June 2008

Message from Dean Richardson: What a year!

One year ago in June of 2007, it was my honor to accept the appointment of Dean of the OHSU School of Medicine. Looking back, when I try to summarize my first twelve months, what comes to mind first is, “What a year!”

Almost immediately, we began to take on challenging strategic tasks while facing some hard financial truths. All of our efforts were multiplied and magnified by the Oregon Supreme Court decision on the state’s tort cap in late December.

Since then, some of you have asked me a similar question in a variety of different ways – something along the lines of, “had it been possible then to predict the future, had I known about the challenges OHSU would face and the ramifications of the tort cap decision, would I still have accepted the position?"

My answer is always the same: Yes. Unequivocally, YES. I am energized and proud to be part of this remarkable process of change. I believe we are moving in a direction that, soon, will cause the national community of academic medicine to wonder: How did OHSU and the School of Medicine do it? How did this academic health center transform itself into such a vibrant and successful national model of collaboration, partnership and financial sustainability?

The reasons are right in front of us. What we have accomplished in just the last year together as we move our institution in a new direction is impressive.

Across the country, academic health centers are facing similar challenges -- shifts and declines in external funding sources, a highly competitive and litigious health care marketplace, increased competition for philanthropic support, a disproportionate responsibility for un- or under-compensated health care and a need for tort reform.

We know the challenges we face are not unique. But the way we are addressing them is; we are leading the way in how these challenges are being met, tamed, and turned into opportunities. We are also showing our openness to the difficult conversations that precede any transformation.

Already, we have made progress in recognizing and implementing the business and organizational structures and practices needed to operate more efficiently. We are finding ways to gain efficiencies that will free-up money to be reinvested in our mission areas.

We have undertaken major restructuring initiatives, such as transitioning the School of Science & Engineering into the Department of Science & Engineering. This endowed department brings the energy and unique vision of 40 faculty members and 200 students, along with new opportunities for collaborative research. It also immediately saves $1 million, with additional savings accruing over time. The transition process was challenging for everyone involved but I am hopeful there is now a sense that the best outcome was realized.

We have made significant progress on the Vision 2020 goal of clinical integration of the OHSU Medical Group and the School of Medicine. As reported below in a separate article, the OHSUMG Board of Directors voted on June 10 to approve the concept of clinical integration and to move forward with the development of a final Integration Plan. Integration will strengthen our compliance and legal position relative to federal laws and the tort cap decision. Equally important, integration will foster new collaborations and enhance strategic decision-making across mission areas.

We are making plans to expand Graduate Medical Education to regional hospitals, have established the Education Leadership Initiative, are working to more effectively support efficiency in the management of basic science awards, have increased our support for strategic diversity initiatives, and have implemented department-level business plans.

And now, we are in the initial planning stages of a new fund-raising campaign designed specifically to support faculty retention and recruitment through more endowed professorships and programs. This is an important undertaking.

Like you, I am, of course, pained by other changes, such as increases in tuition and the decrease in the medical school class size. But even these steps are necessary for us to remain the top tier institution that we are now, and to lay the foundation for exceeding that in coming years.

Change is not easy, and our need for new funding sources is real, but as we begin to deal with and solve the “big” issues currently facing us, as we have over this past year, we will be able to create and sustain the School of Medicine we all envision.

Best regards,

Mark Richardson
Dean

Update: Integration of OHSUMG and the School of Medicine

On June 10, the OHSU Medical Group Board approved a Resolution titled "Integration of the OHSU Medical Group with and into the OHSU School of Medicine." Approval of this Resolution means that the OHSUMG Board approves the concept of integration and authorizes the continued negotiation and discussion by officers of OHSUMG and the School of Medicine for the purpose of developing a final Integration Plan. These discussions are to be framed by the elements defined in the current proposed Plan.

Subsequently, on June 24, the OHSU Board of Directors also voted to approve integration and authorized OHSU managers to continue negotiations with the aim of finalizing an Integration Plan.

The current Plan calls for establishing a Faculty Practice Plan (FPP) in the School of Medicine. The FPP will be an identifiable operating unit within the School of Medicine, governed by a formal Charter, which will become part of the School's constitution. The Charter will establish the Dean of the School of Medicine as the head of the FPP; establish two governing bodies: a Board of Directors and a Management Committee; and establish the position of Associate Dean for Clinical Practice as the CEO of the FPP, reporting to the Dean of the School of Medicine. The FPP is expected to begin operations on January 1, 2009. After a transition period, OHSUMG will be dissolved.

The final Integration Plan is to be voted on again by the OHSUMG Board on September 15, 2008. If the final Plan is approved by the Board in September, the full membership of OHSUMG will vote. This is a change from the timing of the member vote announced previously. This change is an improvement because the full details of the Plan will be available for clinical faculty when they are asked to vote.

The OHSUMG Resolution and the current proposed Plan (Exhibit A) are posted on the School Ozone site: click here. Please send your questions and comments to: integr8@ohsu.edu.

Search Committee formed for Associate Dean for Basic Science

The Search Committee for the recruitment of the School of Medicine Associate Dean for Basic Science has been finalized. Additional information will soon be sent to all School of Medicine faculty describing the position, qualifications, application instructions and deadline. The Committee members are:

Jan Christian, PhD, Professor, Cell & Developmental Biology

John Crabbe, PhD, Professor, Behavioral Neuroscience

David Ellison, MD, Professor, Medicine - Nephrology & Hypertension, Physiology & Pharmacology

Dennis Koop, PhD, Professor, Physiology & Pharmacology

Scott Landfear, PhD, Professor, Molecular Microbiology & Immunology

Deborah Lewinsohn, MD, Associate Professor, Pediatrics, Molecular Microbiology & Immunology

Ashleigh Miller, Graduate Student

Linda Musil, PhD, Associate Professor, Biochemistry & Molecular Biology, Cell & Developmental Biology

Susan Olson, PhD, Professor, Molecular & Medical Genetics

Misha Pavel, PhD, Professor, Department of Science & Engineering

Guy Super, Department Administrator, Biochemistry & Molecular Biology

Grad student Larry Gray to serve on OHSU Board of Directors

Larry Gray – a third-year student in the School of Medicine Graduate Studies program – is the new student representative to the OHSU Board of Directors. Recommended by President Joe Robertson, Larry’s appointment was forwarded to Governor Ted Kulongoski and approved by the Oregon Senate on June 24. Larry's appointment will become effective with the OHSU Board’s October 2008 meeting.

Larry says he will rely on his background as a researcher to help fulfill this leadership role. “Science teaches you to develop an answerable question, and then use that question to propose one or more solutions,” said Gray. “I’d like to use the tools that assist my scientific analyses to address some of the complex issues the Board faces, and create effective data-driven advocacy for students at OHSU.”

Larry grew up in Jonesboro, Louisiana. At 18, he became involved in the installation of worldwide telecommunication networks. The job involved frequent trips to Sri Lanka, Europe, South America, the Caribbean and Africa. During this period, Larry began to understand and embrace underlying principles of diversity that have transitioned with him into his research career. “Living in the U.S. while working with people in developing nations gave me a first-hand understanding of the commonalities that exist even in such radically different environments. Driven by our individual experiences, we each had our own method of working on a task, but together we arrived at the same outcome. Working with different people on a project can broaden the scope of how one goes about things.”

Larry received his Bachelor of Science degree from California State University and conducted post-graduate work there and in Australia before joining the OHSU Graduate Studies program in the lab of Svetlana Lutsenko, PhD, Associate Professor, Department of Biochemistry and Molecular Biology. His research focuses on the role of copper and metalloproteins in the body.

“We are fortunate to have someone like Larry to fill the important role of student representative on the OHSU Board of Directors,” said Mark Richardson, School of Medicine Dean. “His input will be invaluable. His diverse educational background, commitment to OHSU and basic science training make him an outstanding contributor to our community on all fronts."

Allison Fryer, PhD, interim Associate Dean for Graduate Studies, said: “Larry is an individual who, through his scientific discoveries, his recruitment of talented students to OHSU, and his extensive work as a volunteer in the community, seeks to improve the lives of those around him.”

Markus Grompe appointed to Endowed Chair at new Pediatric Research Institute

Markus Grompe, MD, Professor of Pediatrics and Molecular and Medical Genetics, has been named the first Ray Hickey Chair of Pediatric Research and the inaugural director of the Papé Family Pediatric Research Institute. With his appointment, all the elements are in place for OHSU to launch a state-of-the-art regional center dedicated exclusively to pediatric disease research - a vision first championed a decade ago by Peter Kohler, MD, during his presidency of OHSU.

The facility itself - made possible by support from Shirley Papé, RD, and members of her family - became a reality two years ago with the completion of the Biomedical Research Building. With the laboratory built, OHSU officials began an extended search for the right person to shape its research agenda. Two events helped bring that complex process to a close: philanthropist Ray Hickey stepped up to endow the position and Markus Grompe threw his hat in the ring.

Dr. Grompe, an internationally renowned expert in gene transfer and stem cell research, currently manages five "RO1" grants from the National Institutes of Health.

Mr. Hickey, who made his name in business as the driving force behind Tidewater Barge Lines, is an advocate for a wide range of area causes, including OHSU Doernbecher Children's Hospital. Together with daughters Cindy and Linda – the latter an active supporter of health care issues in her own right – Mr. Hickey recognized the need for a top-caliber director.

"It is a great honor to be the first recipient of the Ray Hickey Chair and Papé Institute directorship," Dr. Grompe said. "With the honor comes the challenging job of meeting many different needs. I am confident that with the resources of the Papé Institute we can deliver on its promise to bring pediatric research to a new level." Dr. Grompe intends to recruit scientists both at OHSU and beyond with a broad range of expertise for the institute.

Women in Medicine Report: Part 1

Q & A with Patrice Eiff, MD, Director of the TALENT Program

Patrice Eiff, MD, Professor, Department of Family Medicine, has been instrumental in developing the annual OHSU Representation of Women Report since its inception in 2000. The results of the just released 2006-2007 report are presented in Part 2 of this article. Dr. Eiff answers questions below.

What is the history of this report? We started distributing data about the representation of women faculty at OHSU in 2000. We were required to collect this data for the Association of American Medical Colleges (AAMC) to assist them in their national benchmarking. Since then, however, we have expanded our own data collection. Each year, we have added new dimensions to the report while also retaining the ability to document trends over time.

How does it differ from AAMC reports? AAMC is interested in gender demographics within academic ranks and in leadership positions. We are also interested in looking at gender balance in the areas that may influence how women navigate into leadership positions. For instance, we are tracking the makeup of our search committees and standing committees. We are looking at the gender makeup of residency director positions, vice chairs, division heads – and other stepping stones to leadership positions. This year was also the first time we expanded our reporting at the department level.

How do reports like this help move institutions toward gender balance? They help us pinpoint where to focus our efforts. One example is that it has helped us recognize the role of a search committee’s makeup in promoting gender balance. It’s human nature to pick new leaders that are similar to existing leaders, particularly if they are viewed as successful. If our search committees are diverse, our talent pool for selection becomes more diverse too.

What general trends are evident? Overall, OHSU is similar to other academic health centers in terms of our percentages of women in leadership positions, which means we have a great disparity and gap. However, we have seen a slight increase in the percentage of women at the professor level and we have a greater percentage of women on our standing committees. We consistently exceed national averages in terms of the number of women in over half of our residency programs.

How useful is the “glass ceiling?” metaphor for describing how women advance? Some people are beginning to question the usefulness of the glass ceiling metaphor, as described in the Sept. 2007 issue of the Harvard Business Review. This is because women break through to the top all the time. We have women chairs and other women leaders in academic medicine. Instead, a more accurate metaphor has been described in the literature as a labyrinth, or maze.

How does the labyrinth metaphor explain gender imbalance? There are many places on the career trajectory where a woman may experience barriers to advancement; this is not just at the very top. A good example is the absence of support for “off-ramps” and “on-ramps” to help mitigate the impact of extended leaves when women focus on raising children or caring for elderly family members. It is not always easy to identify solutions when you are in the midst of it; it is easier to see when you look down from the top, taking in the whole. The report helps us to identify our own labyrinth so that we can help women be better equipped with a map of the barriers they may face throughout their careers.

What’s next for the report? Next, we'll begin developing data to compare women and men in terms of time-in-rank. We’ll look at various cohorts from different starting points -- 1990, 1995 and 2000, for example, and examine where these people are now in the institution. That should be interesting. We need to know more about faculty retention and attrition.

Women in Medicine Report: Part 2

National data indicate that women in academic medicine are less likely to attain promotion and tenure than their male colleagues; are under-represented in leadership positions; and are significantly over-represented in junior faculty ranks.

These trends are also evident at OHSU, based on data analyzed for the annual OHSU Representation of Women Report 2006-2007. While the report focuses on faculty across OHSU, this article describes the results only for the School of Medicine.

The report suggests that, although women faculty are promoted at a rate similar to men, the proportion of women at the Assistant and Associate Professor ranks who were nominated for promotion was less than the proportion of men who were nominated.

During the 2006-2007 reporting period, women held seven of the 17 leadership positions in the School of Medicine (Dean, Associate Deans and Assistant Deans). At the department level, women held two of 25 chair positions, 12 of 36 vice chair positions, and four of 51 division head positions.

There were 59 women at the rank of Professor compared to 271 men at that rank. The percentage of women at the rank of Professor has increased from 10% to 13% since 2000. In the past eight years, we have hired 11 new female Professors compared to 56 male Professors and have hired 22 female Associate Professors compared to 46 male Associate Professors.

Three areas in which significant strides have been made are in committees, residency programs and class composition. In the past five years, the percentage of women on School of Medicine standing committees has increased from 32% to 50%. The proportion of total residents who are women exceeds the national average in nine of our 16 residency programs (to be counted, the program must have at least nine residents total). Women comprised 57% of the 2006 entering medical school class (national average = 49%).

To read the full report, please: click here. For questions or comments, please contact Patrice Eiff, MD at eiff@ohsu.edu

Get refreshed! Refresher Course 2008 presentations now on-line

The inaugural Faculty Refresher Course, held on May 29, attracted about 40 faculty members. Developed by Patricia Hurn, PhD, Associate Dean for Faculty Affairs, the refresher course highlighted “Opportunities for Success” within the School of Medicine across all mission areas.

The course included presentations from many School of Medicine leaders. Power Point files associated with the presentation are now posted on the “Professional Development” page of the School of Medicine’s faculty affairs web site (scroll to the bottom): click here.

Faculty Spotlight: Co-discoverer of Smith-Magenis Syndrome - Ellen Magenis, MD

Ellen Magenis, MD, Professor in the Department of Molecular and Medical Genetics, was awarded emerita status in recognition of her considerable contributions to research and clinical care in the field of cytogenetics.

Dr. Magenis’ fascination with genetics and chromosomes began at an early age, when living and cadaveric examples of genetic anomalies were frequently put on show at fairs and large public gatherings. This fascination eventually led to over 150 articles, 120 abstracts and 20 book chapters covering areas as diverse as cancer and Prader-Willi Syndrome.

Co-describer of the Smith-Magenis syndrome which bears her name, Dr. Magenis was a “Clinician-Researcher” long before the term was coined. Her lines of laboratory enquiry were almost always triggered by the patients she saw in her clinic, and by the care she devoted to developing a rapport with each child. Through observation and relationship building, Dr. Magenis was able to gain acceptance for the once-heretical theory that specific chromosomal abnormalities can be linked to specific behavior patterns. One such bond with a patient lasted well over fifty years, enabling long-term periodic assessments that concluded only with the patient’s recent death at the age of 89.

Together with Dr. Ann C.M. Smith from the National Center for Human Genome Research, Bethesda, she identified a deletion on the proximal 17p chromosome as being evidence not of Down syndrome – the accepted diagnosis at the time – but of a distinct and unique syndrome, characterized by mild to moderate mental retardation, delayed speech and language skills, distinctive facial features, sleep disturbances, and behavioral problems.

Dr. Magenis describes one of her chief joys as seeing the options for patients and families that this identification opened up. “Now there are support groups and meetings dedicated to the social and clinical support of a condition that at one point did not even have a name,” she said. “To have enabled this to happen is very gratifying, especially when you get to meet patients and family members who have benefited from your work.”

Pictured: Dr. Magenis with Daryl Anderson, Associate Professor Emeritus, Speech Language Pathology.

Ed Keenan, others honored at annual alumni awards dinner

Dean Mark Richardson presented the annual Dean’s Award to Edward J. Keenan, PhD, Associate Dean of Medical Education, at the School of Medicine Alumni Association Annual Dinner & Awards Presentation on June 1st.

Several other awards were also presented at the Dinner. Kent L. Erickson, PhD, ’75, received the Richard T. Jones, MD, PhD, Distinguished Alumni Scientist Award. The inaugural Esther Pohl Lovejoy, M.D. Leadership Award went to Terry Yamauchi, MD, ’67. Ted J. Vigeland, MD, ’68, received the Charles A. Preuss, MD Distinguished Alumni Award. Six alumni were recognized for their work as members of the volunteer faculty at the School. They are: Donald Blanchard, MD, ’73, Frank DiGregorio, MD, ’89, Melvin Kohn, MD, MPH, Res. ’07, Mark Rampton, MD, ’77, Kenneth Stevens, MD, Res. ’70, Ronald Wolf, MD, ’89.

School of Medicine recipients honored by CeDMA

Students, a faculty member and a program were recognized during the recent Center for Diversity and Multicultural Affairs (CeDMA) Diversity Awards ceremony. President Joe Robertson presented a Student Leadership award to Dr. Michael Core, who graduated from the MD program on June 3, and John Roth, who will graduate from the PA program in August. Dr. Core is a founding member of the OHSU chapter of the Student National Medical Association and a leader in recruitment and volunteer efforts, and Dr. Roth is the Oregon Food Bank Coordinator and frequent student-outreach volunteer. The Faculty Award was presented to William (Billy) Martin, PhD, Professor of Otolaryngology/Head and Neck Surgery and of Public Health and Preventive Medicine, director of four programs within the Oregon Hearing Research Center, and Research Scientist in Residence at OMSI. The Intercultural Psychiatric Program in the Department of Psychiatry was recognized as for its leadership and service in advocating for diversity and multiculturalism on campus and in the community.

Zhongya Wang receives Excellence in Research Award

Zhongya Wang received an award for Excellence in Research Award from the 11th Annual Meeting of the American Society of Gene Therapy. The award recognizes the top seven post-doctoral and graduate students abstracts submitted for presentation at the Society’s annual meeting. Wang was recognized for his work in improving the stability and site-specificity of adeno-associated virus (AAV) vectors for gene therapies for genetic liver disease.

Currently-available AAV vectors rarely integrate, and do so randomly throughout the genome when integration does take place. Wang’s technique inserts genetically-coded DNA into the vector to allow it to integrate into specific target sites more accurately. This results in a vector that is about 10 to 20 times more effective than the conventional AAV construct currently available, and which may have potential in human gene therapy trials for hemophilia and tyrosinemia (a hereditary inborn error of metabolism that causes severe liver disease in infancy).

“I am excited by the potential of this technique,” said Wang, a graduate student from the Department of Cell and Developmental Biology, currently working in the lab of Markus Grompe, MD, Professor of Pediatrics and Molecular and Medical Genetics. “The increased efficiency it gives, combined with the tighter targeting across the genome, makes for some very beneficial applications in clinical trials.”

“This work is not only leading to a vector with improved properties for clinical applications, but is also shedding light on fundamental properties of the life-cycle of this important virus,” said Dr. Grompe. “We are very proud of this recognition.”

Ronald McDonald House recognizes Dean’s office staff

The School of Medicine Office of the Dean received an award from Ronald McDonald House Charities for “outstanding support of the children and families served by Ronald McDonald House Charities.” Since February, nearly 20 staff members in the Dean’s office have organized to provide a home-cooked dinner once a month for the children and families who use Ronald McDonald House as a “home away from home.” Families staying at the house live at least 50 miles from Portland, and have a child who is undergoing extended treatment at Doernbecher Children’s Hospital. Home-cooked meals are often a highlight for the family members, who are frequently trying hard to maintain as normal an environment as they can for siblings of the patient.