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.
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.
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.