Cerra opens up about major challenges in 2008-09

Academic Health Center senior VP talks conflicts of interest, Med School Dean and medical education.

On Monday The Minnesota Daily sat down with Senior Vice President for Health Sciences Frank Cerra in his office to discuss the financial and academic challenges the six Academic Health Center schools have faced over the past year and his goals moving in to 2009-10. Tell me a little bit about where we are with the conflicts of interest policy. I know thereâÄôs only one Regents meeting left. WhereâÄôs that at? That group of people is systematically looking at what is happening in other medical schools, other academic health centers, other universities, what is coming out of the new policies in Big Pharma, and in the device industry âĦ And then weâÄôll be ready to put this together and see what the new policy draft looks like, and begin to take it through the consulting process. I think weâÄôre also in the midst of preparing a position statement on the value added from relationships between faculty and the institution and industry where there is really clear value added. And so what kind of timeline are you working on? Is there a goal for what Regents meeting youâÄôd like to bring the policy to? Not really. I think weâÄôre more interested in a more deliberative, thorough approach where we listen to people and then take forward to the institution some recommendations, because ultimately the institution has to decide what it wants as well as everybody who works in the community. And thatâÄôs the stage weâÄôre at now. So thereâÄôs no rush to get it done? No, I think itâÄôs better we get it to come out the right way than to just kind of push something through for the sake of a new policy. There are a number of very important issues that I think need to be discussed in a collegial environment. And I know a lot of people have expressed disappointment in the way things have gone from the task force recommendations to the draft that was released late January, early February. They want to know whatâÄôs next and how will those folks be able to get their voices heard? There will be a draft policy that will be put in the faculty governance system and the general collegial response system. And theyâÄôll have the chance to voice their opinion either directly or through their elected representatives. I saw the memo that went out from Medical School Dean Dr. Deborah Powell the other day about the Med 2010 initiative, about some changes that are being made. WhatâÄôs your vision for how things are going to go through 2009 and moving into 2010 in terms of curriculum overhaul and curriculum changes? I donâÄôt usually speak about this in terms of curriculum change, because itâÄôs the way weâÄôve always done business: We set a curriculum and we change the curriculum. I think what weâÄôre talking about there is truly a transformation in the way we actually educate the next generation of doctors or nurses or health professionals in general âĦ I think it has to do with how do you construct educational material into forms of knowledge that students can learn and learn better around competencies that they need to achieve, and then to utilize the new game technology or virtual reality âĦ We already have early data that those kinds of learning environments reduce errors when people get to practice âĦ I think there are compelling reasons to move in this direction. I think at the same time, itâÄôs got to be deliberative, thought through moved ahead, not an incremental, but something much more rapid than incremental. Which components are you most excited about/what would you liked to have seen in your medical education? ThatâÄôs a real interesting question. I would have liked to have âÄî well, the assumption youâÄôre making here is that my genre had some idea of computer technology. They didnâÄôt exist when I went to [Med School], they were these great big things with tubes. ItâÄôs kind of like back to the future, IâÄôll take where I am today and if I could take it back there, I think to have learned histology and pathology in that environment would have been very exciting âĦ I think we would have been much better prepared and probably would have been able to absorb a broader base of knowledge, but whatâÄôs more important, become more proficient at the practice and the art rather than test of time and experience. And so, letâÄôs talk a little about finances. How has it been this year for the AHC? And looking forward, how do the books look for next year? I like that, how do the books look. This year has been a major, major challenge for a variety of reasons. None the least of which is the state rescission. None the least of which is looking at the amount of debts students have and trying to figure out how do we create an economic model that will continue to support health professional education âĦ To try and create a sufficient margin in the clinical business, to grow and expand Medical School or health sciences program is increasingly difficult because those margins arenâÄôt there. So weâÄôre having to look at all that and rise to the challenge of balancing the budget while at the same time figuring out what is an economic model where we can on the one hand become more efficient and effective at what we do at less cost âĦ And thatâÄôs what this process is about. ItâÄôs partially strategic positioning, itâÄôs partly looking at your infrastructure and saying how are we doing business âĦ and at the same time going through a process to say weâÄôre going to go in this direction and we are going to have to create new partnerships, and do it on a shorter timeline than we had planned or imagined because of the general economy and because of the state rescission to the UniversityâÄôs budget. And how does the stateâÄôs budget affect the AHCâÄôs plan for the new biomedical center? WeâÄôre moving ahead with the biomedical facilities. âĦ WeâÄôre looking at planning that district as a new campus, itâÄôs called the Biomedical Discovery District. WeâÄôre moving ahead with the magnetic resonance imaging center, weâÄôre beginning to look at these other three facilities not necessarily as three separate facilities but areas of emphasis but interdisciplinary translational research that deals with cancer or cardiovascular disease and then weâÄôre looking at what this third area of emphasis might be around âĦ ItâÄôs a very, very exciting time to plan something like this. ItâÄôs going to happen and weâÄôll actually be well into it by this fall. And will there be newly hired faculty? Or will they be folks already working on these projects? Some of both. I think itâÄôs important that the faculty we have here are appropriately supported; theyâÄôre very good. TheyâÄôre outstanding, they do great work, their grant history is exemplary and so on and so forth. At the same time we need to recruit new faculty, and itâÄôll probably be a combination of that. And weâÄôre working that out now. And I think the other important point is who you recruit and who gets moved from inside the institution depends entirely on the areas of focus of the research âĦ These facilities will also be designed in a way that theyâÄôre flexible. So as you know areas of research emphasis change, over the next 10, 15, 20, 30 years, we donâÄôt expect to be doing the same things we are now, at least I hope weâÄôre not. And when will those be set to open? I suspect the last one we will move in 2015-2016 somewhere in there. LetâÄôs talk about the transfer of the deanship, come July 1 youâÄôre going to be taking on a lot of responsibility. What are you most looking forward to? A couple of comments. I think this isnâÄôt really a transfer, itâÄôs really an integration of two positions to better accomplish the challenges that face us. ThatâÄôs been the presidentâÄôs point of view; itâÄôs also my point of view after studying it. And the challenges we have, have a lot to do with the positioning and success of the clinical enterprise. If youâÄôve been following it, you know weâÄôre on this pathway of convergence with Fairview Health Services, thatâÄôs absolutely critical for our future. In order to, as you pointed out, finish up these biomedical facilities and get it done efficiently, effectively and on time, itâÄôs no small feat to recruit 60 to 120 new faculty in five to seven years, thatâÄôs a lot of work, in addition to the normal turn over. Moving education in the direction of e-education, establishing new economic models, and making our infrastructure more efficient and effective requires a different kind of administrative structure to make decisions and the president decided on this approach. IâÄôve studied it and I think itâÄôs a good one, but itâÄôs not doing two jobs, itâÄôs integrating two jobs into one. Which I think is very doable. At the State of the AHC address, a lot of folks seemed concerned about their schools, outside the Med School. How do you respond to those folks who are maybe concerned that pharmacy, nursing and public health are going to be given less priority to the Med School? Well I think theyâÄôre legitimate concerns, and I congratulate them for expressing them, because if theyâÄôre not out there you canâÄôt talk about them and fix them âĦ So those deans will get plenty of attention, the Deans Council will still continue to be here as a primary policy decision body, the deans will have their one-on-one meetings with the senior vice president, and I will be held accountable by them and by the president for the distribution of resources and the advocacy of the needs of the health sciences schools âĦ But ultimately what you come down to is this: This academic health centerâÄôs major strength is having all of the health sciences schools under one roof. That is also its major leverage in the health care marketplace and in the education of the next generation of health professionals and that must be preserved as a strategic imperative. We hear a lot about the Med School and great breakthroughs coming from the Med School every day. What are some of the other things from the other schools that have really made waves in their fields in the last year? I think there are a number of things, the School of Pharmacy and their medication management program is one. It just improves the quality of the medical care âĦ in reduction of errors, reducing costs. It has revolutionized the care delivery there in many, many different ways. ThatâÄôs just one example âĦ Another one, if you go over to Veterinary Medicine, what theyâÄôre doing in food safety and security is second to none. TheyâÄôre very highly and heavily tied into homeland security, health and human services, and what theyâÄôre finding out about the detection of organisms you hear about, salmonella and the rest and how you prevent that and treat it. âĦ Another one in the college of Vet Med is the joint DVM and MPH degree, so itâÄôs a combination of the masters of public health and the doctorate of veterinary medicine, and recognizing the importance of veterinarians to zoonotic disease, and of course the best example of a zoonotic disease right now is H1N1. So thatâÄôs very exciting. Jumping back to the dean, has there been a decision made about Dean Powell and her future within the AHC? No decision. Dean Powell, the discussions continue with her. But nothing has been decided at this point in time. Just to point out, she is a tenured professor here, so at the very least, she has the right to continue as a tenured professor, but beyond that, thereâÄôs still ongoing discussion. And has she made any indications to whether she has committed to continue as a tenured professor? YouâÄôd have to ask her, I donâÄôt know. If you had one goal a year from now, what is the single thing youâÄôd like to accomplish between now and next year? I would like to have established an environment where the faculty, the staff, the administration have all agreed on the direction we need to go in, what we need to accomplish and all are pushing the same wheel in that direction, and that we have the full support of the state Legislature and the people of Minnesota. And how about a goal that the students might see a little bit more of? Where I would like to be with the students is clearly moving into an environment of e-education where they were learning better than they ever have, and they start at a very high level, I guess I should add parenthetically, and achieving their competencies better and quicker, and moving on to advance their education and practice. If you were a first-year medical student or yourself as a first-year resident, what do you wish you could have asked your senior vice president of health sciences? I think looking back, I grew up in the era of the forced roman legion march of education. You marched to that drum and you finished when they said finish or you were done. And I think what weâÄôre learning is there are better ways of educating where people learn more, and they donâÄôt have to walk around exhausted all the time, and you can actually have more of a personal life. âÄîEmma L. Carew is a senior staff reporter.