2017 State of the College

2017 STATE OF THE

COLLEGE

Steven J. Scheinman, MD President and Dean

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elcome to everyone in this auditorium, and to our colleagues watching by videoconference in Doylestown, Sayre, Wilkes-Barre, Williamsport — and Danville.

TABLE OF CONTENTS Introduction........................................................................................................................2 First Cornerstone: Training programs and educational partnerships.................5 Second Cornerstone: New degree programs........................................................ 10 Third Cornerstone: Innovative, patient-focused education................................. 15 Fourth Cornerstone: Engaging communities.......................................................... 16 Conclusion....................................................................................................................... 24

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The last time I delivered “state of the college” remarks in November of 2015, I could not have predicted how radically different my next such address would be. Then, our school had achieved the strategic intent of TCMC 1.0, namely, the launch of an accredited medical school. In that address, I was issuing a call to move from an entrepreneurial sensibility to a more mature, growth-oriented frame of mind. Our vision then was for “TCMC 2.0”, representing a change in focus from the breakneck pace of a start-up to the more strategic tempo of a mature and fully accredited institution — or, to strain a metaphor, a change from adolescence to young adulthood. Now, of course, we have an entirely new identity, one that I will discuss at length in this address. Before I do, however, I want to revisit the important themes of TCMC 2.0 to demonstrate just how closely our new identity embraces and values all that was central to the mission and vision of the school formerly known as TCMC.

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In 2015, I described five areas upon which the college would focus. They were curriculum, research, partnerships, community initiatives and new programs. I said at that time, “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… in all of these categories, community will be an over-arching, defining theme.” Let me be clear: This vision holds firm today.

We remain committed to community, dedicated to our neighbors’ wellbeing and determined in our pursuit of excellence through innovation. This school will always be this community’s medical college. The major difference today is that we have the stability to support that vision, the opportunity to build upon it using Geisinger’s unique set of research and system strengths, and the resources to implement it on a larger scale than we could have imagined in 2015.

As I lay out where we are today in realizing the vision of Geisinger Commonwealth School of Medicine and where we will be going in the future, I ask that you bear in mind the central goal

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We remain committed to community, dedicated to our neighbors’ wellbeing and determined in our pursuit of excellence through innovation.”

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that unifies our efforts. Our shared vision with Geisinger is to create an open and supportive environment for: Integrated, person-centered care Innovative education and Research, with a focus on population health, — while recognizing that the School of Medicine and the health system are organically connected and mutually interdependent.

That last point is important: The School of Medicine is not the only entity transformed by the integration. Dr. Feinberg has told me on numerous occasions that he believes the School of Medicine will inform the culture of the health system and foster a spirit of continuous learning and inquiry. So we must view the relationship between our school and the Geisinger health system as symbiotic — we mutually enrich each other.

With the shared goal of creating person-centered care, innovative education and research focused on community needs, how has our strategic plan taken shape? We have divided our efforts into four “cornerstones.”

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FIRST CORNERSTONE -

TRAINING PROGRAMS AND EDUCATIONAL PARTNERSHIPS The first cornerstone: We will coalesce all training programs and educational partnerships that both the health system and the medical school have developed and bring them into a single structure, budding off new schools and ultimately becoming a medical university offering a range of academic degrees that will strengthen and align the culture of healthcare delivery, inquiry and medical education.

When we talk about bringing every educational function of both the school and the health system into a single structure, we are talking about a project of vast scope. A helpful way to think about everything that now comes under oversight of the School of Medicine is to organize the educational functions into seven categories: Undergraduate Medical Education (UME) Interprofessional education Graduate Medical Education (GME) Continuing Medical Education (CME) Simulation Library School of Graduate Studies

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UME AND GME At the medical school, we’ve become accustomed to thinking in terms of MD students and MBS students. Now, our body of learners has vastly expanded to include more than 400 residents and fellows in 45 specialties, from anesthesia to urology. All of these will now be overseen by Dr. Iobst, working through the excellent leadership teams here and in Danville. We may add to that number of residents as we conduct a workforce needs assessment to identify areas of healthcare throughout the region that need shoring up. We have engaged the Institute for Public Policy and Economic Development to conduct the assessment on our behalf.

The residency and fellowship programs now within the School of Medicine include several in highly specialized areas that closely align with our mission to address the most pressing health needs of our community. For example, there are fellowships in addiction medicine, clinical psychology & behavioral medicine, and clinical informatics. The integration makes all of these learners “our learners.” (And, by the way, it will make the thousands of Geisinger residency alumni “our alumni.”) We look forward to providing all of these learners with what we have always given “our students” — the best, most forward-thinking education in the most supportive environment available. As an added bonus, all of these programs will support and enhance the education of

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“our original students” — MD and MBS students — and prepare them well to participate in team-based healthcare.

INTERPROFESSIONAL EDUCATION While the medical school has always embraced and taught interprofessional education as a core component of our mission, our transformation to The Geisinger Commonwealth School of Medicine has dramatically enhanced our ability to innovate in this field. We are now part of a high-functioning integrated healthcare delivery system that models team-based care on a daily basis and can now count amongst our learners nursing students, pharmacy students and respiratory therapists, among others. We have just begun to investigate enhanced interprofessional education opportunities; in the long run there will be rich opportunities for new degree programs in the health sciences, including professions of the future that may not yet exist. It is our sincere goal that Geisinger Commonwealth School of Medicine will take interprofessional education to new levels of innovation and excellence, and will work with the clinical system to build new models of team-based care.

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CME Continuous professional development — be it in the form of CME or other training — across the health system, not just the School of Medicine, is now within the school’s purview. In this area, the health system benefits from the school’s ability to meet the continuing education needs of health professionals throughout our part of the commonwealth who are not employed by Geisinger, especially such professionals in rural or remote areas.

In these instances, we now have a stronger platform for creative use of technology to allow learners in remote locations to access our CME content.

SIMULATION The integration has placed Geisinger’s Education and Medical Simulation (GEMS) center under our oversight.

Like our own Clinical Skills and Simulation Center, GEMS in Danville is successful and has well-developed standardized patient programs, high-fidelity simulators and a number of task trainers, all used to develop realistic scenarios for training

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and assessing learners. GEMS is currently used to support the health system’s GME and CME activities, and ours is used for UME activities. Thus, the integration presents an excellent opportunity to develop an integrated simulation program across a broad spectrum of education — from UME through CME. There will be real challenges, but this presents the potential for the School of Medicine to be an important resource for clinicians throughout their careers.

LIBRARY Dr. Iobst and Carien Williams have made a great start in discussions with the Geisinger team towards integrating library functions across Geisinger and the School of Medicine. The health system and the school have agreed upon a set of goals that will ultimately bring all libraries across the system — the medical center’s library in Danville and the many smaller functions at various Geisinger hospitals — under School of Medicine oversight. This will be done in a phased approach and should take about one year to complete. We will conduct a complete inventory of all library functions at all sites. As this transition rolls out, we will convene a user group to represent the needs of a range of constituents, from providers to students to scientists, and we will engage a consultant to advise on how most effectively to serve these needs. At the appropriate time, we will seek to fill our vacant position of a head librarian with

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someone who has experience in both academic and clinical settings. There is strong alignment of goals between Dr. Iobst’s team and the library leadership in Danville, which bodes well for this integration.

SCHOOL OF GRADUATE STUDIES The seventh academic category is the School of Graduate Studies, about to be launched under the direction of Dr. Scott Koerwer. This category actually forms the second of the four “cornerstones.”

THE SECOND CORNERSTONE NEW DEGREE PROGRAMS

The second cornerstone: As is identified thus in our shared vision statement: “We will create new degree programs around areas of research and clinical strengths and innovations, which, in the long run, will expand to comprise multiple colleges within a medical university.”

Under the leadership of Dr. Scott Koerwer we’re starting with a graduate school to administer the growing set of master’s degrees and certificate programs that will be instrumental in moving us, hopefully before long, to university status. We envision building unique and innovative programs around core strengths of the health system. To that end, there are several new programs in various stages of development.

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We are serious about developing master’s degrees in population health, genomics, healthcare informatics, and ultimately other areas as well. Each will build upon existing areas of research and system strength within Geisinger. The master’s in population health underscores the fact that both the school and the health system exist to serve the needs of our communities.

The program’s intent will be to tackle problems that erode the wellbeing of our neighbors — problems ranging from obesity and smoking to the problem of addiction. Our program will be broader in scope than that of a traditional “public health” degree

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We will create new degree programs around areas of research and clinical strengths and innovations, which, in the long run, will expand to comprise multiple colleges within a medical university.”

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because it will cover healthcare administration, public policy and systems, and will incorporate areas of excellence for which Geisinger is nationally known, particularly population genomics and information technology. And it will be informed by the precepts of the quadruple aim — reducing cost, improving the patient experience, improving population health, and improving the resilience of providers.

We also plan two distinct master’s degrees in genomics: an innovative master’s degree in genetic counseling, and a novel degree in genomic informatics, built around Geisinger’s groundbreaking MyCode genomics initiative. The rapid advancement in genomic-sequencing technology will create a demand for scientists with expertise in sequence analysis and interpretation of complex genetic data. This program would appeal to what we believe will be a large number of college graduates seeking a marketable scientific career in genetics.

Another program we anticipate is a master’s in healthcare system informatics. This academic degree will build upon the fellowship program already established and accredited at Geisinger. It, too, would benefit from mutually overlapping elective, or even core, offerings in genomics and population health.

The new degree programs in genomics, informatics and population health will all depend upon an organic relationship

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between Geisinger’s educational and research missions. They are truly interdependent. It is clear that Dr. David Ledbetter, Geisinger’s chief scientific officer, embraces this vision. Moreover, the interfaces between informatics, genomics and population health are exciting. They create distinct opportunities for these Geisinger Commonwealth degrees to distinguish themselves in the market and against other more traditional programs in these fields. Each of these programs has the potential to expand to the doctoral level, and together they will create a platform from which other degrees can be built.

Behavioral health represents yet another area for potential degree program development. The school’s Behavioral Health Initiative currently includes plans for a certificate training program for primary care providers. We see this as just an initial step, with a range of academic programs potentially being developed. There is certainly the potential here for development of master’s and other degrees.

With such growth, it is easy to envision the creation of degree programs in clinical healthcare professions, including emerging new career paths, which over time could justify the creation of additional colleges.

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In addition to the kinds of degrees traditionally associated with a graduate school, we have also engaged in some unorthodox thinking and are considering the concept of a ‘corporate university,’ that would fit within the School of Graduate Studies.

What does this mean? Think about some of the things Geisinger does that are unique to it and that other health systems and even for-profit businesses might envy: the processes it uses to achieve totally integrated care; its creative use of technology; its complete adoption of electronic health records. All of these things are knowledge — and knowledge is content that can be delivered in a classroom and even over the Internet. The possibilities for educational content — and revenue-generating content — in this arena are worth exploring.

Also noteworthy is a new program begun well before integration and now near completion. We are far along in planning for a joint master’s degree in neuroscience that will be delivered in

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partnership with the University of Scranton. This program has been spearheaded by the faculty, particularly Dr. John Arnott, and will enroll its first students this fall. University of Scranton faculty will deliver most of the course content, while the School of Medicine will provide the research and laboratory experience.

THE THIRD CORNERSTONE -

INNOVATIVE, PATIENT-FOCUSED EDUCATION The third cornerstone: We will integrate all of our education programs into an innovative, patient-focused delivery system that will create a leading model for 21st-century medical education and strengthen an academic culture for clinical care.

The third “cornerstone” specifically positions Geisinger to lead the redesign of medical education and patient care by integrating the traditional but separate silos of education and care delivery. It will embrace interprofessional education and work with the clinical system to strengthen a culture of teambased care. This new model will prepare our learners for success in the healthcare system of the 21st century.

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We will integrate all of our education programs into an innovative, patient-focused delivery system that will create a leading model for 21st-century medical education and strengthen an academic culture for clinical care.”

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Coming from UCLA, Dr. Feinberg was accustomed to a health system with a fully mature academic component, so he knows the value of an academic culture. An academic culture is inquisitive and solution-oriented, open to all kinds of people and all sorts of ideas. Such openness invites creativity and brings fresh perspectives to old problems. An academic culture values continuous learning and acquisition of new skills. Above all, an academic culture is one that fosters innovation, and that will transform the approach to both medical education and patient care.

THE FOURTH CORNERSTONE ENGAGING COMMUNITIES

We will engage communities through programs and partnerships that promote population health, including maintenance of the school of medicine’s established educational partnerships with clinical entities and physicians throughout the region.

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We will always be TCMC —

This Community’s Medical College.”

Engaging the community is not something we need to discuss in the future tense — it was a founding principle of our school and 16

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a strength in which we take particular pride. Recall that Fitzhugh Mullen, one of our recent commencement speakers and a thought leader driving the redesign of healthcare in this country, has identified the medical school as a model of post-Flexnerian medical education, by virtue of our curricular innovation and community engagement. Geisinger values and has committed to support our organic connection to the community.

Central to this cornerstone is the retention of our community identity. This includes both our distributed community-based regional campus model and our committed community faculty.

We will always be TCMC — This Community’s Medical College.

The school’s innovative approach to medical education and its person-centered focus continue to be made possible by community faculty commitment. The integration agreement

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explicitly provides that these physicians retain their faculty appointments and that our collaborations with our community hospital partners will be preserved. Since the integration announcement, we have had many individual conversations with physicians and partners throughout our region. We have also held group meetings with clinical faculty at every regional campus. Much to our delight and much to the credit of strong advocacy from key physician leadership, the response from clinical faculty has been, for the most part, positive. We have also heard from physicians who are not thrilled with our new identity.

We must remain sensitive to their concerns, and work with them to maintain and even strengthen our mission to the community and their connection to the college and our students.

And while we still can’t pay our community faculty, we can work to find ways to reward and value them. For example, through Geisinger’s contract with UpToDate, we will be able to provide that resource to our community faculty.

Our commitment to the community is expressed through a range of initiatives — some new and some growing — that manifest our organic connection to the region:

SPRINGBOARD AND INSTITUTE FOR HEALTHY COMMUNITIES Geisinger introduced the Springboard Healthy Scranton

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initiative in December. Dr. Feinberg has described the project as, “a radical approach to transforming the health of an entire community by focusing on preventive care, behavioral health and economic growth.” The goal is to address the social determinants of health, such as health literacy, access to healthy food and transportation to care — that profoundly affect a community’s health, and through the genome initiative to identify opportunities for disease prevention by identifying those with genetic risks. The idea is that the Scranton model — if successful — would be replicated across the country, even in other parts of the world. Springboard’s first two initiatives — the Fresh Food Pharmacy and Precision Medicine through MyCode — are intended to “move the needle” on diabetes, obesity, food insecurity, and chronic disease prevention.

Springboard aligns perfectly with the School of Medicine’s Institute for Healthy Communities. In 2016, we launched the Institute to coordinate and strengthen the many community engagement efforts that the college pursues. These include the many hours of community service provided by students, faculty and staff; the community health research projects; the Behavioral Health Initiative; our pipeline programs; and our many other collaborations with community partners. The Institute will also coordinate the college’s active engagement in Springboard.

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BEHAVIORAL HEALTH INITIATIVE Thanks to BHI’s executive director, Terri Lacey, and a $1.2 million grant from the Moses Taylor Foundation, this initiative has made rapid gains.

The Advisory Committee is now up to 134 members. Terri has reorganized the work groups, which are now: Integration of Care/Certificate Program; Information & Tools; Workforce Development; Autism; and Funding. The critical issues of opioid addiction and suicide prevention are over-arching themes addressed by these multiple work groups.

Dr. Jeffrey Sternlieb, a clinical psychologist in the department of family medicine at Lehigh Valley Health, is leading the effort to design the certificate program and will be its director. The current plan is for a four-month program to be offered twice a year beginning this June, with a combination of live and recorded sessions available online.

A BHI committee is working with a search firm to identify two full-time psychiatrists to support the BHI, medical curriculum and residency program, funded by a generous grant from AllOne. These searches are nearing a successful completion.

REACH-HEI Education is the cornerstone of a healthy community and the vehicle that lifts people out of poverty and leads them to 20

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achieve their full potential. Unfortunately, many of our talented local students aren’t mentored to excel academically. Whether they are held back by poverty or a challenging family life, these students need career exposure, mentoring and a chance to imagine a better future for themselves. When the sheer number of these students is considered alongside of northeastern Pennsylvania’s growing healthcare workforce gap, a program connecting bright students to health-related careers makes sense. That program is the Regional Education Academy for Careers in Health — Higher Education Initiative (REACH-HEI).

REACH-HEI has been a vital expression of community engagement for the medical school virtually since its founding.

Under the leadership of Ida Castro, REACH-HEI has a proven track record of success, with hundreds of its participants having completed their high school and college goals. In 2017, the first cohort of high school students will graduate from universities and some have joined the college family as students in our MD and MBS programs. Ida is now leading a new effort to bring the S TAT E O F T H E C O L L E G E / 2 0 1 7

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program to eighth-grade students at Northeast Intermediate, our next-door-neighbor. Collaboration among the intermediate school, Geisinger Commonwealth and Big Brothers/Big Sisters means that these 37 children from disadvantaged backgrounds now have the opportunity to participate in a “mini medical school.” Though only three months into the program, Ida and Maureen Murtha report enormous enthusiasm from both the middle-school students and our own medical students, and praise from parents and teachers who find the children newly interested in school and in pursuing careers in healthcare.

Recent news reports of REACH-HEI’s success have helped open the door to new funding opportunities, so we expect the program to grow in the coming year.

And, by the way, you may have seen the article a week ago about Ida and her adopted daughter Jolene. It is a heartwarming story. As Ida is proud of Jolene, we are proud of Ida for living the mission of this college, to make the world a better place.

CAMPAIGN FOR SCHOLARSHIPS AND INNOVATION

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The Campaign for Scholarships and Innovation was launched in 2015 with a three-year goal of $15 million. Last spring, our vice president for institutional advancement, Marise Garofalo, announced that her team had surpassed that goal and had raised $15.1 million, a mere seven months after the public launch at the 2015 Gala. Of the $15.1 million raised, 60 percent is designated for annual and endowed scholarships; 23 percent for innovative programming, including the School of Medicine’s Behavioral Health Initiative and our new Preventive Medicine Lecture series; 3 percent for new endowed funds; and 14 percent to be used in areas of greatest need. Community, private and corporate foundations giving represented nearly half of this total, more than $7.4 million. Generous support from hospitals and health systems, physicians’ practices and businesses, as well as individuals, including more than 60 percent of Geisinger Commonwealth’s faculty and staff, accounted for the other half.

Because we have such great momentum in this Campaign, the board voted to increase the goal to $20 million.

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CONCLUSION Everything that we have achieved, and everything we will accomplish, has been the result of the dedicated work of our community faculty, our employed faculty, and the many committed staff whose work is rooted in the academic and administrative support of the college. Their work is vital, evident every day, and very much appreciated by leadership and the students.

Our transition has just begun. It’s really more than a transition, as Dr. Iobst reminds us — it’s a transformation, for the college and for the system. The work can seem overwhelming, but it is exciting. It was my goal today to place all of these moving parts into a cohesive structure, so that members of our School of Medicine community can see how each part fits and how your

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Everything that we have achieved, and everything we will accomplish, has been the result of the dedicated work of our community faculty, our employed faculty, and the many committed staff whose work is rooted in the academic and administrative support of the college.”

daily work serves to move our strategic vision forward. Change can be frightening and it can be difficult, so I want to commend all of you — our staff and faculty — for the fortitude you’ve shown and for your unfailing commitment to our students’ success. You have smoothed the transition for them and for that I am grateful.

Although much work lies ahead, we can undertake it knowing the school is on secure footing — which should give us all the confidence to move forward fearlessly. Great things lie ahead for our students, our school and our community and I look forward to achieving them together.

Thank you.

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COMMUNITY-BASED PATIENT-CENTERED INNOVATIVE EDUCATION 525 Pine Street • Scranton, PA 18509 • geisinger.edu/GCSOM Geisinger Commonwealth School of Medicine is committed to non-discrimination in all employment and educational opportunities.