Visionaries 2022 by DellMedSchool

11 POWERHOUSE DELL MED LEADERS — ALL ON AN AUDACIOUS MISSION. Since launching in 2014, Dell Medical School at The University of Texas at Austin has been rethinking the role of academic medicine in improving health, particularly for those most in need. And we’re just getting started. Out of many, meet 11 visionaries who tell the story of what happens — and what’s possible — when you build a new kind of medical school. You might think of it as the right people, in the right place, at the right time. Read online: dellmedvisionaries.com

EYE CARE FOR ALL

PIONEERING FETAL CARE

TINY HEARTS, WHOLE LIVES

BETTER CARE, LOWER COST

DERMATOLOGIST, DISRUPTOR

JANE EDMOND

MICHAEL BEBBINGTON

CARLOS MERY

PRAKASH JAYAKUMAR

ADEWOLE ADAMSON

REWIRING THE BRAIN

SOCIAL WORK FOR MODERN MEDICINE

EQUITY IN CHILDHOOD ASTHMA

KIDNEY CARE FOR CENTRAL TEXANS

TRAINING A NEW KIND OF PHYSICIAN

JOSÉ DEL R. MILLÁN

DONNA SHANOR

ELIZABETH MATSUI

NICOLE TURGEON & TESSA NOVICK

JOHN LUK

VISIONARIES of DELL MED

“For most people, vision is the most important of the five senses: Almost twothirds of the brain is devoted to vision and eye movement.”

JANE EDMOND, M.D.

EYE CARE FOR ALL In less than five years, Austin, Texas, has become home to a world-class eye care and education program — one that’s focusing on people who need care most. More than 700,000 children in the United States live with vision impairment, many resulting from retinal, optic nerve or neurological conditions. Care, for many, is far away or too expensive. Enter Jane Edmond, M.D., one of 30 pediatric neuro-ophthalmologists in the country — and the only one in Texas. “For most people, vision is the most important of the five senses: Almost two-thirds of the brain is devoted to vision and eye movement,” she says. “It’s a privilege to be able to help restore and improve ocular function — and it’s also really gratifying to help people be able to see and appreciate visual beauty and to find joy that way.”

Edmond, who has operated on and served more than 4,000 children and 2,000 adults over the course of her career, joined Dell Med in 2018 as the inaugural chair of the Department of Ophthalmology and director of the Mitchel and Shannon Wong Eye Institute. Since then, she’s built an academic department, an eye clinic that has already served thousands of Central Texans, and an ophthalmology residency program that received 550 applications for just three positions in its first year. Leading the World’s Largest Association of Ophthalmologists On a national stage, her reputation precedes her: This year, Edmond was named president-elect of the American Academy of Ophthalmology, the world’s

largest association of eye physicians and surgeons. She’ll leverage that position to advocate for expanding access to care locally and nationwide, both through building relationships with local safety net clinics and recruiting equity-driven residents to the field. Local Impact: Access to Care for Those Who Need It Most The thing that keeps her going? “Health and equity in the eye space. When I took this job, there was a waitlist of 900 unor under-insured adults who had never received eye care, who now have access to sight-saving care through new contracts we created at UT Health Austin. A great part of my reason to come to Austin was to attack problems like this.”

VISIONARIES of DELL MED

MICHAEL BEBBINGTON, M.D.

PIONEERING FETAL CARE For families once devastated by severe fetal diagnoses, a new world of diagnostic and surgical possibilities — travel elsewhere not required. Years ago, Michael Bebbington, M.D., received a video of a former patient, Walker, running bases at his Little League game. Maybe standard childhood fare for many — but for Walker and his family, a near miracle: Walker was diagnosed before birth with spina bifida, and his ability to play baseball today is largely due to intervention from Bebbington’s team while Walker was still in utero. From ‘Do or Die’ to Safer & Better “Fetal surgery is still a relatively new discipline. At first, the whole approach to interventions was a ‘do or die’ scenario,” he says. “The problem had to be so severe that if we didn’t do something, the fetus would die. Now, we’re not only saving lives but using advanced technology to make surgical procedures safer, less invasive and more effective along the way.” One-of-a-Kind in Central Texas Bebbington has long pioneered advanced fetal care — treating rare fetal heart conditions to neural tube defects — in communities where such expertise was previously unknown.

Now, he’s continuing that work as co-director of the new Comprehensive Fetal Care Center, a partnership between UT Health Austin and Dell Children’s Medical Center of Central Texas. The center, which has performed 55 successful surgeries in less than a year since its launch, is the only one of its kind in Central Texas — opening a world of diagnostic and surgical possibilities that previously required Austin families to travel elsewhere. Last year, Bebbington led the first twin-to-twin transfusion syndrome laser surgery in the region. And beyond the operating room, he sees the value of comprehensive care as recognizing and caring for all the ways in which these diagnoses impact families. “Even if there is absolutely nothing we can do with surgery, if we can provide compassionate care, we can then change the way parents and families experience the health care system, and the trajectory of how they move forward in their lives.”

CARLOS MERY, M.D.

TINY HEARTS, WHOLE LIVES For the first time, a baby born in Austin can have a heart transplant here at home. But it’s not just about whole hearts — Carlos Mery is thinking about whole lives. Her heart is the size of a strawberry. Born less than a day ago, with little pulmonary veins bringing oxygen-rich blood back to the right side of her heart instead of the left, where it usually goes, she’ll need immediate surgery to survive and thrive. From a World-Renowned Surgeon, Treatment in Austin Four years ago, this baby would have been treated in Dallas or Houston, the nearest cities with pediatric surgical teams able to perform complex procedures on the tiniest of hearts. That changed in 2018, when world-renowned pediatric heart surgeon Charles Fraser Jr. came from Houston to Austin to build the Texas Center for Pediatric and Congenital Heart Disease, a collaboration between UT Health Austin and Dell Children’s Medical Center of Central Texas. One of the first people he recruited to join him? Carlos Mery, M.D., MPH.

1,350 Surgeries & 17 Heart Transplants To date, the program has performed more than 1,350 surgeries, with the Harvard- and Stanford-trained Mery focusing on complex cardiac repairs for people with congenital heart disease, as well as patients with coronary artery anomalies and heart failure. Where before there were none, there have been 17 heart transplants in the last 18 months alone. By traditional — and often stark — measures, the program excels: Though it performs procedures other teams won’t even attempt, its mortality rate from surgery to recovery is 1.7%. (The national average is 2.7%.)

“The emphasis has been mortality, and that is a very low bar. What families are asking is ‘Is my child going to be able to go to college? Will he be able to play sports? Will we be OK long term?’ “We’re taking a scientific, collaborative approach to learning from patients and their families about what they go through across the entire journey, so we can start making that journey better.”

Survival Is Just the Start But survival isn’t a benchmark that satisfies Mery. “Our goal as a program is to redesign the way that we provide care for patients and families,” he says.

Where there were once none, 17 heart transplants and 55 fetal surgeries have taken place in Austin in the past 18 months.

VISIONARIES of DELL MED

PRAKASH JAYAKUMAR, M.D., PH.D.

BETTER CARE, LOWER COST A powerhouse surgeon-scientist brings international expertise to bear on one problem: building a learning health system rooted in value-based care, starting in Central Texas. The patient’s knee hurts. Osteoarthritis is making it harder for her to do basic tasks like load groceries, play with her grandkids, or go for daily walks in the neighborhood.

“This type of technology is allowing us to use data to better engage our patients and build relationships with them like never before,” he says.

Prior to her consult with an orthopaedic surgeon at UT Health Austin’s Musculoskeletal Institute, she fills out a form asking about her pain, function and quality of life. It all seems standard — but behind the scenes, information from that survey combined with clinical data is processed using artificial intelligence, resulting in a personalized recommendation that will help her make a shared decision with her doctor about surgical treatment and more.

It doesn’t stop at AI. Another example: Using infrared light sensors that track movement across the entire clinic, Jayakumar and teammates study their movement patterns, working toward a better understanding of where they’re spending their time. One goal is to maximize face time with patients — another way of ultimately improving their outcomes and costs.

It’s the kind of technology-forward solution that Prakash Jayakumar, M.D., Ph.D., has become known for: Last year, he led a study showing that patients who used the AI tool ultimately had better outcomes and a better care experience. The Big Picture: Better Care, Lower Cost Jayakumar was the first orthopaedic surgeon to be chosen for the prestigious Harkness Fellowship in Health Care Policy and Practice Innovation before joining the faculty at Dell Med’s Department of Surgery and Perioperative Care and the Musculoskeletal Institute. Trained in the U.K. in London and Oxford, and in fellowships across the U.S. and Europe, he’s laser-focused on finding ways to improve health care systemically. Put more simply, Jayakumar is seeking to deliver what we all want: better care at lower cost.

“This is one of those unique settings where we can track both the outcomes that matter to patients and true costs of care in real time. We’re living and breathing value-based health care — and using some neat tools and technologies to do just that.”

ADEWOLE ADAMSON, M.D.

DERMATOLOGIST, DISRUPTOR This dermatologist-researcher has two superpowers: a healthy skepticism for conventional wisdom and a megaphone. Turns out, they’re key to increasing access and making treatment more effective. In the last 40 years, the incidence rate of melanoma increased sixfold, with nearly 200,000 diagnoses expected in 2022 by the American Cancer Society. The catch? The death rate has largely remained flat. Last year, Adewole “Ade” Adamson, M.D., co-authored an article in the New England Journal of Medicine pointing out this data, to both acclaim and intense criticism.

It’s not the first time Adamson — trained at Harvard and MIT, and increasingly recognized as a leading voice in flagging critical, yet overlooked, issues like skin color bias in AI — has challenged long-standing views. He has been vocal, for example, in correcting misinformation about the ability of sunscreen to reduce melanoma risk for Black and other dark-skinned people, to mixed reception even within the dermatology community.

The Diagnosis Epidemic “It’s being called the ‘third rail’ of dermatology. We have an epidemic of diagnosis as melanoma screenings are increasingly pushed for, but it has had no effect on the outcome of interest: death,” he says. “This is not to say screenings aren’t important, as some people may benefit — but many people are potentially having unnecessary procedures done, while others aren’t able to get timely access to dermatologists.”

Challenging Assumptions Now, with grants from the American Cancer Society, Dermatology Foundation, National Institutes of Health and more, Adamson and colleagues at the MD Anderson Cancer Center are narrowing the focus to Texas populations and studying polar, but related, opposites: how to reach people in underserved areas to increase timely melanoma diagnosis, and greater access to new, more effective treatments for this

potentially deadly disease. “I go where the data take me. Sometimes that means I’m challenging some deeply held assumptions about the world, and that can be difficult. To me, more health care isn’t always better. And it takes resources and attention away from people who need them.”

This year, about 200,000 Americans will be diagnosed with melanoma — what some are calling an “epidemic of diagnosis.”

VISIONARIES of DELL MED

JOSÉ DEL R. MILLÁN, PH.D.

REWIRING THE BRAIN Your brain can be taught to signal a computer. If José del R. Millán has his way, brain-computer interfaces will one day make wheelchairs obsolete. Ten years after his stroke, a man paralyzed from the waist down starts “walking,” operating an exoskeleton with his mind. Researchers led by José del R. Millán, Ph.D., study the electrical activity of the man’s brain indicating when he wants to use the robot to take a right step versus a left one. Many sessions later, the results are stunning: The man has less pain. Sensation is beginning to return to his legs. He is able to begin activating his leg muscles voluntarily. It’s real, and it’s just one of the advances that’s possible with the use of brain-computer interfaces — tools that allow the human brain to connect with an external force to control movement or modulation. Brain Signaling Is a Skill (Who Knew?) “The main thing we’ve learned is that people have to be taught how to change their brain signals,” says Millán, a longtime researcher in these interfaces. “Our brain has evolved to control our body, not to relay electrical signals to computers. But once we can teach people that skill — and it really is a skill — that’s when we see incredible advances in their condition.” Millán came to The University of Texas at Austin in 2019 to do this work at Dell Med and the Cockrell School of Engineering, continuing a career contributing to an international body of knowledge surrounding brain-machine interfaces. Most recently, he was responsible for establishing the Center for Neuroprosthetics at the École Polytechnique Fédérale de Lausanne in Switzerland.

A Draw to Texas: Medicine, Engineering & a World-Class University The Texas partnership is unique: a preeminent computer engineer supported by a world-class engineering school, collaborating closely with neurologists at a young, health equity-focused medical school. The possibilities of Millán and his team’s work span prosthetics, interventions for making neurosurgery safer, rehabilitation for nerve injury and damage, and much more. For the 5 million-plus Americans living with some type of paralysis, for example, the advances promise to be life changing. “I have these incredible minds around me — engineers and doctors and patients and families — who trust me to collaborate with them and take care of one another’s ideas. This is the type of multidisciplinary teamwork needed to move forward meaningfully.”

VISIONARIES of DELL MED

“It’s not just a shoulder or a knee that hurts. That whole person is sitting in the exam room.”

DONNA SHANOR, LCSW, LCDC

SOCIAL WORK FOR MODERN MEDICINE From a first-of-its-kind department embedded in a medical school, a cure for modern medicine: social work. Only about 16% of people in Travis County eat the recommended five or more servings of fruits and vegetables daily, while about 65% of people report spending at least 30% of their monthly income on housing. Nearly a fifth of people spend at least half their income on it. An estimated — an astonishing — 80% of the factors that drive health are socalled social determinants like these. Along with mental health care — a third of Travis County adults ages 18 to 44 said they were experiencing poor mental health when surveyed in 2020 — they are the focus for Donna Shanor, LCSW, LCDC, associate chair for clinical integration and director of clinical social work and integrated behavioral health in the Department of Health Social Work.

A collaboration of Dell Med and UT’s Steve Hicks School of Social Work, where she’s an assistant professor of practice, it’s the first department dedicated to social work at a U.S. medical school — and a tacit acknowledgement of the sea change needed in how we think about health and health equity as a biological, psychological and social consideration. Better, More Comprehensive Teams Shanor’s leadership is twofold, teaching social workers who are increasingly a part of interdisciplinary teams alongside doctors and nurses how to improve their skills as clinicians and scientists, analyzing the efficacy of solutions. At the same time, she’s integrally involved in designing systems that support such teams.

In Shanor’s estimation, social workers are the linchpin that has been missing from the health care system all along. “It’s not just a shoulder or a knee that hurts,” she says. “That whole person is sitting in the exam room. That person has a story and a community. If we don’t address that shoulder or knee in the context of those things, they’re not going to get better, and we’re not doing the work we’re supposed to be doing in health care.”

ELIZABETH MATSUI, M.D.

EQUITY IN CHILDHOOD ASTHMA Asthma sends many more Austin kids to the hospital than it should, her first-ofits-kind study suggests. What gives? Atop the shoulders of giants, this researcher is finding out. Kids living in Travis County are hospitalized for asthma at a rate 60% higher than U.S. children overall, with the highest rates of emergency room visits and hospitalizations occurring in some of the poorest, most racially segregated neighborhoods. Elizabeth Matsui, M.D., MHS, a professor of population health and pediatrics and an international expert on the effect of environmental exposures on asthma and other allergic conditions, is the clinician-researcher who uncovered this startling disparity in a first-of-its-kind study. And she, along with her team, is the one doing something about it. Leveraging Campus Expertise for Health After coming to Austin from Johns Hopkins in 2018, Matsui founded the Center for Health and Environment: Education and Research, or CHEER, a hub for environmental health sciences research and education that brings together University of Texas giants in medicine, social work, pharmacy, engineering and natural sciences.

Now, a CHEER-led effort is studying the role of neighborhood and home environmental exposures affecting asthma disparities. The next step? Fixing them through policy, urban planning and other preventative measures, with an eye toward dismantling a history of systemic racism that has often placed pollution-pumping factories in areas where people of color live, learn, work and play.

“There are these huge inequities that have been recognized for many decades, and we have not made a dent in them. It’s past time for everyone to be able to breathe.”

Research That’s Relevant It’s a natural fit with Matsui’s role as founding associate director of Dell Med’s Health Transformation Research Institute, which grounds the school’s focus on research that is primed for direct impact — new treatments, better approaches and the like. But first, childhood asthma. “I would like no child to ever struggle to breathe again,” Matsui says. “That’s the wicked problem. But there’s another really important layer, which is that there are some populations that struggle much more to breathe than others — in particular, kids who identify as Black or Latinx or Hispanic.

Kids living in Travis County are hospitalized for asthma at a rate 60% higher than U.S. children overall.

VISIONARIES of DELL MED

TESSA NOVICK, M.D., & NICOLE TURGEON, M.D.

KIDNEY CARE FOR CENTRAL TEXANS As a dyad, this team is doubling the number of kidney transplants performed locally — and at the same time reducing the number that are needed. Kidney disease can upend a life in mere months — and it’s significantly more likely to impact Black and Latina/o/x patients, who together make up more than 40% of Travis County residents. Nicole Turgeon, M.D., and Tessa Novick, M.D., have wholly different approaches when it comes to addressing the ways kidney disease plays out in Central Texas: The former is a transplant surgeon, and the latter is a health disparities researcher with a background in social work. Both approaches are key to bringing the best possible kidney and transplant care to residents of Travis County. Putting Central Texas on Track to Double Its Transplants When Turgeon moved to Austin in fall 2019 to launch the Abdominal Transplant Center and Pediatric Abdominal Transplant Center, both clinics of UT Health Austin in partnership with Ascension Seton, it meant that Central Texas was on track to double the number of transplants performed in the region annually, including opportunities for nondirected (anonymous) donors to make a local impact. Since the adult center launched in late 2021, six Central Texans have received kidneys, and nine living donors have given theirs. “What an academic transplant program can provide is not just clinical excellence, but building the next generation of transplant professionals and studying ways to address disparities in access to transplantation,” Turgeon says.

“So what better way to advance the field than starting the program in a large capital city where we can serve the community and accomplish these goals?” Preventing Severe Disease for the Most Vulnerable And Novick, a practicing nephrologist and researcher who got her start in social work, comes at the issue from the prevention side, with an eye toward the social determinants of health. Now, in partnership with Central Health and the Mexican Consulate, Novick is piloting a screening program funded by the National Kidney Foundation to pair community health workers with recent immigrants found to have kidney disease. Within six months, the program has enrolled 49 participants, 65% of whom have already been able to obtain insurance and a primary care physician with help from their community health worker in navigating the care system. And for other vulnerable populations, like people experiencing homelessness, Novick’s research points to housing insecurity as a primary driver of worsening kidney disease. “We cannot treat someone without understanding their environment, where they’re living, whether they’re able to access services and care,” she explains. “And they cannot be expected to get better without a stable environment in which to live.”

JOHN LUK, M.D.

TRAINING A NEW KIND OF PHYSICIAN From establishing a free clinic for people experiencing homelessness to mentoring high school students, impact is multiplied by one of Dell Med’s founding educators teaching up-and-coming physicians to be leaders in their own right. John Luk, M.D., is usually more behind the scenes. That’s kind of the point: Luk’s charge is to produce great team members. Not just superstar doctors, but health professionals who rely on and proactively seek the expertise of those around them. To date, nearly 150 medical students have graduated under his guidance, standing out among their peers in collaboration and teamwork skills, according to early reports from the Liaison Committee on Medical Education (LCME), the accrediting body for medical school education programs. “Many of us idealize the role of physicians, but there are so many other professions — nurses, and pharmacists, social workers and more — who do equally significant work in helping people get as healthy as possible,” he says.

Luk, a practicing pediatric hospitalist at Dell Children’s Medical Center of Central Texas, has seen the consequences of poor teamwork over the course of his career: When team members don’t talk, patients suffer. Medications are missed, tests are re-drawn, and care takes longer to administer. Partnership With Peers & Community As a result, he led the creation of Dell Med’s unique four-year interprofessional curriculum in collaboration with health professions partners across UT Austin; at every point in their training, students are exposed to partnership with health professions peers and community organizations, ultimately redefining what it means to be a physician and a leader. The LCME calls the first-ofits-kind curriculum “a model program worthy of emulation by other medical schools.”

Starting a Free Clinic & More Examples of interprofessional student efforts — and Luk’s influence — are visible throughout the Central Texas community: Prior to Dell Med’s existence, he helped clerkship students at University of Texas Medical Branch start a free clinic in Austin, which is now the C.D. Doyle Clinic primarily serving people experiencing homelessness in East Austin. And these days, Dell Med students work with everyone from faith leaders to high school students in long-standing partnerships to improve health and access locally. “I’m proud that these efforts live on, and it continues to evolve. We have a responsibility at Dell Medical School to serve our community and to be there for them long term. It’s core to who we are, and what we do.”

Nearly 150 M.D.s who learned by Dell Med’s Leading EDGE curriculum are now in practice.

VISIONARIES of DELL MED

RIGHT PEOPLE. RIGHT PLACE. RIGHT TIME. dellmedvisionaries.com