UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
2007 REPORT TO THE WASHINGTON STATE MEDICAL ASSOCIATION
Thank you for the opportunity to provide an update on the activities of the University of Washington School of Medicine. The School has had an excellent year in educating its many students and trainees, working to advance scientific discovery, and promoting and providing quality clinical care for patients. This report highlights work in those areas and key initiatives and advances in our efforts to improve the School’s contributions to the state, nation, and world.
This year, the legislature recognized how far the University of Washington has fallen in state funding. The UW’s 2007-2009 operating budget is the largest biennial percent increase in state support in many years. The budget provides $6.3 million in state funding for the University’s Department of Global Health, a joint venture of the School of Medicine and School of Public Health and Community Medicine. Funding will support ongoing costs associated with departmental faculty and staff and will also support a new Institute for Health Metrics and Evaluation, described later in this report.
In addition, $3.8 million is provided to the UW in the operating budget to expand educational programs in Eastern Washington. The School of Medicine will establish a first-year WWAMI site in Spokane and the School of Dentistry will establish a new Regional Initiative in Dental Education (RIDE) program, with an initial site in Spokane.
We are very excited about the educational and research programs that this funding will make possible. The Washington State Medical Association was instrumental in partnering with us to achieve this success, and we are very grateful for the Association’s support.
Programs that advance learning
Vital statistics: The Washington State component of the entering 2007 medical school class had 731 applicants, with 104 accepted. The ratio of qualified Washington applicants to admissions is 7.1 to 1, a slight increase over the previous year. Overall, there were more than 4,500 applicants for 191 positions for fall 2007. Among all students, the entering class in September 2007 will be 52.6 percent female. The average age is 25 with a range of 20 to 46, and the average GPA is 3.68.
In March 2007, 155 UW School of Medicine graduating seniors participated in the National Residency Matching Program (NRMP) and received their residency positions through the Match. Ninety-six percent of the UW students matched with programs initially, and the remaining students secured positions in the post-match “scramble.”
Another 10 students who had previously graduated from the UW entered the matching program as well this year.
Forty UW students are spending their internship year in preliminary and specialty residencies at hospitals in the Puget Sound area; of these, 29 will be in UW-affiliated hospitals. Eighteen UW students will complete their residency training in programs in the WWAMI region; five will be in Eastern Washington.
Among specialties with the highest number of matches, 26 UW students matched to pediatrics, 21 to traditional internal medicine, 21 to emergency medicine, and 18 to family medicine. The percentage of students going into the primary-care specialties this year was 45 percent — nearly half of the medical school class.
The UW School of Medicine continues to lead the nation in primary-care training. For the 14th consecutive year, the School ranked first in the nation among primary-care medical schools, according to annual rankings of graduate and professional schools by U.S. News &World Report. For the 16th consecutive year, the School’s teaching programs in family medicine and in rural health ranked No. 1 in the nation. The School of Medicine ranked in the top 10 in teaching all eight specialties included in the rankings. In addition to family medicine and rural health, these programs are AIDS (No. 4), internal medicine (No. 6), geriatrics (No. 7), pediatrics (No. 8), women’s health (No. 10), and drug/alcohol abuse training (No. 10). In the research school ranking, the UW ranked sixth, moving ahead of Stanford, which last year tied with the UW at seventh. The MEDEX physician assistant program within the School of Medicine was ranked seventh in the nation.
While our leadership in primary care nationally is good news for the state and region, the percentage of students going into primary care, both nationally and regionally, continues to decline. We believe that this decline is caused by multiple factors, including lower reimbursement and longer hours for primary-care physicians. To address this issue regionally, the UW School of Medicine hosted a Primary Care Summit in May for educators throughout the WWAMI region, including regional WWAMI deans. Both difficult concerns and good ideas for promoting primary care were discussed at the summit. We are looking at a number of ways to bolster interest and commitment to primary care, and will have more to report over the upcoming year.
One of the key contributors to declining interest in primary care may be the extent of educational debt that medical students accumulate. In 2006, the percentage of students who graduated with debt declined slightly to 93 percent — down from 95 percent in 2005 — but the median medical-school debt at graduation rose to $105,202 in 2006. This is $10,000 higher than in 2005. Student scholarships remain an important avenue for cushioning students from debt. Promoting contributions to student scholarships remains a priority among the School’s development efforts.
The UW School of Medicine sponsors 81 accredited residency and fellowship programs with a roster of nearly 1,100 trainees. Major training sites are UW Medical Center, Harborview Medical Center, Puget Sound VA, and Children’s Hospital and Regional Medical Center. Eighteen medical centers in the Seattle area serve as affiliated sites, with additional training in numerous local and regional clinics and ambulatory sites. In addition, the UW-affiliated Family Practice Residency Network trains nearly 400 family medicine residents in programs in the WWAMI region; 11 sites are located throughout Washington.
UW residency training programs continue to rank among the top in the nation; as in previous years, most programs matched their top choices. Twenty-eight UW programs and tracks participated in the NRMP Match in 2007. All but 12 of the 202 available slots were filled, and the 12 vacant slots were filled in post-Match recruitment. Of approximately 300 incoming residents and fellows each year, about 40 are UW graduates. The Family Medicine Residency Network did well in the Match; only about five percent of the 130 available positions were unfilled in the first round and all filled in or after the “scramble.” The UW family medicine program matched 100 percent of its positions compared to only 88 percent filling nationally.
Key educational initiatives and milestones
In 1957, the UW School of Medicine’s first medical students began attending classes at temporary sites scattered across campus and throughout Seattle. In 2007, the School celebrated the 60th anniversary of the beginning of classes. This milestone was recognized in a number of ways throughout the past year, including a special program at the All-School Celebration Banquet in June and a well-attended reception at the annual meeting of the Association of American Medical Colleges (AAMC) that was held in Seattle in October for the first time in the Association’s 100+ year history.
The AAMC’s journal, Academic Medicine, the premier medical education journal in the world, marked the School’s anniversary and the annual AAMC meeting being held in Seattle by another first — an issue devoted to one medical school. Academic Medicine’s October 2006 issue featured eight articles on UW School of Medicine programs, initiatives, and activities — including the Department of Global Health, the School’s regional medical education approach, professionalism, multidisciplinary programs, the evolution of required research for medical students, Harborview Medical Center’s academic and underserved missions, and meeting the needs of regional minority students. Copies of these articles are available by sending an email request to maxter@u.washington.edu.
The addition of a Spokane WWAMI first-year site, which was funded through the state legislature, opens exciting doors for further expanding medical education in Eastern Washington. The AAMC anticipates significant physician shortages in coming years and recommends an increase in U.S. medical school graduates by 30 percent over the 2002 level. The new first-year WWAMI site in Spokane will help the state maintain an adequate supply of physicians, especially in Eastern Washington, by increasing enrollment of Washington students by nearly 20 percent.
The Spokane WWAMI site will be located on the Washington State University/Eastern Washington University Riverpoint campus. State funding will cover major renovations in the UW Health Sciences Building to accommodate increased numbers of students and will also provide additional departmental and faculty support. Mike Laskowski, who was WWAMI director at University of Idaho (UI) and Washington State University (WSU) for 14 years, is serving as acting director of the Spokane site while a search is completed to identify a permanent director. Three to five Spokane WSU faculty members will be hired for the site. In spring 2008, scheduling and support planning at the Riverpoint campus will be underway, with new faculty developing their first-year courses in conjunction with UW departments.
The first class of medical students will begin at the Riverpoint campus in fall 2008. This means that in the upcoming year, we will accept 20 additional Washington students for the new Spokane site. Eight new dental students will begin at the same time at the Riverpoint campus through the RIDE program. When the Spokane program is in full operation, there will be an additional 80 medical students training at any given time and 32 dental students. This creates wonderful opportunities for expanding the number of physicians and dentists in Eastern Washington and for building on the outstanding resources and infrastructure for teaching that already exist there. The WSMA has been instrumental in making this happen, and we are extremely grateful. There are, however, challenges remaining: the state funding did not meet the requested levels, and we hope to share additional developments with WSMA in the future.
The UW School of Medicine Colleges program also celebrated an anniversary milestone — as of June 2007, the innovative educational program is five years old. The Colleges program grew out of the School’s comprehensive curriculum review from 1998 to 2001 that called for a stronger focus on teaching our medical students basic clinical skills and on matching students with a faculty mentor who could follow their progress throughout medical school. The Colleges program consists currently of five Colleges, each with six faculty members. Each medical student is assigned to a College upon matriculation and, within that College, to a single faculty mentor. In the upcoming year, the Colleges will add a sixth college to accommodate students matriculating in the new Spokane first-year site.
All medical students are in Seattle for their second year and during this time, they work closely with their faculty mentor in learning basic clinical skills. Students work at the bedside one-half day each week, rotating through three Seattle hospitals with their mentor and small group of students. In those settings, they learn to take a history, complete a physical examination, perform an oral case presentation, initiate clinical reasoning, work on their ethical understanding and professionalism, and complete write-ups. After the intensive contact in second year, College faculty continue to track their students’ progress in third and fourth years of medical school as the students complete clerkships throughout the WWAMI region.
The successful Colleges program is being emulated by other medical schools throughout the nation, including Johns Hopkins, University of Minnesota, University of California at San Diego, and University of Arizona. At the five-year anniversary, the Colleges program has become a fundamental component of our educational system and has added immeasurably to our students’ skill development, satisfaction, and progress. We are indebted to the highly skilled College faculty who dedicate anywhere from 25 to 75 percent of their time to the students and this program.
Last year, this report discussed the launching of the Institute for Surgical and Interventional Simulation (ISIS), a collaborative effort of 18 departments within the School of Medicine, the schools of Nursing and Dentistry and the Department of Electrical Engineering. This institute provides the next generation of educational tools that make surgical and interventional procedures safer, with better outcomes for patients, by increasing precision and minimizing error.
ISIS has made tremendous progress since the 2006 report. The institute became one of the first simulation programs in the United States and Canada to be accredited as a Level 1 Comprehensive Education Institute by the American College of Surgeons.
The program recently moved from temporary quarters in the Health Sciences Building to permanent, state-of-the-art facilities in the UW Medical Center Surgery Pavilion.
The simulation institute has had a number of unique applications in 2006-2007. In perhaps the most unusual, Raven — the surgical robot developed at the UW — was tested by NASA. The robot, while located on the ocean floor in NASA’s underwater human habitat training facility in Key Largo, Florida, was remotely tele-operated by surgeons from the UW using commercial Internet communication. A bit closer to home, a number of visitors had the opportunity to try out the simulators at the UW, including Governor Gregoire.
For UW residents in training, a number of courses that use simulators are being offered through ISIS. These cover diverse procedures, such as central lines and chest tubes for general surgery interns, trauma ultrasound for general surgery R2s, thoracic surgery for R4s, shoulder dystocia for ob-gyn residents, and airway management for internal medicine residents and for anesthesiology residents. Simulation courses are also being offered for medical students, and four general surgery courses are offered for community practitioners in advanced techniques like laparoscopic-assisted colectomy. More information is available at the ISIS website at http://www.isis.washington.edu/
Programs that support scientific discovery
Vital statistics: Despite weakening federal support for research, the UW School of Medicine continued to increase its research support in fiscal year 2006. Total research awards from the National Institutes of Health (NIH) were $573.2 million — an increase of over $34 million from the previous year. The School ranked first among public medical schools nationally and second only to Harvard among all medical schools in research funding from the NIH. As shown in the graph below of top-funded medical schools other than Harvard (which is off the top of the graph), many leading schools are experiencing flattening of their research funding; in contrast, NIH funding for the UW Medicine faculty (the top line in the graph) has increased.
Key research initiatives: The Institute for Stem Cell and Regenerative Medicine, which brings together physicians, basic scientists, engineers, and bioethicists to understand the fundamentals of stem-cell biology and apply these principles to treat disease, received several major financial boosts in 2006-2007. Orin Smith, retired Starbucks president and chief executive officer, donated $5 million for the institute, and an anonymous donor made a gift of $1 million to the institute. These gifts were followed by donations from two Washington families that totaled $2.5 million, a $3 million gift from Michael and Lynn Garvey, and most recently, a $5 million gift from Tom and Sue Ellison. The total contributions to the institute now exceed $17 million. With more than 70 faculty from the UW, Fred Hutchinson Cancer Research Center, and Children’s Hospital and Regional Medical Center, the institute amasses the superb multidisciplinary team needed to achieve the goal of human tissue regeneration. The institute anticipates moving into its new quarters at South Lake Union in 2008, along with several other key research programs at UW Medicine. For more information about the institute, visit http://depts.washington.edu/iscrm/about/index.html
In last year’s report, we announced the creation of the Department of Global Health, a department operated jointly by the School of Medicine and School of Public Health and Community Medicine. The department, designed to improve health care and combat disease in Third World countries, was made possible by a $30 million commitment from the Bill & Melinda Gates Foundation.
King Holmes, a world-renowned leader in AIDS and infectious diseases research and training, became the founding chair of the department in November 2006. Holmes is director of the UW Center for AIDS & STD, head of the UW International Training and Education Center on HIV, and chief of the Division of Allergy and Infectious Disease at Harborview Medical Center. He is joined by Judy Wasserheit as vice chair. Wasserheit previously served as director of the Division of STD Research Branch at the National Institutes of Health and then as director of the Center for Disease Control’s Division of HIV/STD Prevention before coming to Seattle to direct the NIAID-supported HIV Vaccine Trials Network based at Fred Hutchinson Cancer Research Center. More information is available at the department’s website: http://depts.washington.edu/deptgh/
Although large amounts of money are being committed worldwide to international health programs, little is known about whether or how they succeed. Thanks to recent funding from the Bill & Melinda Gates Foundation, the new University of Washington Institute for Health Metrics and Evaluation (http://www.healthmetricsandevaluation.org/) will take on that task. The Gates Foundation is providing $105 million to fund the groundbreaking institute. This is the largest single gift that the University of Washington has ever received. The institute’s goal is to provide high-quality data and analysis on health needs and outcomes, and assess the performance of health programs. Christopher Murray, a world-renowned health economist appointed in May to the faculty of the UW Department of Global Health, will direct the institute. Dr. Murray was previously director of the Harvard University Initiative for Global Health, and is a former senior official at the World Health Organization (WHO).
The Institute for Health Metrics and Evaluation will focus on three areas:
• Health monitoring: Collecting and analyzing data on health indicators and trends, such as the prevalence of major diseases and the availability of health services;
• Program evaluation: Conducting independent, rigorous evaluations of the results and effectiveness of health programs;
• Dissemination: Making health data and information freely available to decision-makers, researchers, and the public.
When fully operational, the institute will consist of more than 100 faculty and staff. It will also establish an international network of collaborating research centers, and provide fellowships to train junior researchers.
The combination of the new Department of Global Health and the Institute for Health Metrics and Evaluation creates one of the world’s most powerful opportunities to advance health globally. It is a privilege to be involved in such remarkable efforts.
Programs that promote patient care
Vital statistics: Johnese Spisso has been named to the new position of clinical operations officer (COO) for UW Medicine and vice president for medical affairs (VPMA) for the University of Washington, effective July 1, 2007. The new COO/VPMA position was created to provide greater clinical and operational coordination among the clinical components of the UW Medicine system — the medical centers, clinics, and clinically active faculty. The UW Medicine system includes Harborview Medical Center, UW Medical Center, UW Medicine Neighborhood clinics, UW Physicians practice plan, and the UW School of Medicine.
In her new role as COO/VPMA, Spisso will provide executive leadership that supports the vision, mission and values of UW Medicine while fostering effective and efficient clinical program operations, growth, and development. Spisso was most recently chief operating officer at Harborview Medical Center.
Key clinical initiatives
Considerable work has been directed toward an initiative at Harborview Medical Center that is rolling out this summer: a new telemedicine initiative across many hospitals in Washington State. This initiative will allow hospitals to reach out to Harborview-based UW faculty for consultation on neurosurgical patients. Selected pilot hospitals will be able to send digital images to Harborview, which will enhance clinical decision-making surrounding the need to transfer. Some patients may be better served by remaining in their local community if surgical intervention is not appropriate. The program will promote further collaboration between UW Medicine neurosurgeons and local emergency departments. This is a creative way to both handle access management at Harborview and provide much needed neurosurgical expertise to the community. For more information contact Cindy Hecker at checker@u.washington.edu.
The establishment of a UW Medicine Clinical Neurosciences Institute is moving forward. The institute will involve a number of clinical departments, and will provide an opportunity to improve the coordination of clinical neuroscience services across UW Medicine, including stroke, neuron-oncology, cranial trauma and restorative neurosciences, congenital neurosciences, epilepsy and movement disorders, pain management, neurodegenerative disease, neuron-radiology, and others.
Faculty honors
UW School of Medicine faculty continue to receive accolades for their research, teaching, and service contributions. In the most recent major honor, Maynard Olson, professor of medicine and genome sciences, has been awarded the 2007 Gruber Prize for Genetics by the Peter and Patricia Gruber Foundation. Olson received this highly prestigious award for his substantial contributions to the human genome project and for applying genome science to biological problems like cystic fibrosis. He currently is studying how the bacterium that causes respiratory infections in cystic-fibrosis patients changes on a molecular level over the years. In its announcement of the award to Olson, the foundation stated that, “The human genome would have been an impossible jigsaw puzzle without his work.” He will receive a gold medal and $500,000 at the American Society of Human Genetics Annual Meeting in October 2007. In the past four years, three of the winners of this prize have been UW faculty. Mary-Clare King, professor of medicine and genome sciences, received the award in 2004 and Robert Waterston, professor and chair of genome sciences, received it in 2003.
Four UW School of Medicine faculty members were among eight UW professors named as fellows of the American Association for the Advancement of Science this year. The newly elected members from the School are: Charles Chavkin, professor of pharmacology, who was recognized for his contributions to the understanding of opioid peptide pharmacology; Evan Eichler, associate professor of genome sciences, recognized for his groundbreaking research on mammalian genomes; Philip Greenberg, professor of medicine and immunology, recognized for his contributions in pioneering the development of T-cell immunotherapy of cancer and understanding the regulation of T-cell immunity; and Buddy Ratner, professor of bioengineering and chemical engineering, recognized for his work on synthesizing, fabricating, and testing biomaterials for medical devices and implants.
Two UW medical school faculty members — Nobel laureate Linda Buck and infectious disease expert Judy Wasserheit — have been elected to the Institute of Medicine (IOM) of the National Academies. A UW clinical faculty member, Washington state health officer Maxine Hayes, was also elected to the IOM. The UW School of Medicine now has 31 faculty members in the IOM.
Mary-Clare King, professor of medicine and genome sciences, received the American Cancer Society’s highest award, the Medal of Honor. King was recognized for her pioneering work in the genetics of breast cancer; she is credited with proving the existence of the first gene for hereditary breast cancer.
Suzie Hwang Pun, assistant professor of bioengineering, received the nation’s top award for researchers in the beginning of their careers. Pun is one of 56 individuals in the nation selected for the 2006 Presidential Early Career Awards for Scientists and Engineers. Pun studies drug-delivery technology and how to use engineering, chemistry, and cell biology techniques to create materials that can transport drug molecules in tissues and cells.
Ruth Ballweg, chair and director of the MEDEX physician assistant program, has received the Washington Rural Health Association’s Outstanding Contribution to Rural Health Award. The award recognizes the role that physician assistants play in the fragile rural health network.
The Departments of Microbiology and Genome Sciences have been ranked at the top of their fields in a new index in the Chronicle of Higher Education. The index ranks faculty productivity in various categories, such as grants and awards, book and article publication, and citation of previous work.
We would like to congratulate Hugh Maloney on his election to the presidency of the Washington State Medical Association. Dr. Maloney, a clinical faculty member in the School of Medicine, is a talented and widely respected physician and administrator, and we are pleased that he is representing WSMA.
We would also like to thank all members of the WSMA for your ongoing support of the UW School of Medicine. Your support takes many forms — from backing important medical school initiatives in the state legislature, to taking a stand on issues important to the advancement of medical education, research, and clinical care, to the ongoing educational commitment of many WSMA members as clinical faculty, preceptors, and mentors for our trainees. We hear from our students and residents on a regular basis how important your support and mentorship are to them, and we appreciate the time you take from your busy practices to help shape the next generation of physicians.