May 12, 2020
What are Deans across the country struggling with in the face of COVID-19?
Obviously medical schools are anchor institutions in every region and the difficulties surrounding COVID-19, from a health and public health perspective, have been front and center on every medical school dean’s mind. The degree of difficulty in communities has varied greatly with the largest metropolitan areas like New York City hardest hit and medical school deans in these regions needing to make difficult decisions about faculty, staff and students in regard to workforce needs and safety, particularly with shortages in some areas of personal protective equipment (PPE). We have been fortunate in Wisconsin that, although there has been a substantial morbidity and hospitalization associated with COVID-19, social distancing practices have been very effective and, to date, the mortality in Wisconsin and even the number of patients seriously ill requiring hospitalization has been relatively modest compared to other geographies.
This is the most difficult challenge to face academic medicine in over 100 years. An extremely difficult challenge has been the economic damage the pandemic is causing to the world’s economy, but specifically to the medical schools, health science universities and academic medical centers. As the backbone of the health care system in this country, academic medical centers, which are staffed by physicians from their medical schools, were required to substantially change their workflow to prepare for COVID-19 patients. As such, almost all non-urgent clinical work was curtailed. This has created enormous losses for the medical school physician practices and their hospitals. Given that it is the clinical revenue from these areas that support the community engagement work, education and research programs at medical school there has been enormous damage to these areas of medical schools as well. This has resulted in layoffs, furloughs and substantial salary reductions for those working within medical schools.
What changes to the residency application process do you see happening this year?
There are many things that are currently being discussed and we expect to have answers early in May. These include pushing back the ERAS deadlines by two weeks or more, limiting or eliminating away rotations for M4 students and limiting or eliminating in-person interviews for M4 students. But the most important point to emphasize is that although the residency application process with be a bit different in some ways for this year, it is unlikely that the differences in the process will impede the most important aspect that most students from MD-granting schools like MCW will Match to excellent programs in the field of their choice.
What do you see being the effects of delays to students taking their USMLE exams, such as Step 1?
Because all students are in very similar positions regarding these difficulties related to the USMLE exams, I anticipate that the effects will be very minimal in the grand scheme. This is not to underplay the difficulties for some students, the anxiety and difficulties in planning that this has caused, but students across the US are facing similar considerations. Again, I believe the most important point to emphasize is that the differences in the process this year will have a minimal impact, in aggregate, of the most important aspect that most students from MD-granting schools like MCW will Match to excellent programs in the field of their choice.
What do you believe the post COVID-19 medical education landscape will look like?
I think that the post COVID-19 landscape will produce further innovations in medical education and increased understanding about how distance learning and virtual learning can be important additions to the overall curriculum in medical school. I do also think that it will accelerate the conversations, and it already has, about the importance for medical education and our physician workforce to have more flexibility in our education systems and processes. I expect an increasing emphasis on competency-based education structures rather than specific timelines will result more rapidly with positive changes such as medical students being eligible to matriculate into residency at multiple time frames during the year rather than the monolithic pathway of all graduating in the spring and starting residency on July 1. That type of system does not make sense, really on any level, and the difficulties of having this relatively rigid system have certainly become clear to many more people through the COVID-19 crises, although many of us have been discussing this for quite some time already.
What are some examples of innovations you see happening around the country? What effect might those have on what we do at MCW?
As it relates to the education system, I have described several of those above. Specifically, at MCW we have already enhanced some flexibility in our education programs as a result of the pandemic and are working on many more such as additional elective courses that can be completed in a distance or virtual capacity. Related to our healthcare system, I believe one of the most important changes around the country that will certainly impact how we provide medical care has been the enormous transfer of medical care to telehealth, which I don’t believe will extinguish or go back to in-person care once the pandemic has passed. Obviously, we will have more in-person care, but we have learned a great deal about how to efficiently and effectively provide care using technology.
Who is your role model for how you want to lead? What about them do you aspire to emulate?
Rather than a specific person I try and emulate specific traits of individuals that I admire. The traits in leaders that I have tried to incorporate into my personal leadership style include:
- Servant leadership – it is critical for leaders to understand this concept in which the leader has as their primary objective to serve the PEOPLE of the organization and the communities of the organization rather than to maximize profits or growth. With this, the leader places PEOPLE development and growth as a principal characteristic of organizational culture – See # 2& 3 below.
- PEOPLE development – during my tenure as dean I have striven to create numerous pathways in which MCW emphasizes the development of the PEOPLE in the organization through implementation of programs such coaching opportunities for all leaders in the SOM, standardized review processes of units, routine meetings to discuss personal development and goal setting opportunities for individuals, units and MCW as a whole.
- Empowering others to take charge of their respective areas (the opposite of micro-management). Yes, guiding as needed and supporting consistently, but understanding that the PEOPLE of MCW have enormous talent and if given the opportunity will innovate and succeed at every turn.
- Communication and communication as a two-way street – Most organizations under-communicate at every level. As a leader at MCW, I have striven to employ many tools to enhance communication and to also model that this is a two-way street that requires attention to listening as a most-important ingredient in communication.
- Diversity, Inclusion and Equity – no organization can be great without working extremely hard to ensure that these are part of the fabric and culture of the organization.
- Effort, hard work, grit. Intelligence and natural ability are fantastic, but excellent results have more to do with effort than ability.
- Joy and Gratitude – most people that know me know that I am a “glass 2/3 full”. I use 2/3 rather than half full because I believe “half full” is a relatively low bar. Organizations that recognize joy and practice gratitude succeed at far greater levels that those that do not have these as core tenants. One of my favorite quotes is: attitude impacts perceptions which influences reality. I truly believe that if you practice gratitude and seek joy your reality will have more joy and appreciation for the wonderful things in your universe.
- Essentiality of MCW – I firmly believe that MCW, as an anchor institution in Wisconsin, is essential to the success of our region, state and beyond. As such, as a leader, it is critical to empower the essential aspects of our organization in education, community engagement, research and clinical care and to ensure that this essentiality is communicated and understood by our PEOPLE, our communities, elected officials and national organizations.
- Knowledge changing life – this phrase embodies much of what is GREAT about MCW and as a leader it is critical for me to support the creation of knowledge in all of our missions as this further deepens the essentiality of MCW.
- Integrity and joint decision making in financial matters.
What legacy do you hope to leave from your time serving as the AAMC Board Chair?
The AAMC is a critical organization in academic medicine – probably the most important organization. My number one objective as the Chair of the Board was to work with the new CEO of the AAMC, Dr. David Skorton, and his Leadership Team to create and implement a new Strategic Plan for the next five years of the organization, which will set the tone for Academic Medicine for the next decade or more. We just approved this strategic plan as the Board last week! One of the most important aspects of this plan and my hoped legacy in serving the AAMC is to ensure that our learners are placed front and center as the rationale for academic medicine’s existence. At every Board meeting I have brought forward the importance of our learners and their perspectives. I have championed the movement forward of Step 1 of the Boards being Pass/Fail, which just recently occurred and increased emphasis on competency-based education (I actually don’t love the words competency-based but everyone uses that and understands that – I would prefer “results-based education”) which will provide increased and important flexibility for learners. In addition, I have championed diversity, inclusion and equity in academic medicine, and this has resulted in specific action plans around gender-equity for academic medicine throughout the US.
Tagged: Medical Education Office of Educational Improvement