Advisory Panel on Research, May 2017 Meeting Summary

Transcription

1 Advisry Panel n Research, May 2017 Meeting Summary BASIC SCIENCE OVERVIEW (led by Rss McKinney, Jr., M.D.) What are yu mst cncerned abut? Use clinical margins, but thse are als disappearing Bth current and new Cmmn Rule are antithetical t the ntin f a learning HC system Public educatin and supprt fr science, als Cngress/decisin makers Thinking abut measuring research impact n HC delivery Bimedical health prfessinal pipeline and diversity at the faculty level, ur ability t recruit Hw d we synergize HC system needs with what academics need t d Ptential dilutin f academic schlarship esp. with lack f funding (e.g., the vanishing physician scientist) Separatin between scientific missin (ability t pursue funding) vs. what s happening n the health system. Junir faculty are getting caught in thse tw directins Sustainability is the real risk, sustaining discvery will change hw medicine is practiced and hw the public is treated in the face f s many pressures Value f diversity in ur respective prgramming- s many disparities and haven t figured ut a way t serve patients where they live and where they are Keeping ur instrumentatin and cre facilities at the level they need t be at fr investigatrs, including high perfrmance cmputing, etc. Critical Questins What des the future lk like fr basic science in schls f medicine? Des it matter that new schls usually dn t invest in basic science research? Is the educatinal missin served well by nn-researchers? Hw d we best serve the critical need t maintain ur basic research/discvery science? REARRANGING THE BASIC SCIENCES: CHALLENGES FACED BY BASIC SCIENTISTS (led by Barry Stein, Ph.D.) Presentatin Summary NIH funding at an 18% rate Career lngevity is lnger than the likelihd f funding

2 The plan t mve frward at Wake Frest is that there will be mre translatinal and clinical research, mre targeted, less discvery and basic science. Areas f fcus: besity, diabetes, Alzheimer s and cancer. Thse were nt areas f strength fr the institutin. Des it wrk t be a targeted place? Did a survey- peple recgnized that Wake is where the knwledge is, but that didn t mean that they were ging t the hspital Have decided that t make basic science an entity, research shuld ffset 75% f salary. Mst places say at least 50% f research effrt. Shrt-term thinking t address financial issues, creates lng-term issue f nt allwing scientists t be cmpetitive. Need lng-term financial planning t avid this. Mitigatin prgrams- 1 year f bridge funding fr salary, but nt fr labratry. Can t just mve smene ver t medical educatin. Likely scenari: basic science wn t disappear frm medical schls, but there will be a dramatic change in the structure f medical schls. Old mdel- training physicians. Other mdel- big research cmpnent, cmpeting with ther hspitals. Future f medical schls: Tp-tier will mve twards institutes, like Salk, where yu have researchers wh pay their way. Slutin : Use 10% f AAMC budget t educate public n what an academic medical center des. Ultimate gal is t get a 1-1.5% ffset in the HC budget. Discussin Arund half f my university s research is related t health. Prpsal aligns with current cncern ver public perceptin f value f science. Wuld this be better abut the value f an institutin in ding science that benefits the public s health? Truly having a brad impact wuld require partnerships beynd the AAMC Scietal issue- wh is ging t pay fr educatin and advances in medical science? Our ability t find crss subsidies is limiting and shrinking. External prblem exacerbated by internal issues- center f gravity shifting t hspital frm academic enterprise. What happens when the steward f the missin is separated frm the steward f the mney? There s n transparency abut what happens at an AMC- unless there is a crisis, they dn t care abut the science. Hw d we get messaging t the nt s general public? Public utreach is an imprtant idea- why wasn t research funding in the ACA? Als, at public universities, peple think the state is funding the institutin. (Military has huge R&D budget). T have this cnversatin, we need t knw what the right amunt fr sciety t spend. ML blg- evidence that the marginal dllar invested drps. There are a lt mre basic scientists nw- part f the reasn that peple are in truble. We can t cntinue with expnential grwth. Business f science being threatened? The mre we segregate basic science frm research as a whle, the mre it is at risk. And the mre we segregate research t the medical schl, and nt having the hspital appreciate that this underlies medical discvery, we put urselves at risk again. Need t wrk internallyhave t cnvince hspitals that their bttm line needs t cntribute t supprt f research. The mre it is seen hlistically as discvery medicine that supprts the entire academic enterprise, the easier it will be keeping it as a cre expectatin. Advisry Panel n Research Meeting Summary May 2017 Page 2 f 7

3 Trying t make a case natinally is very difficult, but we can d a much better jb lcally. Fr example, start educating bard f hspital, legislatrs, always have a basic scientist (vet the stryteller). We have a cmplicated stry and we are nt gd at explaining it t peple We need peple t have elevatr stries. And yu saw a brilliant start t a campaign if yu saw Jimmy Kimmel. The public is ne influence n Cngress, but industry is anther critical surce. N ne has mentined ecnmic impact- shuld this be part f making the case We are in the generatin f individualized cmmunicatin channels, and I dn t knw that we have enugh peple ut there and are nimble enugh t use this medium Hspitals d a gd jb f telling a stry, but SOM and faculty dn t have the discipline t pick a message and speak with ne vice Wh des the respnsibility fall t? Institutins? AAMC? NIH? MODELS OF BASIC SCIENCE & NEW MEDICAL SCHOOLS (led by Michael Friedlander, Ph.D.) Presentatin Summary VTC emphasis n entrepreneurial and translatinal science- als part f P&T prcess and engages graduate students thrugh NIH BEST 4 year MD prgram with intensive research experience integrated in medical schl, als interacting with graduate students Discussin Funding surces- why are all thse different places investing? Carillin- t build brand and reputatin, see it as a lng-term investment that will pay ff in health system referrals and successful prcedures- als have hired graduates f the med schl. VaTechwant t grw verall success in research, psitin themselves amng elite universities t attract undergraduates in technical fields- engineering, infrmatics Have yu lked at NRMN? We initially reached ut lcally t reach ut t HBCUs, d utreach prgrams etc. Have yu been able t measure the impact f the infusin f research and the cllabratin between graduate and med students? There have been publicatins with c-authr grad/med students, still cllabrating during residency. Have created nging relatinship. Mving frward, the real answer will be lking at hw engaged the physicians are in research after residency. Even if physician des nt take research track, still want them t be invlved in that prcess. D yu have plans t cmpare and cntrast with new places wh have nt made this investment in research? Great idea, buy-in might be challenging. Might be great prject fr the AAMC. Culd lk at Lerner, Cleveland Clinic. Vanderbilt. UVa. Is institute applying this t clinical research as well? Hspital has their wn research ffice where they have dne clinical trial wrk etc. Inst. prvides infrastructure fr clinical wrk Advisry Panel n Research Meeting Summary May 2017 Page 3 f 7

4 Has there been a change in the graduate educatin with the integratin? Trying t get a fcus n a 4 year PhD. By being with medical students, the graduate students becme mre interested in the medical side Have yu dne utreach in the lcal cmmunity? Supprt frm the business cmmunity, run utreach prgrams with thught leaders t cme in and speak t the general cmmunity s they can take a sense f wnership and pride Fr faculty, hw des institutin think abut the 50% that is nn grant funded? We re spending a significant amunt f that time in a mentrship rle. There is funds flw attached t that. Usual academic expectatin f setting up new research prgrams that are nt funded yet. Given decisin nt t g with MD/PHD track, have yu thught abut ding cmbined PHD/fellwship prgram? Have definitely cnsidered that. The tensin is the time that wuld be alltted fr the PHD. D have a prcess nw fr MDs t get a masters degree. RETURN TO DISCUSSION OF CRITICAL QUESTIONS (led by Rss McKinney, Jr., M.D.) Hw imprtant is it t have basic scientists wh are ding research in the educatin f physicians? Cncerned that this a false dichtmy. There is an entire dmain f clinical research that teaches critical thinking. Raises the questin f the value f research in the educatin prcess. Shuld AAMC be cncerned abut the stratificatin f medical schls? Medical students benefit when there are peple dedicated t teaching them the prcess f research Ptential leverage f AMCs is that we have verlapping triple missin. If yu pull thse pieces apart, yu disenfranchise each f the ther tw cmpnents. There aren t many AMCs in relatin t ppulatin, and prducts f the wrk serve everybdy. Thse cmbinatins are a critical asset fr us and we need t leverage up, nt dwn. Individual pieces are mre valuable cnnected than separated. Challenge is t financially make that happen, we set at ur institutin centralizatin f the educatinal missin, as peple are paid fr teaching units. Challenge is taking faculty wh are prductive in research and trying t attach them t educatinal value units. Better ROI if they were kept in research missin. Financial incentives push everything apart. Nt s much a false dichtmy, but the educatinal missin is a vague term based n what educatin represents in the real wrld. Fr example, didactic vs. case-based learning. Very different mdel. In the hspital, very difficult t fcus n teaching. Als, as lng as we have curriculum set up in prescriptive way, nt the best use f scientist s time. Is it a weaker argument than it has been histrically that we need basic scientists t d the teaching in medical schls? Sme f the best basic scientists are crappy teachers. Als really need t fcus curriculum and avid redundancy. It s abut research, discvery, infrmatin. It can t always be abut the exact infrmatin yu need t learn. It s abut curisity and engagement. Advisry Panel n Research Meeting Summary May 2017 Page 4 f 7

5 Missing questin: des it matter that all medical schls are underinvesting in teaching abut the imprtance f clinical evidence. Shuld be missin f AAMC t diminish that level f ignrance. Dn t assume that research is basic research, it shuld mean a lt mre than that. What is the likelihd that schls that d nt have research prgrams will develp medical students with the same quality/prficiency? As we change educatinal mdels, is the impact n educatin nt as striking? Differentiatr: are yu training students wh nly knw the prtcl, r really teaching peple the underlying mechanism f disease (knwing hw t fly a plane vs. knwing what makes a plane fly). Des it make a different in the prduct? Yes. Abut 150 medical schls nw. Abut half that invest in basic science research (departments, PIs, discvery). Anther half that dn t d this, but will have basic medical sciences educatin- minimal expsure. If this is nt addressed, the secnd half will just be treading water, and will bring dwn enterprise as a whle. THE APR: WHAT IT SHOULD BE AND DO (led by Rss McKinney, Jr., M.D.) Discussin Need fllw-up n prductive discussins frm meeting Develp 2-3 actin items, revisit at the next meeting, see if there has been prgress Hw can AAMC affinity grups get invlved? (e.g., hw are peple putting tgether and priritizing basic science peratins) Hw des APR infrm agenda f the Bard? Hw des CSO use cnversatins t shape AAMC agenda? Cme at this within the standpint f mentring- hw can AAMC enlarge cnversatin t CFAS Appearance that bard is less invlved in research tpics (may be because agenda is determined n incident basis, things that demand attentin, may nt be fundamental issues) Grup deals with very high level challenges (hw d we pay fr research, change educatin and public views)- we need t cme tgether t make a difference THREATS TO THE RESEARCH ENTERPRISE (led by Rss McKinney, Jr., M.D.) Discussin NIH prpsal t cap funding by GSI Give NIH credit in prviding evidence in supprt f this- AAMC shuld see if there is a better measure that they are basing things n, that gives a different cnclusin. When Cngress is asking NIH why they have nt slved issues, a diversity f thught is needed and s is a diversity f investigatrs. NIH is already ding an experiment in this area-mira, we like that apprach better because there s a carrt and nt just a stick- why aren t they expanding this? Shuld brader impact be brught int discussin- may cause issue f lking at shrt-term impact. Advisry Panel n Research Meeting Summary May 2017 Page 5 f 7

6 Review grups shuld be able t decide n case by case basis that there are diminishing returns. Issue that if yu are a PI n T32, that will cst yu several pints. Als, investigatrs have reached ut beynd NIH (e.g., DOD, fundatins). NIH is nt the center f the research universe. Inference is that if yu have multiple grants, yu will nt d as well. Hw will study sectins respnd t that? Cncerns abut implementatin. Need a better apprach fr develping this system as well as frequent evaluatin. NIH shuld treat this as a scientific inquiry as t which measures t use. Guess that it will be a net zer (bth gain and lss) fr institutins, but sme individuals might lse ut. Nn-research intensive institutins will be hurt if they have nly a few PIs wh are supprting the rest f the prgram. Advice n Discussing F&A- Prpsal t cut indirect csts t get t $6B NIH cut. The research enterprise f private institutins is part f a public missin- clarify that these dllars are being utilized fr a public gd. Als ecnmic impact- if remve the indirects, lse 2100 jbs. Specific and rigrus prcess t negtiate and validate F&A csts- institutins are audited t ensure they meet expectatins. Indirects wuld be cunter t gal f diversify because it wuld cme dwn t endwments and state budgets. Need t educate faculty, because they assume that these are the margins. The separatin between institutins (we are capped n the administrative side) and research institutes F&A rate lks like urs des in terms f expense, but they are paid in full fr thse csts. We are a bargain relative t industry. The attentin n the issue is there, it s nt ging away. Hpe is nt an executable strategy. Let s make sure that we can defend the csts. Whle reasn fr having the frmula was nt t break it dwn by grant. Lessn t be learned frm IME- hspitals have had truble defining where the mney ges. Hw much d yu pay ver the NIH cap (vs. startup, bridge funding)? Need t make case f the legitimate things we pay fr. The mre csts g up, institutins are less able t cmpete. Have an unstable state in pstdc ecsystem. D we have the data n what happens t pstdcs? Hw d we define pstdcs? They are in a pst-prfessinal state. T the academic affairs peple, they are nt a student they are an emplyee, and that prevents actin- need t think abut wh has authrity within the institutin. Nbdy really has authrity unless there is a pstdc ffice, but nt all the same rules are applied because f hw they cme in. Advisry Panel n Research Meeting Summary May 2017 Page 6 f 7

7 It s a very hetergeneus issue, it s very difficult t get yur hands arund what s ging n in the cuntry as a whle. What abut staff scientist mdel? Need the evidence base n pstdcs t be able t make arguments. Cntinue t push cmpacts as a desirable best practice. LEGISLATIVE UPDATES (led by Karen Fisher, J.D. and Tannaz Rasuli) Fr FY18, we need t put aside the president s budget and use FY17 plus $2 billin as the starting pintdn t want this t reframe the message we ve wrked t cnvey t Cngress. Need educatin n F&A with a new administratin and new cngress. NEXT STEPS (led by Rss McKinney, Jr., M.D.) Cntinue cnversatin n basic research. Will prvide updates n GSI. Any additinal inf n pstdc data issue? Helpful t give institutin inf n wh is invlved at AAMC. Identifying peer grup thrugh faculty engagement survey. Advisry Panel n Research Meeting Summary May 2017 Page 7 f 7