Change and perspective

The department, the college, and the rest of University of Iowa Health Care have seen extraordinary changes in a relatively short period of time. Whether it was leadership turnover, expansion downtown and into North Liberty, or the squeeze of labor shortages and inflation, it can be dizzying to compare our current moment with how far we have traveled in the last few years. Many of the changes were challenging to absorb and adapt to, not only because of their speed and quantity, but because a lot of them were driven by factors out of our control. Indeed, some of those factors were hot topics of discussions at Academic Internal Medicine Week earlier this week. In talking with our peers from other institutions, we heard that we are all facing the same obstacles. It was gratifying to learn that we have overcome some challenges that others struggle with. In some cases, it was because we were a little more creative and ingenious, but there also are instances where we benefited from factors endemic to Iowa, like our size or the structure of our health system. On the flip side, we also were reminded that in solving some problems, we still have to address others. Our peers’ approaches to them stand as examples of exciting new avenues to explore, experiments to attempt with our own unique adjustments.

What are we doing well that our peers are not? For one, we can document—and reward—faculty effort in education. Time spent, feedback delivered, some institutions are just unable to measure if they are doing well in this area or where they should improve. Good data will always drive better decisions, and I am happy to report that, in this regard, Iowa stands above our peers. Moreover, we are miles ahead when it comes to innovation in our residency program. The establishment and growth in our distinction tracks, particularly those that focus on medical education and peer-to-peer clinical teaching, highlights how important education is to us. We invest in what we value, and this extramural feedback confirms what we already know. What have our peers been focused on that we should start focusing on? Although we are achieving good results in telemedicine, particularly at the VA, there are elements we need to bring “across the street” and expand upon. Other institutions have also achieved success in safely incorporating language learning models and artificial intelligence as assistants in coding and documentation. We are all eager for our institution to move from its assessment phase and into implementation.

Outside perspective is always beneficial. It has almost always been the case that our invitations to serve as guest lecturers to renowned extramural academic physicians and researchers are accepted. There is a mutual benefit when it comes to advancing our shared missions. Whether they are here for a day or more, our faculty and our trainees receive a fresh approach to interesting questions and the guest gets to access to how another institution operates, while also opening the door to new collaboration opportunities. And as we saw at AAIM this week, we learn that faculty at other institutions face the same challenges. But often, there is another benefit: some guests get to renew old ties to Iowa, whether because they were once on faculty or because they trained here. This was the case with last week’s Grand Rounds presenter, Dr. Neeraj Agarwal. It has been more than a couple decades since Dr. Agarwal was a member of our residency program, so it is lovely to hear that the experience he had is still so valuable to him. One aspect in particular that is as true today as it was 20 years ago is our ability to provide trainees with rewarding exposure to research. We may not convert every one of them into physician-scientists, but by providing them with a thorough grounding in the fundamentals, we help more see how they can contribute to future discovery and why it is important.

I think we underestimate our talents for envisioning and enabling a better future in everything we do. We respect tradition and become excellent at the things that need no improvement, but when we see opportunity, our creativity kicks in. We encourage good ideas and we spend a lot of time actively enabling the fostering of new good ideas. Two recent examples spring to mind. Dr. Matt Soltys has more than tripled the number of participants in his just-completed Transition to Residency course for rising internal medicine interns. I encourage you to at least watch the video at the top of that post to get a sense of the project. But then after you have read through the story and seen all the photos, take a look at the list of participating faculty and residents who assisted in the delivery of this course. There are more than three dozen names there. I think that says a lot about what our culture is like here. We pitch in, we collaborate. A similar number of researchers attended the special “data blitz” session of our Research Seminar Series last week as well. Dr. Chad Grueter’s call for brief five-minute presentations from faculty was answered by a half-dozen colleagues. It was clear from the questions and conversations afterward that some new ideas and potential new partnerships were sparked.

Finally, there are few members in our department who more clearly embody the best way to blend tradition and innovation than our Chief Residents. I would like to extend a warm congratulations to Drs. Adam Blaine, Tyler Maggio, Marcus Osman, and Mackenzie Walhof, who will spend the next academic year readying themselves to take on the responsibility in the 2025-26 academic year. Thank you for stepping up!