State of the School

1. State of the School Art Kellermann, MD, MPH F Edward Hebert School of Medicine January 22, 2014 Unclassified

2. Summary • The Hebert School of Medicine is faced with significant challenges and organizational threats • These challenges are more than offset by numerous opportunities to make critical contributions to health professions education, research and performance improvement in the MHS

3. Summary • The underlying premise for the Hebert School of Medicine is as sound today as when the school was founded more than 40 years ago • If we stay true to our mission, and pursue our goals with discipline, vision and purpose, we’ll make lasting contributions to the health of our nation and the world

4. Acknowledgements • The observations discussed in this address are derived from wide-ranging discussions with HSM faculty members and students, as well as senior university leaders, regents, deans, chairs, center directors, members of the Faculty Senate, committees, alumni, public officials and private citizens • In other words, YOU

5. “America’s Medical School” USU’s SOM and GSN each have over 25 clinical teaching sites across the US

6. Our Medical Students • All in a uniformed service • ~170 students per class: • 680 total • Avg. age: 24.4 years • Female: 35% • Prior military service: ~32% • Minorities: ~20-23% Class of 2015

7. Our Graduate Students • ~ 175 civilian & uniformed students • Masters and doctorate programs • A limited number of International students • Unique emphasis on military-relevant topics and programs

8. We are Part of a Larger Whole • Inouye School of Nursing • ~170 military students & several federal govt civilians in the DNP & PhD programs • Armed Forces Radiobiology Research Institute • Radiobiology research in five major thrust areas • Postgraduate Dental College • 3 programs; administered from USU’s campus in San Antonio

9. F. Edward Hebert School of Medicine One of 141 LCME-accredited medical schools* * Source: http://www.lcme.org/directory.htm 9

10. F. Edward Hebert School of Medicine One of 141 LCME-accredited medical schools* * Source: http://www.lcme.org/directory.htm 10

11. USU’s “Supplemental” Curriculum • Preventive and Occupational Medicine • Combat Casualty Care: • Environmental Medicine and extreme environments • Global infectious diseases • Disaster & humanitarian assistance • Combat Stress and other psychiatric issues • Communications • Cultural Competency • Leadership and Officership • Teamwork • The Military Healthcare System • The Operational Environment • Austere, resource constrained, and often dangerous environments • Learn/train in a joint environment • Ethical Decision Making in Operational Environments 11

12. USU’s “Supplemental” Curriculum • Preventive and Occupational Medicine • Combat Casualty Care: • Environmental Medicine and extreme environments • Global infectious diseases • Disaster & humanitarian assistance • Combat Stress and other psychiatric issues • Communications • Cultural Competency • Leadership and Officership • Teamwork • The Military Healthcare System • The Operational Environment • Austere, resource constrained, and often dangerous environments • Learn/train in a joint environment • Ethical Decision Making in Operational Environments • We are the leadership academy of the MHS 12

13. USU Doctors in the MHS ~10% of physician accessions ~25% of the total medical officer force ~33% of the MHS’ top clinicians & MD leaders

14. Our Research is Relevant to the DoD • Combat casualty care • TBI & regenerative medicine • Psychological health • Rehabilitation sciences • Emerging infectious diseases • Performance optimization • Prev. Med & Public Health • Disaster Medicine & humanitarian assistance

15. Where Do We Go From Here? ) Opinions are those of the presenter and do not represent positions of USUHS or the Department of Defense Unclassified

16. External Challenges • Furloughs and fiscal uncertainty • Salary and hiring freezes • Travel restriction • NIH funding cuts • Little national visibility • Poor brand recognition • Our MTFs under pressure • The MHS is challenged as never before

17. Internal Challenges • Our faculty is small relative to the size of its mission, and demographically imbalanced • Curriculum reform has increased teaching workloads w/o a matching increase in resources; concerns expressed about equity of effort • ↓ research funding + ↑ teaching = ↑↑ stress • In challenging times, bureaucratic hassles & obstacles are even harder to take

18. However, USU Also Has Formidable Strengths… • We are nationally unique. We have a vital mission, excellent facilities & equipment, outstanding students, a talented faculty, no debt and a funding base that’s stronger than most • Our work is well aligned to our sponsors’ priorities and needs • We have loyal alumni & many friends in the MHS, the PHS, and other federal agencies

19. We Also Have a Top-Tier Board • Ronald Blanck, DO (Chair) Chairman and Partner, Martin, Blanck, and Associates • Otis Brawley, MD Chief Medical Officer, American Cancer Society • Sheila Burke Senior Public Policy Advisor at Baker Donelson, former COS to Bob Dole • Haile Debas, MD Executive Director of Global Health Sciences at UCSF • Ronald Griffith, GEN (Ret) Serves on Board of Visitors at the Virginia Military Institute • Michael M E Johns, MD Past Chancellor Emory University and Dean at Johns Hopkins • Kenneth Moritsugu, MD Former Dep. SG, Vice President Global Strategic Affairs of Life Sciences, Inc. • Gail Wilensky, PhD Economist and Senior Fellow at Project HOPE, former HCFA Administrator

20. We Also Have a Top-Tier Board • Ronald Blanck, DO (Chair) Chairman and Partner, Martin, Blanck, and Associates • Otis Brawley, MD Chief Medical Officer, American Cancer Society • Sheila Burke Senior Public Policy Advisor at Baker Donelson, former COS to Bob Dole • Haile Debas, MD Executive Director of Global Health Sciences at UCSF • Ronald Griffith, GEN (Ret) Serves on Board of Visitors at the Virginia Military Institute • Michael M E Johns, MD Past Chancellor Emory University and Dean at Johns Hopkins • Kenneth Moritsugu, MD Former Dep. SG, Vice President Global Strategic Affairs of Life Sciences, Inc. • Gail Wilensky, PhD Economist and Senior Fellow at Project HOPE, former HCFA Administrator Plus the ASD(HA) & the 4 Surgeons General

21. Opportunities • We have access to mechanisms and sources of funding that are largely out of reach of other medical schools • We offer a great deal to students • We have a compelling mission, and equally compelling stories • The MHS needs what we produce – outstanding graduates, discoveries, capabilities & ideas

22. Threats • A bad report from the LCME • Our MTFs lose too many patients • Congress eliminates the CDMRP • The MHS is sharply downsized • We’re targeted by a future BRAC • The DoD severely cuts our budget, or decides that we are irrelevant to its mission

23. Priorities • People • Programs • Purpose

24. People • Curriculum reform • Sustainability, coordination & resources • The LCME • Time to prepare! • Diversity • We can and will do better • Respect • We need to take a hard look at ourselves & each other • Leadership • Our job is to train the future leaders of the MHS

25. People • Overcome constraints • People, resources & programs • Promote excellence • Engagement & impact • Encourage collaboration • Between investigators, departments and institutions • Enhance diversity • It will make us stronger and better • Build for a brighter future • We’re in this for the long haul

26. Programs • The DoD is our #1 client (11/53/290) • Ask not what WRB can do for you; ask what you can do for WRB • Our off-campus faculty and MTFs matter; we are America’s medical school • Global health is a national security issue. Are we ready to play an important role? • The MHS needs high value discoveries & innovation. We can provide them

27. Programs • The Line is our #1 priority • We need to build our brand w/ key groups and individuals • We must strengthen our ties w/ current funders, cultivate new ones and devise new mechanisms of support • We have opportunities to forge strategic alliances inside and outside the MHS • We will tackle problems that matter

28. Purpose Our business is saving: • Lives - Through our teaching, practice & high-impact research • Function – Through HPO, expert medical and surgical care, neurological & behavioral science & expert rehabilitation • Dollars – In addition to becoming better stewards of our own resources, we can help the MHS become more efficient and effective

29. 2014 MHS Pillars • Modernize infrastructure – governance, technology, innovation, PCMHs • Medical capabilities – training, career development • Rebalance force structure – human capital • Develop strategic partnerships – w/ agencies and academic institutions • Benefit reform – tied to benefit commission • Global health engagement – Whole of gvt

30. From “Good” to “Great” • Level 5 Leadership • First Who…Then What • Confront the Brutal Facts (Yet Never Lose Faith) • The “Hedgehog Concept” • A Culture of Discipline • Technology Accelerators

31. The “Hedgehog Concept” “The Fox knows many things, but the hedgehog knows one big thing” • Foxes pursue many ends at the same time and see the world in its complexity. They are “scattered or diffused, moving on many levels” • Hedgehogs embrace a basic principle or concept that unifies and guides everything - Jim Collins, Good to Great, Harper Collins, 2001

32. Collins’ “Three Circles”

33. Our Mission “[USU serves] the uniformed services and the Nation as an outstanding academic health sciences center with a worldwide perspective for education, research, service and consultation; we are unique in relating these activities to military medicine, disaster medicine, and military medical readiness.” - Source: USUHS Mission Statement

34. Our Mission “[USU serves] the uniformed services and the Nation as an outstanding academic health sciences center with a worldwide perspective for education, research, service and consultation; we are unique in relating these activities to military medicine, disaster medicine, and military medical readiness.” - Source: USUHS Mission Statement

35. The Bottom Line To ensure a bright future, we must: • Support the Line, and the MHS • Set & enforce high standards for ourselves and our trainees • Boost our visibility & reputation • Cultivate new sources of support • Wisely manage our resources • Tackle high-impact issues & ideas

36. “America’s Medical School” “[USU] is the nation's federal health sciences university…committed to excellence in military medicine and public health during peace and war.”

37. “America’s Medical School” “We are the nation's federal health sciences university…committed to excellence in military medicine and public health during peace and war.”

38. Last Decade’s Challenge J Trauma Vo.l 25 no. 2 August Supplement 2013

39. This Decade’s Challenge

41. Questions?