July 1, 2020, marked another important milestone in the short history of our medical college. The former NSU College of Medical Sciences (CMS) was officially merged into the Dr. Kiran C. Patel College of Allopathic Medicine (NSU MD). Achieving this milestone signifies NSU leadership’s trust and confidence in NSU MD’s ability to successfully pivot, undertaking a merger involving the integration of 45 new faculty and staff, revitalize a degree program midst a global pandemic and accreditation year.
This complex institutional merger began on June 4, 2019, when president Hanbury convened an institutional task force comprised of six deans of NSU’s Health Professions Division (HPD), the Dean of the Honors College, the Dean of the Halmos College of Natural Sciences and Oceanography, the Dean of Undergraduate Studies, and the Provost. The task force, led by Dean Stanley Wilson, was charged with evaluating the future disposition of CMS following the July 2019 retirement of Dean Harold Laubach. The task force was asked to make recommendations about how to potentially reorganize CMS and its programs to increase operational efficiencies, heighten the interest of prospective students, and more fully meet the needs of the colleges it serves.
For almost three decades, CMS has operated as a centralized resource, delivering basic science instruction in anatomy, pharmacology, physiology, microbiology, biochemistry, and pathology to all HPD colleges. In addition, the college hosted the Master of Biomedical Science Program (MBS) designed as an enhancer program for students who wish to further their knowledge in preparation for professional careers in medical fields, higher education, and biomedical research. In November 2019 the taskforce unanimously recommended to the president that he fold CMS into NSU MD. It further recommended the formation of an external advisory committee to evaluate and address the course delivery needs across the HPD colleges to ensure that curricula are delivered in accordance with best practices.
The taskforce’s recommendations were well-aligned with NSU MD’s increasing faculty and staffing needs to deliver a world-class MD degree while meeting LCME accreditation standards. The merger would revitalize the MBS degree program through collaborative engagement among CMS and NSU MD faculty as peer educators. By redesigning the MBS degree as part of the merger, the program became more competitive in the marketplace and an important student pipeline that enhances diversity in NSU MD. Moreover, the merger will potentially facilitate successful faculty recruitment from a national pool of high caliber researchers and educators attracted to a new MD program that has well-established basic science underpinnings. The University’s aim to achieve national preeminence by 2025 will be dependent on being able to recruit faculty of the highest caliber into the health professions, and particularly into the MD program, which by its very nature has established itself as highly selective.
A “Transition Team”, comprised of constituents from each HPD college was organized to catalyze the transition. Dr. Irving Rosenbaum was appointed Interim Dean of the CMS Transition Team and was charged to facilitate an orderly “handover” of CMS to NSU MD by July 1, 2020. Dr. Rosenbaum is a skilled, senior administrator presently serving in the dual roles of Vice President of the Health Professions Division and Executive Associate Dean of Administration in the MD College, thereby assuring that institutional expectations and the resources needed to accomplish the new MD College’s accreditation goals are well matched. Dr. Rosenbaum worked closely with Dr. Ronald Chenail, the NSU provost, to assure institutional support for, and alignment of these merger plans. Dr. Rosenbaum primarily focused on the re-design of the MBS program, which was administratively assigned to NSU MD in January 2020.
In parallel, NSU MD leadership began planning for broad areas of programmatic integration, including but not limited to the development of communication plans, organizational re-alignments to comply with LCME requirements, post-merger governance, joint effort reporting, and a financial re-design that meets institutional cost-saving expectations while also enhancing efficiencies and quality of the post-merger educational and research programs. The significance and complexities of the implementation challenges that comprise a cross-college merger cannot be overstated, including the following:
Mission-Based Accounting/Budgeting: With regard to joint financial modeling, the MD college’s process of mission-based accounting/budgeting was essential to begin assessing and capturing each faculty member’s effort and productivity according to assigned teaching, research/scholarship, patient care, and service missions, and then, to align faculty effort and its value with the prospective post-merger budget for each mission. Mission-based accounting fosters transparency. It enables an academic unit to measure faculty productivity relative to revenue. It informs the true costs of an academic unit’s missions, enabling it to make wise investment decisions. Finally, it empowers the unit to justify its consumption of resources to its various constituents.
Re-tooling Scholarship: Faculty arriving from a college that was historically focused solely on teaching can struggle to find their way in a college where scholarship and research are an essential core mission. The risk is that the combined product would evolve into a two-track system, in which MD faculty engage in cutting edge research and development while the former CMS faculty sit on the sidelines. With an immense commitment to faculty development and authentic cross-college integration, NSU MD immediately mobilized mechanisms that, over time, will foster growth in scholarship for all faculty, regardless of their starting point. These mechanisms include mentorship activities, in which seasoned, senior members of the MD faculty form interdisciplinary teams of research-intensive faculty and those who are less experienced, to write grants together, author papers together, and learn from each other. These types of efforts not only result in richer discovery but also a healthier culture in which all faculty embark on trajectories of growth and accomplishment.
Teaching Effort Reporting: NSU MD carefully tracks effort using a reporting model developed by the AAMC Group on Educational Affairs Consensus Conference on Educational Scholarship to identify and classify faculty teaching activities [Advancing Educators and Education: Defining the Components and Evidence of Educational Scholarship. Washington DC: AAMC, 2007]. This approach assigns educational activities to five categories, with recommendations for ways to document quantity, quality, scholarly approach, and scholarship for each type of activity. It is designed to assist faculty in documenting their professional achievements as educators. The five categories are Teaching, Curriculum, Advising and Mentoring, Educational Leadership and Administration, and Learner Assessment. This effort tracking approach uses contact hours with students for specific types of activities, with multipliers to calculate total time involved, effort as a proportion of FTE throughout the year, and time allocated for producing a specific product, such as a PBL case. Multipliers were developed based on a report by Watson and Romrell [Watson RT and Romrell LJ. Mission-Based Budgeting: Removing a Graveyard. Acad Med 1999; 74 (6): 626-40)] and based on best practices in other medical schools. Establishing consensus on effort reporting is especially relevant when faculty have dual appointments and, as in the case of the former CMS faculty, when they provide teaching/research/service missions across two or more colleges. Despite initial reluctance, the above effort reporting approach has garnered much interest among other HPD Colleges, who have been invited to participate in a fall 2020 ‘work effort taskforce’, aimed to build consensus and to provide recommendations to the provost for institutional consideration.
Communication Plan: What may have been the most challenging aspect of this complex and difficult reorganizational process was to bridge the cultural differences between a basic science teaching unit and a medical college and to merge incompatible educational practices into a new, integrated model. Of particular importance was ensuring that the new model combined best practice pedagogies with the curricular requirements of a medical school. To accomplish this, NSU MD started a communication plan as soon as merger conversations began in the fall of 2019. The solution was to balance the conflicting requirements of transparency and confidentiality, all while managing the high level of emotion associated with both success and loss that are inherent to any merger process. NSU MD initiated in-person onboarding discussions with all CMS faculty members in January 2020, followed by weekly joint online meetings necessitated by the Covid-19 pandemic. The intent was to create a communication platform that brought faculty from diverse backgrounds together to engage in a dialogue that would minimize anxiety, boost morale, and retain talent. Using the Zoom platform, 95% of both MD and CMS faculty participated in discussions, which included the online transition of the MD curriculum, the reorganization of work assignments and effort reporting, and most recently, planning for the fall semester return of our students, faculty, and staff.
Despite the official July 1, 2020 integration of CMS into the NSU MD, most of the abovementioned programmatic work is still ongoing and the idea of coming together as a single, united college is still in its very early stages. Carrying the business solution of a merger into the landscape of academic medicine and higher education does not mean that the deliberation, planning, business model development, and instructional implementation will be resolved instantly. As a matter of fact, such mergers are very time consuming and the effort is immense, especially when staff and faculty members are already stretched, as in our case, due to an extensive, already-challenging accreditation process. On the other hand, using the core principles as outlined above, this institutional merger has already resulted in greater interdisciplinary faculty collaboration, improved operational and financial efficiencies, and the revitalization of the Master of Biomedical Sciences program that is expected to see a sizeable increase in the fall and winter semesters.
Managerial transitions hold enormous potential for positive change—if executed well. However, they also pose very real threats of failure if not implemented cautiously and thoughtfully. As William Bridges wrote in his classic Managing Transitions—Making the Most of Change, “We know that managing people and organizations during times of tumultuous change are some of the most difficult tasks a leader faces.” This statement takes on even more weight and meaning when a global pandemic hits in the midst of an ongoing inter-college merger.
In a circumstance such as this, a data-driven, transparent, and stakeholder-inclusive process optimizes the likelihood of successful cross-college mergers for institutional advancement. NSU MD demonstrated agile and adaptive leadership, highly familiar with and attuned to institutional culture, which enabled it to succeed and thrive in the face of rapid and uncertain change. Add to that mix a good measure of creativity and innovation, while executing the plan in a highly collaborative environment, and the net result has been an immense synergy where all students, faculty, and staff—One NSU—are attaining their greatest possible achievements, both as individuals and as a team.