A Special Message from Dean Wilkes

The July 4 holiday begins the most popular time for summer vacations for many of us. I wish for each of you a well-deserved rest. Prior to vacation season, I’d like to share some good news about our School.

Even though we’ve not reached the June 30 end of the current fiscal year, it’s clear that you have knocked it out of park in all areas of our School’s mission.

In education

  • The incoming class of 156 medical students has a mean GPA of 3.86 and a mean MCAT of 518.27 (the 97th percentile!). This year the class is 57% out-of-state and continues to have good diversity. The BIMS PhD programs have recruited a strong new class of graduate students.
  • 99% of our class matched in outstanding post-graduate programs.
  • Richard Baylis, MD/PhD student in the lab of Gary Owens, attended the 68th Lindau Nobel Laureate Meeting in June, where he and other young investigators from around the world had the opportunity to mingle with and get feedback from 43 Nobel Laureates.
  • All of the accrediting bodies that were required to approve the establishment of the School of Medicine-Inova Campus did so without stipulation. Our admissions team is getting ready to start recruiting the class of 2023, which will be the first class to have the option to do their clerkships at the Inova Campus.

In the clinical realm

  • Over 25% of our physicians are included on the 2017-18 Best Doctors in America list. This is phenomenal!
  • Becker’s Hospital Review recognized our hospital as one of the 100 Great Hospitals in America in 2018.
  • Our hospital continues to be #1 in Virginia.

And in research

  • SOM funding is poised to exceed last year’s totals, thanks to the continued outstanding efforts of all of our faculty and new strategic hires.
  • We scored a 21 on our CTSA application! Although we’ll know more in August, a number of people outside of UVA have confirmed that this is an extraordinary score.
  • The Hartwell Foundation again named UVA as one of its Top Ten Centers of Biomedical Research.
  • The UVA IRBs received accreditation from the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP).
  • The U.S. News & World Report rankings were further evidence of the extraordinary work you do. Primary Care rose to 21 (from 24) and Research went to 26 (from 27).

Finally, the School is in a strong financial position with operating revenues exceeding expenditures. Year-to-date through May 2018, the School of Medicine had an operating net income of $8 million. The Dean’s Reserve funded $31 million in strategic investments in all mission areas in clinical and basic science departments, as well as in centers. In addition, with strong financial management at all levels, we are entering our fourth consecutive year of no tuition increase for medical students.

You, our faculty, are the reason we have had such a remarkable year and are in a strong position both academically and fiscally. I am deeply grateful to you for your commitment to our shared vision and for your hard work that has resulted in this banner year for our School.

With warm regards,

David S. Wilkes, MD
Dean, UVA School of Medicine
James Carroll Flippin Professor of Medical Science

Coming This Fall: Patient Student Partnership

The Patient Student Partnership will pair our students with a chronically ill adult or pediatric patient to follow for all four years of medical school.

With the success of the Phronesis Project (which we wrote about here), the School of Medicine has expanded this longitudinal patient experience and made it part of the curriculum for this year’s incoming class. This program, known as Patient Student Partnership (PSP), will pair each of the 160 students in SMD22 with a chronically ill adult or pediatric patient to follow for all four years of medical school.

Students will attend clinic visits, be present as the patient’s advocate, and help the patient navigate the Health System. This partnership will give students the opportunity to learn about healthcare through the eyes of a patient and to witness the trajectory of chronic illness.

This first patient relationship will give students context to their medical education and will provide them with a real-world touchpoint, something in which to ground their newly acquired knowledge.

A few things to note:

  • Clinicians: Please be aware that, starting in October 2018, first-year students will accompany patients to clinic visits in the role of patient advocate.
  • Pre-clerkship faculty who teach students: Students now will have real patients and thus real exposure to health problems to complement classroom learning.

This is a notable moment in the continuous improvement of our curriculum. Students will receive unique patient exposure during their first semester of medical school. This relationship promises to be an enriching and rewarding (and educational!) experience. It is my hope that the early formation of a special doctor-patient relationship will remind our students exactly why they chose to study medicine at the University of Virginia in the first place.

As students enter their fourth year of study, they will begin the process of handing off their patients to the newly arriving first years — and the cycle will begin anew for many of our patients.

Everything we do at the School is in service to our patients, and the feedback from previous years’ participants has been very enthusiastic. Patients loved the same thing I love, namely, watching our students grow and evolve into young physicians.  And the students have recognized that our patients are our best teachers — something most doctors always have known.

Thank you to all of the faculty who worked on the Phronesis Project. That pilot set the groundwork for this amazing next step. Also, thank you to all the primary care clinics and specialty practices across Grounds who aided in recruiting patients and provided this opportunity for our students. And most importantly, I thank our patients. Without their generosity this initiative would be impossible.

For more information on PSP, visit the website. If you have questions, contact Colleen Kiernan.

R.J. Canterbury, MD, MS, DLFAPA
Wilford W. Spradlin Professor
Senior Associate Dean for Education

Highlights: March MAC Meeting

Opening Comments from the Dean
David S. Wilkes, MD

  • Dean Wilkes highlighted three individuals who received distinguished recognition:
    • B. Cameron Webb, MD, JD, Assistant Professor of Medicine and Public Health Sciences, was recognized by the Congressional Black Caucus and the National Minority Quality Forum as one of the “40 Under 40 Leaders in Minority Health.”
    • Pamela Sutton-Wallace, Medical Center CEO, was among the “Top 25 Minority Executives in Healthcare 2018” identified by Modern Healthcare.
    • Richard Baylis, MD/PhD student in Gary Owens’ lab, is among 600 students worldwide selected to attend the 68th Lindau Nobel Laureate Meeting. He will have the opportunity to meet and talk science with 43 Nobel Laureates.
  • IT Security Upgrade
    • The recent upgrade was made with the primary purpose of addressing urgent needs to ensure patient data is safe. This has brought about some unintended outcomes, such as variable access to programs and files resulting in work-arounds. The dean reminded people that Health System shared drives (e.g., “Y”) can be used for sharing or storing information, including PHI. Non-confidential information can be shared via UVA Box or Collab. Call the Help Desk at 434.924.5334 if you are having trouble accessing programs or files. We will have another update at the April MAC.

Funding Analysis/NIH Rankings
Margaret A. Shupnik, PhD

  • Dr. Shupnik showed a chart of funding over a 10-year period and noted that total funding is up and we are diversifying our portfolio. There has been a big increase in successful non-modular grants.
  • The NIH ranking contains all awards – new, renewed, non-competitive continuations, and supplements of all types of awards. It includes all subcontracts if the PI is at UVA and does not include NIH subcontracts received from other institutions.
  • There is considerable volatility of dollars awarded among the rankings of 35-45 and one grant has the potential to bring about an increase or a decrease in the rankings.
  • Dr. Shupnik’s analysis shows that we have many fewer P and U grants than other institutions and this appears to be the primary factor in our ranking not being higher. These awards enable scientists to do the kind of work that one person cannot do alone, and they bring more than funds – they also bring impact and status within the scientific community and provide infrastructure and administrative support.
  • Resources are available – ResearchNet, the Conafay Group – at the institutional level, in addition to department resources such as pre-submission grant review. ResearchNet can provide some shared SOM/VPR support for complicated team/center proposal submissions.
  • NIH rankings information is at http://www.brimr.org/NIH_Awards/NIH_Awards.htm.

On the Path to Academic Success
Susan M. Pollart, MD

  • Annual reviews, which are required for every faculty member, are especially important for faculty at the end of their first three years. For tenure eligible faculty members, it is important to realistically assess potential for the first promotion. For tenure ineligible faculty, the appointment after the third year of employment must be for three years. Regardless of tenure eligibility, faculty members not meeting expectations at the end of the third year of employment can be given a one year notice of non-renewal.
  • Promotion and Tenure
    • New guidelines provide updated/clarified guidelines regarding criteria for excellence in team science.
    • Dean Wilkes is sending the SOM P&T Committee’s specific recommendations to individual faculty members (promoted on July 1, 2017) who are eligible for further advancement (i.e. tenured associate professors, tenure eligible associate professors, and tenure ineligible associate professors). These recommendations identify areas to recommended focus to help ensure success in their next advancement.

Health System Financial Overview
Douglas Lischke, Chief Accounting Officer

  • Mr. Lischke provided an update of the consolidated Health System financials.

Health System Board Update
A. Bobby Chhabra, MD

Dr. Chhabra shared highlights from the February 28, 2017, HSB meeting. The HS goals dashboard for FY18 showed strong performance with eight out of twelve indicators green.

The next meeting will be Tuesday, April 10, 2018, in the BIMS Classroom.

UVA Provides MOCA, Not Latte

(l-r) Keith Littlewood, MD; Chuck Stanton; Saimon Malakor; Angel Thompson; Maria Vazquez-Amaral, JD; Vaia Abatzis, MD; and Ira Rubenstein.

Did you know that the University of Virginia School of Medicine is one of the 20 charter sites for physicians to receive their Maintenance of Certification in Anesthesiology (MOCA)? Doctors travel to sites across the country for recertification, and here at UVA, they spend a day in the Claude Moore Medical Education Building’s Medical Simulation Center, learning and demonstrating their proficiencies for patient care.

In the 10-year MOCA re-credentialing cycle, anesthesiologists must earn 50 points in their knowledge and skills assessments. By coming to our Simulation Center every five years, doctors can earn 25 points on each single-day visit. It is, by far, the most efficient way of getting those points. We take this seriously and, points aside, strive to provide an enriching learning environment for attendees.

We push them, and we push them hard. The entire day is almost entirely simulation-based. Participants break up into teams and experience simulated patients in crisis situations: cardiovascular instability, hypoxemia, malignant hyperthermia, anesthesia toxicity. The works. Then we add a twist: How do these situations resolve with, say, pregnant patients?

Not every test is an emergency. We also present participants with situations that are common or from which they would benefit from practice, like sepsis. From rare to common to close-calls to abnormal … our Simulation Center provides a variety of learning experiences.

SOM’s MOCA Is More than Recertification
Because no patient is cared for by a single person, the healthcare team’s performance is also evaluated. After each exercise, the team gathers to debrief. I believe this is a crucial part of the experience. The team candidly talks about what happened during in the simulation. They answer the question, “What were you thinking?” in an educational, non-judgmental way. There is a tacit assumption that our participants are smart and provide good care to patients — but, what trap did the team fall into? What were they doing (or not doing) together? We not only care about what occurred to result in the simulated patient receiving a bad outcome, but also what can be done to ensure this does not happen again. It is an opportunity to raise the bar for all attendees.

MOCA is administered through the American Society of Anesthesiology, and they invite participants to take a “customer satisfaction” survey. Feedback on our Sim Center experience has been wonderfully positive. Many physicians are happy to come to our School and receive their recertification in this manner. For us, it’s not just a matter of making sure anesthesiologists have their points and that they can check an item off their to-do list. We take pride that, when participants leave UVA, they feel it was a worthwhile experience. Many leave Grounds feeling that the day spent in our Simulation Center changed the way they think about their practice. That is incredibly rewarding.

Our Simulation Center is excellent and there are many talented people who have contributed mightily to its success, from the moment it was conceived to today. This includes Dr. Marcus Martin, Dr. Mark Kirk, Dr. Vaia Abatzis, Dr. Keith Littlewood, the Claude Moore Foundation, and the faculty and staff who envisioned the NxGen curricula and support the center itself. They have my gratitude and my thanks.

R.J. Canterbury, MD, MS, DLFAPA
Wilford W. Spradlin Professor
Senior Associate Dean for Education

iCan. Can You?

A few months ago, we discussed the development of VMED, an integrated learning-, curriculum-, and student-management system. The development team is still working on the first iteration of the product, which we hope to have available in the summer to test.

Related to VMED is the Interactive Clinical Assessment Navigator (iCan), a tool through which we can assess entrustable professional activities (EPA). EPAs cover basic skills a physician should have, such as taking a patient history, documenting an encounter, performing basic procedures, collaborating as part of an interprofessional team, and interpreting lab values. In terms of use, we have seen dramatic expansion of iCan’s use in the past few months. It was first implemented in part of the clerkship class, then moved to all of SMD19, and is now also being used by SMD20. By the fall, SMD21 and SMD22 will be using it as well. It’s exciting to see a product we developed being implemented so widely and quickly.

But this is about more than a new tool and who is using it. This is about using the lean methodology and continuous process improvement to make our systems better. Better for faculty and better for students. It’s about asking, “Is this the best way to assess our students’ clinical performance?” If it’s not, we stop the process and collaborate to find a solution. The key word here is “continuous.” There’s no finish line in our improvement journey.

iCan is a part of the larger VMED system and, thus far, has been well received. The team is continuing to meet with system leaders, clerkship directors and coordinators, faculty, and staff to discuss what to expect from iCan and to understand how it will help facilitate preparation for the next academic year.

I offer my thanks to Maryellen Gusic, MD, who has been a champion for EPAs and iCan, and is one of the reasons its expansion across the cohorts of students is going so well. For more information on VMED — a timeline, progress dashboard, and other documentation — visit the website here. If you have questions, please contact Kim Holman. Keep an eye on the Dean’s Office Blog in June for the next VMED update.

R.J. Canterbury, MD
Senior Associate Dean for Education
Wilford W. Spradlin Professor

Making Virginia Medicine Better: (l-r) Dr. Megan Bray, Dr. Mary Kate Worden, Kim Holman, Dr. Maryellen Gusic, Robert Pastor, Dr. Randolph Canterbury, and Mark Moody.

Highlights: January MAC Meeting

Opening Comments from the Dean
David S. Wilkes, MD

  • Budget Construction
    • As the budget season gets underway, we will all have to consider the significant implications of the recent tax bill. We expect immediate restrictions that will be ongoing. Just two examples (changes in 340B reimbursements and the loss of automatic inpatient status for Medicare total knee replacements) result in an annual decrease of $14 million. We anticipate an additional annual decrease of $10 million due to the impact of the repeal of the individual mandate of the Affordable Care Act.
    • These reductions will hit the Medical Center’s bottom line and, clearly, will influence what it is able to pass through to the School of Medicine.
    • Although we must plan for financial restrictions, we must not compromise on excellence.
    • We must prioritize and focus on what is strategic and necessary, and we must determine what we will not do.
  • DAR Feedback
    • Several chairs noted that the DAR does not provide a mechanism for faculty to offer feedback on the chair’s performance.
    • The 2015 Faculty Forward Survey had robust data (due to high faculty participation) to share with the chairs. The survey will be administered again in the fall of 2018, and, as in 2015, it will be helpful if the chairs encourage their faculty to participate.
    • In the fall of 2019, we will conduct a 360 feedback survey that focuses exclusively on the chair.
    • Thank you to those who provided feedback on the DAR process.

February Medical Alumni Gathering
Anne Watkins

  • The Medical Alumni Association’s winter retreat will be held February 16-17 at the Lansdowne Resort and Spa in Leesburg.
  • Now that the graduate degrees have moved to the School of Medicine, the MAA is actively interacting with our graduate students. The retreat will feature a Friday evening poster session that will feature the work of about 40 graduate and medical students.
  • All faculty and students are invited to attend.
  • org/event/2018-Winter-Retreat/

New Business

  • Dr. Nataro asked about unexplained variances between RVUs and collections. Susan Rumsey will bring administrators together to discuss this further.

The next meeting will be Tuesday, Feb. 13, 2018, in the BIMS Classroom.

Highlights: December MAC Meeting

Opening Comments from the Dean
David S. Wilkes, MD

  • Implications of HR 1, Tax Cut and Jobs Act, on Graduate Student Stipends
    • Negative impact upon our students, UVA, and nation
      • College will be less affordable
      • Discourages participation in higher education
      • Discourages employer investment in employee learning
      • Decreases US competitiveness
      • Brightest minds will go outside of the US to advance
    • Elimination of Section 117(d) provisions
      • Devastating to research programs
      • No longer able to provide tax-free tuition for graduate students
        • Example: stipend of $24K and tuition waiver of $29K – student’s tax bill triples to $4,920
      • Erodes progress made in developing strong interest in STEM programs
        • Puts STEM education out of the reach of many students
      • Our legislators
      • Themes of Incoming UVA President Ryan
        • Community: opportunity to interact with and learn from a broadly diverse group of students, faculty, staff
        • Discovery: new knowledge that solves problems, leads to practical application, and brings new perspective to enduring questions
        • Service: public universities serve the public, starting with their own states
      • New Strategic Hire: Ken Walsh, PhD. Professor of CV Medicine and Director, Whitaker CV Institute, at Boston University SOM. Starts January 25, 2018. $.9M year one, $3.5M over five years.

Overview of Equal Opportunity & Civil Rights Policies and Reporting Options
Catherine Spear, AVP Equal Opportunity & Civil Rights
Emily Babb, AVP for Title IX Compliance & Title IX Coordinator

  • Presentation addressed:
    • Notice of non-discrimination and equal opportunity
    • Policy of Sexual and Gender-Based Harassment and Other Forms of Interpersonal Violence (Title IX Policy)
    • Preventing and Addressing Discrimination and Harassment (PADH Policy) and Preventing and Addressing Retaliation (PAR Policy)
    • Why reporting is important
    • How to report prohibited conduct under these policies
    • How to address prohibited conduct
  • See presentation.

December Health System Board Update
A. Bobby Chhabra, MD, Chair of Orthopaedic Surgery

  • Dr. Chhabra shared highlights from the December 6, 2017, HSB meeting. The HS goals dashboard showed notable improvement in solid organ and bone marrow transplants and addition investments by Seed & Venture Funds, moving these two indicators to green. All other categories are yellow.
  • FY18 first-quarter financial results were shared.

The next meeting will be Tuesday, Jan. 9, 2018, in the BIMS Classroom.

It’s Time for You to THRIV

THRIV’s inaugural class of scholars: (l-r) Dustin Walters, MD; Jessica Keim-Malpass, PhD, RN; Kathleen McManus, MD, MS; Brynne Sullivan, MD; and Kyle J. Lampe, PhD.

The Translational Health Research Institute of Virginia (THRIV) program has announced a new call for proposals for mentored career development awards for junior faculty at UVA who are pursuing a career in clinical or translational research.

THRIV is a transformational cross-Grounds collaboration that leverages the latest advances in data science to accelerate innovation in health-related research and facilitate team science. THRIV seeks to support highly qualified junior faculty for activities related to the development of a successful clinical research or translational research career.

The first group of scholars came from three different schools across Grounds — the School of Nursing, the School of Engineering and Applied Sciences, and the School of Medicine — and I am excited see that applications are now open for the next group of promising scientists.

The THRIV Scholar Career Development Program aims to train the next generation of translational researchers in principles of data science, the conduct of rigorous and reproducible science, and to promote team science as a means to enhance innovation and discovery in health-related research. The program provides up to 75% salary/fringe support for up to 2 years for Scholars in addition to funding for research-related expenses and training.

For details visit THRIV’s website, or contact Sandra Burks.

Margaret A. Shupnik, PhD
Gerald D. Aurbach Professor of Endocrinology
Professor of Medicine
Senior Associate Dean for Research

Highlights: November MAC Meeting

Opening Comments from the Dean David S. Wilkes, MD

  • We learned a number of lessons from the DARs/CARs.
    • Accountability is key across all missions.
      • In education, we must ensure that students are prepared to perform the Entrustable Professional Activities.
      • In research, we must diversify the funding portfolios, maintain the standards for research funding per square foot of lab space, and maximize salary support on grants.
      • In the clinics, we must improve efficiencies across the board in the ambulatory setting and we must establish a group practice.
    • The reviews highlighted several priorities.
      • As leaders, we are all responsible for working together and guiding institutional change.
      • We must improve organizational structures and processes. In the dean’s office, we are doing this through developing business intelligence, improving IT infrastructure, and piloting the Be Smart initiative (lean processes).
      • We must build and strengthen external relationship across the University, through the Inova partnership, and through the CTSA initiative.
      • We will take education to a higher level through innovations in our graduate and master’s programs.
    • One of the programs we learned about in the DARs is the Silo Busters program in the Child Health Research Center (CHRC) in the Department of Pediatrics. James Nataro described Silo Busters for us.
      • The program is designed to facilitate interactions with basic scientists. Eligible basic scientists who will be working with Pediatrics faculty members are given joint appointments in the CHRC.
      • The research may be conducted in the lab of either the primary or the secondary appointee.
      • The objective is to attract basic scientists to work with clinicians.
      • The first Silo Buster recipients will be announced before the end of this year.

Bobby Chhabra, MD
The Department of Orthopedics’ clinical trials have grown from 4 trials in 2013 to more than 60 today. Over the last year, the clinical trials infrastructure has been fully supported by the overhead negotiated through the industry “rate card” mechanism.

Dr. Chhabra explained the methodology for developing the cost expectations for the rate card. It takes into account salary expenses (investigator and trial support staff) and OTPS. Billing may be based on an hourly rate or on trial enrollment and other milestones.

The rate card provides a process that is more streamlined and transparent for the budgeting process. It makes is easier for industry to set up trials. It provides salary support for MDs and PAs. The rate card helps to ensure that clinical revenues do not support the expenses of clinical trials.

VMED: Making Teaching and Learning Simpler

Making Virginia Medicine Better: (l-r) Dr. Megan Bray, Dr. Mary Kate Worden, Kim Holman, Dr. Maryellen Gusic, Robert Pastor, Dr. Randolph Canterbury, and Mark Moody.

Technology is supposed to make our lives easier and allow us to work faster or smarter; but it has to be the right technology, employed correctly. Too often we find some tech to be “good enough” and try to make it suit our needs. “Good enough” causes us to create Band-Aid solutions and workarounds which can translate to extra work and frustration. Over the years, the School of Medicine has been using a patchwork quilt of commercial and custom educational programs and software, added and modified where needed. We’re getting rid of them for something better.

The School of Medicine is in the process of building VMED, which stands for Virginia Medicine. This is an integrated learning-, curriculum-, and student-management system that is being designed with the specific needs of UVA in mind. We want to provide a seamless experience for students, faculty, and administration. With a system of our own design, we can build it to meet our needs instead of trying to muscle through the constraints of commercial software.

To build VMED, we started with the foundation of the UME NxGen Curriclum, the UVA 12 Competencies for the Contemporary Physician, which are our education program objectives for the MD degree. These competencies drive our educational activities and assessments, and VMED underpins those learning objectives and those, in turn, support our student management, online content delivery, assessments, gradebook, program evaluation, and much more. All of this assists us with our AAMC and LCME reporting and predictive analytics regarding our students’ USMLE performance. VMED, built from the ground up, also provides us with longitudinal data not only to assess our student performance but also provides us with program evaluation data necessary for continuous quality improvement

In simplest terms, we are replacing critical components in the student information system and think it will be a huge improvement for all. Student Source, Oasis, X-Credit, and Faculty Toolbox are a few of the current applications that are being replaced.

The largest pieces of VMED include:

  • the online testing system — Three classes of students are now using this.
  • a clinical assessment tool for undergraduate medical education — iCAN, which stands for Interactive Clinical Assessment Navigator, is the tool we use for assessing entrustable professional activities (EPA).
  • a learning management system for students — A home for resources, schedules, enrollment, and gradebook.
  • evaluations — Student-to-student, student-to-faculty, and student-to-course.
  • mapping of the curriculum — mapping to the physician competencies, which speaks to our accreditation as a medical school.

Most medical schools are using commercial products or open-source tools to deliver their curriculum to students and to map it for accreditation purposes. We’ll be joining a small community that is developing software from scratch. We’re moving forward with this because of the successes we’ve had with the new testing system and EPA programs — they are proof that we have the resources and the talent in the School of Medicine to build something that will suit our specific needs.

What Does This Mean for You?
We’re working on VMED now. Some modules have been piloted, but we’re also gathering requirements for future modules. The initial release of the learning management system will roll out in August 2018 with iterative releases to come in the months and years to follow.

Faculty who are teaching in the classroom or in the clinic have already seen some of these changes, particularly those using the assessment methodology for EPAs and those using the new online testing system. I hope that VMED will simplify teacher workflow for class preparation, approval of teaching materials, setting up exams, and reviewing student performance, and that it will offer faculty a clear view of how your work supports the physician competencies.

I would like to thank Dr. Megan Bray, Dr. Maryellen Gusic, Kim Holman, Mark Moody, Robert Pastor, Michael Szul, and Dr. Mary Kate Worden for their tireless efforts on VMED. It could not have happened without their hard work.

As more modules of VMED are ready for release, I’ll talk about them here. Stay tuned!

R.J. Canterbury, MD
Senior Associate Dean for Education
Wilford W. Spradlin Professor