University of South Florida College of Medicine
University of South Florida
College of Medicine
LCME Institutional Self-Study
Report of Committee Two:
Institutional Setting: Academic Environment: Research/Graduate Programs/Basic Science
Study Year 2005-2006
The contents of this report represent the judgments and opinions of the members of this Self-Study Committee. The committee has made every effort to ensure that the information represented is accurate. The LCME administrators have not audited the data in the text of the report and there may be some discrepancies within the database or executive summary as a result. While every attempt has been made to provide and evaluate information accurately and objectively, the committee acknowledges that any errors of fact in this report are unintentional.
(Printed October, 2006)
Table of Contents
I. Executive Summary/Key Issues. 3
II. Responses to Questions in Guide to Institutional Self-Study 8
III. Analysis of Recommendations and Deficiencies Relevant to Committee as Identified by Most Recent LCME Review in 1999 15
IV. Major Changes since Last LCME Review in 1999. 18
V. Areas of Strength 20
VI. Areas of Concern and Challenges 21
VII. Review of Compliance with Established LCME Standards 22
VII. Recommendations, Possible Solutions and Strategies 29
IX. Issues of Concern Relevant to Other Committees 32
X. A ttachments 33
XI. Narrative of Process 33
XII. Database Accuracy 33
XIII. Committee Membership 33
Executive Summary/Key Issues.
Research
• Research, a major priority of the University of South Florida, is an essential and highly valued mission of the College of Medicine.
The University of South Florida is now one of only 95 public and private universities at the highest level of research universities as classified by the Carnegie Foundation for the Advancement of Teaching. Since the last site visit in 1999, university research funding has risen from approximately $171,000,000 to $287,000,000. Research funding for the college has kept pace, increasing from almost $64,000,000 to $113,000,000, approximately 40% of total university research funding.
• The college has a well-defined strategic plan to develop core facilities and resources committed to recruit a substantial number of new research faculty in the near future.
A new vice-dean for research was appointed in January 2006. The Office of Research in the college will be instituting several new programs to support research, graduate and post-doctoral education, and to assist faculty securing extramural funding. These plans include assisting with the preparation of grant applications, instituting an internal grant review process, and creating a significant infrastructure to support research. The University Research Council provides two cycles of competitive intramural research support each year, and college funding encourages faculty effort for pilot studies and grant application development. New Signature Programs in the college will provide additional seed funding for interdisciplinary research projects.
• The faculty in consultation with the Administration has identified four "Signature" research areas for targeted investment.
Institutional and faculty initiatives and direction-setting processes have identified four areas of current research strength as initial targets for investment in infrastructure and human talent. These four signature programs include Neurosciences, Cardiovascular Health and Diseases, Allergy, Immunology, and Infectious Diseases, and Cancer Biology. The signature programs will guide new faculty recruitment and the development of core facilities. Co-directors from basic and clinical disciplines have been selected to serve as program directors of these signature programs. Each signature program has been provided with seed funding to facilitate synergy and collaboration and create a “Community of Scholars,” which involve students and faculty interested in these disciplines. In addition, the following emerging areas of research interest have been identified: Women’s Health, Sports Medicine/Orthotics/Prosthetics, Biomedical Engineering, Nano/Regenerative Medicine, and Pharmacogenomics.
• The college promotes an environment of integrity in research.
The College of Medicine and USF Health have developed a code of conduct and expectations for faculty and staff and established an Office of Compliance which is increasingly incorporated in all activities of the Colleges of Medicine, Public Health and Nursing with full participation by the respective colleges through representation on the Professional Integrity Advisory Committee (PIAC). Full details are available at: . IRB and IACUC committees have grown to support COM research. The vivarium is AAALAC accredited and meets the current needs of the faculty.
Several offices at the university are involved extensively with research integrity and compliance. The USF Division of Research Integrity and Compliance provides seminars and workshops to faculty on “Becoming a New Principal Investigator,” issues of research integrity, scientific misconduct, human subjects’ protection, and conflicts of interest. The office also sponsors monthly meetings of the “research administrators” and bimonthly meetings of the clinical research coordinators. Doctoral graduate students receive training on research ethics and integrity as part of their training. Medical students receive training in ethics that includes aspects of research design, the history of research ethics, informed consent for research as opposed to treatment, the difference between research and practice, conflicts of interest, important codes (Nuremberg, Helsinki, and Belmont Reports), IRB structure and function, etc. Financial conflicts of interest are reviewed by an HSC Conflict of Interest Committee to determine the most appropriate action regarding a study.
Research - Opportunities for improvement
• Currently, there is a lack of research faculty at junior ranks.
• Research space is only marginally adequate to support the initial phases of a new faculty recruitment plan.
• The College of Medicine has inadequate core facilities.
• The status of F&A (“indirect”) cost returns to the college as a percentage has remained largely unchanged since the last review.
• There is a need for more conference rooms for seminars and presentations (50-100 person capacity) and audio-visual equipment (notebook computers, projectors, white boards, etc.) either located in the rooms or easily accessible.
• Specific concerns about the effect of pharmaceutical representatives and their practices on campus have frequently been expressed by students and faculty leaders.
• Accounting methods for grants and contracts from industrial sources such as the pharmaceutical and biotechnology industry result in discrepancies between the recorded awards in clinical research and the substantially smaller amounts actually collected. The primary reason is under-recruitment of patients in studies.
Graduate Education
• The PhD Graduate Program has evolved from one in which students enter directly into a basic sciences department or from a Neuroscience Concentration into a new Interdisciplinary Biomedical Sciences PhD program with a focus on four signature research areas.
There are currently 56 masters and 88 doctoral students enrolled in PhD and master’s programs in the basic sciences and other related disciplines as well as 23 post-doctoral fellows. Most PhD students receive an annual stipend of approximately $21,000 and in-state tuition wavers. A Graduate Certificate Program was started in 2004.
• The graduate program is evaluated by the faculty and external reviewers, both on an ad hoc basis and as part of periodic accreditation reviews. There is a standard evaluation process centrally administered for all graduate courses that includes students, faculty and departmental feedback.
Three external reviews of the graduate program in 2001, 2004, and 2006 have occurred since the last LCME accreditation visit. Following the 2001 review, a major college retreat led to the development of the Multidisciplinary Biomedical Sciences (MBS) track that combines strong biomedical sciences training with increased research opportunities for graduate students. A process of returning tuition generated to academic units for investment in identified goals of college programs was also initiated. The recent 2006 review supports the continued faculty-driven evolution of the PhD program with a substantial series of recommendations that are currently being discussed and implemented.
(See Attachment 1 - 2006 Review of PhD graduate program)
Graduate Education - Opportunities for improvement
• The recruitment process for graduate students can be improved.
• Standardized formats and criteria can be established.
• Increased program funding from stable sources for stipends, tuition wavers, and health insurance that promote program growth and anticipate changes can be made.
The White Paper from the 2006 graduate program review provides a comprehensive summary of recommended actions that are being reviewed and implemented.
(See Attachment 1 - 2006 Review of PhD graduate program)
Basic Science
The quality and quantity of the commitment by the faculty to medical and graduate education are excellent. The faculty also has a very strong record of community and public service at the local, state, and national levels, and in college and university governance. The college also has many productive funded researchers, and specific areas of strength such as the Neurosciences. However, overall there has been a lack of a critical mass in the various targeted research areas.
• New interdisciplinary basic science departments have been created through mergers of departments, and will be important components of a new School of Basic Biomedical Sciences within the College of Medicine that also incorporates core facilities and centers, and Signature Programs that integrate basic, translational, and clinical research.
• Faculty recruitment plans targeting goals in our Strategic Plan for Research have been implemented.
• The college is developing a program for mission based budgeting to align revenue sources with the major missions of the College of Medicine.
There has been attrition of basic science faculty in recent years, partly due to reductions in base budget funding from the state. Other concerns are equity of resource allocation, including finance, compensation, and space, faculty assignments relative to collegiate mission, and promotion and tenure relative to assignment and pathway. The college is developing an Asset Investment Management System (AIMS) to align revenues and expenditures and to improve the processes of faculty assignments and evaluation.
There are four faculty career pathways: tenure earning, clinician educator, research scientist, and scientist educator. Some faculty are reported to have the perception that those in clinical departments cannot effectively compete for new tenure-accruing support from state resources. The process of assuring appropriate assignment and evaluation at the departmental/divisional level continues to be a high priority in bringing accountability to the promotion and tenure process.
• Faculty development is a high priority
Development programs for faculty in the College of Medicine are provided primarily through the college Offices of Faculty Affairs, Professional Integrity, Research, Office of Educational Affairs, Information Services, HSC Library, Continuing Professional Education and the University Teaching Enhancement Center. Programs are offered on an ongoing basis and focus primarily on the following: orientation of new faculty, technical skill enhancement (IT and Library), and professional development addressing topics such as promotion and tenure, grant-writing and management, compliance and teaching skills enhancement.
The USF Health Leadership Institute started in January 2006 under the direction of the USF Health chief operating officer. Initial Leadership Institute participants will be College of Medicine faculty with the goal of expanding the class to include faculty from the Colleges of Nursing, Public Health and the School of Physical Therapy in 2007. The Leadership Institute is a component of a planned comprehensive faculty development program in the College of Medicine.
Basic Science - Opportunities for improvement
• Faculty perception of obstacles related to collaboration and integration of both education and research are related primarily to geographic separation of sites where faculty are primarily located as compared to USF Health on the campus of the College of Medicine and their assignment to competing institutional priorities in research, clinical care, and education.
The administration of USF Health and former deans have attempted to mitigate such issues by activities such as extensive use of email, video conferencing, and communications by the dean through publication of Items of Excellence (the IOE report), Counsel with Faculty Council, faculty meetings at affiliate sites in order to ensure local participation (i.e. specific meetings at TGH, ACH, etc.), codification of affiliation agreements , and the development of a resource allocation system, AIMS, to more equitably address resource allocation related to mission with accountability to the individual faculty member
The Environment for Medical Education
• The program leading to the MD degree is conducted in an environment that fosters intellectual challenge and a spirit of inquiry.
There are many opportunities provided for student attendance at faculty activities, including the following: the Dean’s Lecture Series presented on evenings on a quarterly basis; IBS (formerly) and Neuroscience Spring Seminar (currently) Series, Moffitt Grand Rounds and Seminar Series, ACH and Tampa General Hospital Weekly Grand Rounds, Cardiovascular Initiative Monthly Seminar Series, Cell Therapy Initiative Seminar Series, Departmental Seminar Series, Named Lectureships, External Dissertation Examination Speakers Series, Local Symposia organized or co-sponsored by faculty/USF, and Colloquia.
• Students have the opportunity to participate in research and other scholarly activities of the faculty.
The Summer Research Program includes eight weeks of full-time work in COM laboratories or clinical research settings on a variety of research projects. Students are required to write an abstract of their work, provide a report at the end of the summer and present at the next HSC Research Day, as well as at other scientific meetings. For the last several years, 30-40 % of each class has participated in this experience. Students are encouraged to present their research at the annual COM Research Day and are judged separately. During the fourth year of medical school, students also have an opportunity to continue or engage in research interests that they might have under the guidance of a faculty member in the college. Students can select research and independent study electives for up to five months in duration in their senior year. When senior “research” electives, independent study, and other activities are considered, an analysis by the dean of students indicates that among seniors graduating in 2006, 49/93 (53%) participated in research activities during their time at USF.
(See Attachment 4 - Numbers of first-year medical students in summer research program 1993-2006)
• MD-PhD program
In the past, an ad hoc program has provided several medical students and a resident with opportunities to earn the PhD. A formal MD-PhD program proposal is under consideration.
• Other students diversify the environment.
COM faculty provide opportunities for undergraduate students from various colleges and selected high school students to conduct research in their laboratories.
• Medical school faculty members are working more closely together in teaching, research, and health care delivery.
New Signature Research Programs provide a formal and structured environment to encourage close interdisciplinary collaboration between faculty and students from different disciplines, departments, and colleges. Through the HSC Direction Setting process COM Office of Research has also been involved in facilitating a number of other interdisciplinary activities in the HSC and university.
The College of Medicine has been awarded (on 9/1/05) a five-year NIH K30 Clinical Investigation Curriculum Development Grant which has been implemented as the "Scholars in Patient-Oriented Research (SPOR) Program."
In March 2006, an application was submitted to NIH for a planning grant to develop a center or institute of clinical and translational research at USF Health with a goal of applying for a full NIH Institutional Clinical and Translational Science Award (CTSA) by 2009-2010. These are annual multi-million-dollar grants that will create and maintain an Institute of Clinical and Translational Sciences to serve as a training site for clinical and translational research, as well as to provide leadership, infrastructure, core facilities, and other support functions and mechanisms. This institute will create productive and synergistic ways for basic and clinical investigators from all potential interacting areas to collaborate and develop long-lasting, robust, and innovative clinical and translational research programs the university.
• The College of Medicine faculty continues to develop active integration of the basic and clinical sciences throughout the four years of the curriculum.
The Profession of Medicine course at matriculation pulls together basic and clinical faculty to teach around a series of state of the art clinical topics (e.g., breast cancer and stroke) to model the collaborative process vis-à-vis translating bench research and basic science foundations to clinical practice. The Clinical Problem Solving course in the second year offers case studies with basic scientists and clinicians participating together as facilitators. In the fourth year program two required courses, Critical Care and the Integrated Clinical Neuroscience clerkships, each have “back to the basic sciences” modules in which our basic science faculty participate along side clinicians in case based conferences.
The Environment for Medical Education – Opportunities for improvement
Students already develop presentations on contemporary areas of research in several courses. Increased participation by medical students in lecture series, seminars, grand rounds, etc. needs to be more actively encouraged, but will be dependent on making time available in the curriculum. Related issues encompass the development of incentives that include recognition in students’ individual portfolios, and incorporation in individual student evaluations as a form of additional unique learning experiences that assist in the process of developing life-long learning skills to ensure competency as well as encourage collegiality and professionalism.
• A month-long clinical research clerkship has been proposed and an additional period of clerkship is available in the fourth year for students to focus on research. The college is planning a program of Scholar Concentrations that will be ready for the 2006-2007 academic year. The programs will provide opportunities for linking students with new college research Signature Programs that bring basic and clinical scientists together.
• Lack of training grants
• Outcomes assessment
The college must develop a better process to track outcomes of student research and its future impact, including such measures as publications, employment, and other student generated information.
Responses to Questions in Guide to Institutional Self-Study
5. Evaluate the graduate program(s) in basic sciences, including involved departments, numbers and quality of graduate students, quality of coursework, adequacy of financial support, and overall contribution to the missions and goals of the medical school. Describe the mechanisms for reviewing the quality of the graduate program(s) in basic sciences and comment on their effectiveness. Assess whether the graduate programs have an impact (positive or negative) on medical student education.
Committee Response: Since the last LCME accreditation, the PhD program in Medical Sciences has developed from a program in which students enter directly into one of six basic sciences departments to a portfolio of strong programs that now emphasizes admissions into a Multidisciplinary Biomedical Sciences (MBS) track. This evolution is continuing with the recent merger of the six Basic Science Departments into three new Departments within a new School of Basic Biomedical Sciences and a planned Graduate Program in Interdisciplinary Biomedical Sciences.
In recent years, the largest percentage of PhD students have been admitted into the MBS track. The MBS program was designed to combine strong biomedical sciences training with increased research opportunities. During orientation week for the incoming students, faculty members from all medical science disciplines present their current research projects. Without restriction to any one department, students are given the opportunity to choose three mentors of interest for a five-week laboratory rotation. A mentor can be chosen from among graduate faculty conducting research at the College of Medicine, H. Lee Moffitt Cancer Center, the Byrd Alzheimer’s Institute, the James Haley and Bay Pines Veteran's Administration Hospitals, All Children's Hospital, Shriners Hospital, and/or Tampa General Hospital.
In addition to the three five-week laboratory rotations, the fall semester of the MBS track involves participation in a core eight-credit course that provides an essential background in biochemistry, molecular biology and cell biology. A third course that includes training in research ethics completes the first semester curriculum. Students typically select a mentor by the end of the fall semester and by the spring semester will begin to follow more specific course requirements directed toward their selected research area.
Students admitted to the PhD program are well qualified, with average GPAs of around 3.4 (out of 4.0) in such majors as biology, chemistry, microbiology, etc.
(See Attachment 3 - Demographics of PhD program graduate students)
|Year of matriculation |2000 |2001 |2002 |2003 |2004 |2005 |
|Number of students |15 |15 |14 |17 |19 |20 |
| | | | | | | |
|Avg. UG GPA |3.27 |3.57 |3.29 |3.44 |3.39 |3.39 |
| | | | | | | |
|Avg. GRE |1254 |1215 |1171 |1133 |1108 |1195 |
It is noteworthy that in the last three years, an average of more than 40% of the graduate students matriculating were underrepresented minorities, as indicated in the following table.
| |
Most PhD students receive an annual stipend of $21,000 (increased $22,000 in 2006-2007) and in-state tuition wavers. Students are responsible for paying fees that include half of their health insurance.
Accepted students are typically guaranteed stipend and tuition support throughout their tenure, provided they make adequate progress toward their degree. Adequate progress is defined by such metrics as maintaining at least a 3.0 (out of 4.0) GPA, successfully passing a qualifying examination prior to admission to PhD candidacy, and successfully writing and defending their dissertation. Typically, central funds are used to support first year students. Some central funds are available to support students in subsequent years as necessary. However, there is a general expectation that stipends and tuition will be covered by competitive fellowships, research grants and other sources in the later years.
An associate dean oversees the graduate program. The program is evaluated by the faculty and external reviewers, both on an ad hoc basis and as part of periodic accreditation reviews. Details of such reviews are provided later in this report. There is a standard centralized evaluation process for all graduate courses that includes departmental, faculty, and student feedback.
Plans are currently underway to fully integrate the PhD program so that all incoming students would enter into a new Interdisciplinary Biomedical Sciences PhD program. Implementation of this new PhD program is planned for fall 2007. Newly designed common facilities that will promote medical and graduate student health and well-being which include recreational and social facilities and the Scholarly Concentration in Research and MD - PhD programs in development will further enhance these interactions.
7. Evaluate research activities of the faculty as a whole, including areas of emphasis, level of commitment, quality, and quantity, in the context of the school’s missions and goals.
Committee Response: The University of South Florida is now one of only 95 public and private universities at the highest level of research universities as classified by the Carnegie Foundation for the Advancement of Teaching. Since the last site visit in 1999, university research funding has risen from approximately $171,000,000 to $287,000,000. Research funding for the college has kept pace, increasing from almost $64,000,000 to $113,000,000, approximately 40% of total university research funding.
Research funding in the basic science departments is modest given the goals and aspirations of the college and university. Data from the USF Office of Research (“Crystal Report”) as of May 18, 2006 indicate that 25 faculty with primary appointments in the three newly merged basic science departments (excludes basic science researchers in other departments) are Principal Investigators on grants awarded in 2005-2006. The total research funding in the basic sciences has fluctuated over the last five years, reaching a peak in FY 2003-2004. The recent decline in funding may be attributable to several factors, including a lack of investment in new faculty and facilities for the Basic Science Departments in recent years, realignment of research faculty into the DIO, and national trends in funding.
|Departments |FY01-02 |FY02-03 |FY03-04 |FY04-05 |Mergers |
| | | | | | |
|Anesthesiology |524,732 |1,315,883 |1,726,839 |1,619,533 |719,362 |
|Aging & Brain Repair |1,139,843 |1,014,258 |1,055,325 |1,446,504 |2,746,429 |
|DIO |27,811,904 |30,766,155 |32,249,780 |7,248,897 |3,329,855 |
|DIO |0 |0 |26,313,042 |27,901,897 |0 |
|Family Medicine |353,362 |342,442 |319,257 |708,486 |384,847 |
|Internal Medicine |5,252,474 |7,784,274 |7,423,293 |7,471,670 |8,282,446 |
|Neurology |1,340,733 |3,033,511 |2,860,316 |3,413,464 |4,336,157 |
|Neurosurgery |1,090,160 |2,280,234 |1,807,738 |1,328,600 |201,965 |
|Obstetrics & Gynecology |718,892 |1,570,015 |663,040 |1,425,041 |1,218,384 |
|Ophthalmology |1,131,498 |2,601,904 |1,869,128 |737,185 |1,959,726 |
|Otolaryngology |739,281 |456,875 |433,425 |238,525 |0 |
|Pediatrics |5,904,147 |7,996,132 |1,0702,124 |30,586,677 |32,856,201 |
|Psychiatry |3,136,285 |2,820,515 |3,938,177 |4,381,400 |3,200,128 |
|Radiology |1,168,296 |2,105,492 |105,5541 |1,467,116 |19,895 |
| | | | | | |
|Total |50,311607 |64,087690 |92,417025 |89,974995 |59,255395 |
Research is an essential and highly valued mission of the college. Dr. Abdul Rao, Senior Associate Vice President for Research and Graduate Studies at USF Health and Vice-Dean for Research in the College of Medicine was appointed in January 2006. The college has a well-defined strategic plan to further enhance core facilities and to recruit a substantial number of new research faculty in the next several years. New interdisciplinary basic science departments have been created through mergers of departments, and will be important components of a new School of Basic Biomedical Sciences within the College of Medicine. In addition to the new streamlined departments, four signature programs or existing areas of strength have been identified within the college including Neurosciences; Cardiovascular Biology; Allergy, Immunology, and Infectious Diseases (AIID); and Cancer Biology. These programs cut across departmental, disciplinary, center, and affiliate boundaries to bring together both clinical and basic sciences faculty, staff, and students with similar research interests in order to enhance clinical, translational and basic science research, improve graduate and medical student education, and improve the quality of health care provided by USF Health and its affiliates.
The Signature Programs will guide new faculty recruitment and the development of core facilities. Co-directors from basic and clinical disciplines have been selected to serve as program directors of these Signature Programs. Each Signature Program was provided with seed funding to facilitate synergy and collaboration and create a “Community of Scholars” which involve students and faculty interested in these disciplines. The programs will provide new opportunities for team-building and greater participation in medical and graduate education.
8. Assess the adequacy of the resources (equipment, space, graduate students) for research. Evaluate any trends in the amount of intramural support for research and the level of assistance available to faculty members in securing extramural support.
Committee Response: Over the last two fiscal years, the College of Medicine has generated approximately 40% of extramural research funding at the University of South Florida which is now one of only 95 public and private universities at the highest level of research universities as classified by the Carnegie Foundation for the Advancement of Teaching. The next greatest contributor to university research awards accounts for only 10% of awards. The percentage of F&A (indirect costs) returned to the college remains the same as at the last accreditation visit, when it was recommended that the amount be increased.
The university research council provides two cycles of competitive intramural research support each year, and college funding supports faculty effort for pilot studies and grant application development. In addition, signature programs will provide seed funding for interdisciplinary research projects ($100,000 per year for each signature area). The vivarium is AAALAC-accredited and meets the current needs of the faculty. The machine shop facilities are adequate. Several core facilities are available in the college and at affiliated institutions, but there is a significant need for additional facilities. As part of the restructuring of Basic Sciences, the creation of the School of Basic Biomedical Sciences, and the revitalization of the Office of Research in the College of Medicine, we expect institutional support for faculty development in research endeavors to increase substantially. The new Office of Research in the college with a new Vice-Dean will be instituting several new programs to support the research enterprise and assist faculty in their abilities to secure extramural funding. These endeavors include the provision of assistance with the preparation of grant applications, instituting an internal grant review process, and the creation of a significant infrastructure to support research.
9. Assess the impact of research activities on the education of medical students, including opportunities for medical students to participate in research.
Committee Response: The participation of medical students in research enriches their experience and provides important opportunities to develop the knowledge and skills to critically evaluate medical and scientific literature and contribute to the development of new knowledge. There are numerous opportunities for medical students to participate in research.
Summer Research Program. For about fifteen years, the COM Office of Research has sponsored a Summer Research Program to first-year medical students who are matched with COM faculty members. For the last several years, 30%-40 % of each class has participated in this experience.
The Summer Research Program includes up to eight weeks of full-time work in COM laboratories or clinical research settings on a variety of research projects. Students are required to write an abstract of their work, provide a report at the end of the summer and present at the next HSC Research Day, as well as at other scientific meetings. Some of the students are continuing projects they have already started with faculty members during their first year, and most projects will require further work in the future. Many will have the potential for publication and presentations, once their work is complete. The dean’s office provides a modest summer stipend to each student who participates in this program.
To supplement the above program, the COM Office of Research holds an American Heart Association grant to support a summer research experience for medical students. Each year, three medical students are selected for this experience in a COM laboratory conducting cardiovascular related research. The AHA fellows are required to present their research at an AHA seminar, submit and present at the annual HSC Research Day, and develop a manuscript for publication. The AHA fellows frequently continue their research while completing their medical school training. The Office of Research follows the individuals who participated in the program and have identified a number that continue their research interests well beyond their residency and fellowship training and into their clinical practice.
Senior electives. During the fourth year of medical school, students also have an opportunity to continue or engage in research interests that they might have under the guidance of a faculty member in the college. When senior “research” electives, independent study, and other activities are considered, an analysis by the Dean of Students indicates that among seniors graduating in 2006, 49/93 (53%) participated in research activities during their time at USF.
Research Day. Students are encouraged to present their research at the annual COM Research Day and are judged separately. Several undergraduate students carry out their senior thesis with COM faculty, and compete for grants and awards under their mentorship.
MD-PhD program. An ad hoc MD / PhD Implementation Workgroup has developed a proposal for the MD / PhD Program in Medical Sciences that is currently under review and discussion by the faculty and administration.
10. Develop a composite assessment of the educational, research, and administrative service activities of the basic science departments, in the context of the mission and goals of the medical school. (In addition to department-specific data in the Faculty section of the database, see also responses for standards IS-11 and IS-12 in Section I of the database, and departmental finances and facilities described for standards ER-2 and ER-4 in Section V of the database.) Include the following areas in the assessment, noting any specific departments facing major challenges:
· Leadership (including stability of departmental chair positions).
· Faculty (including numbers, experience and expertise), in total and by discipline.
· Finances.
· Space and facilities.
· Quality and quantity of teaching, research, and service.
· Involvement and success in graduate education.
Committee Response: A major reorganization of the basic science departments and the development of a School of Basic Biomedical Sciences were completed in April 2006. Six basic Science Departments were merged into three (molecular medicine, molecular pharmacology, and physiology, and pathology and cell biology). Two chairs of former departments were appointed to three year terms to lead two of the new departments following an internal search. A search for a new “permanent” chair for molecular medicine has been initiated. This new structure will support and complement several cross-cutting interdisciplinary signature research areas.
The following table lists the numbers of faculty in the basic science departments.
|Revised 4/2006 |Full-Time Faculty | |
|Department* |Prof |Assoc |Asst |Inst/Other |Vacant[1] |Part-Time |
|Pathology and Cellular Biology |6 |4 |1 |5 |0 |0 |
|Molecular Medicine |17 |1 |4 |4 |1 |7 |
|Molecular Pharmacology and |9 |9 |2 |4 |2 |0 |
|Physiology | | | | | | |
|Physical Therapy |2 |1 |4 |7 |3 |2 |
|DIO Basic Science |9 |11 |28 |6 |11 |1 |
Teaching Responsibilities – Revised After Reorganization
| |Number of Courses Taught per Year* |
| |Medical Students |Graduate Students |Dental Students |Nursing |Physical |Undergraduate |
|Department** | | | |Students |Therapy |(baccalaureate) |
|Pathology and Cellular |2 |22 |0 |0 |1 |1 |
|Biology | | | | | | |
|Molecular Medicine |2 |30 |0 |0 |1 |0 |
|Molecular Pharmacology & |2 |25 |0 |0 |2 |1 |
|Physiology | | | | | | |
|Other (Physical Therapy, |0 |3 |0 |0 |37 |0 |
|Internal Med) | | | | | | |
*List only courses for which departmental faculty have primary and ongoing responsibility (e.g., reporting final grades to the registrar) Includes 4 courses pending approval as of 4/01/2006
** Replace indicated department names with names used at your institution, as needed.
***Report Pathology data here only if you report Pathology as a basic science department in the LCME
Finances are adequate, but there has been attrition of basic science faculty in recent years, partly due to reductions in base-budget funding from the state in recent years. Currently a majority (59 %) of basic science full-time faculty remains on fully state-funded positions without risk of loss of salary and are not dependent upon grant funds for a portion of their compensation. The college is developing a program for mission based budgeting (AIMS) to align revenue sources with the major missions of the college. This system will improve the connection between the allocation of resources and assignment, particularly related to the education mission. Over the short term, this discussion and planned implementation creates an environment that fosters increased accountability, but also anxiety and concern by faculty regarding perceived value of various activities. Because there is a goal to achieve national research prominence, there is pressure to augment research activities and an incentive plan has been put in place to increase these activities.
Research space is only marginally adequate to support the initial phases of a new faculty recruitment plan and the development of additional core facilities. Substantial additional research space and core facilities are essential to recruit and retain a strong faculty.
The quality and quantity of the commitment by the faculty to medical and graduate education are excellent.
There are many opportunities provided for student attendance at faculty activities which include the following:
The Dean’s Lecture Series presented on evenings on a quarterly basis
IBS (formerly) and Neuroscience Spring Seminar (currently) Series
Moffitt Grand Rounds and Seminar Series
ACH and Tampa General Hospital Weekly Grand Rounds.
Cardiovascular Initiative Monthly Seminar Series
Cell Therapy Initiative Seminar Series
Departmental Seminar Series
Named Lectureships
External Dissertation Examination Speakers Series
Local Symposia organized or co-sponsored by faculty/USF
Colloquia
The faculty also has a very strong record of community and public service at the local, state, and national levels, and in college and university governance. The college also has many productive funded researchers, and specific areas of strength such as the neurosciences. However, overall there is a lack of a critical mass in the various targeted signature research areas and inadequate core facilities.
Analysis of Recommendations and Deficiencies Relevant to Committee as Identified by Most Recent LCME Review in 1999
LCME Findings:
• Augmentation of space and facilities for teaching and research; and the results of strategies and tactics to enhance research in the institution.
• Steps taken to address problems of interim leadership, faculty attrition, residency program probation, and legal issues in the Department of Ophthalmology.
• The LCME also requests that the dean inform both Secretaries when an associate dean for research is appointed, and when vacant chairs in Anatomy, Neurology, and Ophthalmology are filled.
Committee Response: Finding: Augmentation of space and facilities for teaching and research; and the results of strategies and tactics to enhance research in the institution.
The college has new teaching space for team learning and evaluation of clinical skills. The Clinical Skills Assessment Center was renovated for education and teaching and provided state-of-the-art computerized clinical-care simulators. Ground will soon be broken for an advanced health care facility on the north campus and a second clinical COM facility is being constructed on the TGH campus. In addition, a major building project was completed in St. Petersburg consisting of the Children’s Research Institute (50,000 gross square feet with 30,000 net square feet of wet laboratory space) and the creation of a substantial research endowment for the recruitment of investigators. In addition, the H. Lee Moffitt Cancer Center also began construction of a combined clinical-and-research building completed in 2003 that accentuates the leadership position of the COM nationally in cancer research. The Byrd Center for Alzheimer’s disease research is under construction on campus. The Center for Aging and Brain Repair is moving to new research space adjacent to newly renovated Psychiatry research laboratories. There are major new facilities for interdisciplinary research and technology transfer in the research park. A conference center-hotel for advanced medical training is also planned for the park. Additional research space and core facilities on the COM campus, however, remain a major unfilled need. An Interdisciplinary Research Building and a Research Building for the COM are listed on the university’s “PECO” list.
Various strategies and tactics to enhance research in the institution were initiated including:
• Dr. Philip Marty was appointed in early 2002 as the Associate Dean for Research and has recruited individuals to facilitate grant development and management for faculty in the COM.
• Two large classrooms were renovated and lab spaces were upgraded in 2001.
• In addition, COM developed a research-incentive-compensation program which provides stipend supplements related to achievement of extramural, peer-reviewed research bearing full indirect cost ranging from $5,000 to $15,000 annually, based on the magnitude of the award(s).
However, attrition in faculty numbers within some departments has continued. A plan for consolidation, re-organization, and renewal of basic science departments is being implemented. The College of Medicine is committed to significantly growing its basic science, translational, and clinical research enterprises that contribute to improved preventive, diagnostic, and therapeutic outcomes in the field of medicine. Performance assessment and accountability are essential parts of our plan. No single metric offers a complete picture of the “state” of research at an institution. Biomedical research is expensive and requires a substantial infrastructure, so NIH rankings and “indirect cost” rates offer information about an important type of peer-reviewed research. As USF moves toward its goal of being a top 50 public research university, the College of Medicine should strive to increase its ranking among all medical schools in National Institutes of Health extramural funding from a rank of 79 (2004 Expenditures) to a rank of 60 by July 1, 2010. Achieving this goal will require doubling of NIH awards above and beyond the expected increase of universities currently ahead of USF. Other important indicators include citations of peer-reviewed publications, the number and quality of students and fellows who choose to study at the institution, and awards and prizes.
Finding: Steps taken to address problems of interim leadership, faculty attrition, residency program probation, and legal issues in the Department of Ophthalmology.
The status of the Residency Programs is described in the report by Committee 3.The Ophthalmology residency received full accreditation. By 2001, their match has been exceptionally competitive and fills easily with graduates of LCME accredited medical schools. There are no significant legal issues remaining with respect to the Department of Ophthalmology.
Previously noted vacancies in chair positions were filled. The college informed both Secretaries when an associate dean for research was appointed, and when vacant chairs in Anatomy, Neurology and Ophthalmology were filled. We received a letter from the LCME on October 8, 1999 indicating the LCME reviewed and accepted our report of August 19, 1999 on these matters.
1999 Survey Team Report: While not constituting violations of accreditation standards, there are opportunities for improvement in some areas:
• There currently is no process for the periodic review of departments.
Departments and chairs are reviewed annually by the dean. Uniform reporting formats now provide for a detailed discussion of plans and expectations for the coming year. Selected departments have had external reviews at the request of the administration. Chairs are reviewed by the faculty through surveys developed by the Faculty Council.
(See Attachment 2 from COO Kasti)
• The financial package for the recruitment of junior faculty members is well below the national mean. This could affect the college's ability to attract new faculty to support its research mission.
Since the last review, new research faculty have been recruited in clinical departments, including Pediatrics and the Center for Aging and Brain Repair. In recent years, a limited number of new tenure earning assistant professors have been appointed in the basic science departments, with 70% of their salaries at the 50th percentile of AAMC annual survey (70:30 with 70% “guaranteed after the first few years of employment and with tenure.) Dean Klasko has elevated the research mission to a higher priority. As noted above, a new Vice-Dean for Research, Dr. Abdul Rao was appointed January 2006. Current plans include basic sciences reorganization, new faculty recruitment with competitive, well-defined start-up packages, core facilities development, etc., all designed to attract new faculty to support the research mission.
• Almost one-half of indirect costs from research grants are retained by the University. In an environment of decreasing resources, these funds could help support the college's expanding research mission.
The status of F&A (“indirect”) cost returns to the college as a percentage has remained largely unchanged since the last review. More than half of the F&A costs continue to be managed and maintained in the university's Office of Research, although allocation and policies are under active discussion. Moreover, many grants formerly submitted through the college and university by members of the Department of Interdisciplinary Oncology are now submitted through the Moffitt Cancer Center, further reducing the return of indirect costs to the college.
1999 Survey Team Report:
At the time of the survey visit, a number of areas were in transition. These have the potential to impact the college of medicine and its educational program.
• The mission of the college of medicine has been revised to heighten the attention to research, a position that has received support from the University president. In order to enhance the research function, an associate dean for research is being recruited and funding is being sought for a facility to support clinical and outcomes research. Other changes, such as increased support for graduate education in the biomedical sciences, have been proposed.
• An Associate Dean for Research, Dr. Phil Marty, was appointed following the last site visit.
• Research remains a major priority of the university. Since the last site visit in 1999, university research funding has risen from approximately $171,000,000 to $287,000,000. Research funding for the college has kept pace, increasing from almost $64,000,000 to $113,000,000, approximately 40% of total university research funding.
• A School of Basic Biomedical Sciences is being developed to advance research and teaching missions. Faculty recruitment plans have been implemented.
• IRB and IACUC committees have grown to support COM research.
• The funding for the Office of Graduate Affairs has risen 5% since 1999-2000. Total Funding (state + UMSA + Fee Waivers) in that year was $1,281,747. In 2005-2006 funding was $1,348,124. In 2000 - 2001 twelve laptop computers were purchased for loan to graduate students. Students now have 29 computers available from the graduate office.
• In 1999, the Office of Graduate Affairs staff included a part-time associate dean and a full-time administrative assistant. As of July 2006, the office will include an associate dean, a full-time administrative assistant, a senior recruiting officer, an office assistant, and a director of the PhD graduate program. The new office will be the Office of Graduate and Postdoctoral Affairs.
• The Multidisciplinary Biomedical Sciences (MBS) track for graduate (PhD) students has been developed.
4 Major Changes since Last LCME Review in 1999.
Research
• The University of South Florida is now one of only 95 public and private universities at the highest level of research universities as classified by the Carnegie Foundation for the Advancement of Teaching. Since the last site visit in 1999, university research funding has risen from approximately $171,000,000 to $287,000,000.
• As noted above, an associate dean for research was appointed following the last site visit. A new Vice-Dean for Research Dr. Abdul Rao was appointed in January 2006. The college has a well-defined strategic plan to develop major core facilities and resources committed to recruit a substantial number of new research faculty in the next several years.
• The faculty in consultation with the administration has identified four "Signature" research areas for targeted investment.
• The College of Medicine and USF Health have developed a code of conduct and expectations for faculty and staff and established an Office of Compliance which is increasingly incorporated in all activities of the Colleges of Medicine, Public Health and Nursing with full participation by the respective colleges through representation on the Professional Integrity Advisory Committee (PIAC). Full details are available at: .
• The CRI at ACH is complete and provides research space for USF faculty. The Moffitt Cancer Center has a major new research tower and cores and the Byrd Center for Alzheimer’s disease research is under construction on campus. The Center for Aging and Brain Repair is moving to new research space adjacent to newly renovated Psychiatry research laboratories. There are major new facilities for interdisciplinary research and technology transfer in the research park. A conference center-hotel for advanced medical training is also planned for the park. Additional research space and core facilities on the COM campus, however, remain a major unfilled need.
Graduate Education
• The PhD Graduate Program has evolved from a program in which students enter directly into one of the basic sciences departments and a neuroscience concentration. In 2004, the Multidisciplinary Biomedical Sciences (MBS) track was developed. In 2006, a new Interdisciplinary Biomedical Sciences PhD program with a focus on the Signature research areas is underdevelopment.
Basic Science
• New interdisciplinary basic science departments have been created through mergers of departments, and will be important components of a new School of Basic Biomedical Sciences within the College of Medicine that also incorporates core facilities and centers, and Signature Programs that integrate basic, translational, and clinical research.
• Faculty recruitment plans targeting goals in our Strategic Plan for Research have been implemented.
• The college is developing a program for mission based budgeting to align revenue sources with the major missions of the College of Medicine.
Faculty development and communication
• Faculty development is a high priority within departments and additional attention to mentoring is an offshoot of the AIMS process. Faculty development programs in the College of Medicine are provided by the College Offices of Faculty Affairs, Professional Integrity, Research, Office of Educational Affairs, Information Services, HSC Library, Continuing Professional Education and the University Teaching Enhancement Center. Programs are offered on an ongoing basis and focus primarily on the orientation of new faculty, technical skill enhancement (IT and Library), and professional development addressing topics such as promotion and tenure, grant funding and management, compliance and teaching skills enhancement. The USF Health Leadership Institute started in January, 2006 under the direction of the USF Health Chief Operating Officer.
• Four faculty career pathways are as follows: tenure earning, clinician educator, research scientist, and scientist educator. Some faculty are reported to have the perception that those in clinical departments can not effectively compete for new tenure accruing support from state resources. The process of assuring appropriate assignment and evaluation at the departmental/divisional level continues to be a high priority to bring accountability to the promotion and tenure process.
• The administration of USF Health and prior deans have attempted to mitigate the geographic dispersion of the faculty by activities such as video conferencing, faculty meetings held at affiliate sites, extensive communication by the dean through publication of Items of Excellence, and many other approaches.
The Environment for Medical Education
• Students have increased opportunities to participate in research and other scholarly activities of the faculty.
• The college has new teaching space for group learning and evaluation of clinical skills. Ground will soon be broken for an advanced health care facility on the north campus and a second clinical COM facility is being constructed on the TGH campus.
• MD/MPH and MD/MBA dual degree programs have been established and a formal MD/PhD Program proposal is under consideration.
• Medical school faculty members are working more closely together in teaching, research, and health-care delivery. New Signature Programs in research provide a formal and structured environment to foster close interdisciplinary collaboration between faculty and students from different fields.
• The College of Medicine faculty continues to develop active integration of the basic and clinical sciences throughout the four years of the curriculum.
5 Areas of Strength
• Reorganization plan for the enhancement of basic research in the college
• The college is committed to and continues to develop an Interdisciplinary Biomedical Sciences Program that combines vigorous training with increased research opportunities for graduate students.
• The College of Medicine has been awarded (September 1, 2005) a five-year NIH K30 Clinical Investigation Curriculum Development Grant which has been implemented as the "Scholars in Patient-Oriented Research (SPOR) Program." Dr. Ken Zuckerman is PI and Dr. Phil Marty is Co-PI. This program is a very important step for USF COM in developing its ability to train academic patient-oriented researchers and to improve the overall research environment within USF Health.
The curriculum has been developed and applications are being accepted for the first class of trainees, which will begin July 31, 2006. The idea is for a selected group of up to 24 total physicians and other health care professionals per year of training with terminal health professional degrees (e.g., MD, DO, MSN, PharMD, Physical Therapy) to receive either a Masters or PhD degree in Medical Sciences with a focus in Patient-Oriented Research. Fellows, residents, and junior faculty members are eligible for the program, and their direct supervisors (training program directors, division directors, and department chairs) must guarantee that 75% of their time and effort will be protected for a minimum of two years for their research, education and career development activities related to this program. The core program will last for two years and will consist of 30 hours of core courses and additional mentored research (additional advanced courses, longer period of research, and higher level of research productivity required for the PhD degree). There will be many courses that all of the trainees in the SPOR Program must take (Research Ethics and Integrity; The importance of Diversity in Patient-Oriented Research; Medical and Scientific Communication Skills [writing and presenting abstracts, slide preparation skills, audience interaction skills, manuscript preparation, etc.]; Grantsmanship; Colloquium in Planning and Development of a Successful Academic Research Career; Biological Basis of Human Diseases; Basic Research Tools for Enhancement of Translational Clinical Research; Biostatistics and Informatics; Epidemiology, Theory and Practice of Clinical Trials Design). Other courses will be customized for the needs of the trainees (e.g., Cancer Biology; Immunology; Pharmacology; Pharmacogenomics; advanced basic science courses relevant to individual trainees’ research needs, Survey Research, advanced biostatistics and informatics, advanced clinical research study design). Because of the effort involved in creation and maintenance of many of these courses and because many other individuals in the institution would benefit from some of the individual courses, although they may not wish to seek a degree, we will attempt to make these courses available on an individual and space available basis for other trainees and faculty at the institution.
• In March 2006, an application was submitted to NIH for a planning grant to develop a center/institute of clinical and translational research at USF Health with a goal of applying for a full NIH Institutional Clinical and Translational Science Award (CTSA) by 2009-2010. These are annual multimillion dollar grants to support creation and maintenance of an Institute of Clinical and Translational Sciences, which will serve as a focus for all training specifically related to clinical and translational research, as well as leadership, infrastructure, core facilities, other support functions, and mechanisms to bring together in productive and synergistic ways basic and clinical investigators from all potential interacting departments, institutes, centers, and programs at USF, which may contribute to maintaining long lasting, robust, and innovative clinical and translational research programs in the university.
• Strong faculty development program.
• Social hours and seed grant programs to promote interdisciplinary research
6 Areas of Concern and Challenges
• Lack of Basic Science faculty at junior ranks.
• Research space and core facilities at the COM (reference above – responses to previous concerns).
• Need to expand seed funding for interdisciplinary programs.
• Lack of well-equipped adequately-sized conference rooms for seminars and presentations.
• Specific concerns about the impact of pharmaceutical representatives and their practices on campus have been expressed in several settings by students and faculty leaders. This area is of growing concern and needs substantive discussion and consistent (and enforced) policies.
• The discrepancies between awards in clinical research and the substantially smaller amounts actually collected. The primary reason is the method of accounting for grants and contracts from industrial sources such as the pharmaceutical and biotechnology industry. On the other hand, a contract may be negotiated with a biotechnology or pharmaceutical company, for example, for $5000 per patient for a maximum of 20 patients. Once this grant or contract is signed, the institution lists a grant for $100,000 ($5000/patient x 20 patients) in the current year. However, if only two patients are entered on the study and meet the criteria for payment that year, the institution receives $10,000 from the company. If the grant is not completed the first year, the same $100,000 grant or contract usually may be listed in the following year since it is still open, although perhaps accrual will end and no additional patients may be placed on the study. In contrast, an NIH grant for $500,000 over five years ($100,000 per year for five years) is listed in institutional research funding reports as $100,000 for each year, not the full $500,000 each year, which is the accurate way of reporting the real research support received.
• The need to offer students more research opportunities through programs such as the Scholarly Concentrations and the MD/PhD program, and for better outcomes measures on the percentage of medical college graduates who participate in research and academic careers.
• Lack of training grants.
• Lack of faculty lounge.
9 Review of Compliance with Established LCME Standards
IS-12. A medical school should be a component of a university offering other graduate and professional degree programs that contribute to the academic environment of the medical school.
There should be regular and formal review of all graduate and professional programs in which medical school faculty participate, to foster adherence to high standards of quality in education, research, and scholarship, and to facilitate the progress and achievement of the trainees.
Committee Response: There are currently 56 masters and 88 doctoral students enrolled in PhD and master’s programs in the basic sciences and other related disciplines. There are 23 post-doctoral fellows. There is a new Doctor of Physical Therapy Degree program. New programs in graduate Medical Sciences include the following:
1. Master of Arts in Bioethics & Humanities
2. Master of Science in Bioinformatics & Computational Biology
3. Masters of Science with a concentration in:
a. Pharmacology and Molecular Therapeutics
b. Biochemistry & Molecular Biology
c. Medical Microbiology and Immunology
d. Medical Microbiology & Clinical Immunology
e. Medical Science
f. Anatomy
There is also a Graduate Certificate Program started in 2004. USF COM offers six Graduate certificates (Aging and Neuroscience, Biochemistry and Molecular Biology, Bioinformatics, Biotechnology, Clinical Investigation, and Molecular Medicine).
The faculty of the College of Medicine, represented by the Graduate Medical Sciences Education and Graduate Student Affairs Committee, regularly evaluates the graduate program. Following an external review, a major college retreat on August 27, 2002 led to the development of the Multidisciplinary Biomedical Sciences (MBS) track that combines strong biomedical sciences training with increased research opportunities for graduate students.
Several external reviews of the graduate program have occurred since the last accreditation visit.
In 2001, the program was evaluated at the request of (then) recently appointed USF President Dr. Judy Genshaft. Dr. R. William Caldwell from the Medical College of Georgia reviewed the program and recommended development of an interdisciplinary program – this has been done, as noted above.
The 2004 SACS Accreditation process for the University of South Florida included a review of the graduate program. The university and graduate PhD programs received reaffirmation of their accreditation in that year.
An external review of the graduate program was completed in March, 2006. The review supports the continued faculty-driven evolution of the PhD program with a substantial series of recommendations (Appendix 1) that are currently being discussed and implemented. Opportunities for improvement include the recruitment process for graduate students, a more uniform set of qualifying examination formats and expectations, and increases in and more stable sources of program funding for stipends, tuition wavers, and health insurance to enable program growth and to meet the changing external environment.
The White Paper from the 2006 graduate program review (Appendix 1) provides a comprehensive summary of areas for improvement and recommended actions that are being reviewed and implemented.
IS-13. The program of medical education leading to the MD degree must be conducted in an environment that fosters the intellectual challenge and spirit of inquiry appropriate to a community of scholars.
Committee Response: A spirit of inquiry is intrinsic to the USF medical curriculum. In addition to the research opportunities enumerated elsewhere, students develop presentations and research papers on “hot” and contemporary areas of research in several courses, including Molecular Medicine, Pharmacology and the Profession of Medicine. Such activities will be further encouraged by the development of the new Scholarly Concentrations Program. Increased participation by medical students in lecture series, seminars, grand rounds, etc., will be dependent on making time available in the curriculum. Related issues include the development of incentives, including recognition of students’ individual portfolios, and incorporation of individual student evaluations as a form of additional unique learning experiences that assist in the process of developing life long learning skills and habits to assure competency as well as the encouragement of collegiality with one’s colleagues as a part of the development of professionalism.
Faculty, staff, and students in the College of Medicine are engaged in many areas of biomedical research. Institutional and faculty initiatives and direction setting processes have identified four areas of current research strength as initial targets for investment in infrastructure and human talent.
• Neurosciences
• Cardiovascular Health and Diseases
• Allergy, Immunology, and Infectious Diseases
• Cancer Biology
In addition, the following emerging areas of research interest have been identified: Women’s Health,
Sports Medicine/Orthotics/Prosthetics, Biomedical Engineering, Nano/Regenerative Medicine, and Pharmacogenomics.
These research thrusts are multidisciplinary because they promote teams that span both basic and clinical departments within the college and USF Health as well as driving new collaborative relationships with researchers across the USF campus and that include many partners in our community and throughout the state, the nation, and the world.
Four primary strategic initiatives have been identified in order to achieve the above research goals. These goals include:
• Improving resources of and financial support for research in the College of Medicine;
• Establishing a fertile research environment that encourages national prominence;
• Employing world-class researchers; and
• Improving Research Facilities and Equipment
Several offices at the university are involved extensively with the research compliance and related problems. The USF Office of Research Compliance provides seminars and workshops to faculty on issues of research integrity, scientific misconduct, human subjects protection and conflicts of interest. Their office is also responsible for following up on specific issues or allegations that come to their attention that involve faculty in the Health Sciences Center. The COM Office of Research is notified about ethical issues and makes informal reviews of the allegations. To supplement training of faculty, the COM Office of Research presents at least two seminars to new and/or interested faculty on “Becoming a New Principal Investigator.” This seminar reviews some approaches to successful grant-writing and gives guidance on compliance issues such as appropriate use of grant funds, conflict of interest issues, research integrity, and other related topics. The office also sponsors monthly meetings of the “research administrators” and bimonthly meetings of the clinical research coordinators to address administrative issues, changes in regulations from federal agencies, and concerns of the staff. Speakers are invited to provide information on USF procedures and rules for administering grants and clinical studies.
All doctoral graduate students receive training in research ethics and integrity as part of their training as noted above. All faculty conducting human subjects research are required to complete a program approved by the university on human subject’s protection. A number of courses are provided to meet this requirement which also includes the NIH web-based program. The USF Office of Research Compliance maintains a data base of faculty who present certification as having completed this training. In order to process a study involving human subjects through one of our Institutional Review Boards, this certification needs to be current.
Over the last two years, extensive efforts on the part of the College of Medicine administration has been made to inform faculty of conflicts of interest in research. An extensive policy is maintained by the Health Sciences Center and requires faculty disclosure of any conflicts of interest both of commitment and financial. Financial conflicts of interest are reviewed by an HSC Conflict of Interest Committee to determine the most appropriate action regarding a study. Human subject’s studies are scrutinized carefully. Appropriate management plans are required before a proposed study is processed through the Institutional Review Board.
The College of Medicine and USF Health, in particular, have developed a code of conduct and expectations for faculty and staff and established an Office of Compliance which is increasingly incorporated in all activities of the Colleges of Medicine, Public Health and Nursing with full participation by the respective colleges through representation on the Professional Integrity Advisory Committee (PIAC). Full details are available at the following link:
IS-14. Students should have the opportunity to participate in research and other scholarly activities of the faculty.
Committee Response: As previously noted above, students have numerous opportunities to participate in research.
• Summer Research Program
For about fifteen years, the COM Office of Research has sponsored a Summer Research Program to first-year medical students who are matched with COM faculty members. For the last several years, 30%-40 % of each class has participated in this experience.
The Summer Research Program includes eight weeks of full-time work in COM laboratories or clinical research settings on a variety of research projects. Students are required to write an abstract of their work, provide a report at the end of the summer and present at the next HSC Research Day, as well as at other scientific meetings. Some of the students are continuing projects they already started with faculty members during their first year and most projects will require further work in the future. Many will have the potential for publication and presentations, once complete. The Dean’s Office provides a modest summer stipend to each student who participates in this program.
To supplement the above program, the COM Office of Research holds an American Heart Association grant to support a summer research experience for medical students. Each year, three medical students are selected for this experience in a COM laboratory conducting cardiovascular related research. The AHA fellows are required to present their research at an AHA seminar, submit and present at the annual HSC Research Day, and develop a manuscript for publication. The AHA fellows frequently continue their research while completing their medical school training. The Office of Research follows the individuals who participated in the program and have identified a number that continue their research interests well beyond their residency and fellowship training and into their clinical practice.
• Senior electives
During the fourth year of medical school, students also have an opportunity to continue or engage in research interests that they might have under the guidance of a faculty member in the college. Over the past seven years, an average of approximately 4% of the senior class selects research electives each year.
• Research Day
Students are encouraged to present their research at the annual COM Research Day and are judged separately. Several undergraduate students carry out their senior thesis with COM faculty, and compete for grants and awards under their mentorship.
• MD-PhD program
In the past, an ad hoc program has provided several medical students and a resident with opportunities to earn the PhD Shortly after his arrival, Dean Klasko asked the faculty to develop a white paper for an MD/PhD program at USF. An ad hoc MD/PhD Implementation Workgroup has developed a proposal for the MD / PhD Program in Medical Sciences that is currently under review by the faculty and administration. Another group, chaired by Dr. Jeff Fabri, has developed a proposal for an MD/PhD program with the PhD in Biomedical Engineering. An MD/PhD degree in Cancer Biology is another appropriate option.
• Scholarly Concentrations Program
This new program for 2006 includes a concentration in research. The program will develop and enhance analytical thinking skills and decision making capabilities, provide mentorship and guidance to participating students, encourage the development of peer group interactions, incorporate self-directed learning and analytical skills into the practice of medicine.
IS-15. All medical school faculty members should work closely together in teaching, research, and health care delivery.
Because the education of both medical students and graduate physicians requires an academic environment that provides close interaction among faculty members, those skilled in teaching and research in the basic sciences must maintain awareness of the relevance of their disciplines to clinical problems. Conversely, clinicians must maintain awareness of the contributions that basic sciences bring to the understanding of clinical problems. These reciprocal obligations emphasize the importance of collegiality among medical school faculty across disciplinary boundaries and throughout the continuum of medical education.
Committee Response: The Signature Research Programs provide a formal and structured environment to foster close interdisciplinary collaboration between faculty and students from different disciplines, departments, and colleges.
Through the HSC Direction-Setting process, the COM Office of Research has been involved in facilitating a number of interdisciplinary activities in the HSC and university. These activities include:
• Research Collaborations facilitated by HSC Research Office
o Patient Safety (financial support from the USF Health)
o Hospice, Palliative Care, and End-of-life Issues (financial support from the USF Health)
o Florida Prevention Research Center (Health promotion/disease prevention) --provided grant review, letter of support, and expertise on grant efforts [we are currently looking at an RFA in which we can help develop a grant application with the Prevention Center and faculty in medicine (family and internal) and nursing].
o Biodefense/emerging infectious diseases (grant writing and support)
o Cell therapy (facilitate meetings, help with grant applications, support for research seminars)
o Florida Alzheimer’s Center and Research Institute (facilitated meetings to address affiliation)
o Aging (facilitated meetings, supported research seminars and mentoring program)
o Cardiovascular (facilitated planning of and provided support for the first annual symposium, scheduled meetings, supported seminar program, assisted with the developed proposals, provided letters of support)
o Pepin Heart Institute (helped propose a plan to initiate cardiovascular collaborative research with University Community Hospital and USF faculty)
o Biomedical Engineering (facilitated meetings, helped develop DARPA pre-proposal, wrote subsequent congressional earmark proposal)
o NASA Space Research (facilitated meetings, assisting with proposal, assisting with subsequent congressional earmark proposal)
o Diabetes & Cardiovascular Disease Collaborators (USF and ACH) Facilitate collaboration between basic and clinical scientists to find a cure for diabetes.
The USF Health Office of Research also works with the COM Committee on Research to plan the HSC Research Day usually scheduled for the later part of February each year. Students and faculty are provided opportunities to present their research at this event. Approximately 150 presentations are given each year with about 70% coming from students (both pre and post). We also have a featured speaker on a topic of current national/international interest to the HSC.
The COM Office of Research also worked with a faculty committee to organize a Cardiovascular Research Symposium expected to be held annually. Nearly 50 researchers from across the HSC and community provided presentations related to CV research. The faculty committee continues to meet and is engaged in planning research seminars and future symposia.
With support from Pfizer, the COM Office of Research sponsored a two-day grant writing workshop (May 21-22, 2004) for faculty, staff and student in the HSC and USF. Faculties from other universities in the state were also invited. Featured speakers included Dr. Anthony Coelho, Director, NIH Office of Extramural Programs, Dr. Craig Hanis, University of Texas Health Science Center at Houston, and Dr. John Sleasman, USF. For the NIH program held on the first day, attendance was approximated at 250. For the second day of more intense grant writing presentations, attendance was limited to 75 individuals. The Office of Research and Scholarship on the main USF campus has sponsored a summer 2006 grant writing workshop “How to Obtain Peer-Reviewed Federal Funding for Research: A Proposal-Writing Workshop.”
• Education
The College of Medicine faculty continues to develop a curriculum designed to engage students in courses that cut across traditional and emerging basic science disciplines and that tightly couple and integrate the basic and clinical sciences throughout the curriculum.
The Profession of Medicine course at matriculation pulls together basic and clinical faculty to teach around a series of state of the art clinical topics (e.g., breast cancer and stroke) to model the collaborative process vis-à-vis translating bench research and basic science foundations to clinical practice.
The course sequence after this introduction includes Molecular Medicine which integrates biochemistry and cell biology, followed by organ systems form and function where Anatomy (including organ histology and embryology) and Physiology are coordinated with Imaging and Physical Diagnosis. Attention then turns to the brain and nervous system in Medical Neuroscience and Introduction to Behavioral Medicine.
The second year offers a fully integrated program that includes Principles of Medical Immunology and Infectious Diseases, Pharmacology, and Pathology and Laboratory Medicine, and Physical Diagnosis. Joint cases that integrate basic principles and clinical problems bring together basic and clinical faculty in these courses throughout the first and second year. The basic and clinical faculty are also working together to develop common evaluation tools and examinations that emphasis the relevance of basic science material in clinical medicine through case vignettes. Students also develop presentations on contemporary areas of research and their clinical relevance in several courses.
The Clinical Problem Solving course in the second year also offers case studies with basic scientists and clinicians working together as facilitators.
In the fourth-year program two required courses, Critical Care and the Integrated Clinical Neuroscience clerkships, each have “back to the basic sciences” modules in which our basic science faculty participate along side clinicians in case based conferences. For example, in the Critical Care clerkship, there are case presentations on the evaluation and management of acute congestive heart failure and arrhythmias in which clinical cardiologists work with faculty members from the departments of pharmacology and physiology. Similarly, during the ICN clerkship, neuroscientists review the relevant anatomy as it relates to both the normal neurological examination and common disorders and disease states.
New Signature Research Programs provide a formal and structured environment to coax close interdisciplinary collaboration between faculty and students across different colleges. Through the USF Health Direction Setting process, COM Office of Research has also been involved in facilitating a number of other interdisciplinary activities in the HSC and university.
The new Scholarly Concentrations Program noted above will begin in 2006. This program aims to support the educational development of medical students by providing opportunities for scholarly endeavors in areas of special interest, including Research, Education Business of Medicine, Law and Medicine, International Health, and Epidemiology and Biostatistics. The program is an opportunity for students to acquire a “minor” in a field of academic relevance.
The College of Medicine has been awarded (September 1, 2005) a five-year NIH K30 Clinical Investigation Curriculum Development Grant which has been implemented as the "Scholars in Patient-Oriented Research (SPOR) Program."
In March 2006, an application was submitted to NIH for a planning grant to develop a center/institute of clinical and translational research at USF Health, with a goal of applying for a full NIH Institutional Clinical and Translational Science Award (CTSA) by 2009-2010. These are annual multi-million dollar grants to support creation and maintenance of an Institute of Clinical and Translational Sciences, which will serve as a focus for all training specifically related to clinical and translational research, as well as leadership, infrastructure, core facilities, other support functions, and mechanisms to bring together in productive and synergistic ways basic and clinical investigators from all potential interacting departments, institutes, centers, and programs at USF, which may contribute to maintaining long-lasting, robust, and innovative clinical and translational research programs at the university.
Increased participation by medical students in lecture series, seminars, grand rounds, etc. needs to be more actively encouraged but will be dependent on making time available in the curriculum. Related issues include the development of incentives, including recognition in students’ individual portfolios, and incorporation in individual student evaluations as a form of additional unique learning experiences that assist in the process of developing life long learning skills and habits to assure competency as well as the encouragement of collegiality with one’s colleagues as a part of the development of professionalism.
A month-long clinical research clerkship has been proposed and five months are available in the fourth year for students to focus on research. The college is planning a program of Scholarly Concentrations that will be ready for the 2006-2007 academic year. The programs will provide opportunities for linking students with college Signature Programs in research that bring basic and clinical scientists together.
• Faculty Development
Development programs for faculty in the College of Medicine are provided primarily by the college offices of Faculty Affairs, Professional Integrity, Research, Office of Educational Affairs, Information Services, HSC Library, Continuing Professional Education and the University Teaching Enhancement Center. Programs are offered on an ongoing basis and focus primarily on the orientation of new faculty, technical skill enhancement (IT and Library), and professional development addressing topics such as promotion and tenure, grant funding and management, compliance and teaching skills enhancement.
The USF Health Leadership Institute started in January, 2006 under the direction of the USF Health Chief Operating Officer. Initial Leadership Institute participants will be College of Medicine faculty with the goal of expanding the class to include faculty from the Colleges of Nursing, Public Health and the School of Physical Therapy in 2007. The Leadership Institute is a component of a planned comprehensive faculty development program in the College of Medicine.
• Obstacles
The perceived obstacles relate principally to geographic dispersion, equity of resource allocation including finance, compensation, and space, faculty assignments according to collegiate mission and promotion and tenure based on assignment and pathway.
Faculty perception of obstacles relative to collaboration and integration of both education and research are connected primarily to geographic separation of sites where faculty are primarily located as compared to USF Health on the campus of the College of Medicine and their assignment to competing institutional priorities in research, clinical care, and education. Those faculty at the H. Lee Moffitt Cancer Center are primarily engaged either in basic science related research with intense pressure to seek and maintain competitive federal funding and to achieve tenure on a classic pathway contrasted with clinicians who are assigned up to 95% in revenue-generating clinical activities yet are expected to demonstrate significant teaching and scholarly activities based on standards that may be disproportionate to their assigned faculty duties. Similarly, faculty at sites such as the Tampa General Hospital and All Children’s Hospital are geographically separated and often perceive that they carry a disproportionate share of USF Health’s revenue-generating activities in support of the overall mission of the College of Medicine. Faculty at the Children’s Research Institute in St. Petersburg, as basic scientists, are significantly distanced by geography and perhaps philosophy from their basic science colleagues and the Graduate Program in Medical Sciences at the College of Medicine and H. Lee Moffitt Research Institute and possibly the developing Byrd Center for Alzheimer’s Disease.
The current administration of USF Health and previous deans have attempted to mitigate such concerns by employing activities such as the following:
□ Extensive use of email for communication to all faculty at all sites
□ Extensive use of video conferencing which is expanding exponentially in its use to promote collegiality
□ Extensive communication by the dean through publication of Items of Excellence (the IOE report)
□ Counsel with Faculty Council to address faculty-related issues as they arise through a monthly forum which is video-conferenced to Tampa General Hospital and All Children’s Hospital locations
□ Faculty meetings are being held at affiliate sites in order to ensure local participation (i.e. specific meetings at TGH, ACH, etc)
□ Codification of affiliation agreements to reflect the nature of assignment of faculty to geographic sites
□ The development of a resource allocation system, AIMS, to more equitably address resource allocation related to mission with accountability to the individual faculty member
The four faculty career pathways are as follows: tenure earning, clinician educator, research scientist, and scientist educator. Some faculty are reported to have the perception that those in clinical departments cannot effectively compete for new tenure-accruing support from state resources. The process of ensuring appropriate assignment and evaluation at the departmental/divisional level continues to be a high priority to bring accountability to the promotion and tenure process. The AIMS process is being piloted in 06-07 and will contribute substantially to the achievement of this goal.
Recommendations, Possible Solutions and Strategies
Medical Education
The college has new teaching space for group learning and evaluation of clinical skills. Ground will soon be broken for an advanced health care facility on the north campus and a second clinical COM facility is being constructed on the TGH campus. MD/MPH and MD/MBA dual degree programs have been established and a formal MD/PhD Program proposal is under consideration. Medical school faculty members are working more closely together in teaching, research, and health care delivery. New Signature Research Programs and the Scholarly Concentration Program will provide additional opportunities for students and a formal and structured environment to coax close interdisciplinary collaboration between faculty and students from different fields.
• The College of Medicine faculty must continue to develop active integration of the basic and clinical sciences throughout the four years of the curriculum.
• The faculty shall provide medical students with an increasingly integrated curriculum and additional opportunities to participate in research and other scholarly activities.
• Provide more conference rooms with a capacity of 50-100 persons (e.g., for seminars and presentations) and audio-visual equipment (notebook computers, projectors, white boards, etc.).
• The college needs to review, revise as necessary, and enforce policies on pharmaceutical representatives and their practices on campus and where students train.
• The implementation of a formal MD-PhD Program should be considered.
• Increased participation by medical students in lecture series, seminars, grand rounds, etc. should be more actively encouraged but will be dependent on making time available in the curriculum. Related issues include the development of incentives, including recognition in students’ individual portfolios and incorporation in individual student evaluations as a form of additional unique learning experiences.
• The college must develop a better process to assess student research and its future effect, including such measures as publications, employment, and other student generated information.
• A new lecture series on Principles and Fundamentals of Clinical and Translational Research has been proposed for the Evidence Based Medicine Course (MS I & II) and should be considered. This project is designed as a step to create a new course, Principles and Fundamentals of Clinical Research, as part of an entire program in Clinical Research for medical students. This would be delivered initially as a part of the existing Evidence-Based Medicine course for MS I and II students through the College of Medicine. This course will serve to teach first and second year students in the College of Medicine the fundamental issues pertaining to clinical research. This program will be delivered in portions during two 3-week blocks, one presented to the first-year medical students and one to the second-year students. The program will use an award-winning pedagogy developed and utilized for the last 8 years at the USF Center for Entrepreneurship. The established course, Evidence-Based Medicine, demonstrates the importance of understanding and application of clinical research in the field of medicine. The goal is to develop a basic understanding of clinical research principles in medical students, many of whom may eventually be leaders on a clinical-research team. The importance of clinical research has been identified by the American Association of Medical Colleges (AAMC) as an important focus that should be emphasized in medical school curricula.
• A new month clinical research clerkship should be considered.
• The new program for Scholarly Concentrations should be supported and implemented in the academic year 2006-2007.
Research
The faculty in consultation with the Administration has identified four "Signature" research areas for targeted investment.
• Financial and administrative support must be provided to these Signature Programs in Neurosciences; Cardiovascular Health and Disease;, Allergy, Immunology, and Infectious Diseases; and Cancer Biology.
Each Signature Program has been provided with seed funding to facilitate synergy and collaboration and create a “Community of Scholars,” which involve students and faculty interested in these disciplines. The Office of Research in the college will be instituting several new programs to support the research enterprise and assist faculty in their abilities to secure extramural funding.
• These plans must include the provision of assistance with the preparation of grant applications, instituting an internal grant review process.
• The college must implement a well-defined strategic plan to develop core facilities and make a sustained commitment of the resources necessary to recruit a substantial number of new basic science faculty members in the near future and retain productive basic science faculty researchers.
• The college must refurbish, renovate, and develop substantial additional research space to support the recruitment and retention of basic science faculty.
• The college and university need to develop a plan to improve the return of F&A (“indirect”) cost funds to the College of Medicine.
• The university and college need to improve accounting methods for grants and contracts from industrial sources such as the pharmaceutical and biotechnology industry so that recorded awards in clinical research match amounts actually collected.
Graduate Education
Plans are currently underway to fully integrate the PhD program so that all incoming students will enter into a new Interdisciplinary Biomedical Sciences PhD program. Implementation of this new PhD program is planned for fall 2007. Newly-designed common facilities to promote medical and graduate student health and well-being include recreational and social facilities, the Scholarly Concentration in Research, and MD - PhD programs under consideration that will further enhance these interactions. The recent 2006 review of the graduate program supports the continued faculty-driven evolution of the PhD program with a substantial series of recommendations. These proposals must be reviewed by the faculty and administration. The committee offers the following recommendations:
(See Attachment 1 - 2006 Review of PhD graduate program)
• Develop a fully integrated graduate program.
• Improve the recruitment process for more well-qualified graduate students.
• Establish a more uniform set of qualifying examination formats and expectations for our students under the new program.
• Work to develop increases in and more stable sources of program funding for stipends, tuition wavers, and health insurance to enable program growth and to meet the changing external environment.
• Develop a credentialing process for faculty mentors.
• Establish policies for return of tuition funds from students outside the doctoral program to support development of the graduate program.
• The faculty should acquire training grants. The Office of Research and Graduate and Postdoctoral Affairs should facilitate and provide databases needed for the development of training grants.
Basic Science
• The college should continue to enhance and support the growth and development of a) the new interdisciplinary basic science departments created through mergers of departments, b) the new School of Basic Biomedical Sciences within the College of Medicine, and c) Signature Programs that integrate basic, translational, and clinical research.
• Faculty recruitment plans targeting goals in our Strategic Plan for Research must be sustained for the next decade to ensure a net increase of at least 57 basic science research faculty.
• The college must complete the development and implementation of the Asset Investment Management System (AIMS) to align revenues and expenditures and to improve the processes of faculty assignments and evaluation.
• Continue with the implementation of initiatives to support faculty development in the areas of teaching, research competitiveness and compliance, mentorship, and leadership.
• Continue efforts to mitigate the effects of the geographic separation of the faculty.
11 Issues of Concern Relevant to Other Committees
None.
12 Attachments
• Attachment 1 - 2006 Review of PhD graduate program
• Attachment 2 - Format for annual review of departments and chairs
• Attachment 3 - Demographics of PhD program graduate students
• Attachment 4 - Numbers of first-year medical students in summer research program 1993-2006.
XI. Narrative of Process
The committee met approximately twice each month from January to May 2006. The committee reviewed the database, suggested additions and changes, and mapped database material to the standards. The committee jointly discussed and developed responses for each section of the report, submitted queries to administrative liaisons, and reviewed and edited each section of the preliminary and final reports during meetings and by e-mail.
XII. Database Accuracy
Database sections included the required LCME database elements. The committee reviewed the sections appropriate to our deliberations. The accuracy of the databases was confirmed through committee discussions. As of May 2006, some data were pending (e.g., final report on research awards for 2005-2006, current and pending training grants, including individual trainees supported by grants or grant supplements).
Committee Membership
Bruce G. Lindsey, PhD, Self-Study Committee Chair
Professor & Chair, Molecular Pharmacology & Physiology
Burt Anderson, PhD
Professor, Molecular Medicine
Eric S. Bennett, PhD
Associate Professor, Molecular Pharmacology & Physiology
Faculty Council
Barry B. Bercu, MD
Professor, Pediatrics
Nagwa Dajani, MD, PhD
Assistant Professor, Neurosurgery
Faculty Council
Denis English, PhD
Professor, Neurosurgery
Director, Cell Biology/Center for Aging and Brain Repair Research
Peter Medveczky, MD
Professor, Molecular Medicine
Paul R. Sanberg, PhD, DSc
Distinguished University Professor
Vice Chair, Academic Affairs/Department of Neurosurgery
Kenneth E. Ugen, PhD
Professor, Molecular Medicine
Lynn Wecker, PhD
Distinguished Research Professor, Molecular Pharmacology & Physiology
Associate Dean, Research
Alison Willing, PhD
Associate Professor, Neurosurgery
Ken Zuckerman, MD
Harold H. Davis Professor of Cancer Research
Professor, Oncology, Internal Medicine & Molecular Medicine
Director, Division of Medical Oncology & Hematology
Josh O’Donnell
Graduate Student Year 3
John Curran, MD, Administrative Liaison
Senior Executive Associate Dean, Academic & Faculty Affairs
Joseph Krzanowski, PhD
Professor, Molecular Pharmacology & Physiology
Associate Dean, Graduate Affairs
William G. Marshall, Jr., MD, MBA, Administrative Liaison
Assistant Professor, Surgery
Associate Vice President, USF Health
Clinical Research & Venture Development
Philip Marty, PhD, Administrative Liaison
Associate Vice President, USF Health
Strategic Partnerships and Governmental Affairs – USF Health
Abdul S. Rao, MD, MA, DPhil, Administrative Liaison
Professor, Molecular Medicine
School of Basic Biomedical Sciences
Senior Associate Vice President, USF Health & research - USF
Senior Associate Vice President, Research - USF
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[1] Vacancies in former departments approved as of January 1 2006. Reorganization/consolidation of basic science departments may alter this allocation.
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