July 25, 2011

Fostering an Academic Culture at the Forefront of Health Sciences Education

A Message from the Chancellor

I’ve been at UCSF long enough by now to be able to witness the University’s seasonality. I saw how the entire campus takes a deep breath in the summer. And when fall arrived, so too did a fresh crop of students, so young and energetic, ready to ask anything, and thinking the sky’s the limit. In our clinical settings, the seasons shift, with literally hundreds of new residents and fellows arriving in the June fog. But the feeling is the same.

It’s a marvelous thing to have a calendar that marks the ebb and flow of the academic seasons. That’s something that’s missing in private industry. You don’t see that annual infusion of new intellect and energy – and the lack of cynicism that it brings. Trainees really give you the sense of endless possibilities, of rebirth.

I have a particular fondness for UCSF’s educational mission because that’s what brought me here in the first place. I had gone to medical school in Reno and when I arrived at UCSF as an intern in 1982, I was more than a little intimidated – I’m pretty sure I was the first UCSF resident who hailed from my medical school. My fellow trainees were so talented and smart – and they oozed self-confidence.

But I quickly came to understand what is truly special about UCSF. My chief residents were Seth Landefeld, who is now the chief of geriatrics at UCSF, and Greg Fitz, now the dean of the excellent medical school at the University of Texas –Southwestern. They were like gods to me – so smart, so intellectual, so well read. But they were also funny, warm, and helpful. I knew that I had landed at just the place I wanted to be: a place committed to training the very best health care providers and researchers, but doing it in an amazingly warm and nurturing environment.

I’ve seen a lot of academic institutions since then, but I’ve never seen another training environment that matched the one I found here. I am committed to doing what I can to preserve that special culture and, in some key ways, make it even better.

Of course, the environment we operate in has changed since I first arrived three decades ago. Everyone is concerned about whether California’s budget woes will start to degrade the quality of education our students receive. We are being held more accountable for the quality of our educational enterprise and delivery systems, with more frequent inspections by outside accreditors such as the Joint Commission, the Liaison Committee for Medical Education, and the Western Association of Schools and Colleges. When the latter came to inspect last year, I was intensely interested in seeing an objective outside measure of where we stand.

And I was pleased to see how impressed the inspectors were by our new 22,000-square-foot Teaching and Learning Center, where UCSF students from all four of our professional schools of dentistry, medicine, nursing and pharmacy, can hone clinical skills using lifelike patient simulators (or even so-called standardized patients – actors playing the role of a patient), receive training in telemedicine, and practice inter-professional collaborations and teamwork.

The center, which was still under construction at the time of the inspection, was such a novelty to the visitors that they put on hard hats and went over there to take a tour of the technology-enhanced classrooms, the student technology commons, and the training center for instruction in telemedicine.

The group of inspectors, each from their own institutions, then took off those hats and asked us simply, “How did you get that done?”

“I’ve seen a lot of academic institutions…but I’ve never seen another training environment that matched the one I found here.”

Creating a great academic culture is tricky: you need people who are committed to their own excellence, and that takes a lot of focus, perhaps even a bit of selfishness. At the same time, teaching and mentoring are acts of astonishing generosity – giving of yourself to help the next generation of students succeed.

You can walk around the halls and see this culture alive everywhere: our basic scientists teaching novice PhD students a critical technique of scientific discovery; a pharmacy student learning basic pharmacology from a world expert, patiently guiding her through the complexities of drug metabolism; a nursing student at a bedside with a senior instructor, learning the best way to interview a new patient; a medical resident being instructed on how to deliver bad news to a patient recently diagnosed with lung cancer.

Doing this well requires an educational culture, but it also requires a strong curriculum and modern educational tools. We serve more than 4,000 students, and our educators are constantly innovating. For example, rather than training medical students in the old model of two years of basic science and two years of clinical care, we’ve moved toward much more interdisciplinary teaching, and have even begun a few experiments in which students take care of panels of patients over an entire year rather than switching from one clinical subspecialty to another each month.

And we’re applying the tools of scientific inquiry to education as well. Just as we study a new drug or procedure to see whether it is better than the alternative, we do the same with new curricula. This means that when we discover a better way to teach students how to do a complex surgery, or deliver end-of-life care, we can disseminate this knowledge, improving the education of students elsewhere. It is this combination of local innovation and excellence, and broader dissemination, that’s responsible for our high standing in the educational world.

I’m proud of UCSF’s consistent place among the top hospitals and schools of medicine, dentistry, nursing, and pharmacy in US News & World Report’s annual rankings. In the magazine’s 2010-2011 report, the School of Pharmacy ranked No. 1, the schools of nursing and dentistry No. 2, and medicine No. 4.
To attract the best and brightest, UCSF is committed to making its world-class graduate education programs more accessible – that is, more affordable. Even in a difficult funding environment, we're working hard to find new resources to support our students – particularly recognizing the heavy debt load that many professional students face at the end of their education.

I’m proud of these things, but when I think about education, I’m still thinking about my own arrival at UCSF three decades ago, when I learned that one could be surrounded by the best, brightest colleagues and teachers and be pushed to be better than she knew was possible – all in a nurturing, supportive environment.

I want to be sure that trainees and students of all kinds who come to UCSF experience the same things I did. If we can provide them the same experience I had, translated to reflect our new understanding of the needs of today’s learners and tomorrow’s leaders, I’ll be very pleased.

Photo by Elisabeth Fall