2019 Duke University School of Medicine State of the School Address Part 1

Good afternoon and welcome everybody. By the number of e-mails I got apologizing for people not being here. I’m really happy of the turnout. I do realize this is a time of year of family travel and I want to make sure that I transmit as much information as I can in a very short period of time, because I can’t stand when people say I didn’t know. So I’m putting on my New York speed and really gonna go through a lot of stuff. But but I want to give everybody a sense of opportunities, things that are coming, and certainly welcome you to communicate with anybody in the dean’s office to get more information, because it’s a lot of stuff. Anyway there’s no question that the strength of our institution is really based on those who have chosen to spend their careers here and so it’s very fitting to start out by recognizing those who had such an impact on Duke’s trajectory who have passed away this year. So please take a moment. It’s quite an amazing group of people and I can say I knew most of them because I was a medical student here. I want to also mention that Brenda, we will be celebrating Brenda Armstrong this fall on the Medical Council the medical alarm weekend for her contributions to medical education. And then we just had the passing of Jim Weingarten. Jim was a chair of medicine both here and at Penn. He was director of NIH. He was an amazing iconic figure in academic medicine. And so we will have a chance to celebrate him down the road as well. Anyway start with my deans guiding principles One Duke and Service and I hope as we go through an incredible amount of information today you will see though that we are really pushing the concept that if we leverage everything that makes up Duke, we will have a major advantage and major impact. And if we don’t we will miss a big opportunity. And then certainly the concept of service. I really believe that the reason you have administrative structures is to provide service for our very very talented students and faculty and so we always have an eye on that as well. Big agenda. So I’m gonna go through a lot. So let’s get started. First of all new leadership. Hard to believe that Colin Duckett our vice dean for basic science has only been here a year I think he’s probably aged more than a year, in that time. He’s embraced the job and it’s a big job. But Colin came last summer. David Paige is our latest. David is here. David raise your hand. A recent recruit from University of Wisconsin to chair the Department of Biostatistics and Bioinformatics. Scott Soderling is not new to Duke but he became chair of the Department of Cell Biology this spring and Gerry Dawson also not new to Duke but has agreed to be the next director of the DIBS Duke Institute for Brain Sciences and Susanna Naggie joined the dean’s office as associate dean for clinical research initiatives and regulatory affairs. Now, Harvey Cohen has given up the reins for the Center for Aging, leadership transitioning to Heather Whitson. First of all, Harvey looks the same as he looked 40 years ago. So he he’s discovered the secret. It’s pretty amazing. But he has agreed that this was a prime time to turn over the reins to Heather Whitson. Now Harvey is not really giving up a lot because he virtually trained everybody that’s anybody in geriatrics medicine, so his influence will still be there which we’re very happy about. Leslie Curtis; she became a new chair last year. She didn’t know that she would also take on another leadership position. She has been functioning as interim director of the Duke Clinical Research Institute as we went through a very intensive strategic planning process preparing for a national search for the next director. DCRI has been an amazing entity that’s really moved the whole needle in clinical research but they’re about to enter a new very very exciting phase. So stay tuned for that, and thank you very much to Leslie. So let’s start with some honors there’s no way I can it can possibly hit all the honors that our faculty get. But I wanted to recognize a few. First of all Sue Jenks-Robertson was inducted into the National Academy of Science and just adding to that, a second woman from Duke was inducted the same year Susan Alberts who is a professor of biology on campus was also inducted. Jane Richardson received one of the highest honors in biophysics from the National Academy of Sciences as well. Distinguished professorships, I always kind of feel bad when I go to this dinner because School of Medicine dominates but one of the reasons is because we’re just so big and so we had many many of our faculty received distinguished professorships this year. In terms of other faculty honors some of the highest honors are the National Associations for Physicians Scientists and we had for inducted into the Association of American Physicians and two inducted in the American Society of Clinical Investigation. And have to remember our up and coming scientists and so we have had an internal award system called the Strong Start program which was funded by the Duke Endowment. And here we recognize five up and coming scientists for their promise with significant resources to facilitate their careers. And then we had four fellows inducted in the American Association for the Advancement of Science. So obviously our faculty are being highly recognized nationally, and there are many many more. But what about some milestones. First all buildings. Everybody knows there’s a new building MSRB3 which we went into in the fall of 2008. Not very creative in our naming of buildings so if you know donors, particularly donors that want names on building we are open for business. The next building to open is our Duke Health Interprofessional Education Building on Trent drive. This is going to be the home for a nursing, orthopedics, occupational therapy, and physical therapy. And the new Office for Interprofessional Education. So a very appropriate name for that building. Had a couple of changes in departments this may be subtle. The Department of Community Family Medicine has switched its name. Now to get a change of a department name is extraordinary here. It has taken a year but is now the Department of Family Medicine and Community Health. This is an important pivot to health as opposed to caring for those with with ongoing disease, and I think it’s really an indication of where we’re going in general, in delivery of care. And then just recently the division of Head and Neck Surgery and Communication Science was elevated to department status with Howard Francis taking on his division chief he’s taking on the role as interim chair as we go through a process of naming the chair. But part of that process has been a very detailed discussion with Allen Kirk participating, Howard participating, Ted Pappas, to really think about how do we structure a number of departments that are going to be be coming department status in the next couple of years, particularly being thoughtful about how we leverage resources. If we create structure in all these departments we really are not being very efficient. So we are going to create a section of surgery we’re still debating the name that will have a vice dean that will really be an umbrella for a number of departments that we think will be spinning out from largely surgery in the next couple of years. So lots of major initiatives many of them fall under our research plan, and I just wanted to remind you what that looked like. We went through about a year planning process that defined clear goals, then the core strategies to achieve those goals. And some very critical enablers that we must do in order to be successful. And then some of the initiatives that I’m going to go over
today they all mapped to at least the goal and at least one of those strategies. So long list, but we’ll get through them. First of all the Science and Technology Initiative, I
hope most of you have heard about this. This is a really exciting moment in the University’s history. Both campus and School of Medicine have decided to work together on both the fundraising initiative as well as a faculty hiring initiative that really targets basic science across campus. Now the whole process is very different
from how we normally identify faculty, because it’s somewhat centralized. Centers and institute directors and chairs can nominate candidates but it’s not restricted to one area, it’s really broad for a lack of better description. It’s looking for best athletes that really will enhance the current exciting level of science here but are also community leaders in science. And so we convened a committee. Just look at the members of that committee. You’ll see there our National Academy members are Nobel laureates. You can imagine they are robust debates about the candidates and their science. But it is really working incredibly well. And in fact, we have had our first successful science
and technology hire Zizi as he’s called from the Carnegie Institution of Embryology. He’s a transposeon scientists that applies that work to both stem cell work as well as cancer. Really exciting. A top young scientist in the country. Now how are we going to support this? rRight from the beginning we said it is not going to come from current resources that
go to fuel departmental hires. And so we are really dependent on philanthropy and I’m really really happy to announce, first of all in the spring of this year a very significant Duke Endowment grant that was given to both campus and School of Medicine, but very very recently the board of directors of the health system committed 50 million more dollars for this initiative. So I want everybody to think about
this. This is the board of directors of our health system not of the School of Medicine. And yet they clearly recognize the importance of discovery science in all that we do, and I think that was an extraordinary
commitment. So we are well on our way to both raising the money as well as recruiting the scientists. It is an ambitious goal. It’s not only about individuals it’s also about buildings. We are thinking of a greater than a billion dollar campaign ultimately. But as I said we’ve really started I think very well. Last year we announced that this school of medicine was very successful and both in NIH initiative and a Burroughs Wellcome initiative to fund creativity and innovation around enhancing the physician-scientists pipeline. We are the only institution that got two NIH 38 as well as the Burroughs Wellcome award. That allowed us to put all our resources together and stand up the Physician-Scientists Development Office under the dean to work with all the clinical departments to really enhance our pipeline of physicians-scientists from medical school through residency fellowship and early faculty. And so you can see the major pillars. They’re all about training programs, funding particularly third,, year captive audience as well as providing technicians support
during our resident and fellow training time which is quite innovative, developing guidelines so that all our areas of medicine can figure out how to work with their accreditation bodies to build
research training in the clinical years so you’re not doing this kind of detour of three to four years before a
scientist gets back to picking up their science. So this is very exciting and thank you Sallie and Rasheed for leading this. And Stephanie Feel for being such a great administrative
support. Now we did promise, as part of our strategic planning, that we would think about how to bring the community of faculty focus on genomics and genetics together. We came up during that process with the concept of a genomics collaboratory. And I’m very pleased to announce that Svati Shah has been named the new director and associate dean for that collaborator. So just give you a concept of what this is. It’s an umbrella, that really serves as a convener of the community of scientists that sit now across campus in every department, focused on genomics and genetics. They’ll be certainly academic events, particular invited speakers, seminars, data sessions, but a convening site and then resources that are used to recruit faculty, particularly faculty that the community thinks really fill in gaps, and to seed new initiatives. So I’m very excited about Svati’s leadership and more to come on that. As most of you know Gene Washington, when he arrived, he invested in five areas of multidisciplinary research called the translating Duke Health Initiatives. These were neuroscience, cardiovascular, immunology, early childhood, and cancer. And the idea was you bring a team of scientists, from basic science to implementation science together to really develop creative new approaches to some of our most challenging problems. This has been tremendously successful, you can see by the numbers a lot of internal grants awarded. I want to really emphasize that there is a lot of opportunity for internal funding. You have to read your emails you have to look at Web sites. More often than not I hear after the deadline. “I didn’t know.” So just look at the Translating Duke Health emails as one example. Over 2.5 million in seed funding to date. Lots of investment in infrastructure, lots of educational symposia that bring this very diverse group of scientists together. And I think the most tangible early result is really been seeding partnership hires. Sometimes it’s a small amount of resources sometimes it’s substantial that kind of closes the deal. And in fact that investment has already led to additional funding opportunities. That was the idea that new ideas come together, they started to really take seed, and then the next thing you know you have put together a group that can be very competitive for big funding opportunities and sure enough we are seeing that happen. So let’s talk a little bit about data science. That was a key goal that we would really have to up our game in data science and in fact if you looked at all the strategies almost all of them are dependent on a robust data science platform. If you think of our education, it’s dependent on a robust data science platform. So in thinking this all through, when I started as you might remember we recruited Rob Califf back to lead an entity that I called the “Health Data Science Center.” He decided to call it Forge. I don’t know maybe Eric can tell us what that what the connection is but it has really taken hold. If you look at the list of projects under the Health Data Science Center it’s it’s amazing. It’s everything from how to use use A.I. to more efficiently read images to how to use A.I. to figure out who are most vulnerable patients are that need very specific intervention in our health system. The idea was you bring together clinicians with data scientists and you can do remarkable work with access to the data. So that was the initial vision. Well this has become a lot bigger vision, because we realize that we have an opportunity to transform health. Being a leading center of health data science, particularly around machine learning and artificial intelligence. And so this concept of A.I. health at Duke I like that it’s easier for me to understand that and than Forge, really was the brainchild of Rob Califf and Larry Carin. Larry is the vice Provost for Research and an A.I. scientist himself. Now one thing that I didn’t know at the time is actually Duke is a top tier institution for A.I. research. And I think that is remarkable and a remarkable opportunity. And me always trying to leverage that opportunity to bring that power to health is something that I think Duke can do extraordinarily well. So that’s kind of the concept behind A.I. health. Getting a little bit down into the details, the mission is to empower health improvements in health care transformation from data and A.I. insights. It contributes to what Forge’s missions are around data liquidity, health system innovation, workforce development, misinformation which is one of Rob’s real focused issues, and then really the concept of red zones. That’s particularly relevant to the South, where so many of the the statistics around health are going in the wrong direction. So with that it’s about recruiting faculty. I did mention Dave Paige certainly as the B & B chair but also this is going to be a major focus of recruitment for their science and technology initiative. It’s about really fundamental A.I. research that will be done by those talented faculty. It’s about how do we implement the findings in our own health system, and that’s going to be largely through the constructs of learning health units that I’ll talk about in a minute. And ultimately it’s about improving population health, particularly as we transition to value based care. And then an education platform across the continuum of undergrads to very senior faculty. In fact Larry has already hosted two or three single day education opportunities for faculty that have been oversubscribed just to get a basic 101 on machine learning and A.I.. So this really is a one Duke initiative School of Medicine, School of Engineering. Arts and Science. DHS, OIT, all working together to build this umbrella that I think will have a tremendous impact. Now if you’re kind of a visual person which Gene Washington tells me he always is. This is what it looks like visually. Rob likes to say that A.I. is the fifth industrial revolution and the data and data science is the next electricity and it feeds in to everything that we do. So I think this is exciting. I think this is something that Duke can and should absolutely excel in and should have a tremendous impact particularly on the patients that we take care of in our own health system. Now I said the implementation arm of this vision are these learning health units that Adrian Hernandez and Michael Pencina have really been working on. What is this construct look like, where you can bring together most likely around service lines, cardiovascular surgery, clinicians, clinical researchers, and data science. There is no reason in the world why clinical research should be separated from clinical care. That is a very costly inefficient model and in fact if you really can bring this all together you are doing daily research as you care for patients. And frankly that would be a positive use of the EMR once we get there. So it’s really integrated teams of data scientists clinicians and clinical researchers to facilitate our care that we provide. And it’s kind of a circular process. An essential question comes up. You need the right data to answer the question. The right science to help you answer that question, derive an answer evaluate it, and ultimately implement it to have impact. So very exciting vision you can imagine going from the vision to actually this operational is kind of challenging but we’re getting there. So what is the long term vision and again this is really team’s vision not mine but really driven by Adrian. Current state: passive patients and clinical engagement. Future state: active engagements of patients and clinicians. Current state: challenging to make every encounter count to improve an individual’s health. Future state: we’re leveraging that real world data every day to provide evidence to improve the care of the individual as well as the care of a population. Current state: clinical practice is parallel to clinical research. Future state: it’s all embedded in the same system. And then ultimately these are not one-off studies that we do, but this data becomes a rich resource to improve care nationally. So exciting vision. And we’re building the pieces for that. A little bit more on data science, I announced last year that we were in a very interesting collaboration between Duke, Stanford and Verily. I think this went live two years ago Adrian? So it was many many years in the making, went live two years ago, and we have killed it. We we beat the enrollment timeline by I don’t know how much Adrian. We’re pretty far ahead which bought us a lot of credibility, working with an industry partner that had a lot of mistrust about what happens in academic. I mean mean that the reputation is that we’re inefficient generally, can’t make things happen fast. So this first step was really important. Now it’s really important for you all as scientists to understand this opportunity, because part of the agreement was that once we developed this rich data source on 2,500 individuals that had every omics platform. Constant monitoring, physiologic monitoring, imaging, all of this information available over four years worth of time. You will start to see individuals transition to disease and so it becomes a really rich resource to do hypothesis driven science off of the data which was not hypothesis driven. And we as a participating initial inaugural institution have a a leg up on the opportunity to use that data. So within the next year we’ll be launching calls for you to come up with ideas of what questions you might want to ask. And then again putting together teams to be able to address those questions. Now this was not done by one person there was a coordinating center run through DCRI, by Adrian Hernandez and also CTSI and then Svati Shaw was the PI, Kelly Markham was the coPI. A lot of time and effort went through in making this collaboration work but success breeds new opportunities and in fact now Verily trusts us a bit more and so we are entering into a new consortium which is a Baseline Health System consortium with Verily and some other academic partners. And the idea here is to develop technology and tools to really transform clinical research. So all very exciting. I was on a conference call with the Verily team and once I had my interpretation of the language which was quite different I think we all agreed that the the aspirational goal is one that we want to really partner on. We also participated and convened a Open Science Forum in Washington this winter. It was in February. The bold ideas that researchers and sponsoring entities share data from early clinical research early clinical phase trials with a larger research community, with other pharmaceutical companies, with industry, with government that if you really shared data, first of all, you could take huge costs out of clinical research, but really advanced the science much more rapidly. But you can imagine there are a lot of barriers to do tha. But the guiding principle that emerged from that meeting was that open science and data sharing in early phase research that’s needed and should be used to do better science. That ultimately can improve health. And one of the initiatives we’re starting right away is really coming up with creative ways that sharing data is recognized in an APT process, so that the idea of sharing data won’t disadvantage the scientists that actually shares the data, but will further their career as well. So one of the areas that we want to focus on was increasing commercialization and entrepreneurship. Just to give you a snapshot of how we’re doing them largely through Robin Rasor’s office working with our faculty. 222 invention disclosures this year, 53 patents issued ,73 licenses and most excitingly for new startups. And this is everything from apps to really tools and I think really showing the creativity and innovation of our faculty.

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