State of the Department, 2020

The following is an abridged and edited transcript of last week’s State of the Department address. To view the entire presentation, click here (hawkid login required).

Good afternoon, everyone. It’s a real pleasure and honor to be delivering the State of the Department address. I look forward to this every year. This has been a year like no other. And I think that in many ways the department has thrived. What you see on the bottom right on the screen is a theme I will show a couple of times in my talk. I will be interested to see if anybody ultimately figures out what that means.

The department of medicine, as you know, it’s not necessarily a structure or a bureaucratic entity. It’s really people who are united in a mission that revolves around our core activities of education, patient care, and research. And this doesn’t occur in a vacuum. It occurs in the context of a broad strategy that the department has pursued over the years that ultimately leads to growth, results which we celebrate, and evidence of innovation. And I hope during the course of my presentation today to underscore many of those areas of success. This is the outline of my talk, covering a broad swath of activities. This is a year like no other. And it’d be very hard to start this talk without really stating that this year has largely been defined by the COVID-19 pandemic.

But, you know, very early on during the pandemic, I am very proud of our department in the way that it pivoted to address the growing pandemic.

There was the creation of the Influenza-Like Illness clinic very early on to begin screening of individuals with symptoms. We really led in the way that we treated patients in our ICUs under the leadership of Greg Schmidt and Kevin Doerschug as shown here. And we also innovated in the establishment of the Home Treatment Team. I put on the right hand side of this slide, really, some amazing statistics that have come about as a result of us being in the vanguard of managing patients at home. And we show you a couple of bits of data here to show that we managed a significant number of patients on the Home Health Team, nearing 900, around the time that this slide was drawn. And this is now dated I’m sure; we’re probably closer to a thousand. We really were able to manage the majority of these patients at home to minimize their admission to the hospital.

Note the low rate of admission to the ICU and very high survival of individuals who participated in the home care program. And really, I just want to give a shout out to everybody on the team who really stepped up and innovated during this very challenging time to provide the best care for all the patients who came to us to seek care. COVID had a significant impact on UIHC. There was a dramatic fall off in our hospital census in April and May as the health system, really sort of cleared out in order to be prepared to manage what we thought could happen. But nevertheless, despite that downturn, the department really rebounded quite spectacularly.

I’m showing on this graph the first quarter of fiscal 2020. So that is July, August, September of 2019 compared to the same period in 2020. You can see very clearly that there was a significant recovery of our clinical activity starting very much in July and continuing even to the present time, despite the fact that we’re now facing a bigger surge of COVID cases. Also, throughout the pandemic, it became very clear that many of our faculty in the department at the University of Iowa really became nationally prominent spokespeople in terms of a trusted source of information about the pandemic, about prevention, about treatment, and really advocating with our leaders in the state and nationally to promote the best practices to prevent the spread of this disease.

I’d also say that, there’s a part of you as a leader that never wants your headline on the front page of the Washington Post or the New York Times. We have been in the news quite a bit recently as it relates to the coronavirus pandemic, but really what you see when you read those articles is that you see leadership, you see competence, you see, a sense of being in charge as opposed to a sense of chaos, in terms of how we have managed to deal with the pandemic here at the University of Iowa and particularly in our department. I would also say that the pandemic has brought out a side of us, which I’m going to call a care for humanity and a care for those who are underserved.

This picture here of Rolando, reminds me of the fact that there is a significant population of patients from the Hispanic community who were diagnosed with COVID, who came to our ICU and the team in the ICU under their leadership really stepped up and provided service and support to these individuals and to their families, way beyond the call of duty. And for this, I am proud. The entire department is also proud and very grateful. And then, moving forward, we have now established clinical services to manage the post COVID care of patients. In the current surge, we have doubled our ICU capacity, reassigned staff, and we have continued to provide top flight care for all the patients who come to see us. I do want to give a shout out to all of the faculty, to the faculty in the Pulmonary division, to the faculty in the Hospitalist Program, and also to our house staff and fellows who have really stepped up and gone beyond the call of duty to take on extra shifts, to give up time off, time away from their families, to ensure that all of our patients are being managed in the best possible way.

The other thing which happened this year, which I do want to talk about again, was the issue of racial justice that really came to light with the murder of Mr. George Floyd in Minneapolis. And that really galvanized us as a community to examine what our core values are in the areas of diversity, equity, and inclusion to really ensure that we, as a community, hold close to the core value that we’re all created equal and that every individual person should be treated with respect. That said, it is very easy to lose sight that this is really work, which has to be ongoing. And that, although we are clearly at this point in time focused very heavily on the COVID pandemic, that this work doesn’t stop. And in fact, it really has allowed me and others to really do some self-reflection about how are we doing in the area of diversity.

What I’m showing you here are some data looking at the number of patients that we have seen here at UIHC, and what percentage of them are underrepresented minority, you can see that is about 10% and then contrast that to the total faculty at the University of Iowa and the total staff at the University of Iowa. And then I said, okay, what about our College of Medicine? And you can see that the faculty who are underrepresented minorities as defined by the the United States government is about 7.4% in the entire College of Medicine. Then what about our department? You can see that our residents and fellows in terms of their demographics mirror, to a certain extent, what we see in the community. And I’m not saying that should be the goal to its end. I think we should do better, but I want to point out the fact that as a faculty, we have quite a ways to go yet, and this really needs to be an ongoing imperative for us as a department, and we need to own it, and we need to speak openly about it and really focus on how we can advance this.

What this slide is showing is the breakdown of diversity by rank within our faculty. And you can see that really the data are cut in two ways. In green are underrepresented minorities as defined by the U.S. federal government, specifically black, Hispanic, Pacific Islander, or Native American, and the orange color are any person of color. So you can see that at the early ranks, we are clearly having success in increasing the diversity of our faculty. As you go across to the more senior ranks, it is very apparent that there still remains work to do.

But, some of the things that we have already begun to do to advance our commitment in the area of diversity, equity, and inclusion have been spearheaded by our vice chairs shown here, Nicole, Vice Chair for Diversity, Christie, Vice Chair for Faculty Affairs, Isabella, Vice Chair for Research, and Kim, Vice Chair for Clinical Affairs. We have initiated listening sessions. We rolled out implicit bias training across the entire department. We are looking very closely at how we conduct our evaluation of all faculty going through both for recruitment as well as the promotion and tenure process, and also restarted a very active Women in Medicine meeting series. And I know that they have met probably two or three times in the last three months, which have been very well attended and covered a variety of topics. And I know that the feedback that I’ve received has been incredibly positive. I’m also very proud of the work that has been done to bring topics to Grand Rounds that do address issues of diversity, equity, inclusion, and racial justice. And this is something that we are committed to continuing to doing as a department.

So let me move now to research, and this has been a really wonderful and very successful year in our research mission. I show you here data on the number of grant submissions in fiscal 2018 and ’19. And you can see in fiscal ’20 that there are still a number of grants still in the review process. So once these come in, you can see that we’ve had a significant increase in the number of grants that we have submitted, where this number will, in fact, if you sum these two, will be about 655 submissions, yielding more awards, in terms of success rates, particularly at the NIH.

This graph shows our total research funding broken out by federal or non-federal across these fiscal years. And again, the bottom line message here is that we certainly have seen a significant growth in total extramural funding. I will speak a little bit more about about NIH funding in a subsequent slide because the federal fiscal year is different from the university fiscal year, as this number lags a little bit, the federal fiscal year.

This is what I’m going to call the NIH rankings arms race. Blue Ridge is a group that puts out every year, a summary of NIH funding across the country, and then it ranks them. And if you start at the top at fiscal year ’15 and let’s go to the rank column, you can see that in fiscal year ’15, the department brought in $29.5 million in NIH funding. And that allowed us to be at a rank of 33. There was some slippage in the subsequent year in fiscal ’16, and then we really began to turn things around. And you can see that by the end of federal fiscal year ’20 we will have brought in an excess of $40.5 million in NIH funding to the department, which really represents a significant growth from fiscal ’15. The somewhat challenging part of these data is that it really, you know, the rankings are to a large extent, determined by how our other peer institutions are doing.

So, whereas, five years ago, $29 or $30 million could put us comfortably at rank 33, $40 million is still putting us not so comfortably at [a projected] 34. And the implication of this is that for us to continue to rise in our NIH funding, we really will require a significant investment from the institution to continue to grow our tenure track faculty group, to increase our ability to continue to expand our funded NIH portfolio. But I think this graph again should give us a lot to celebrate in terms of the way as a department, we have steadily year over year for the most part, continued to increase our ability to attract NIH funding to the department, which as you would know, is the largest contributor of NIH dollars to the College of Medicine.

Our faculty have also excelled in scholarship in terms of their publications. We have been publishing all over the place in some excellent journals. And if one actually looks at it, for example, by impact factor, the impact factor, being a rough measure of the citation impact of the work published in a given journal, that the higher, the impact factor, then the more widely cited that work potentially can be. And you can see that within the over 15, impact factor 15, range, nearly 40% of our publications are really in journals of the highest degree level of impact factor. So again, I want to congratulate the faculty for their tremendous scholarship.

In terms of our research goals, we want to continue to grow our tenure track. We want to be able to recruit individuals of really two broad phenotypes; one, individuals with existing research programs that we can attract here to Iowa, and secondly, those individuals with high potential who we should be identifying and bringing to Iowa or from our own ranks, who with appropriate levels of support can be leveraged to ongoing success. We want to ensure that we mentor our current trainees towards career development awards. We also want to maintain our strong focus on training future physicians scientists, both through our physician scientist training pathway, and also through a new program that we just received NIH funding for. I want to give a shout out to David Stoltz and Manish Suneja who successfully competed for an R38 grant from the NIH, which basically will allow us to offer to our categorical residents, not those in the physician scientist training program, but our categorical residents, the opportunity to actually take a year off from their training to be fully supported with a stipend to conduct research.

More to follow as that funding occurs and as this program is rolled out, but I think it’s a tremendous honor and prestige for us as a department to have received one of these very competitive awards. We also want to ensure that we continue to grow clinical research. Very interestingly, when I surveyed all the faculty in January this year about research, I actually got more feedback from the clinical track faculty stating, among other things, that they also wanted to be much more involved in research, particularly in clinical research and that, as a department, we should focus resources to increase the capacity and reduce the barriers to growth in clinical research programs. And that is something that we are committed to and will be focusing on in the current year.

We are very good as faculty in the department in putting in individual investigator initiated research grants, for example, R01 grants. Where we have not been as strong, especially recently, and this is where our peer groups who are rising in the rankings have really done a good job, is getting team science grants put together, which bring significantly more NIH funding. And so I think that the NIH has made it very clear that they are really focused on supporting large grants focusing on big data to answer big questions. And this is something that I would like for us as a department to begin to focus on, and how we can develop the ability to compete for some of these awards. I recognize that there is aging infrastructure and limitations in space that could hinder the growth in our research mission, which I can tell you from the institutional standpoint that they also recognize this. And I believe that part of their current space, strategic planning will include authorization to identify and erect another research building. Ultimately, I think it’s important to state that any vision to significantly increase our department’s NIH rankings will require significant levels of investment by the institution, but also I would hope, and I’m quite confident that will be the case, a significant commitment by all of the members of the faculty to continue to compete vigorously for funding opportunities as they arise.

Education is the other significant mission of our department and again is an area where we excel. I want to call out the leadership of our education teams as shown here under the expert and passionate guidance of Manish Suneja, our Vice Chair for Education, who has again gone beyond the call of duty, particularly during this COVID challenging year, but really to identify the team that coordinates both undergraduate education and the team that coordinates graduate medical education.

What I should also say is that we have been very proud of the fact that the medical students, when they complete their graduate questionnaires, our scores for the internal medicine clerkship experiences are in the top 10% nationally, again, speaking to the quality of the education team that are supervising them, and we will continue to improve what we do. I don’t think we are exactly where we should be, particularly in terms of ensuring that we focus on the clinical skills of all the medical students that come through our rotation. And I think that we’ll see continued focus and rigor in that area.

And of course we have an award winning residency program, and this picture shows the individuals who lead and oversee this, this group are in the middle of recruiting right now. And so I know all of the tremendous work and effort that you’re putting into this. I want to give a special shout out to the chief residents pictured here who really have been a strong glue to support all of our house staff and trainees during what has been an incredibly challenging year because of the COVID-19 pandemic. We really intend to continue to maintain our national reputation for excellence. Dr. Suneja tells me that the percentage of applicants with AOAs interviewing for our residency is greater than at any time in the past. We will continue to focus on ensuring that we recruit a diverse class of residents and fellows, and the reason for that really is that we view all of our trainees as the critical pipeline to our future.

We have a wonderful group of interns that joined us in the summer of last year. And this is again, really a highly accomplished group of individuals. Many of you have met and had a chance to round with them on the wards. We are very proud of our ability to recruit some of the finest medical students from across the country. This increasingly cluttered slide shows the breadth of the institutions across the country, and in fact the world, from which we are now recruiting the members of our house staff program.

Now, the other part of our training of course, is number one, where our residents go after they complete their training. And you can see that we also send our trainees across the country to complete subspecialty training. And since 2017, a hundred percent of our trainees who desire fellowship training have gone on to fellowship training. Just off the press, because we had the match a week and a half ago, 100% of our residents entering the match this year are headed to fellowship, but more impressively is that 50% of our residents are staying at Iowa, a strong testament to the quality of our training and education here. We did pretty well in terms of our own internal fellowship programs in terms of slots filled, except for one in particular, which is really a symptom of a national trend in that sub-specialty, but I think we are going to be working on ways to enhance the competitiveness of that program in a very challenging recruiting environment.

I want to give a shout-out to all of our residents who are going onto subspecialty fellowships. I think that our senior residents have done very well this year in the match. And we’re very, very proud of your achievements. And for those of you who are leaving Iowa, we wish you well, we have your number, we’re going to try and recruit you back after you get trained.

A couple of other points I wanted to just highlight in terms of innovations, is that, you know, when we accept trainees into our family here in the department of medicine, we don’t make the assumption that everybody is coming in with identical levels of skills. So one of the innovations that the team has put forward is to early in the academic year to do an objective structured clinical exam sessions with all of our incoming trainees to ensure that we identify areas of potential growth and opportunity and ensure that everyone is more or less level set in terms of their expectations. The pandemic this year got more challenging, but that didn’t stop us. We basically pivoted to hybrid in-person and virtual events that ultimately achieve the same goals.

The other challenge, of course, as you know, is recruiting in the COVID era. There were times when we would go out to restaurants and eat with recruits. And now we are doing it all virtually. Thus far, I would say that from the fellowship recruiting experience, I would say that went well. We are very optimistic that will also go well with regards to our recruitment of residents. But if you go on YouTube, we have our own YouTube channel now. Please follow us. We have a lot of video material.

And this is just a snapshot of some of the different stories that we have now put out on YouTube, really speaking to many of the unique aspects of life in Iowa and life in our program. And again, a shout out to some of our trainees who have produced some beautiful pieces on, for example, a day in the life of a resident or day in the life of an intern. And again, I really encourage all of you to go and take a look at these, which, I think, have been very effective in getting the word out in terms of the unique aspects of the quality of our programs.

The department really are our people, and this slide just reminds you that we are a large department with significant numbers of faculty and significant numbers of trainees and is continuing to grow. I feel very fortunate to be surrounded by an amazing leadership team. Honestly, I think much of the success of our department really speaks to the tremendous work and effort that our vice chairs have committed to ensuring that the department remains strong and vibrant. We also have very devoted division directors also, who within their respective divisions, as well as in the department writ large, have very effectively been executing their roles, and contributing to the overall success of the department.

We also have a very strong and robust relationship with our colleagues at the VA. A quick word about the VA is that the VA is a critical part of our department. They support 113 physicians in nine sections, provide significant salary support across both the clinical and research and administrative missions. They support 31 physician scientists or other investigators, with $13.7 million in VA-funded research and also support significant parts of the costs and expenses of our fellows. And there are other programs, such as the Quality Scholar program, which has been a very wonderful feeder for junior faculty across multiple divisions.

We have had a lot to celebrate in our department this year, across our missions. And this slide shows significant recognition that our clinical faculty received this year in the clinical excellence awards. You can see that half of all the awardees as shown here are members of the Department of Medicine: Brad Manning, Greg Schmidt, Dr. Johlin, and of course our fearless hospital epidemiologist, Dr. Salinas, as well. This is really a testament to the significant impact that our department has had broadly, and the recognition that we are receiving from the university.

We have had a lot of news in the area of leadership. I’m not going to read every one of these pictures, but just pause it here for a second, so you can scan this slide to really underscore that as a department, we have provided leadership at the level of the college, leadership at the level of the state, and also leadership in national organizations as well.

We’ve had too numerous achievements in research to count, and again, I’m not going to go through each one of these cartoons. This is actually all on our department’s website and our department’s blog, but suffice it to say, that we have had tremendous success in achieving grants across the entire spectrum from career development awards, pre-doctoral and postdoctoral fellowships, program projects, et cetera. And again, we, as a department are very proud of all of the faculty who have successfully competed for extramural funding.

And again, we lead in excellence in patient care. I won’t go through all of these images, but really just to highlight for all of you that we again have really significantly advanced the clinical mission of UIHC, and want to call out everybody, and others not necessarily shown here, who have received either recognitions or awards or for meeting very important milestones clinically in your respective services.

And then our education story is also a very strong and inspiring one. And again, tremendous examples of excellence in terms of scholarship, in terms of national recognition, in terms of institutional recognition for work and very strong commitment to the critical mission of education within our discipline.

The department is always being renewed by the growth of new faculty. We are very pleased that you have chosen to be recruited to the University of Iowa, and really wish you every success in your endeavors during your time here with us. The majority of the growth has historically been in the clinical track, with some recruitment in the tenure track as well, and some recruitment as well in the research track. Or simply coming to work every to put your all in delivering compassionate care to the many patients who turn to us for care, often in times of greatest need.

I do want to talk a little bit about gender diversity in our department. Again, this is another important area that I want to put this data in front of you to really show you that we have made some progress, but there’s still a far way to go. And you can see clearly as we go up the rank from associate or instructor to full professor, the percentage of women at the highest ranks in our department, still significantly lags the percentage of men in those ranks. And this really represents something that we need to continue to focus on moving towards change. A couple of notable zeros here in the chief and the chair section. So, you know, perhaps one can, you know, do some work on this and, and whoever replaces me whenever that happens, maybe it should be a woman. And we also need to focus our efforts on increasing the gender diversity amongst our division chiefs. With that said, we certainly have many women in senior leadership roles elsewhere within the department, but again, there’s still work to be done.

I want to give a brief shout out to our colleagues in the foundation who really support our philanthropic work. And this slide summarizes the total philanthropy that the department received this year, the total philanthropy was just north of $6 million. So again, I want to thank our colleagues in the foundation and really to everybody who has worked with them to highlight the wonderful work that we’re doing here in our department and to provide a means for those individuals who want to give back financially to support our multiple missions.

Given the size of our department, I’ve really focused a lot on our ability to communicate not only internally, but externally, and what I can say I’m very proud of is that our department, within the college, and I would say nationally as well, has really taken a lead in multiple ways to get the word out both internally and externally about who we are, and what we are doing within our department. We have on the web a number of avenues that you all see. Views is my blog I write every couple of weeks. Making the Rounds, which we put together on the alternating weeks, department, spotlights, articles, et cetera. We’re pretty active on social media. I didn’t have a Twitter account until a year and a half ago, but I’m now, you know, firmly on there with I guess the last time I checked about 1300 followers. Our department’s Twitter account has about nearly 2000 followers. The Chief Residents have a Twitter account with about 500 followers. And I will just share with you, I think my favorite Twitter handle is @jazzscrubs. That is one of our Chief Residents. I won’t tell you who that is, but if you want to type it in the chat box, who you think @jazzscrubs is, you can let me know. But we certainly are getting the word out on social media about what we’re doing.

And also, I would just want to highlight the fact that, as I said earlier, you know, we have a YouTube channel and I give a shout out to Trevor and the audio-visual team for really putting together high-quality video work that we have really leveraged to get the word out about what we’re doing within our department. So we have multiple channels now, with one clear message that our department is strong. It’s growing, it’s vibrant, and I believe that this approach has really contributed to our ability to remain very competitive both in recruiting trainees, as well as new faculty members in our department.

We don’t live in a silo. And so it’s important for me to underscore and to highlight our community outreach work, which is also summarized here in this slide. This year, our focus was on shoes, and you can see the statistics over on the right, in terms of how many pairs of shoes you in the department donated to individuals in the community in need.

So I want to just end by acknowledging some individuals. First of all, I want to acknowledge you as members of the department. It takes a village to run a department that is successful by many measures, especially in and under some of the most trying circumstances that we have seen certainly as a community and a country over the course of this year.

I want to thank the executive leaders of the enterprise. The Dean, the CEO, Dr. Winokur, the Executive Dean, other senior leaders within the enterprise that I work with very closely to ensure that we have a place for our needs and aspirations to be heard so that we can work together to achieve our goals. I also want to give a shout-out to the administrative staff within our department. I do want to underscore each and mention all of the division administrators, who behind the scenes are quietly supporting part of the work that goes on to support many aspects of our department’s mission. I want to welcome Mazin Abu-Ghazalah who joined as the new administrator in GI. I also want to thank Denise Zang. Denise is our new departmental administrator, who will soon be with us nearly a year by the end of next January, and has really made a significant mark and impact on our department during her tenure here and really has been a very positive addition to our family. So Denise, thank you very much. And again, this is not a belated welcome, but really just a belated Thank You.

Now, all the slides I showed you, you know, I didn’t sort of stay up late last night putting this stuff together, but I do want to acknowledge Trevor Jackson and Ann Armstrong for their expert help in getting together a lot of the material that has formed a part of this presentation. Everybody knows Trevor now. And so if they see Trevor, they come running because he has a camera and you probably get posted somewhere. And so I think that we really created a culture that we really want to celebrate everybody’s success. And I want to thank the group for fostering that.

So we look forward, hopefully to a better year next year. And again, I remind everybody to sign up, to take the vaccine. The core of who we are, is a department that wants to build a strong community with the best people that we can attract to be a part of our department to focus and commit ourselves to the highest level of rigor and integrity in what we do. And I think what this year has taught us is that it’s so critical that we become nimble and able to adapt to rapidly changing circumstances. And as we do that, I think that hopefully our DNA will be one that will be characterized by intense and ongoing innovation. So I want to close by thanking all of you for really the tremendous pleasure and honor it is to serve as your chair and to be able to give this talk each year. And in closing, I would say that the state of our department remains very strong. Thank you very much.

About E. Dale Abel, MD, PhD

E. Dale Abel, MD PhD Francois M. Abboud Chair in Internal Medicine John B. Stokes III Chair in Diabetes Research Chair, Department of Internal Medicine Director, Fraternal Order of Eagles Diabetes Research Center Director, Division of Endocrinology and Metabolism Professor of Medicine, Biochemistry and Biomedical Engineering

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