2016 State of the College

2015-2016

State of the

College Steven J. Scheinman, M.D., president and dean

W

elcome to my second State of the College address. I am honored to be

joined by all of you, including members of our board of trustees, faculty, staff and several generous and engaged benefactors and community members — including Mr. Michael Altier, a founding supporter of the college who recently celebrated his 100th birthday. I want to offer a special welcome to the trustees in attendance today. I welcome our colleagues at our campuses in Wilkes-Barre, Williamsport and Sayre who are watching on video. Finally, I want to recognize those in the audience who are the reason we are here today: our students.

Table of Contents Chapter 1: Inflection Point..................................................................................2 Chapter 2: Curriculum.........................................................................................6 Chapter 3: Research..........................................................................................10 Chapter 4: Partnerships....................................................................................12 Chapter 5: Community Initiatives.....................................................................16 Chapter 6: New Programs................................................................................20 Chapter 7: Institutional Priorities......................................................................21 Chapter 8: Conclusion......................................................................................24 State of the College 2015-1016

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A year ago I called that moment a second “inflection point.” We were now fully accredited and still independent, with a growing track record of success by our MD and MBS graduates. I emphasized then the remarkable accomplishments in recent years, including our innovation in curriculum, the maturation of our pi-

Steven J. Scheinman, M.D., president and dean

oneering Longitudinal Integrated Clerkship (the LIC), our flipped-classroom active-learning emphasis and the community experiences that are part of all four years of the curriculum.

But I also spent time discussing ways in which our curriculum is actually quite traditional and the important challenges that remain in curricular innovation.

The Behavioral Health Initiative was just about to get underway. I outlined the successes of the REACH-HEI pipeline program as an expression of our community mission. I described our progress in fundraising. I discussed our financial constraints and how our enhanced reserves had strengthened the board’s confidence in our ability to remain independent for at least the near future.

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Accreditation was indeed a significant milestone in the history of TCMC. The year since then has been one of great transition: we reconsidered and redesigned our signature curricular program, the LIC; we expanded our network of clinical partners, most notably launching our fourth campus at Guthrie in Sayre; we welcomed yet another class of more than 100 students; and we learned that our economic impact to the region and state — another dimension of community wellbeing — amounts to $65.2 million. In sum, we have achieved the strategic intent of TCMC 1.0: the creation of an accredited medical school.

But while accreditation was significant, it is not, by itself, the ultimate goal. It was a necessary step toward achieving our mission, but we are still a long way from accomplishing everything we can. Accreditation is a basic function, with-

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out which we cannot perform. As I said last year, now that we are accredited, we are ready to take on the harder work of pushing the envelope of innovation and serving our mission by transforming the health of our communities. We are in the last year of a three-year strategic plan that we created in the heat of the effort to achieve accreditation.

As that plan is ending, we need to start work on our next strategic plan and the timing is perfect. We are now ready to envision what TCMC 2.0 will look like. We are now ready to build upon our success to date – a heroic effort by many – and reboot ourselves, moving past “TCMC 1.0” to focus beyond mere accreditation and to conceive how we will serve our communities, continue the innovation of our founding and improve health and wellbeing.

As we begin, as a community, to conceive what “TCMC 2.0” will look like, it will be important to start with a shared vision. Our mission is clear and is embodied in our mission statement, which we all know so well (you could probably

We are now ready to build upon our success to date — a heroic effort by many — and reboot ourselves and move past ‘TCMC 1.0,’ focusing beyond accreditation to conceive how we will serve our communities, continue the innovation of our founding and improve health and wellbeing. page 4

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recite this from memory): “The Medical

Commonwealth College

edu-

cates aspiring physicians and scientists to serve

In everything we do, we need to promote a culture of innovation,

society using a commu-

because we’re not there yet;

nity-based, patient-cen-

because what got us here will

interprofession-

not be sufficient to get us to

al and evidence-based

where we need to be.

tered,

model of education that is committed to inclusion, promotes discovery and utilizes innovative techniques.”

In our strategic planning process for TCMC 2.0, the language we use to express our mission will inevitably evolve because we will need to distill how to articulate the vision from which TCMC’s mission was conceived. The strategic planning process will begin with finding the right words to capture our evolving understanding of that vision in terms we can all see clearly.

How should we pursue this in TCMC 2.0? Let’s think of the vision as it applies to curriculum, research, partnerships, community initiatives and new programs.

In every one of these categories we need to focus on health and wellbeing. In everything we do, we need to promote a culture of innovation, because we’re not there yet; because what got us here will not be sufficient to get us to where we need to be. In all of these categories, community will be an over-arching defining theme.

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We require students to do at least 100 hours of community service.

In curriculum there is much we can do to push the envelope of innovation.

Last year I outlined opportunities to promote more horizontal and vertical integration in the curriculum, with more robust early clinical experiences; more attention to cutting-edge content, such as healthcare economics, public-health policy, genetics and genomics, healthcare quality and safety, teaching skills, leadership skills, and research methods; and an ultimate shift to an earlier start date for the clinical clerkships.

We are justifiably proud of being at the forefront in having a community-based curriculum. Our clinical experiences are in the community setting. We require students to do at least 100 hours of community service. We have a robust Interprofessional Education Coalition with multiple community partners. We require all students to perform community-based research projects (CHRPs) and quality-improvement community-collaborative projects (QuICCs). Yet we have not offered a clear definition of “community service� and so those activities — while page 6

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certainly very meritorious — are highly miscellaneous. The time students have to pursue CHRPs and QuICCs is very limited and so the projects themselves and their outcomes are modest.

We encourage a discussion of how to make the student research experiences — the CHRPS and QuICCs — more meaningful by rethinking their structure and timing within the curriculum. One suggestion is to create tracks with ongoing projects that students would pursue for several years — in teams and in partnership, for example — with the quality efforts of our partner clinical systems, perhaps culminating in a fourth-year “capstone” project as an outcome. Our department chairs have begun to consider such alternatives. This will be an important discussion over the coming year.

We need to develop a meaningful definition of ‘community service,’ one that is clear, that is service learning and that is aligned with our mission to improve community health.

We need to develop a meaningful definition of “community service,” one that is clear, that is service learning and that is aligned with our mission to improve community health. We need to find ways for students to connect these community-service activities organically to the curriculum. We also need to apply a clear definition to the “community service” activities that faculty and staff perform.

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Our vice president for community and government affairs, Ida Castro, has begun the process of gathering input from faculty, staff and students on creating such clarity around our understanding of “community service.” This will be an important part of the strategic planning process.

We heard recently from Dr. Pedro Greer from another new medical school, Florida International University (FIU), about its curriculum’s intensive focus on community service as a fundamental principle of educating the complete physician.

At FIU, they begin the first year not by dissecting a cadaver, but by examining living patients. Dr. Greer expressed admiration for what we’ve been doing and stated his belief that we’re far ahead of most medical schools in this regard. But we need to take this opportunity to coalesce our community themes and innovate further in curriculum.

Another important effort in curriculum is our continued focus on student success. While we all resent efforts to “teach to the test,” the unavoidable reality is that USMLE Step 1 scores are more influential now than ever in determining success in obtaining residencies. I applaud our vice dean, Dr. Iobst; our curriculum dean, Carien Williams; and the Curriculum Action Committee for the attention they are giving to assessment of student performance and for the steps they and others have taken to make grade remediation a meaningful and valuable process. We will also need to work on aligning content and on monitoring the quality of the content in the curriculum.

We need to make sure that our process for considering such innovations is one that adheres to academic tradition and common sense. Fortunately, we have a strong process. We all agree that the role of the faculty in developing and delivering the curriculum is critical, but that, as the LCME has made clear, the page 8

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dean is ultimately accountable for curricular issues. I need to rely on Vice Dean Iobst and Associate Dean Williams to oversee and coordinate these curricular initiatives with the meaningful input of the faculty as organized through the Curriculum Action Committee and its subcommittees.

Finally, we need to disseminate what we have learned from our innovations.

TCMC has been at the forefront of educational innovation. We are the only medical college in the nation that has years of experience associated with implementing a large-scale, disseminated LIC. We have profound learnings from this innovative work and we must share these learnings with the entire medical education community. That community should look to us for direction as LICs become a gold standard for the clinical learning environment. We should also

All of our research at TCMC needs to focus on addressing community needs, from cancer to neurological disease. In this regard, even our laboratory research can be community research.

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have the courage to challenge ourselves constantly, never ceasing to innovate how we teach our students. The moment we rest on our laurels is the moment we lose our innovative edge.

Over the past year, our associate dean for research, Dr. Planey has led a task force to address our research mission. Their recommendations are very valuable, particularly with regard to our laboratory-based research program, but they stopped short of articulating a vision for non-laboratory community-based research for understandable reasons: such a vision would depend on institutional strategic priorities, external partnerships and resources, all of which are issues that required broader input. The strategic planning process for TCMC 2.0 will provide that opportunity, but allow me to offer a framework for that discussion.

All of our research at TCMC needs to focus on addressing community needs, from cancer to neurological disease. In this regard, even our laboratory research can be community research. I believe that an active laboratory research program is an important element in the environment for training doctors, even beyond its value in advancing medical knowledge. Because our resources are limited and it will be difficult to consider expanding the size of our laboratory program, we must do all we can, such as through promoting innovative collaborations, to help our lab scientists be as successful as they can be. Dr. Pam Lucchesi, our new department chair in Basic Science, has a number of creative and constructive ideas in this regard.

We can do much through partnerships to enhance the success of our laboratory research efforts. Geisinger’s genomics initiative offers a wonderful opportunity page 10

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for investigators to explore the clinical significance of the biological pathways they study by analyzing variants in those genes in a very large population from this very region. This is a golden opportunity to explore genes potentially relevant to cancer or heart disease, for example.

Our new partnership with the Blumberg Institute and PA Biopark represents another great opportunity for collaboration. We should also do more to offer opportunities for our students, and students from other colleges, to work in our laboratories. For example, as we rethink the CHRPS and QuICCs, we might consider the option of a laboratory research track.

And TCMC must expand our research direction beyond the laboratory. This is true for at least two reasons: to make our research as relevant as possible to the community and because many types of community-based research are relatively less expensive, an important consideration when resources are limited, as ours are.

Our partnerships with community colleagues on healthcare quality and safety, on behavioral health or on healthcare outcomes should offer opportunities for us to develop research programs. As an institution that takes such pride in its innovative approach to medical education, we certainly ought to strengthen our infrastructure around the research of education as an opportunity for our faculty to publish more and so that the college can become as widely recognized for innovation as it deserves. We might choose to expand our resources around epidemiology and public health. We can’t, of course, do everything; we should make decisions strategically. The strategic planning process will provide a context for these important discussions.

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We have often noted that our mission to improve community health can only be realized in collaboration with community partners. We have been fortunate to have had a strong relationship with Blue Cross of Northeastern Pennsylvania and look forward to working with Highmark as we get to know each other better.

Since our founding, we have been fortunate to have partnerships and collaborators in higher education, governmental agencies, corporate and service organizations. This list is long and we value these relationships.

Guthrie Robert Packer Hospital, Sayre

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This year, I will draw your attention to just a few. We have strong relations with all the other excellent academic institutions in the region, such as the University of Scranton and East Stroudsburg University, with both of whom we have joint degree programs, and King’s College, which has graciously provided us with space for our initiatives in Wilkes-Barre. We have been able to build the core of our clinical training network with vibrant collaborations with the CHS hospitals, Susquehanna Health, Pocono Medical Center, Allied Health Services, Lehigh Hazleton, Wayne Memorial, Guthrie, Geisinger and other valuable clinical part-

We are thrilled with...our recent collaboration with Guthrie. Guthrie is not just a hospital, but an impressive and respected clinical system. It also has an active research institute.

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ners throughout the region. We are thrilled with the progress we have made this year in expanding our clinical training network, particularly our recent collaboration with Guthrie. Guthrie is not just a hospital, but an impressive and respected clinical system. It also has an active research institute. The Guthrie leadership have been enthusiastic, responsive and creative partners, as evidenced by the remarkable speed with which that new campus was launched. We look forward to strengthening that relationship.

I have also been encouraged by our growing relationship with the new leadership at Geisinger. Dr. Feinberg has made clear that he would welcome a closer relationship than we have had in the past. We are discussing a significant collaboration on medical student education. I am optimistic that before long we will be able to have a cohort of medical students receive their clinical experiences in Danville.

We have been working with Dr. Michael Murray, director of Geisinger’s genomics initiative, on the joint recruitment of a faculty member who will spend 25 percent of his time at TCMC to develop a stronger curriculum around genetics and genomics and to teach in that curriculum. I am happy to report that on Friday, Dr. Murray received a signed acceptance from Dr. Murugu Manickam from Ohio State. Some of you have met him and he will be a wonderful colleague.

We have now had three TCMC students who have had an excellent research experience with Dr. Murray’s team. And as I’ve mentioned, the opportunities for faculty research collaboration are real.

For several years the leadership of the Baruch S. Blumberg Institute (the BSBI) and PA Biopark innovation incubator in Doylestown have been eager to forge a partnership with us and it is now happening. We are close to launching an page 14

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The leadership of the Baruch S. Blumberg Institute (the BSBI) and PA Biopark innovation incubator in Doylestown have been eager to forge a partnership...it is now happening with TCMC’s MBS program

extension of our MBS master’s program to be delivered in Doylestown. This initiative has been led by Drs. Jennifer Boardman and Pam Lucchesi, with helpful input from the faculty’s representatives, Drs. Jess Cunnick and Kathy Doane.

The curriculum will be identical to that of our established MBS program, but it will be delivered differently, after hours and using the impressive scientists on the BSBI staff who, with appropriate vetting, will be given adjunct faculty status at TCMC. With my full support, Dr. Scott Koerwer, vice president for strategic initiatives and planning has been discussing this initiative with our faculty and working with them to make it happen. I am excited about this initiative for several reasons, not the least of which is the opportunity it creates for our faculty to form relationships with the world-class scientists at the Blumberg Institute. As I

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have said on several occasions, in any such partnership there are three principles we need to apply: First: the partnership must be aligned with our mission; second: it must at least be self-supporting and, ideally, generate net revenue; and third: it should offer the opportunity to expand our faculty. The Doylestown partnership fulfills all three principles while enhancing our reach and furthering our reputation as an innovative, community-based medical school. In the initial stages, the faculty expansion will comprise the appointments we give to scientists at the Blumberg Institute, but in the long run I expect that the revenue we generate will allow us to add at least one faculty member located here.

And while the description of how BSBI and the BioPark align with our mission and principles for partnerships, there is one additional, essential point I must highlight. This partnership, once again, puts TCMC at the forefront of defining and creating the future learning arena for our students. By partnering a medical school with an internationally regarded research institute and leveraging an incubator as a classroom (housing nearly 40 start-up companies), we will create a learning arena that may be unprecedented in the commonwealth and beyond for biomedical science graduate students. As with our founding, our LIC, our commitment to community and our determination to create physicians and scientists for the future of health and wellbeing, this initiative will be distinctive and worthy of our talents, time and commitment.

I will draw your attention to two particular initiatives, each of which has already begun to impact our communities: the Behavioral Health Initiative and our high school and college student pipeline efforts. page 16

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With the exception of the success of the college itself, I think it fair to say that our Behavioral Health Initiative (the BHI) is the activity that’s generated the most excitement and hope.

It is palpably evident to everyone in this community, as it has been to me since I arrived, that our needs in mental health, substance abuse and suicide prevention are substantial. People are excited about our Behavioral Health Initiative (the BHI). With the exception of the success of the college itself, I think it fair to say that this is the activity that has generated the most excitement and hope. This positive response reflects our own enthusiasm for the BHI. Once again, this effort rests on partnerships – in this case with the Luzerne Foundation, with the Wright Center, with Community Care Behavioral Health and with many dozens of agencies and other community partners represented on our large advisory committee, which is now up to a membership of more than 80 people.

With only 20 percent of her time available for this effort, Dr. Tina Wydeen has done an extraordinary job as director of the BHI. She chairs the advisory committee and the working steering committee and coordinates the efforts of several task forces.

Pennsylvania Secretary for Aging, Teresa Osborne speaks at the BHI’s July launch.

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An application for a residency program in psychiatry was submitted by The Wright Center, with participation by TCMC, and while the ACGME has held back on approving it for now, a strengthened application will be resubmitted with the hope of having residents begin training within the next few years.

Dr. Richard Silbert, a TCMC faculty psychiatrist from Community Care Behavioral Health, chairs a task force designing a certificate program in mental health and substance abuse, which is aimed at primary-care providers. We hope to have this program ready to launch by the fall semester. We also have task forces working on models of integrated care, telepsychiatry, suicide prevention and autism.

Frankly, these activities have grown to a point where a part-time director and a patchwork of ad-hoc support by TCMC staff are no longer enough to keep up with our ambitious goals. I am seeking support from funders for a full-time director; administrative support; two faculty psychiatrists to teach in the certificate and residency programs, as well as the undergraduate curriculum; and tuition support for primary-care physicians to take the certificate program. Until such funding is obtained, we will be limited in our ability to pursue the ambitious goals of the BHI. One of the ways we have contributed to community wellbeing is through the pipeline opportunities that we have offered to underprivileged high school and college students through the REACH-HEI program.

We have been very proud of the remarkable success of the students who have gone through REACH-HEI and, although its federal funding ended two years

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ago, Ida Castro has done yeoman’s service in maintaining as many elements of the program as possible. For example, the Hazleton School District has contracted with us to continue the program for 25 of its students per year

I am inspired by these initiatives in service to the community.

They are so much a part of our vision and our identity, that I would love it if people come to see the letters ‘TCMC’ as representing ‘This Community’s Medical College.’

and Ida has managed to use those funds to engage 50 Hazleton students in this year’s program. Her efforts to restore federal funding are ongoing.

Given the very impressive objective evidence of REACH-HEI’s successful outcomes, I am optimistic these efforts will ultimately prove successful. This has been a wonderful manifestation of our commitment to create opportunity for the people of northeastern Pennsylvania.

I am inspired by these initiatives in service to the community. They are so much a part of our vision and our identity, that I would love it if people come to see the letters “TCMC” as representing “This Community’s Medical College.”

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Encouraged by the success and academic excellence of our existing Masters in Biological Sciences (MBS) program and of its graduates, we are actively working on developing several new degree programs and considering several more, consistent with our mission and the principles I have listed. I have mentioned the expansion of the MBS program with Doylestown, and development of a certificate program in behavioral health. We have had discussions with the University of Scranton on a joint one-year master’s degree in neuroscience in which each institution would provide one-half of the credits, with TCMC’s role being primarily to offer the research experience.

Propos als that have not yet reached the stage of planning include possible master’s degrees in teaching anatomy and/or simulation education. I believe that these plans would fit well with our interests in innovating educational delivery and I would be very receptive to exploring their feasibility. A growing relationship with clinical partners such as Geisinger could offer the opportunity of developing formal degree programs around some of their areas of strength.

We spent a fair amount of effort this year exploring the creation of a clinical integrated network based around our hundreds of voluntary faculty members in independent practice. We saw this as a potentially exciting opportunity to contribute to healthcare transformation in the region, to link us more closely with our physician faculty and to enhance educational and research opportunities. However, in the end, for several reasons we decided to forgo pursuing this network. page 20

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These reasons include the initial financial investment required, potential risks — of various kinds — and the significant time and effort involved in doing it correctly. This latter consideration was very real and a valuable case lesson. We are a small institution with large ambitions. Our bandwith — the size of our staff, of our faculty, and of leadership — is small and is already stressed to pursue the many innovations and initiatives I have already discussed. With everything heaped on our plate, we need to be selective so that we can pursue our real priorities confidently and with excellence, and to find the resources to do so.

I have discussed our initiatives, our mission and our ambitious goals, but we should also acknowledge the very real issue of resources. To cite a sentiment attributed variously to Bertrand Russell, Benjamin Franklin and Henry Ford: “Vision without resources is hallucination.”

We already strain to find space for the programs, faculty and staff we have now.

For this reason, we are exploring several opportunities to make constructive use of undeveloped space on campus. Space renovation will depend on identifying capital funds. We have been working with an architectural firm to design and calculate the costs of such renovations so that we are ready to seek these funds when appropriate. Since all of this will take time, we are also exploring opportunities to identify space near the campus that might be available sooner.

TCMC has the financial reserves to operate for years, but we still do run an annual operating deficit. It is a high priority to close that deficit and preserve State of the College 2015-1016

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those reserve funds. This will allow us to use our resources to pursue our mission through initiatives, to ease some of the pressure on student tuition and, especially, to guarantee our permanent W.T. Smith Manual Arts Building

sustainability.

Year by year

we have had good news in this regard. Each year we have beaten our budget, we write the next budget even more conservatively, and then we beat that budget. Great credit is due to our vice president for finance and administration, Ann Noon and her entire team, as well as the many financial managers at TCMC for their capable and conscientious efforts.

We already strain to find space for the programs, faculty and staff we have now. For this reason, we are exploring several opportunities to make constructive use of undeveloped space on campus.

Ida Castro and I have spent a great deal of time in Harrisburg and in the local offices of the many state legislators of our large region. I am encouraged by the strong support TCMC has earned, from all directions, among legislators and the executive branch. We have made a strong case for increasing state support to the medical school that has most embraced a mission to the community and the commonwealth. We wait eagerly to see what will emerge, eventually and hopefully not too much longer, in the state budget.

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We have also now officially launched the Campaign for Scholarships and Innovation. Our goal is to raise $15 million, with the priority being for student scholarships. At the gala, we announced that, in the silent phase, we had already raised more than 60 percent of that goal, $9.45 million. To put that in perspective, the founders’ original campaign, the campaign that created 50-percent scholarships for the entire charter class, raised $5.2 million. Much credit is due to Marise Garofalo, our vice president for institutional advancement, and her small team for having gotten us so far along so quickly. I am also grateful for the strong support of our board, all of whom have made personal commitments to the campaign that, when added together, top $2.1 million.

Together with the campaign, but for reasons that go well beyond fundraising, we are pursuing a branding initiative with the goal to gain community recognition, both in this region and nationally, of TCMC for its mission and accomplishments and for being a regional and not “just� a Scranton school. The themes of the branding campaign are Community, Wellbeing and Innovation. I hope you have heard me use all of these words multiple times in this talk. You have seen some of the early images for our branding campaign in the material supporting the gala, and you will see much more in the coming months.

In all of these efforts, our board has been engaged and supportive. They have been financially generous, but also very generous with their time and attention to the college. In 2014 and 2015, the board expanded its membership, with the addition of Dr. Edith Mitchell of Philadelphia; Dr. Greg Threatte from Albany, New York; Dr. Susan Sordoni; and Mr. John Menapace. This fall, we were thrilled to welcome our newest board member, David Hawk, of Gertrude Hawk Chocolates.

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For those of you who attend our Community Meetings regularly, I trust that little of what I have discussed is new to you. Putting it all together, however, reinforces, for me at least, how truly ambitious our plans are and how exciting. Because we are so small, each one of our faculty and staff is much closer to these activities than would be the case at larger institutions. I am continually amazed by the sense of community, our collective and individual sense of ownership of the college and, in particular, of our commitment to student success, as embodied in our staff and faculty. It is one of our unique strengths, and the biggest reason why I am so very honored to be a part of this team.

Although the strategic planning process now starting up will be less exhausting than its predecessor, it will once again be rigorous, comprehensive and inclusive and will engage a very high percentage of every group at TCMC. And, as Dr. Koerwer always promises, it will be fun!

It is with a sense of excitement and continued commitment to the mission of this extraordinary school that I invite you all to join us in expressing a vision and strategy for TCMC 2.0.

Thank you.

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TCMC’s Class of 2019

COMMUNITY

WELLBEING

INNOVATION

525 Pine Street, Scranton, PA 18509 • www.tcmc.edu • 570-504-7000 The Commonwealth Medical College is committed to non-discrimination in all employment and educational opportunities.