State
of the
School 2017 – 2018
Steven J. Scheinman, MD President and Dean, Geisinger Commonwealth School of Medicine Executive Vice President and Chief Academic Officer, Geisinger
Table of contents Introduction........................................................................................................................2 A new model of an educational continuum and clinical culture.......................5 Synergy and integration among the clinical, research and educational activities, which reinforce each other................................................9 Defining the ideal experience for our students, patients and the health of the community.........................................................................................12 Conclusion...........................................................................................................................15
State
of the
School 2017 – 2018
Oct. 9, 2017 – Just over nine months ago we changed our name to Geisinger Commonwealth School of Medicine. At the stroke of midnight on Jan. 1, 2017, we officially became part of Geisinger and the process of implementing a full integration began. This is a complex and exciting challenge that will take time to realize fully, but we are in the process of defining and creating the medical and health professions education and the health system of the future.
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Introduction This school was founded with a mission to educate aspiring physicians and scientists to serve society using a community-based, patient-centered, interprofessional and evidence-based model of education that is committed to inclusion, promotes discovery and uses innovative techniques. Since our founding we have lived this mission, which remains unchanged. It fits perfectly within Geisinger’s purpose: Everything we do is about caring. And it exemplifies Geisinger’s values of kindness, excellence, learning and innovation. As you’ve heard me say many times, we remain This Community’s Medical College. Becoming part of Geisinger gives us the tools to deliver on our mission in ways that would not have been possible on our own or with any other partner. Geisinger’s systemwide strengths in medical informatics, genomics and population health are now our strengths. They will inform the development of innovative master’s degrees in our new graduate school, and enrich the continuum of healthcare education from the undergraduate MD curriculum through curricula in our dozens of residency programs and on through our continuing professional development programs and training in other health professions. And the link with academics will strengthen these research programs themselves.
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State of the School • 2017 – 2018
Thus, while our mission remains unchanged, our ability to deliver it is now turbocharged. For example, our community has been eager for us to produce physicians who will return here to practice. Having a medical school helps, but a stronger predictor of where physicians practice is where they train for residency. In that vein, the dean of the medical school is now also chief academic officer at Geisinger. In that capacity I am responsible for all 55 residency and fellowship programs, concentrated in Danville but also spread across a half-dozen other sites, including hospitals in Scranton and Wilkes-Barre. This presents the opportunity to expand residencies, particularly in the northeast. Toward that end, we commissioned a workforce analysis for the region that will help guide us in taking a strategic view of Geisinger’s overall portfolio of graduate medical education, to be led by Michelle Thompson, MD, associate dean for Graduate Medical Education, reporting to Vice Dean Bill Iobst, MD. Our mission hasn’t changed, but our footprint has gotten larger. Integration with Geisinger has brought the opportunity to develop clinical education sites, beginning with the successful launch of the Central Region Campus based in Danville. We are actively developing additional sites in places like Geisinger Holy Spirit in Harrisburg and even AtlantiCare, a member of Geisinger, in Atlantic City, N.J. And this expansion will not be confined to Geisinger sites such as these. We have had exciting discussions with partners such as the leadership of St. Luke’s new facility in East Stroudsburg and with Doylestown Hospital, in a town where we already have a campus at the Pennsylvania Biotechnology Center of Bucks County where we deliver our Masters in Biomedical Sciences (MBS) program. These opportunities together would significantly broaden the diversity of experiences for our students.
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We are excited that our current non-Geisinger partners, including Guthrie, Wayne Memorial, Evangelical Hospital and others continue to be enthusiastic about our students. Guthrie has asked for — and we have agreed to — a long-term contract cementing our relationship. We have had and will continue having a series of highlevel summit discussions with our community partners, and including respected community physicians like Eric Blomain, MD, in leadership positions at the school. Our volunteer faculty, all of whom are either members, fellows or masters of our Academy of Clinical Educators, continue their proud commitment to our students. As an innovative new medical school now linked with an innovative clinical system, we have an extraordinary opportunity to define what a university for the health sciences and an academic health center of the future should — and will — look like. Its basic elements will be those that already exist in our nature and our vision for this integration: • Creating a new model of an educational continuum and clinical culture • Facilitating synergy and integration among the clinical, research and educational activities • Defining the ideal experience for our students, our patients and the health of the community
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A new model of an educational continuum and clinical culture Our mission is to educate the healthcare workforce for the future. We will prepare our graduates not merely to treat illness, but to enable and maintain wellness. To meet this mission, we will embrace a full continuum of educational degree and non-degree programs. To do this, we must reshape the relationships that we form with students, corporations, clinical venues and, once again, the communities we serve. We are now in a great position to restructure how healthcare education occurs, through my responsibilities as chief academic officer for all of Geisinger’s educational programs in medicine, nursing and other professions. We have made significant progress in our first nine months in integrating the essential elements of education across the system: • Library – We are executing a plan to integrate library functions supporting the clinical, research and education missions under a single head medical librarian. The search is underway for an expert in both clinical and academic library functions, who will have the title of associate dean for library services. • CME – We’ve made significant progress in integrating our Continuing Medical Education program with Geisinger’s professional development function.
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• Clinical simulation – We have also begun integration all of Geisinger simulation activities and our Sim Center, with the goal of achieving synergies and strengthening our offerings to serve our learners optimally. Working with the visionary nursing leadership team led by chief nursing officer Sue Robel, we are exploring a range of opportunities for the educational enterprise to expand nurse training. The nursing school at Geisinger Lewistown Hospital has the best track record for board passage of any nursing school in the state. Program director Maryann Brown and our education leadership team are excited to explore several opportunities to address community needs: • Program expansion – Adding undergraduate curriculum content will allow the expansion of the currently small RN program in Lewistown to a bachelor’s (BSN) program. This content would include material such as informatics, genomics and population health that would build upon existing strengths, fit well with our other initiatives and create reputational excellence and appeal for this program. • Multi-campus delivery – Expanding the nursing program from its hub in Lewistown to other sites within the system will offer more opportunities to train Geisinger nurses. • Specialty programming – Developing a psychiatric nurse practitioner program, based in Danville, will fulfill a more specialized need. We are also working with the leadership of Geisinger’s program in women’s health to explore development of a midwifery training program. Among the substantial gaps in the workforce in this region is its diversity. So we are very proud and excited about the Center of Excellence award for $3.4 million we
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received this year, thanks to the stalwart efforts of vice president and chief diversity officer Ida Castro. This highly competitive award will make it possible for us to establish programs to increase the diversity of our medical school class, to create opportunities for diverse and first-generation-to-college students in health professions and to build upon the success of our REACH-HEI pipeline program. As new programs are developed, whether it be through REACH-HEI, the School of Graduate Studies or education entities yet to be conceived, we have set ourselves up to become a university for the health sciences, which means a new way to think about our educational enterprise and ourselves. Imagine for a moment that admission to one of our degree programs is no longer limited to accessing curriculum that leads to a degree. Instead, what if admission to the nursing program was more attuned to beginning the journey across the educational continuum, ultimately to join the healthcare workforce and perhaps be groomed for future leadership roles? The relationship might expand to include employment, student loan forgiveness, ongoing professional education and credentialing in areas such as population health, genomics and informatics, management — and ultimately, leadership development. Now, in place of nursing, re-imagine this scenario with any of the degree programs we offer. This is much more than merely receiving a degree and being sent on your way. This is education, engagement and placement in the healthcare industry — a guided journey across an entire spectrum or, if you will, a continuum. It’s clear: We have the opportunity to create a new educational paradigm. We will transition educational programming from single, linear entry and exit points to a continuum of becoming lifelong ontological learners in the Geisinger education ecosystem. Ontological learners is a sophisticated way of saying that learning means a change in identity, a change in the person and the development of purpose. Our goal is much more ambitious than merely to convey a body of knowledge; we are in the business of professional identity formation. As part of this continuum, we will rethink the concept that alumni are merely stewards of the institutional brand and generous donors. We will view alumni as evolving members of the family who give back — not only financially, but by being mentors, teachers and, ideally, employed members of the continuum.
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In this way, the education continuum is a dramatic departure from the concepts associated with becoming a traditional academic health center. While certainly still impressive, these institutions (academic health centers) are not the model of the future and they are not what we will measure ourselves against. As our planning process continues and we look forward to our accreditation visits from the Liaison Committee on Medical Education (LCME) and the Middle States Commission on Higher Education, we will explore, discuss and define what we believe will be the essential attributes of becoming Geisinger Commonwealth University and what that will mean for our current and future students and their experience. For this to be possible and for our continued success in integrating into Geisinger, we must focus on the interaction of all parts of the enterprise. That’s why, as our integration proceeds, mission also calls us to attend carefully a number of “business-side” initiatives. As members of the Geisinger family, it is incumbent upon all of us to be prudent and careful with our resources. For this reason, we are: • Continuing to close the deficit gap and to create revenue-generating programs • Seeking out opportunities for the school to collaborate with other Geisinger functions • Nurturing external partnerships and alliances with other local and regional institutions of higher education • Committing to operational efficiency as a theme at Geisinger and incorporating it into our selfstudy for maintaining our Middle States and LCME accreditations • Serving as stewards to our communities, students, partners and patients by embodying our signature values Focusing on all parts of the enterprise also leads us to our second element: synergy.
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Synergy and integration among the clinical, research and educational activities, which reinforce each other We were praised by our 2014 commencement speaker, Fitz Mullan, MD, as “the model of the post-Flexnerian medical school” for our focus on active learning, longitudinal curriculum and community engagement. But I have also been candid about my view that, with all of these innovations, there is much more we need to address in medical education. There is a range of topics that we ought to address more substantively in our curriculum; these include medical informatics, genomics, population health, health policy, the cost of care, social determinants, healthcare economics, patient experience, resilience, the humanities, healthcare quality and safety, health systems engineering and leadership training. I challenge anyone to identify anything on this list that will not be necessary for the physician of the future — or any of these that medical schools cover adequately now. Once again, we have the opportunity to create the curriculum of the future, and Dr. Iobst, vice dean, is preparing the faculty and his leadership team for the essential discussions ahead. Dr. Iobst and I also agree that it would be foolish and difficult to attempt to wedge all of these topics within our current curriculum. So our goal will be to take a fresh look, from a blank slate, at how the ideal curriculum should be structured, in which these topics, as well as education in fundamental science and clinical training, will be integrated both horizontally and vertically.
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We will be taking this on in earnest after our LCME visit in February 2019. But between now and then we will be exploring a number of these topics through pilot efforts. Examples include: • The four-year genomics thread being spearheaded by Greg Shanower, PhD, that is underway, beginning with the third-year Clinical Education Days • Embedding a version of the Epic electronic medical record into the Sim Center • A group working on a curriculum on quality and safety, chaired by Peggy Shoemaker, MD, coordinated with Geisinger’s chief quality officer, Neil Martin, MD, and also with the national Patient Safety Movement Foundation • Efforts of a group of faculty and students who are thinking about how the humanities can strengthen our curriculum Geisinger’s chief scientific officer, David Ledbetter, PhD, has built a remarkable research program with nationally recognized strengths in genomics, informatics and, with the health plan, population health. These will bring substantial expertise to our curricula and new programs, which will be shaped around these themes. And the synergies with medical education will also strengthen the research program. Our graduate programming, led by Scott Koerwer, EdD, vice dean for Graduate Studies, will serve as a resource and, in a sense, a backbone in creating curricular themes across our growing set of programs. In addition to the expansion of our MBS program, you have heard me speak proudly of our plans for new master’s degrees. Our goal is to launch master’s degrees in medical informatics and genomics in the next academic year, and subsequently a degree in population health. These will be unique degrees, not reproducing anything now available. Each will build upon existing areas of strength at Geisinger. They will
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not exist in isolation; the curricular content and faculty expertise in these programs will also support new curricular programming for the MD degree, residency programs, continuing medical education and, as mentioned earlier, the other health professions. These new degree programs will not be delivered exclusively in the still-traditional manner — residential, face-to-face, during hours that we set. Instead, our new programmatic offerings will be accessible to traditional and nontraditional students alike, be they full-time students, working professionals or seasoned leaders. Our future programs will: • Be delivered synchronously and asynchronously • Lead to “micro-certification” or to a degree • Leverage technology • Evolve the relationships that we form with students (members of our family in the education continuum) Two essential elements of the educational continuum at Geisinger include the understandings that: • New curricula are developed with all programs in mind, not exclusively any one program. As exemplified by the work of Bruce Levy, MD, in informatics curriculum development, his work will impact UME, GME, new graduate degrees, nursing education and more. • All programming must be focused on creating an ideal experience for the student.
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Defining the ideal experience for our students, patients and the health of the community Upon becoming the CEO of Geisinger, David Feinberg, MD, addressed this fundamental question: Should Geisinger focus on managing illness, like other academic health centers, or should we view our mission more broadly as being responsible for the health of the community? Dr. Feinberg has offered a clear and definitive answer: We are about health. We express this directly through practices that promote the health of our employees: premium reductions for achieving health goals, promotion of smoking cessation and vaccination, and moving toward eliminating unhealthy food choices, like sugared drinks, within our walls. We will also express this through acknowledging, in all curricula, that the social risk factors are stronger determinants of health outcomes than even the quality of healthcare, and that it is the responsibility of health professionals — certainly including doctors — of all of us as educators, and of our students, to promote behaviors and policies that contribute to the health of the community. We have already initiated many strategic initiatives to move this focus forward. We are excited by the progress of the Behavioral Health Initiative (BHI), headed by Terri Lacey, which has marked a number of significant milestones, including receipt of almost $5.5 million in funding from a variety of local foundations and donors. This support demonstrates community recognition of the need for improved behavioral services in our region and faith that BHI was the right vehicle for change.
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Among the BHI’s accomplishments are: • The Wright Center’s new psychiatry residency program, launched in July • The Autism Taskforce’s needs-assessment report, which will also be used to advocate for more autism services at the state level • Progress in recruitment of psychiatrists, supported by the AllOne Foundation • The imminent rollout of our certificate program for primary care We are very proud of the REACH-HEI pipeline program that has changed the lives of more than 700 underprivileged students in this region since its launch in 2010. This past year the program was expanded to the eighth-grade level at Northeast Intermediate School, the middle school next door, providing a “mini medical school” experience to 32 students. This year we have added a ninth-grade program at Scranton High School, and the Latino Medical Student Association will offer an introduction to life sciences and mentoring to 20 seventh-graders at Northeast Intermediate. The new Center of Excellence grant will allow us to build upon this progress. Ida Castro, vice president and chief diversity officer; Marise Garofalo, vice president for Institutional Advancement; and others continue to seek funding to support and maintain this progress. In that vein, allow me to offer an update on our highly successful Campaign for Scholarships and Innovation. The campaign continues through November of 2018 and is currently at $23 million, well beyond the original goal of $15 million announced in 2015. Almost half of the $23 million raised to date is designated for student scholarships — this is vital to our mission of recruiting local students and underrepresented minority students. But this is not enough. This year’s graduating class set a new record for debt: $243,000 per graduate.
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We simply must raise more scholarship money to support our students, so many of whom are from families of modest means. This year we secured the largest personal donation in the school’s history from a Scranton native, Jerry Halpin, who grew up on Pine Street. His $5 million estate gift will support the costs of renovating the Manual Arts Building and connecting it with a bridge. And on Oct. 21, we honored Susan Sordoni, MD, and Volunteers in Medicine; Lou DeNaples Jr., MD; and Bob Naismith, PhD, at the 2017 gala. The alumni recruiting committee, under the leadership of Mike Ferraro, MD, continues its important work of fulfilling our implicit promise to the community by recruiting Geisinger Commonwealth alumni to come home to the region and care for our neighbors. And we aspire to do more than merely teach about the social determinants of health. We continue to expand our engagement with the community through the programs I’ve just noted, the many other elements of our engagement with this community, and through our support of Geisinger’s Springboard Healthy Scranton initiative that will bring attention to the social risk factors of health, including food adequacy and education.
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Conclusion We have a golden — perhaps unprecedented — opportunity to create the medical education of the future. Our financial and human resources functions are coming into alignment through our planning processes, and I have great expectations for all that is ahead. The achievements I’ve just listed, and the many more that time prevented me from discussing, are not small things. The pace of our progress has been head-spinning. Every function at our school has had to evolve the way it works. There is not one faculty or staff member who has not had to work harder and cope with some uncertainty. I am grateful to all, especially to Ann Noon, chief financial officer, and her teams for leading the integration work to date. The fact that we continue to pull together to complete such consequential work — in just nine months — speaks volumes about the caliber of the Geisinger Commonwealth family. That’s why, as I review all that has transpired, I do so with pride and gratitude to all who’ve made it possible. To all of the faculty and staff I say, sincerely: Thank you.
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The course I’ve laid out for our future is challenging. It should stir your entrepreneurial spirits. It stirs mine. We are forging something new by merging community-based learning with a health system, leading the change in the way we care for people — focusing on one student and one patient at a time, while also caring for entire populations in ways that make wellness central to healthcare, to education and to how we prepare the healthcare workforce of the future. It’s a great honor to play a role in leading this change. It is my sincere pleasure to be a part of the team — the Geisinger Commonwealth team.
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570-504-7000 geisinger.edu/gcsom
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