Dean’s Corner – September


2018-19 School of Medicine Leadership Development Fellowship
Richard DiCarlo, M.D.
Senior Associate Dean for Faculty and Institutional Affairs

The School of Medicine began a new program for selected faculty members in 2018-19: the Leadership Development Fellowship.  This program aims to provide faculty with the opportunity to develop leadership skills and experience.  It also aims to advance certain initiatives within the Dean’s Office.  While we are ‘starting small’ (we selected three faculty members this year), we hope that it proves to be a worthwhile program that grows over time.

Many schools have their own in-house leadership programs that are largely didactic in nature.  Participating faculty typically meet on Saturdays several times per year and have lectures on academic medicine, finance, clinical partnerships, conflict resolution, leadership qualities, etc.  A leadership ‘project’ is often a small part of these programs.  We wanted to emphasize direct mentorship and active involvement in an ongoing initiative within the school.

The program is open to faculty at the rank of Associate Professor or above.  After an application process, selected faculty work under the mentorship of an Associate Dean for 6 months.  This entails meeting weekly, attending Dean’s Staff Meetings, Administrative Council Meetings, and other functions as time allows.  Fellows also spend approximately one-half day per week on a project in the Dean’s Office, working under the guidance of their mentor.  In addition to this, we provide the Fellows with several AAMC monographs about Academic Medicine and leadership.

Although this was the first year of the program, there was considerable interest among the faculty and we received nine strong applications.  The three faculty selected were Dr. Randy Roig, Department of Medicine, Section of Physical Medicine and Rehabilitation; Dr. Bradley Spieler, Department of Radiology; and Dr. Jason Mussell, Department of Cell Biology and Anatomy.

Dr. Roig is working with Dr. Charles Hilton, Associate Dean for Academic Affairs.  He is gathering data on current GME funding paradigms in Southeast Louisiana and assessing possibilities for new funding partnerships between clinical sites and sponsoring institutions.  Ultimately, this could lead to the development of new programs, particularly in fields currently underrepresented in our region.

Dr. Spieler will work with Dr. Sam McClugage, Associate Dean for Admissions and Dr. Cathy Lazarus, Associate Dean for Student Affairs.  He is currently laying the groundwork for his project by gaining IRB approval and exploring available data sets.  He will develop an anonymized tracking system for longitudinal follow-up of students matriculating into medical school.  He will correlate metrics used in the admissions selection process with academic performance in medical school, professionalism, specialty selection, success in the match, performance after graduation, and other metrics.  Ultimately, this may inform the evaluation of prospective students during the selection process.

Dr. Mussell will work with me in the Office of Faculty and Institutional Affairs beginning in the spring semester.  He will collect and review promotions guidelines from a sample of peer and elite medical schools that have educator tracks for faculty promotion.  We will work with the Faculty Assembly, Appointments and Promotions Committee, Department Heads and others to develop guidelines that align with our school’s needs and history.  Ultimately, this may result in a new promotion pathway for both clinical and basic science faculty.

This is an exciting development for the school of medicine.  We hope that it will serve to improve the school with new programs and initiatives.  We also hope that individual faculty benefit in terms of career development and scholarship.  We have started with just a few faculty members this year.  I will depend on their input as we consider refining and expanding this program in future years.


Dean’s Corner

We Must First Live in Equity 

Robert Maupin, M.D. (Associate Dean for Diversity and Community Engagement) 

While there has been a tremendously important and overdue focus on advancing frameworks of equity in addressing the health disparity challenges that our patients face, within our own culture we must first learn to “Live in Equity”. Living in equity acknowledges that we look within and must first heal our own professional communities. At the recent AAMC Learn, Serve, and Lead meeting’s leadership plenary, Dr. Darryl Kirsch the retiring President and CEO remarked that “We must be relentless in surmounting the obstacles still in our path from unconscious bias to overt harassment to gender- and race-based gaps in salary equity. A systematic review and meta-analysis of harassment and discrimination in medical training by Fnais et al. (2014), in Academic Medicine in reviewing 51 studies reveals that close to 60% of medical trainees have experienced harassment or discrimination during their training. Female gender and nonwhite race/ethnicity were significant in high incidence of harassment and discrimination, and the most cited source of harassment was from consultants.  

Adding a balance in perspective in the AAMC leadership plenary, co-presenter Dr. M. Roy Wilson, Chair of the AAMC Board of Directors observed that “We must do more to ensure that all segments of the public are included in our profession and that biases, even if unintended, do not systematically exclude persons of certain population groups.” A very recent publication in JAMA Network Open, Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace, Osseo-Assare et al. (2018), conducted a qualitative study of work place experience of black, Hispanic, and Native American resident physicians. Findings focused on 3 major themes in workplace experience: a daily barrage of micro-aggressions and bias, minority residents tasked as race/ethnicity ambassadors, and challenges negotiating professional and personal identity while seen as “other”.  Another study published in LGBT Health by Chester et al. (2014), characterized the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center thru the use of an anonymous, online institutional climate survey to assess the attitudes and experiences of LGBT employees and students. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain “closeted” and were harassed despite medical center policies of non-discrimination.  

Collectively these examples speak to the heightened urgency for our academic medical centers to prioritize the health of our institutional climate in a way that fully embraces a true culture of inclusion. Constructive approaches to find an effective path forward are embodied in examples provided in recent publications in OB/GYN literature – Sexism in obstetrics and gynecology: not just a “woman’s issue”, Hughes & Bernstein (AJOG 2018), and Institutional Responses to Harassment and Discrimination in Obstetrics and Gynecology, Eichelberger et al.(Obstet Gynecol 2018). The authors collectively focus on range of interventions which include (but only represent a few from a larger list): create open forums to listen to others’ perspectives on issues of disparity, examine the problems of unconscious bias and gender disparity and how peers participate in it, intentionally build teams that are diverse and inclusive, train in the identification and response to micro-aggressions, and actively track data on harassment and discrimination events as exists with other quality measures. Most importantly such efforts will reflect first steps in our recognition and commitment that we must transform our internal climate and culture in a way that allows us to Live in Equity first before we can be effective in our accountability in advance equity for our patients. 

New Year’s Message from Dean Nelson 

As you know the School of Medicine (SOM) completed our LCME accreditation site visit in November.  While we will not know the final outcome of this visit until late February at the earliest, the preliminary findings suggest that we will have an excellent outcome.  The site visit team was impressed with all of our preparation, our facilities, and the strong relationship we have with our clinical partners.  They were overwhelmed by the energy, enthusiasm, and collegiality among our faculty, students, residents, and staff.  I believe that they recognized the true nature of this institution and the dedication that you as faculty, residents, students, and staff bring to this institution on a daily basis.  I met with the site visit team on the first evening of their visit (Sunday, November 12th) and conveyed your commitment to the mission of the school.  I feel that what I said to the site visit team is appropriate to serve as my New Year’s address to you, the readers of The Pulse.  I strongly feel that without you the SOM would not be the exceptional institution of learning that it is today and what it will continue to become in the future.  I wish you a joy-filled and peaceful New Year.

(The following is a copy of Dean Nelson’s opening remarks given to the LCME:)


First I want to welcome you to New Orleans and to the LSU School of Medicine. The fact that you have all dedicated so much of your time to our reaccreditation underscores how important this work is.  As you are well aware Louisiana and our school have faced several significant challenges during the past few years. Hurricane Katrina, significant state budget cuts to higher education and the replacement of the Charity Hospital system with several public-private partnerships. As I am sure you can imagine this has not only been a period of great challenges, but also one of opportunity and transformation.  One constant throughout this period has been the dedication and resolve of our students and our faculty not only to recover but to be reborn. We are all well aware of the high standards that are required to train the next generation of physicians and we have dedicated significant resources to address those standards.  We have invested in our students, our faculty and our infrastructure.  During the next three days I hope you will sense the resilience, energy and commitment to excellence that characterizes our school.

I believe the two most significant changes since our last accreditation are the public-private partnerships, and our curriculum renewal:


As you know from our self-study, the dismantling of the Charity Hospital system was a transformative event for our school.  Governor Huey Long established the LSU School of Medicine in 1931, and built it next to the newly completed Charity Hospital.  Our guiding purpose was to train doctors for Louisiana and to care for the underserved of Louisiana.   At that time, Charity Hospital had over 2000 patients and our students had an unparalleled wealth of learning opportunities and a dedicated faculty with a strong commitment to service: service to their patients, service to their students, and service to Louisiana.

Over time, ‘Big Charity’ became a system, with smaller charity hospitals scattered throughout the state.  The doctors in those smaller hospitals became our faculty, and our students rotated to the charity hospitals in Baton Rouge and Lafayette.  Those hospitals served the underserved of their communities.   Even after Katrina, when Big Charity finally closed its doors, we opened the Interim Public Hospital with the same spirit of service that had characterized our school for 75 years.  In fact, one could say that Katrina underscored our commitment to the school’s mission.

But there is another side to this story that people sometimes forget.  The charity system was chronically underfunded.  By the early 2000s, buildings were in need of repair, patient services were reduced, technology was dated, and even the most dedicated of our physicians found it difficult to provide the care our patients required and the optimal training opportunities for our learners.

As it became clear that the state was dismantling the Charity System, there was both anxiety and cautious optimism.  Anxiety that we would lose our identity – our guiding purpose of service – but optimism for better facilities and support to teach our students and care for our patients.   Over the next three days you will see that our faculty remain as dedicated to teaching and service as they always have been.  They are outstanding mentors, and they serve as role models for our students.  University Medical Center and all of our partners provide our faculty with state-of-the-art facilities to treat our patients with the respect and care they deserve, and allow our students to learn the fundamentals of medicine with the full support of modern technology.

The relationship with our private partners is strong and the outcomes have been very successful.  The stability of our leadership has fostered the trust necessary for a strategic alignment between our school and all of our partners. I and members of my staff meet with the leaders of LCMC (Louisiana Children’s Medical Center) and University Medical Center (UMC) on a regular basis.  We travel to Baton Rouge monthly to meet with our faculty and the leaders from Our Lady of the Lake.  We also travel to Lafayette several times per year to meet with faculty and hospital leaders.  We go more often if issues arise.  I believe that frequent and open communication between the institutions has been the key to our success with all of our partners.  We understand their needs for efficiency and performance, and they recognize the needs of the faculty to teach and engage in scholarship.

The benefits of these partnerships for our clinical enterprise have been substantial.  The school has seen an increase in its operating budget of over $100 million since 2012, prior to start of our new partnerships.  This has been due to increasing clinical revenue.  While some is due to increased collections (partly fueled by Medicaid expansion), the most significant change has been increased revenue from new hospital contracts that compensate our faculty at fair market value.  Furthermore, all of the service line directorships in UMC have been awarded to members of our full time faculty.  This provides stability for our departments and fosters cooperation in the development of strategic initiatives.  For example, with the full support of the hospital, the surgery department recruited an experienced and outstanding faculty member from Wake Forest to serve as director of the burn unit we are building together.  Again with the support of the hospital, the cardiology section recruited several highly experienced faculty to initiate a structural heart program at UMC.

These new partnerships have also directly benefitted our education programs.   First, the number and breadth of patients on our teaching services has increased. As beds continue to open up at UMC, we expect that trend to continue.  Our students train in markedly improved facilities on all three campuses.  There are ample conference rooms, workrooms for residents and students, call rooms, and computer workstations.  Furthermore, our students receive hands on training in a facility with state-of-the-art technology, such as the new intraoperative MRI (the only one in Louisiana).   In summary, I believe you will find that the leadership of UMC and all of our partners support the educational mission of our school and are committed to our faculty.  Our Faculty Forward survey in 2015 demonstrated a level of uncertainty that our faculty felt when the hospital first opened under this new arrangement.  UMC leadership has done a great deal to build trust and engage the faculty.  Recent results from our follow-up StandPoint survey indicate that there is substantial improvement in that relationship and it gets stronger as we continue to move forward together.

The partnerships have also provided our faculty with additional opportunities for research and scholarship.  UMC has initiated several business engagement strategy sessions with involvement of our faculty.  The burn unit, a palliative care medicine program, and primary care initiatives are all examples of programs proposed by LSU faculty and acted upon by UMC.  There is great potential to expand UMC’s role in research even further.  UMC, LSU, Tulane and other institutions have begun plans for a major initiative to become an NCI designated cancer research center, which has the potential to be transformative for both institutions and Louisiana.

With respect to our new clinical partners, I would be remiss if I did not mention the new VA hospital that opened its clinics almost exactly one year ago – on Veteran’s Day.  Until recently, LSU has played a small role in the VA.  In Louisiana there is a statute referred to as the “Dual Employment Law” that stated a state employee could not receive compensation from Louisiana and the federal government at the same time.  Three years working with the state legislature, I was able to exempt LSU from this law.  Since that time, we have significantly expanded our clinical and research activity in the VA.  The first inpatients were admitted this summer, and the VA expects to have 200 beds open by the spring.  Already, we have over 50 faculty with dual appointments.  The chiefs of neurology, orthopedics, and neurosurgery at the VA are members of our faculty.  We have received approval for over 50 new resident positions.  As the staged opening of the hospital proceeds, our ultimate goal is to have as many as 90 residents training in the VA.  While we only have a few student rotations in the VA at the present, we expect that it will become an important resource for our undergraduate education program as well.

Curriculum Renewal 

The recent curriculum renewal was a very deliberate process that involved numerous faculty, the leadership, and incorporated a great deal of student input.  We first established several basic goals that we wanted to accomplish.  These were approved by the faculty and included:

  • Make classes more integrated and clinically relevant
  • Reduce contact hours, reduce lecture hours, and increase active and engaged learning
  • Devote more time to teaching, feedback, and assessment of clinical skills
  • Provide more time for clinical experience, career exploration, and professional development
  • Increase time devoted to topics such as cultural competency, health systems and patient safety, skills of life-long learning, critical reading of the medical literature, and interprofessional education

Given our goals, we needed to provide faculty development for new pedagogy, so we engaged outside speakers and used our internal education leaders as a resource as well.  We have invested heavily in our own faculty:  we have 16 new course directors and new directors of the clinical and basic sciences curriculum in the Office of Undergraduate Medical Education.  The Office of Undergraduate Medical Education has additional coordinators, and it moved into its own office suite within the Student Learning Center.  We have also invested in our teaching facilities; we upgraded lecture halls, improved WiFi access, and expanded library hours.  Our largest infrastructure investment has been the construction of a Team Based Learning classroom that will enhance our use of TBL and other engaged learning modalities.  This project will be finished this summer in time for the 2018-19 academic year.  The curriculum renewal has achieved the goals we established at the outset.  We have measured outcomes such as student perceptions of integration and clinical relevance, curriculum hours, student satisfaction with clinical training, and content hours devoted to specific curriculum topics.  Throughout this renewal process, our faculty members have worked collaboratively with our students to obtain timely feedback and continually improve.

Other Initiatives 

While those are two major developments since the last site visit in 2009, you will learn about other important aspects of our program during the next three days:

The regional campus in Baton Rouge highlights the excellent teachers we have located at that campus, and the resources and stability provided by our clinical partner in Baton Rouge, Our Lady of the Lake Regional Medical Center.  The facility they have provided for us is outstanding and our students in Baton Rouge receive an excellent education in a supportive environment.

The Houses program started as a professionalism initiative, but has become much more than that.  It involves over 100 faculty members and provides mentorship for students, clinical teaching, career advising, and is a mechanism for faculty development.

The Rural Scholars Track started in 2001 and placed the first program graduates into rural primary care practice in 2008. To date we have 51 graduates of this program in rural primary care practice in Louisiana, and another 36 in the pipeline.

The medical school took a leadership role in developing the Health Sciences Center (HSC) initiative in interprofessional education (IPE).  The HSC now has an IPE director and all of our students work with other health professions students in all four years of the curriculum.

You will see that our faculty remain committed to research and scholarship in addition to being accomplished teachers and expert clinicians.  Some highlights of our research program include that we are one of only 8 comprehensive Alcohol Research Centers in the U.S, with over 24 years of continuous funding; the director of our cancer center, Dr. Augusto Ochoa, is the only investigator in Louisiana that is a member of Biden’s Moonshot initiative; we have had a 37% increase in new R01 grants in 2017; we have been awarded a new COBRE P20 grant for cancer research, and two 3rd phase COBRE P30 grants; and our LACATS program, a 3-way partnership between LSU, the Pennington Center in Baton Rouge, and Tulane is developing a state-wide clinical trials network and has recently been renewed for another 5 years of funding of $20 million.

Finally, I would be remiss if I did not mention our progress on diversity, which is important to our school.  We have always had very strong and successful pipeline programs, and we know these have contributed to diversity in health professions students nationally.  After review of the renewed LCME standard, and after consultation with Marc Nivet from the AAMC, we began to focus more closely on diversity within our institution.  We have revised our policy and are tracking our progress.  We have seen recent improvement in some areas and are defining processes to continue this trend.  One notable finding has been that our largest source of medical students, the LSU main campus in Baton Rouge, has produced a declining number of African American applicants to medical school in the last few years.  That is something we intend to address in the coming years.  This issue is also of concern to our students.  I think the increased attention to health disparities against the background of national politics has put this in the forefront for many students.  Our faculty have seized this opportunity to develop additional curriculum in cultural competency and the role of unconscious bias.  As an institution, we have engaged with the students and used their input as we discuss these issues with faculty, residents, and leaders.

I am sure that you will hear more about this during your time here, but you should know that I fully support these efforts, and I applaud the LCME for driving schools toward excellence in this area.


All of these developments have moved forward despite significant decreases in state support and the underlying uncertainty that the school faced in its realignment with new clinical partners that began 5 years ago.  They are a testament to the dedication of the school’s leadership, faculty, and students.

Let me conclude by saying we have embraced the opportunity to prepare for this site visit.  We undertook the self-study as an honest evaluation of our programs, with improvement as the ultimate goal.   So, we enthusiastically welcome you to New Orleans and to LSU.  During the next three days I hope you will sense the resilience and the energy that characterizes our school.




Student Affairs – New Member

Robyn White

This summer the School of Medicine’s Office of Student Affairs welcomed a new coordinator, Robyn White.  Robyn is a native New Orleanian who has spent the last three years living in southern Utah, where she worked as the Registration Coordinator and taught English at Dixie State University. In her previous roles, Robyn has worked in event management for the Marriott Corporation and has worked in International Education, having led student groups abroad to Europe and South Africa.  Robyn is excited to be taking on her new role and looks forward to planning events hosted by the Office of Student Affairs

Dean’s Corner

Stepping Into a New Position

By Richard DiCarlo, M.D.

Senior Associate Dean for Faculty and Institutional Affairs


When Dr. Hollenbach asked for a ‘Dean’s Corner’ column for this edition of The Pulse, I considered all of the ongoing work in the Dean’s Office about which I could write. There are new initiatives and ongoing projects in many areas: Undergraduate Medical Education, Graduate Medical Education, Student Affairs, Diversity, and Clinical Affairs to name a few. These are all exciting changes. It is also exciting that our relationships with University Medical Center, Children’s Hospital, the newly opened Veterans Affairs hospital, Our Lady of the Lake Regional Medical Center, and Lafayette General Medical Center continue to grow. All of this is happening in addition to the enormous amount of work many people are putting into preparations for our upcoming LCME reaccreditation site visit. You have heard about curriculum renewal, new pipeline programs, expansion of the clinical enterprise, and other initiatives. These may be topics for future columns and you will certainly hear more about the LCME in coming months. So I decided, instead, to write a little bit about the Office of Faculty and Institutional Affairs.


I am still taking stock of the processes in the office, and have no new initiatives to report on. I am extremely grateful for the excellent office staff who keep everything running smoothly, and who have been extremely patient with me as I learn the responsibilities of the position. As I reflect on the last few weeks, the first thing that comes to mind is that the scope of operations is enormous and complex. The second thing that comes to mind is the astounding amount of service that Dr. Letourneau provided to the school in her role as Associate Dean in this office.


Walking through the file archives, I can see walls of faculty appointment and promotion packets that date back nearly 20 years. It is an impressive sight, and it is overwhelming to imagine that Dr. Letourneau played a role in every faculty appointment and promotion. She mentored countless faculty members for career development and provided valuable advice for advancement. She carefully read every CV and advised changes when necessary to ensure the best chance for success in the promotion process. She provided guidance to every new department head, advised them about all school processes, and assisted them with new hires. She read every letter of appointment and reassignment to ensure accuracy and clarity of expectations. She cultivated good working relationships with our clinical partners that will benefit all of us in the years to come.  The list goes on and on.


At the end of every day, as folders full of letters, PM-11s, credentialing packets, malpractice verification requests, and other forms land on my desk for review, I am reminded of all that Dr. Letourneau did for the school. Throughout her years of service, she treated everyone with respect and remained a strong advocate for the faculty. We all owe her our gratitude for years of hard work and dedication. Every day, I gain a greater appreciation for her perspective and her depth of understanding about the challenges we face. I am grateful for the mentorship and advice she continues to provide, and remain somewhat daunted by the person I am following in this office, and the role I have to fill.