentoring of trainees, given at the Medical School Convocation in September

V.A. appointments: During this past year, an appointment mechanism has been developed for those faculty who are full time at VA

Promotion guidelines clarification: With the collaboration of Dr. Dewhurst, a clarification of the current Regulations of the Faculty has been put in place to address some of the issues in promotion for faculty in the Cores.

A look forward:

  1. Continue the timely Ad Hoc Committee and Steering process, with all Ad Hoc reports requested within 4-5 weeks of committee assignment, to go to the next monthly meeting of the Steering Committee
  2. Implement the computer program and enter all the data for prior COI Management Plans and plans currently being developed, and formalize the compliance review processes for existing COI Management Plans.
  3. In collaboration with the Senior Associate Deans for Basic Research and Clinical Research consider the addition of an additional Option (Track) in the Regulations of the Faculty for faculty with major responsibilities in the Cores and for faculty with major teaching contributions extending across broad aspects of URMC.
  4. Work closely with Senior Leadership in the implementation of the compensation plan as it interfaces with the Regulations of the Faculty.
  5. Continue the open door policy for the mentoring of chairs/senior faculty
  6. Increase the mentoring awards for trainees, to give one for mentoring in the basic sciences, and one for mentoring of residents and/or fellows
  7. Continue to have input as a member of the Task Force on Faculty Discipline, chaired by Provost Kuncl, to develop standardized offer and reappointment letters, including language for suspension of academic appointments for just cause.

Here’s to an exciting year ahead,

David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry
University of Rochester

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