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New Year's Resolutions from the Dean's Office, 2006

Dr. David Guzick, M.D., Ph.D. January 13, 2006

This is the second annual recitation of "New Year's Resolutions" from the Dean's Office—specifically, the goals and plans of the Senior Associate Deans for Academic Affairs, Basic Research, Clinical Affairs, Clinical Research and Graduate Education, and of the Associate Deans for Medical Student Education and Graduate Medical Education. Each of the following sections, shown in alphabetical order, was written by the individual responsible for the office described:

 

 

 

Academic Affairs – Richard Burton, MD

Richard Burton, MD
Richard Burton, MD

The office of the Senior Associate Dean for Academic Affairs (SADAA) continues to foster the recruitment of outstanding and diverse faculty; to mentor Chairs and Center Directors; to advise Chairs in matters of faculty appointments, reappointments, promotions, and decisions for tenure; and to lead the Ad Hoc and Steering Committee processes for promotion, tenure, and appointment decisions.

Looking Back

Redesign Project for New URMC Web Site: The Web Site Redesign is being directed by the SADAA. Over the past year a great deal of progress has been made: All stakeholders have agreed to our "rebranding" as the University of Rochester Medical Center, with a single web site integrated across the entire Medical Center enterprise. Internal web resources, once scattered across the Medical Center, have been coordinated into a work group, reporting directly to Senior Leadership Team (SLT) via the SADAA. The Educational Task Force and the Research Task Force have completed their reports for overview and internal user needs profiles in those respective areas. A national firm with expertise in user need assessment was retained and has completed the analysis for multiple external URMC user groups in education, in research, and in clinical areas. Examples of such external user groups are medical student applicants, residency applicants, graduate student applicants, postdoctoral applicants, faculty recruits, chair recruits, prospective patients, and referring physicians.

Conflict of Interest: The Conflict of Interest Advisory Group (CIAG) has been formed, advisory to the Dean, and is functioning smoothly. This is chaired by the SADAA; the composition of the group includes selected senior basic science and clinical faculty, and University leadership in technology transfer and intellectual property, legal counsel, research administration, and the office for human subjects protection. During the past year individual situations have been considered, management plans developed and sent to the Dean for approval, and then forward to the University Conflict of Interest Committee, chaired by the Provost of the University. CIAG, based on the activities of the past year, has developed a uniform guideline when a conflict of interest management plan is required, or when a faculty member needs to either recuse him/herself from the study or divest from the commercial interest.

Search for the New Chair of Pediatrics: The Search Committee, chaired by the SADAA, has conducted an extensive national search, yielding many superb external and internal candidates. After thorough review and interview processes, three outstanding final candidates were identified. Current discussions and decisions are now by the Senior Leadership Team.

Resolutions for 2006

Assessment of Teaching: Efforts are underway to enhance the accurate assessment and documentation of teaching skills and teaching efforts to facilitate more objective inclusion of these into the considerations for academic promotion.

Conflict of Interest:

  • A new faculty information form will be used (to replace two prior forms), designed to be more clear and more specific. As in the past, the University requires all faculty on a yearly basis complete these, delineating areas of potential conflict of interest.
  • The guideline format will be posted on the web (with the new faculty information form) to indicate when faculty need to develop a management plan, or to either recuse from the research or divest.
  • A standardized form will be implemented to document proper follow up on previously completed, approved, and filed conflict of interest management plans.
  • Mechanisms and processes will be coordinated for identifying and managing potential conflicts in purchasing.
  • CIAG is working closing with the University Conflict of Interest Committee on issues related to consulting and Securities and Exchange Commission regulations.

Website: With the essential internal and external assessments of the website completed, the next steps are about to begin. A unified Core Web Group (CWG) is being created with web site staff from Web Technology, from Marketing, and from Medical Informatics. CSW will report directly to SLT via the SADAA. Also being created is a central budget for the CSW Web Site Redesign project. Centralized CWG Space has been identified to permit co-location of this Core Group to increase efficiency, avoid duplication of effort, and to streamline maximally productive interactions with each of the URMC Departments and Centers. The web redesign project is being implemented in four phases, each phase involving design and architecture, content creation and migration, and web technology tracks.

Basic Research—Howard Federoff, M.D., Ph.D.

Howard Ferderoff, MD, PhD
Howard Federoff, MD, PhD

 

Looking Back

We have enjoyed growth in our grant portfolio this past year in the face of an NIH budget that itself grew modestly. This reflects great success in securing a small number of large NIH grants. The FY06 budget appears flat making the challenges substantive. Given the high degree of collegiality and collaboration at our institution, opportunities for multidisciplinary projects and cross campus interactions I anticipate continued growth although perhaps less in our R01 portfolio.

Resolutions for 2006

Reflecting on the strategic planning process that we have undertaken my office will advance extant activities and commence several initiatives.

  • Establish metrics for productivity: This concept was proposed last year. We have begun to develop a small working group to identify the areas that should be considered in the development of new metrics. This should transcend dollars and include other measures such as scientific impact, community impact (teaching/service/mentoring), and peer recognition. These should drive faculty career planning and also resource allocations.
  • Evolve URMC core services: As noted in my New Year's overview last year (2005) we identified the need to recruit a new Chairperson (a board certified DVM) for DLAM to oversee our increasingly complex vivaria needs. With the assistance of many we succeeded in bringing Dr. Jeffrey Wyatt back to the UR and this has had a positive impact on our community. Among the exciting programs Jeff has implemented one deserves special mention. He created and has begun a veterinary medicine residency. This past year also witnessed the creation of a new proteomics core focusing on mass spectrometry. We have in development several other protein oriented core concepts: phage display and yeast two-hybrid interactions. These will be piloted this year. In addition, several of our existing cores will be reviewed with the goal of improving services and expanding opportunities if warranted.
  • Expand our incentive plan: The plan now encompasses the individual incentives program which recognizes tenure track faculty contributions made to R, K, P, T and U type grants. A P grant program persists. We will continue to refine our approach to have the maximum impact. In addition, we have begun discussion for development of new incentives for community service and outstanding teaching. I anticipate that these will mature through committee work this year. We will continue to recognize our recipients at the URMC Convocation.
  • Facilitate support of scientific enterprise through structured corporate relationships: This past year has seen success through the operations of the still nascent but growing Office of Corporate Alliance (OCA). Through the initial efforts of Andrew Deubler and the current stewardship of Dr. Claudia Stewart we secured support for the Johnson & Johnson Discovery Fund. We recently completed our first review of applications and will shortly make several awards. This will program will continue this year. Relationships with other companies are being cultivated with the expectation of growing interest in the URMC. The OCA will gradually expand its profile and work with investigators to facilitate and support their own corporate interactions.

Clinical Affairs—Kenneth DeHaven, M.D.

 

Looking Back

Kenneth DeHaven, MD
Kenneth DeHaven, MD

URMFG Operating Guidelines: URMFG has been functioning for more than a year according to the operating guidelines adopted in October, 2004, which created a structure for systematic input and oversight by clinical department chairs and center directors. The Executive Committee has been meeting monthly, and the Advisory Committee (the committee of the whole) quarterly.

Payer Relationships: In 2005 URMFG worked jointly with Excellus and RIPA to improve its working relationships. In this new relationship Kenneth DeHaven, MD was named to the RIPA Board, a first for the Director of URMFG. This coming together has also resulted in URMFG being able to create market movement in payer conversion factors, which in the case of Excellus/RIPA had remained flat for several years. This movement was considerable with Preferred Care, Aetna, and United HealthCare as well, all of which will have a significant positive effect on URMFG's bottom line in 2006.

AllScripts Roll-out: During the past year the Allscripts project successfully proved ROI on the pilot initiative and converted to a system-wide roll out. To date, over 60 providers and 200 support staff in 10 sites are using Allscripts Touchworks for complete automation of their outpatient practices. Additionally, the Continuity of Care Record (CCR) technology in Allscripts has been implemented in 18 ambulatory areas to address a JCAHO initiative that mandates accurate and timely maintenance of the medication, problem, and allergy lists.

Omega Replacement Project: By far, the largest IT project in 2005 was to replace Omega with IDX as SMH's patient management/patient accounting system. The project has been underway since January 2005 and its targeted go-live date is October 2006.

Resolutions for 2006

URMFG Operating Guidelines: A major focus for 2006 will be to evaluate how well this new structure is performing. A retreat is being planned to determine what is working well, what is not working so well, and to consider modifications or additions to recommend for adoption by senior leadership.

Payer Relationships: URMFG will persist in pressing for an appropriate rate of reimbursement for clinical services, and will continue to work together with Excellus and RIPA as we face the next threat to health care payments, the shift of funding for health insurance premiums from employers to employees under the guise of "consumer directed health care."

AllScripts Roll-out: The Allscripts project team is enhancing their resources to accelerate the implementation of TouchWorks at URMC from 3 years to 2; there will be three separate implementation tracts, one for primary care, one for hospital based practices, and a third for ambulatory specialty areas. By the end of CY 2006 the team anticipates completing nearly 60% of the system-wide implementation goal.

Information Technology Initiatives: Continued work on the Omega replacement project requires dedicated URMFG staff and resources from the Shared Services Organization (SSO). Our goal is to implement the Payer Contract Management and Electronic Document Imaging modules. The Payer Contract module will enable us to compare our contracts to actual payments to better identify incorrect payments. The Electronic Document Imaging system will allow users to view remittances and other documents on-line and help reduce the amount of paper stored in billing offices. A common patient database across URMFG and SMH will have many benefits, requiring ongoing collaboration with both ISD and SMH.

Finance: Our annual audit by PricewaterhouseCoopers in June 2005 highlighted areas where URMFG needs to tighten controls to ensure compliance of non-for-profit financial and accounting regulations. Areas of focus for FY 2007 include an accountability structure that ensures departments are completing detailed cash reconciliations, maintaining appropriate documentation, and following all polices and procedures. URMFG administration has created the tools required to accomplish this, trained departments, and will complete quarterly testing across all departments to verify compliance.

Clinical Research – Thomas A. Pearson, MD, MPH, PhD

 

Looking Back

Tom Pearson, MD, MPH, PhD
Thomas Pearson, MD, PhD

The NIH Road Map Initiative, involving a commitment of 1-2% of an otherwise flat NIH budget, took shape in 2005 in the form of "Reengineering of Clinical Research." As it turns out, much of our planning and development activities in clinical research in 2005 will put us in a stronger position for competition for large NIH funding opportunities in 2006. These activities included:

  • Completion of a Clinical Research Strategic Plan in August, 2005, including strong support for a new clinical sciences building as the "home for clinical and translational research" at URMC, organization of 6 cross-disciplinary research programs, recommendation for 10 shared clinical research support units, and a functional Clinical Research Review Process Improvement Team with a number of policies to assist investigators in grant submission.
  • Translational Research has been brought into the spotlight by successful renewal of the General Clinical Research Center for another five years, organization of a regional Translational Research Network (though NIH decided against reviewing applications submitted at its own request!) and the Clinical Research Seminar Series promoting translational researchers across the URMC.
  • Clinical and Translational Research Training continues to be a major emphasis with successful renewal of the Clinical Research Curriculum Award (K30) for another 5 years; expansion of pre- and postdoctoral research training programs including 29 NIH training grants (T32) and four faculty development grants (3 R25 and 1 K12), with 21 oriented toward clinical research; and continued success in obtaining 35 individual career development awards in clinical research (7 K01, 8 K08, 15 K23, and 3 K24).
  • Expansion of Population–based Research with establishment of the Rochester Prevention Research Center and a Special Interest Project, the Coordinating Center for the National Cardiovascular Health Intervention Network, both funded by the Centers for Disease Control.
  • The continued growth of an evenly balanced research program, essentially half basic and half clinical, enhancing the opportunities for translational research. The 2005 Clinical Research Resource Inventory identified $220 million of sponsored research at the University of Rochester evenly divided between basic and clinical research as well as an additional $28 million in sponsored research training, conferences, and other research-related programs.

Resolutions for 2006

The 2005 Clinical Research Strategic Plan has been integrated into the URMC Research Strategic Plan and will pursue institutional, private, state and federal support for high priority initiatives. These coincide with a number of new NIH programs. These initiatives include:

  • Continued development of a Clinical and Translational Research Institute as the "academic home for clinical and translational research." This facility will allow, for the first time at URMC, the juxtaposition of several academic departments, clinical research programs and units, shared clinical research support units, administrative and regulatory support units, and community outreach programs.
  • Continued expansion of a technical infrastructure to support clinical and translational research, including clinical research methodology development, pilot studies, informatics, services for research participants (both subjects and investigators), and additional core translational and clinical research technologies.
  • Enhanced regulatory and administrative support for investigators to fulfill ethical, legal, regulatory, and financial responsibilities with improved efficiency.
  • Expansion of training and education in clinical and translational research, including: Launch of the Academic Research Track for medical students interested in academic careers as an enrichment of the MD curriculum with additional lectures, summer research preceptorships, and year-out programs in research; new Masters Programs in Clinical Investigation and in Translational Research; a new PhD Program in Translational Biomedical Sciences; and an expanded, URMC-wide Seminar Series on Research Translation.
  • Expansion of community programs in clinical research, including collaborations with regional basic scientists in need of translational collaborations and facilities and with regional clinicians for the dissemination of new products of clinical and translational research. These will take the form of public education programs and consortium of Upstate New York institutions interested in Clinical and Translational Research.
  • Evaluation of clinical research programs for return on investment. The Clinical Research Resource Inventory will be updated at regular intervals and a series of clinical research benchmarks will be followed annually to assure growth of the clinical and translational research enterprise.

Graduate Education – Paul La Celle, M.D.

 

Looking Back

Paul La Celle, MD
Paul LaCelle, MD, PhD

The need for training of outstanding doctoral students in the biomedical sciences continues, particularly as new career opportunities in biotechnology, technology transfer, law and regulatory roles and an in industry evolve. Our concerns for 2005 included enhanced recruiting efforts to enroll high quality students who would particularly benefit from our research and training environment and also to develop program enhancements to prepare students for the new career opportunities.

Recruiting: The number of applicants increased despite reduced international student interest: Applications from US citizens and permanent residents increased 65% and over half of those who interviewed were enrolled. In the present recruiting cycle, applications from US citizens and permanent residents increased 13% and international applications by 17%. This predicts a larger applicant pool from which a class of 70 highly qualified PhD students will be recruited for September 2006.

Program Development: To enhance our curriculum, new programs are being established: 1) the SMD and the Simon School of Business will join to offer a combined MBA/PhD degree, which will allow students to complete both degrees in 5.5 years; 2) A translational and clinical science track is planned to provide in-depth exposure to mechanisms of major disease processes, cardiovascular, cancer, neurological and metabolic endocrine disorders; some features of this new track will be available in September 2006.

Resolutions for 2006

MBA/PhD. Program: The plan is to have an approved program in place for admission of selected candidates in September 2006. The program will permit entering students to begin the MBA simultaneously with some PhD work, and then complete the PhD and industry internships in subsequent years; some current upper class graduate students may complete the MBA toward the end of the PhD work.

Translational and clinical research track: This will require summer course work in physiology and pathophysiology and throughout the first and second years of graduate study exposure to disease processes via BPL-style learning. The qualifying examination will be completed by the end of the third semester and basic science and clinical advisors identified to guide each student in thesis work, which may have application for translational research. This program will build on the existing strong program in the Department of Pathology and Laboratory Medicine and major clinical departments, and relate to the educational efforts of the Department of Community and Preventive Medicine.

Enrichment: Efforts to enhance the awareness of PhD students regarding career opportunities in biotechnology, management, and teaching will begin in 2006; a biotechnology symposium will be offered as well as a summer teaching institute in which alumni will present seminars to assist students in preparing for teaching at the college-level. Additionally, teaching experiences will be provided by course offerings and outreach efforts through the Department of Environmental Medicine and through established adjunct teaching appointments in regional colleges.

Graduate Medical Education – Diane Hartmann, M.D.

 

Looking Back

Diane Hartmann, MD
Diane Hartmann, MD

Goals for Graduate Medical Education as outlined in January 2005 included initiating plans for a clinical skills/simulation center as well as the development of e-learning opportunities.

Skills Center: A group of representatives from surgical and procedural-based disciplines has formulated a proposal for the center, which is currently under review by senior Medical Center leadership. An action plan is expected to be initiated in 2006.

e-Learning Modules: Two e-learning modules (pain management and delivering bad news), developed by Dr. Timothy Quill and colleagues, are now available on the GME website. Information discussed in the modules has been supplemented by live case based conferences with trainees and faculty learning to refine and practice new skills. Additional modules (family discussion concerning DNR, determination of capacity and informed consent, discussing adverse outcomes and motivating change) developed by this group will be available on the website in 2006.

ACGME Accreditation: The most significant event in the past year for Graduate Medical Education at the University of Rochester was the completion of our ACGME Institutional Accreditation site visit in February 2005. The University of Rochester was the first institution in the country to receive a 6-year accreditation cycle and received no citations.

Resolutions for 2006

Rather than breathing a "sigh of relief", the GME division has interpreted the ACGME assessment as an acknowledgement of our position on the leading edge of graduate medical education and a challenge to remain there. Initial plans are in place to launch a project in 2006 to ensure that each of our 68 training programs promote excellence in teaching and evaluation of the 6 ACGME Core Competencies (patient care, medical knowledge, communication, professionalism, practiced based learning and improvement and system based practice). It is expected that this "Competent Institution" initiative will encompass the entire medical education continuum from medical students through the continuing education of attending physicians. An important component of this project will be the identification of outcomes to assess its effectiveness. In addition to standard information such as training program match rates, accreditation visit outcomes, and initial board certification pass rates, our programs will be challenged to develop ways to collect data on external outcome measures (e.g. clinical quality indicators, patient surveys, employer evaluation of graduates) to verify trainee and program performance. The Medical Center has recently purchased a comprehensive computer program to collect and track evaluation and performance date for all programs. Training and implementation of the system will be conducted in 2006.

Medical Student Education—David R. Lambert, M.D.

 

Looking back

 

David Lambert, MD
David LAmbert, MD

In reviewing the plans set for 2005, the School of Medicine and Dentistry's Academic Research Track (ART) was formally developed and began full implementation. This program provides interested students with additional instruction and a year of research experience to prepare them for academic positions in the tradition of the school. The experiences and successes in the Double Helix Curriculum have led to numerous abstracts and submissions under the guidance of Drs. Steven Lurie and Ron Epstein. As noted in the GME report, plans have moved forward for a Surgical/Clinical Skills Center to facilitate the teaching and assessment of core competencies for students, residents and physicians in practice.

Resolutions for 2006

Liaison Committee on Medical Education (LCME) Visit Preparation: While the LCME will be conducting a reaccreditation visit in 2007, the first six months of 2006 we will be working to ensure that our programs and facilities meet the required updated standards. Some of these include clearer guidelines of the diseases/conditions of patients that medical students encounter and also their level of involvement. In addition, tracking the hours students spend in clinical situations is a new requirement. The second half of the year will begin our year long ‘self assessment' which gives us an opportunity to look at what we do with a critical but creative eye and to celebrate our many achievements. From that we will generate our report to the LCME prior to their visit. We will be sharing more on this as it nears.

Curriculum Plans: The Curriculum Steering Committee will be identifying the broad goals of Basic Science in the curriculum. This will then lead to a full assessment and re-evaluation of teaching in the third year with plans to implement any changes in July 2007. Additionally, the ‘Themes' which are woven throughout the curriculum will be re-evaluated and strong consideration made to making ‘Professionalism and Physician Self-Awareness' an identified theme throughout the four years. Dr. Cheryl Kodjo will be developing a cultural competence program through the curriculum.

Technology Updates: The Problem Based Learning (PBL) rooms that have been integral to our curriculum and assessments will be changed from analog to digital technology which will improve the ease and flexibility of their usage. The school will continue its roll out of the new evaluation system which is web-based and highly user friendly. This initiative is being carried out successfully by the Office of Curriculum under John McCarthy.

Curriculum Database: The medical school and medical center library are working to choose a vendor or self develop a curriculum database of topics and teaching venues. This will allow instructors easy access to determine what students have already learned.

Student Groups: We will continue to foster and support our medical student groups including the Student National Medical Association (SNMA), Asian Pacific American Medical Student Association (APAMSA) and SPECTRUM (Lesbian, Gay, Bisexual and Transgender Student Group) along with other groups. Diversity is essential to the medical school and medical center.

Student Lounge Renovation: I would be remiss if I did not point out that the medical student lounge. Parts of the lounge had not been changed since the early 1970's and while that might be nostalgic for alumni returning for their 25th reunion, the goal is to have it updated by March. Wireless access will eventually be included and there will be a new piano to allow our musically talented students an outlet. We are looking at some ideas for a lunchtime "Arts in the Atrium" series for the medical center.

Admissions: Under the superb leadership of Dr. John Hansen, we continue to attract outstanding medical students; our goal is to provide them with a set of challenges that will stretch them to achieve their extraordinary potential. We remain committed to maintaining a diverse and safe educational environment, and to an unwavering commitment to community service.

Whew! I think you will agree that there is no shortage of ambitious and exciting plans in the Dean's office for 2006. This is all being done in the spirit of the University of Rochester's motto…Thus,

Meliora,

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