Merging Colleges Ignite Opportunities for Fostering Preeminence

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.

A Message to the NSU MD Community

Undoubtedly, the past few months have been both challenging and unsettling. As we continue to fight the Covid-19 pandemic, distress and anxiety have been exacerbated for so many across the nation by the tragic death of George Floyd and the resulting social unrest, the likes of which have not been seen since the civil rights protests of the 1960s. We mourn this senseless loss of life and feel the outrage we all share. At the same time, we strongly condemn all acts of violence against other people and the unlawful destruction of public and private property.

Every person has the right to feel safe, accepted, heard, and valued. Respect for and inclusion of people from all backgrounds is one of NSU’s core values and a guiding principle in all that we do. We see this demonstrated every day as our faculty, students, and staff work together to make a positive difference in our world. But, to truly manifest the just and safe world we all desire, our nation must come together with compassion and empathy to extend that same attitude of acceptance, respect and care to every corner and every constituency in our land, especially right now to African American communities who are justifiably feeling unsafe, angry, and vulnerable.

As we all go forward together, I want you to know that our medical College is here for you, to ensure, in every way we can, that each of you has the opportunity to achieve your dreams in a community of equality, respect, support, and safety. Please reach out to me or other faculty or staff if you need support or assistance. We are here for you.

“Darkness cannot drive out darkness; only light can do that.” Dr. Martin Luther King, Jr.”

Sincerely,

Johannes Vieweg, M.D.

Achieving a Successful Return to Campus Life

Last week, Governor DeSantis announced the re-opening of Florida’s health systems, including the continuation of elective surgeries.  He also launched the “Re-Open Florida Task Force” to plan for a safe and robust re-opening of Florida’s economy. These decisions were likely prompted by tremendous economic pressures and have been justified by a gradual decline in the rate of new Covid-19 infections in Florida, which total 30,525 confirmed cases and 1,045 deaths, as of April 23. It should be noted, however, that due to present limitations in the availability, reliability, and frequency of SARS-CoV2 testing, new case rates are less predictive for successful viral mitigation than death rates, which have not yet shown a precipitous decline in our state.1

Death rates are a lagging indicator that signal when community case transmission is on the decline, providing an additional degree of confidence that Florida citizens and business owners can gradually resume recreation and commerce in our state. Therefore, it is prudent to recommend activating South Florida’s re-opening only after experts detect a definitive downward trend, both in new cases and mortality, especially in the densely populated Miami-Dade, Broward, and Palm Beach Counties.

The pandemic has had a profound impact on higher education. Nationally, universities are grappling with uncertainties about student enrollments, demand for student facilities and services, online education capacities, campus workforce allocations, and suddenly smaller endowments. There is no existing gold standard for determining what constitutes a “safe” return to campus, nor is it clear how academic programs should be adjusted to the new normal. Moreover, there is no roadmap for how to achieve sustainable administrative efficiencies in the post-COVID-19 era. Clearly, this is a complex, multifaceted process that requires operational agility, careful planning, and expert execution.

On the NSU campus, the president, in consultation with university leadership, is taking a deliberate and measured approach for safely and effectively returning students, faculty, and staff to campus as soon as is reasonably possible. It is anticipated that there will be continual course corrections as more data become available while the rest of the State of Florida returns back to business.

Here, we have identified five essential elements that will help ensure the robustness of our master plan for the safe resumption of on-campus activities:

  1. Use testing followed by gradual increases in student and faculty densities to lower the risk of on-campus transmission of SARS-CoV2.

Before returning to campus and resuming scholarly activities that involve regular contact with other individuals, a documented infection status via nasal swab PCR and/or serologic antibody testing should be required. If a person tests PCR positive, they must not return to campus and should maintain a self-quarantine at least 21 days after the onset of symptoms. Symptomatic individuals, regardless of their testing status, should not return to the workplace or resume social interactions for 21 days. Individuals refusing testing should not be permitted to return during the ramp-up phase.

While PCR testing is indicative of the presence of an active virus, evidence of a past Covid-19 infection will soon be available through commercialized antibody testing. A person who is antibody positive for SARS-CoV2 has been exposed to the virus and likely has protective immunity, although none of the tests can demonstrate protection, just a history of infection. While reliable antibody testing is not widely available at this time, Cellex, Inc. (Research Triangle Park, NC) has received FDA approval for testing under emergency authorizations and more than 90 other companies have developed serologic testing kits that could, once validated, be used as a marker for a safe return to the workplace.

While all this testing may sound rather burdensome, these practices are very similar to what is required for children (to confirm vaccinations or antibodies against measles, mumps, and rubella and varicella) before being granted entry into schools. Similarly, healthcare workers are required to present evidence of vaccination or antibodies to Hepatitis before being allowed to enter clinical environments.

Most experts recommend a staggered three-pronged re-entry approach with approximately 1/3 of the workforce and 1/3 of the student body to be permitted re-entry, once the individuals within these subgroups are confirmed PCR-negative. Two weeks later, a second wave would then re-enter, with staggered workday shifts so that campus community density remains lower than usual. After another two-week interval, the third wave would re-enter, still employing rotating shifts to maximize social distancing.

  1. Develop an infection control plan for after re-entry

Students and employees should only perform on-campus work if clinically well and if using a Covid-19 self-monitoring app, adopted by the university. Well-documented disinfection procedures and protocols should be in place in all campus environments and places where people gather. Alcohol-based antiseptics should be used to disinfect all work environments on a regular schedule. Hand sanitizers should be readily available, and signage should be displayed reminding people to wash their hands with soap and warm water for twenty seconds. Special antiseptic cleaning procedures should be adopted for shared equipment and facilities, such as telephones, computer terminals, copy machines, door handles, break rooms, elevators, and bathrooms. Whenever possible, HEPA filters should replace traditional air filters within the HVAC system to remove particles that are greater than 10 nanometers in size. UV lights should be utilized in laboratories, safely installed to prevent prolonged human UV exposure. Finally, the use of surgical masks and glove infection control procedures should be used if there is a high likelihood of close contact with individuals within the environment who may be unaware of their Covid-19 test status. Activation of a Contact Tracing Protocol is highly advisable when new cases are confirmed on campus, which would entail prompt PCR testing beginning with the first contact, followed by a series of tests over days if indicated. Additionally, students and employees need to be advised to self-monitor and self-quarantine if indicated, and anyone with a hint of symptoms should be instructed to leave the work environment immediately, be tested, and contact tracing should then be initiated.

  1. Maintain social distancing protocols

Even when all realistic testing precautions are taken to ensure that students/employees with active infections do not enter the campus, additional safeguards must still be taken if there are still active cases in the community. Auditoria, classrooms, conference rooms, workrooms, laboratories, workstations, buses, cubicles, and campus restaurants should be populated such that the physical space between students/employees is at least eight feet. Office environments with open cubicles will be particularly challenged but can be rendered safer with reductions in the number of cubicles, implementation of plexiglass barriers, and cubicles spaced further apart. Masks can be used in these situations and gloves are recommended for any contact that requires a transfer of potentially contaminated objects.

Additional precautions are needed for confined, shared spaces, such as elevators, stairwells, and waiting rooms. Elevators should be limited to two people at a time, located at maximal distance from each other. Stairwells should be limited to one person per flight of stairs. Waiting areas should have seating spaced at least 8 feet apart and provide markers indicating where people should stand to allow for safe social distancing. Break rooms/lunch areas should limit gatherings to a number that allows appropriate social distancing (6 feet, <10 people), and request staggering of lunch/meal breaks to minimize individuals being in small spaces without masks. Increased use of signage throughout university educational and office buildings should be employed, to remind employees of good infection control practices, including social distancing, hand hygiene, hand washing, cough etiquette, and a universal mask policy.

  1. Adjust human resource policies

An important component of the post-COVID environment will be revisions to human resources policies and procedures. Teleworking and remote education should be encouraged until we can ensure that there is little or no risk of active infection in the community. Flexible and staggered work schedules should also be permitted to ensure that proper spacing of personnel is achievable. Gatherings of more than a few people in a confined space should be avoided and may require changes to past work routines. Liberal sick leave policies should be put in place to ensure that people with symptoms do not attend work. Employees at increased risk due to age or medical vulnerability should be encouraged to telework or remain at home until a safe workplace environment can be ensured.

Importantly, increased levels of anxiety, depression, and even symptoms of post-traumatic stress can be expected among students and employees following long periods of social isolation and fear from the pandemic itself. Employees should be informed about ways to access professional help benefits through employee assistance programs, or professional behavioral health services. Access to medical providers via telehealth services should be emphasized so that employees with symptoms or concerns know how to easily access competent care.  Employers should work to increase communications with employees. This will allow for information about the safety of the workplace to be shared, as well as for employees to give feedback to employers. Trust and transparency are powerful tools that enable everyone to feel more comfortable returning to work and other locations where people will be gathering.

  1. Develop ongoing surveillance and monitoring plans

Even with stringent precautions, constant surveillance will be necessary. Screening procedures for students and employees need to be established so that anyone with symptoms such as cough, temperature elevations above 99.8 F, or generalized malaise, cannot come into close contact with other individuals. Apple and Google recently announced their launch of an automated contact-tracing system. It is different from conventional contact-tracing since it will allow people to know who they have been in close proximity to and, also, will ensure safe social distancing. Most importantly, it can operate at a far greater scale than conventional contact tracing, which will be necessary given how far the outbreak has spread in most states and countries. Finally, it will be important to monitor ever-changing recommendations from credible sources such as the CDC or local public health departments and adjust processes and procedures accordingly.

Conclusions

New resources, policies, and procedures will have to be implemented to ensure a safe campus and workplace environment. At a minimum, such resources include:

  1. Enhanced disinfection and cleaning protocols prior to ramp-up and during the ramp-up phase.
  2. Body temperature monitoring at all university entry points, consistent with EEOC guidelines.
  3. App(s) for self-monitoring and to interface with employee health services.
  4. Serologic and PCR testing availability via Quest Diagnostics or other clinical laboratories, along with immediate deployment of contact tracing by medical staff.
  5. New HR policies and procedures to encourage continued remote work and learning, while allowing for flexible works schedules to minimize crowding.

Once a vaccine or other effective treatment for COVID-19 is available, the paradigm will shift. It will then be much easier to ensure that people are protected and remain healthy. In the meantime, reasonable precautions and best practices will enable us to take safe steps that can bring us closer to a return of normal campus life. While the post-COVID-19 world may never look exactly like it used to, we can create a path forward that ensures necessary precautions and, with adjustments, enable a return to more normal ways of living, learning, and interacting.

1 https://www.nytimes.com/interactive/2020/us/florida-coronavirus-cases.html

 

 

Foundations for the Future and Sustainability of our Medical College

During yesterday’s virtual town hall meeting, many NSU MD students and faculty asked about our level of preparedness and the extent to which we have planned for the post-COVID-19 era. My response to them underscores both the gravity of the situation and our unique ability to adapt to our circumstances successfully, ensuring that the steps our College takes today will position us even more expediently for success and preeminence in the future.
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Managing the Challenges and Opportunities of the 2020 COVID-19 Pandemic

Recent days have brought unprecedented challenges and opportunities to our higher education and academic medicine community because of the ongoing spread of the coronavirus (COVID-19). Last week, the U.S. Government declared the COVID-19 outbreak a national emergency, enabling significant actions to diminish the risk of further infections as well as to protect the U.S. economy. As government and university officials continuously monitor this situation, it has become clear that proactive, rather than reactive measures are necessary to diminish viral spread and minimize health and safety risks to students, faculty, staff and our communities.
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Response to the Coronavirus Outbreak

We all are experiencing a great deal of uncertainty as we respond to the evolving coronavirus (COVID-19) outbreak. I want to thank Dr. Hanbury, his advisory team, our faculty and students and the entire NSU community for their leadership, support, resilience, and adaptability. We will continue to monitor this situation and want to make certain that everyone is informed as we depart from our normal routines and make necessary adjustments to mitigate the spread of COVID-9.

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New Master of Biomedical Sciences Program

In this context, it has been shown that Masters programs offered within a medical school environment can better prepare students to become competent health professionals, while enabling them to build more competitive applications to medical school. Moreover, Masters programs in the biomedical sciences that include electives in other concentrations accelerate the personal and professional development of students. The outcome is that such programs attract the best and brightest students to the medical school and the university.

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Doing the Right Thing

In a survey of more than 2000 employees across all professions and sectors of the United States economy, researchers found that when academic and/or private sector institutions set the highest ethical standards within a workplace, employees responded with a greater commitment to their work, improved loyalty, and greater enthusiasm for making impactful contributions. Establishing a “Doing the Right Thing” culture within an academic institution – without cutting corners – leads to more ethical and productive behavior on the part of the administration, faculty, students, and staff, while building trust within the organization as a whole.

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Adapting to Constant Change

Culture eats strategy for breakfast, a phrase originated by Peter Drucker and made famous by Mark Fields, President at Ford, and an absolute reality! Any university that disconnects these two elements jeopardizes institutional progress in an ever-changing academic environment. Changing an organization’s culture in times of rapid change, and adapting to such changes, has been recognized as one of the most difficult leadership challenges in medical education and academic medicine. In order to succeed, there must be clear communication and alignment at the executive level in institutional leadership so that expectations are well-aligned, institutional directions are clearly communicated, and goals, strategies, and tactics are fully articulated to university faculty and staff. As our college advances rapidly toward full accreditation, organizational change has become the ‘new normal’ for all of us, raising the question of how to best thrive without losing sight of true North on our compass.

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2019 Year End Reflections

As announced during the October 2019 faculty meeting, I would like to welcome our students, faculty, staff, colleagues, and friends and communicate – from the dean’s perspective – about our ongoing activities, plans, directions and challenges that will influence our culture and shape the collective vision for the future of our MD College. I am planning on sending updates every other week during the academic year and if you have comments, suggestions or announcements of events of general interest, please let me know, so that such news can be shared with our whole community. Please address your queries and comments to jvieweg@nova.edu

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