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Speaking Frankly - Dr. Cerra Opens Up?

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From the Daily:

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 there’s only one Regents meeting left. Where’s 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.

And then we’ll 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 we’re 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 you’d like to bring the policy to?

Not really. I think we’re 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 that’s the stage we’re at now.

So there’s no rush to get it done?

No, I think it’s 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 what’s 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 they’ll 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. What’s your vision for how things are going to go through 2009 and moving into 2010 in terms of curriculum overhaul and curriculum changes?

I don’t usually speak about this in terms of curriculum change, because it’s the way we’ve always done business: We set a curriculum and we change the curriculum. I think what we’re 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 …

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.

We already have early data that those kinds of learning environments reduce errors when people get to practice.

I think there are compelling reasons to move in this direction. I think at the same time, it’s 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?

That’s a real interesting question. I would have liked to have — well, the assumption you’re making here is that my genre had some idea of computer technology. They didn’t exist when I went to [Med School], they were these great big things with tubes. It’s kind of like back to the future, I’ll 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.

I think we would have been much better prepared and probably would have been able to absorb a broader base of knowledge, but what’s more important, become more proficient at the practice and the art rather than test of time and experience.

And so, let’s 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.

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 aren’t there.

So we’re 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.

And that’s what this process is about. It’s partially strategic positioning, it’s partly looking at your infrastructure and saying how are we doing business … and at the same time going through a process to say we’re 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 University’s budget.

And how does the state’s budget affect the AHC’s plan for the new biomedical center?

We’re moving ahead with the biomedical facilities. We’re looking at planning that district as a new campus, it’s called the Biomedical Discovery District. We’re moving ahead with the magnetic resonance imaging center, we’re 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 we’re looking at what this third area of emphasis might be around.

It’s a very, very exciting time to plan something like this. It’s going to happen and we’ll 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 it’s important that the faculty we have here are appropriately supported; they’re very good. They’re 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 it’ll probably be a combination of that. And we’re 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.

These facilities will also be designed in a way that they’re flexible. So as you know areas of research emphasis change, over the next 10, 15, 20, 30 years, we don’t expect to be doing the same things we are now, at least I hope we’re not.

And when will those be set to open?

I suspect the last one we will move in 2015-2016 somewhere in there.

Let’s talk about the transfer of the deanship, come July 1 you’re going to be taking on a lot of responsibility. What are you most looking forward to?

A couple of comments. I think this isn’t really a transfer, it’s really an integration of two positions to better accomplish the challenges that face us.

That’s been the president’s point of view; it’s 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 you’ve been following it, you know we’re on this pathway of convergence with Fairview Health Services, that’s 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, it’s no small feat to recruit 60 to 120 new faculty in five to seven years, that’s 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.

I’ve studied it and I think it’s a good one, but it’s not doing two jobs, it’s 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 they’re legitimate concerns, and I congratulate them for expressing them, because if they’re not out there you can’t talk about them and fix them.

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.

But ultimately what you come down to is this: This academic health center’s 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 … in reduction of errors, reducing costs. It has revolutionized the care delivery there in many, many different ways. That’s just one example.

Another one, if you go over to Veterinary Medicine, what they’re doing in food safety and security is second to none. They’re very highly and heavily tied into homeland security, health and human services, and what they’re finding out about the detection of organisms you hear about, salmonella and the rest and how you prevent that and treat it. Another one in the college of Vet Med is the joint DVM and MPH degree, so it’s 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 that’s 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, there’s still ongoing discussion.

And has she made any indications to whether she has committed to continue as a tenured professor?

You’d have to ask her, I don’t know.

If you had one goal a year from now, what is the single thing you’d 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 we’re learning is there are better ways of educating where people learn more, and they don’t have to walk around exhausted all the time, and you can actually have more of a personal life.

—Emma L. Carew is a senior staff reporter.


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