AIMING HIGH | From the Office of the Chancellor

We are all familiar with the game show “Jeopardy!” Of the different types of “championships” on this program, you may be aware of a “College Jeopardy!” Championship, which features undergraduates from U.S. colleges. But did you know that the Triological Society, a prestigious organization within the field of Otolaryngology - Head and Neck Surgery (which we will call “ENT”), holds a national “Resident Bowl” quiz game? And did you know that ENT residents at LSUHS recently won first place? Yes, that happened! At the 2025 annual meeting of the Triological Society, our ENT residents beat out 11 other teams, including Johns Hopkins, Harvard, UCLA and others.

The 2025 annual meeting was held in Orlando. It was a great opportunity for ENT faculty members and residents across the nation to present research and share experiences. This year, eight LSUHS medical students won travel award from the Triological Society to present their research. Within the meeting, the ENT Resident Bowl showcases the clinical knowledge, quick thinking and teamwork of three ENT residents from each program. A fun part is that teams wear a thematic costume. Our team found out that they would be competing only the week before, so they didn’t have time to prepare a costume. Instead, they dressed “business casual,” and said that they dressed as “Dr. Nathan’s Favorite Residents.” Moderators ask multiple-choice scientific questions and allow teams 12 seconds to choose their answers. Teams then hold up an A, B, C, or D to indicate their responses. The first round consists of 25 questions, and the three highest-scoring teams move on to the final round. This was played in elimination fashion. All teams started with three oranges. Every missed question cost an orange. In the end, the other two teams were left with no oranges and were eliminated, leaving the LSUHS ENT residents as the winner of the Resident Bowl. (Or should it be called the “Orange Bowl"?)

The performance of our ENT residents in this ENT Resident Bowl is awe-inspiring. Winning first place no doubt speaks to the extraordinary intrinsic talent and capabilities of our residents, but also speaks volumes about how Department Chair Cherie-Ann Nathan, MD, Resident Program Director Michael Yim, MD, and all the other departmental faculty bring out the best in their trainees. From speaking with the Resident Bowl team, another contributing factor is the camaraderie among residents in which they help each other learn and grow – personally and professionally – throughout their program.

So, who are these amazing ENT residents?

Joel Badders, MD, PGY1

Dr. Badders grew up in Nacogdoches, TX. Having developed a passion to help people and wanting to have a meaningful career, at 18 years old he decided to pursue medicine. Shortly after graduating from Baylor University, he married his now wife, Bridgette, and started a family. Dr. Badders developed an interest in ENT while attending University of Texas Medical Branch (Galveston) for medical school. He completed an away rotation at LSU-Shreveport and was impressed by the camaraderie and robust surgical training in the ENT residency program. Having matched here for residency, Dr. Badders comments that he “has been incorporated into a culture of pursing excellence and teamwork, the same culture that led to winning the Trio Society resident bowl.” As a first-year resident, he reports that he “feels fortunate to follow Mallory and Mark’s example.” His tip for next year’s participants is to “have smart upper-levels on your team!”

Mallory Peters, MD, PGY4

Mallory Peters is from Farmington Hills, Michigan. She attended the University of Michigan for her undergraduate education. Growing up with a registered nurse for a mother, she was interested in healthcare early on. Despite a preferred admission offer to pharmacy school, she switched gears and decided to apply to medical school. After an unsuccessful first application, she remained focused on her goal of becoming a physician and she found the field of otolaryngology during her gap years working in a pediatric ENT clinic. She loved the team of surgeons she worked for, their kind and happy demeanor, and the life-changing care they were able to provide to complex patients. She continued to follow this interest when she was ultimately accepted to Oakland University William Beaumont School of Medicine in Michigan. At medical school, Dr. Petres found mentors she describes as “stellar,” who helped her further explore the field and solidify her decision to become an otolaryngologist. Dr. Peters was drawn to the strong female representation in leadership at LSU. In particular, she was inspired by Dr. Nathan's trailblazing career, which motivated her to apply to the LSUHS program. Now in her  year of residency, she states that it “was a fun moment to win the Trio Bowl with my fellow residents, especially in view of my nonlinear journey to the ENT field and becoming the first physician in my family.” Dr. Peters loves her new Louisiana home and enjoys spending time with her co-residents, both inside and outside the hospital. She was married in New Orleans to her husband Jeremy, and has two dogs, Rocket and Charlie. 

Mark Landry, MD, PGY5

Dr. Landry was born in New Iberia, Louisiana. He went to Tulane University in New Orleans for college, where he studied French. Initially, he was not quite sure what he wanted to pursue for a career, but after some soul searching, he states that he “felt like a lot of his family was made up of lawyers and he chose medicine.” After working in New Orleans after college, Dr. Landry enrolled at LSU School of Medicine in Shreveport, where he has been for the past 9 years. During medical school, he always enjoyed the head and neck anatomy lab; this, coupled with the hard-working but happy demeanor of Dr. Nathan’s department, drew him towards Ear, Nose, and Throat as a specialty. Residency for him started when the world shut down from Coronavirus in 2020, and over these past five years he has enjoyed getting to live and learn here. He enjoyed representing the ENT department at the Triological Society Resident Bowl, as he has always been a fan of Jeopardy. Dr. Landry enjoys residency in Shreveport, where he feels like “it is the perfect place to continue developing my career along with my wife, Kendra, and our two kids, June and Thomas.” 

With laudations to our ENT Resident Bowl winners, and to the excellence of all our residency and fellowship training programs,

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport

This edition of Aiming High focuses on the story of one of our faculty members, Jamie Toms, MD, Assistant Professor of Neurosurgery, who is performing life-changing surgery for patients with Parkinson’s disease and other movement disorders.

Our clinical faculty members choose to be trained in different disciplines based on a variety of factors – their intrinsic interests, an early clinical exposure to a field that sparks their fancy, and/or a personal or family-related reason. The organ system related to their chosen field is often held by our faculty not only to be their “favorite,” but one that should be recognized as being of the utmost importance. That said, I think we all would agree that the brain is an extremely complex and fascinating organ. It functions much like an orchestral conductor, regulating and coordinating everything in our body. The brain is not only essential for our survival, but it controls our thoughts, feelings, and actions.

Like a conductor who coordinates the roles of the different parts of the orchestra, a healthy brain coordinates the activity of its four lobes, each of which has its own role to play – the frontal lobe for problem-solving and personality, the parietal lobe for our senses and navigation, the temporal lobe for language, memory and emotion, and the occipital lobe for processing visual information. A healthy brain, with all of its lobes well-functioning and well-coordinated, is critical for maintaining overall well-being and a high quality of life. Sometimes, however, insults to the brain – e.g., trauma, environmental, cancer, or a genetic mutation – disrupt its normal functioning and causing a range of symptoms and impairments, often having profound physical and emotional effects.

The healthy brain does its work through billions of nerve cells or neurons. Each neuron has a cell body that can be stimulated, which then transmits this electrical impulse down the neuron’s axon to release chemicals called neurotransmitters into the gap between the neuron and the target cell (often another neuron), whose activity is either excited or inhibited. In Parkinson's disease, neurons in the brain slowly break down or die. Many Parkinson's disease symptoms are caused by a loss of neurons that produce the neurotransmitter dopamine. Among other regulatory functions, dopamine is essential for smooth and coordinated movements. Decreased dopamine leads to irregular brain activity that causes movement problems and the other debilitating symptoms of Parkinson's disease.

Another neurological condition that affects millions of individuals is essential tremor (ET). Sometimes called ‘benign essential tremor,” it can sometimes be devastating. This condition causes involuntary rhythmic shaking. It can occur in any part of the body but usually occurs in the hands and becomes particularly severe when doing simple tasks, such as drinking or writing. Although the cause of ET is unknown, it sometimes can be genetic and run in families. This disease is commonly misdiagnosed as PD, but unlike PD, ET does not cause other health problems.

Patients with PD and ET are usually first treated with medications. When such treatments no longer adequately control motor fluctuations, surgical treatments may be effective. A surgical procedure called Deep Brain Stimulation (DBS), which has been used and approved by the FDA for Parkinson’s disease in 1997 which has been increasingly used in recent years as the procedure has been refined, can produce extraordinary improvements in function. This procedure involves the placement of leads into specific nuclei of the brain. These leads are then attached to a pulse generator and battery that reside under the skin, much like a pacemaker. The DBS generator delivers an electric charge through the leads and causes a clinic response.

Beginning at LSUHS in 2021, Dr. Jamie Toms began a DBS program that has become a major resource for the entire N. Louisiana region. Consider Mr. D.P., a 68-year-old man who had essential tremor for the past six years. His tremor started on the right side and progressed to the left. He had trouble feeding himself and was reluctant to go out in public. He had tried medication and conservative management but ultimately had a bilateral thalamic deep brain stimulator placed.

Dr. Toms grew up outside the small town of Quitman, Louisiana, to John and Lori Toms. John Toms worked in a family grocery store and later worked offshore in the oil field. Lori Toms was a homemaker. Dr. Toms attended Quitman High School and then Louisiana Tech University, where he obtained a Bachelor of Science in Animal Biology. His original dream was to go to graduate school and be a Paleontologist, but during his sophomore year of college, his sister Victoria (Tori) tragically passed away. Tori was born with spina bifida and hydrocephalus. She was in and out of the hospital most of her life. Dr. Toms describes her as “amazing, with such a love of life and people.” After much prayer and consideration, Dr. Toms decided to pursue a career in neurosurgery to care for individuals like his little sister. He was accepted through early decisions to LSUHS School of Medicine and completed a neurosurgery residency at Virginia Commonwealth University (VCU). While at VCU, he eventually found his calling in functional neurosurgery. “Turning off someone’s debilitating tremors, improving the lives of those with Parkinson’s disease, and curing epilepsy through surgery,” he says, “inspired me to learn and perform these procedures.”

After completing a fellowship in Functional Neurosurgery at VCU, Dr. Toms states that “I was given the opportunity to start my dream job. I was offered a faculty position at LSUHS in Shreveport. I began working at LSUHS in August of 2021. Not only do I get to teach future doctors, train residents, and do research, but I also get to take care of my community. Louisiana is my home. This north Louisiana community raised me, and I am so happy to be able to be part of this LSU family.”

Started and continuing as a community partnership, Dr. Toms will soon be performing DBS on the 100th patient in the program, in collaboration with Drs. Natalia Chunga Iturry and Harleen Kaur of the Department of Neurology. In addition, Dr. Toms has brought several other innovative treatments to N. Louisiana. Working in collaboration with Drs. Mostafa Hotait and Dr. Roohi Katyal, he implanted the very first reactive neural stimulator in the region. Moreover, under Dr. Toms’ leadership, LSUHS has become one of the busiest cranial robotics programs in the country. He now has a fully accredited Functional Neurosurgery Fellowship at LSUHS; one of our neurosurgery residents, Dr. Ryan Diaz, during his 7th year, will be the first fellow next year.

Dr. Toms married Brittney Cloud, a nurse practitioner from Calhoun, LA, during his second year in residency. Gabriel Toms, age 5, was born in Richmond, VA during residency. The couple was then blessed with Alexei, age 2, while in Shreveport, and another is on the way.

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport

January 9, 2025, marked my second anniversary as Chancellor of LSU Health Shreveport. It has truly been my honor and privilege to work with all of you – our faculty, staff and students at LSUHS and the Ochsner LSU Health System – in aiming high to achieve the ambitious vision we have set for our institution. We have made significant progress, but that doesn’t mean we will not encounter speedbumps as we move forward.

The enthusiastic support we have enjoyed from the citizens of our local communities in North Louisiana, as well as our donors, legislators and business leaders, has helped enormously, as has the support from the leadership of LSU and its Board of Supervisors, and from the leadership of Ochsner Health.

In recent days, study sections at the National Institutes of Health (NIH) have been canceled, and a hiring freeze – described as temporary – has been announced. (Similar actions have been taken at other federal agencies.) OMB has issued guidance requesting that federal agencies temporarily pause grant and other programs while a process has been completed to determine whether such programs are inconsistent with the President’s Executive Orders on a variety of matters. Furthermore, news reports suggest the possibility of extensive cuts in NIH and Medicaid funding. Many faculty members have contacted me to express significant concern about how these actions, if implemented, might adversely impact our research and clinical missions, and secondarily affect our educational programs.

My message is this: First, these are very early days; what actually occurs with regard to NIH and Medicaid, and how it translates to LSU Health Shreveport, will play out over time. Indeed, some consolidation of NIH Institutes and measures that improve Medicaid efficiency on a national level could be beneficial. Second, no matter what occurs, we will be true to our missions and vision. Furthermore, we will do so in a manner that fulfills our basic principles: in clinical practice we are guided by patient-care quality as our highest priority, and in education and research we reach for excellence above all else. If overall funding for our missions is reduced due to federal cuts, we will do what we can in freeing up resources to make sure that faculty and staff can still do their work according to these principles.

Per ardua ad astra is a Latin phrase meaning "through adversity to the stars" or "through struggle to the stars." This is the official motto of the Royal Air Force of the British Commonwealth, but perhaps it is fitting for us in the face of the current uncertainty and potential adversity.

Here are two quotes that may be pertinent:

"It's your reaction to adversity, not adversity itself that determines how your life's story will develop." Dieter F. Uchtdorf

"This is no time for ease and comfort. It is time to dare and endure." Winston Churchill

I remain steadfast in the vision that I articulated for LSU Health Shreveport when I arrived two years ago and know that you will continue to join me in working towards its achievement: To develop a high-performing, functionally integrated, academic health center for N. Louisiana and beyond, which creates unstoppable momentum and transforms the region.

Let’s review the basic strategies about how we will achieve our goals, while considering the impact of NIH and Medicaid cuts if they were to be more than temporary.

Patient Care

Patient care is where our reaction to uncertainty and potential adversity, and not uncertainty/adversity itself, will dictate our future.

In the clinical enterprise, achieving our goal of high performance requires a partnership of LSUHS and OLHS that is functionally integrated with joint decision-making, and that places patient-care quality as Job 1. If we jointly make decisions and create a culture that results in the highest levels of patient care quality in all domains, financial success will follow. That is, we will create the kind of clinical and financial environment that attracts and retains the most talented faculty, students, residents and staff, who will generate momentum in the positive feedback loop between patient care, education and research.

The interesting thing about achieving all the goals expressed in the previous paragraph is that they require behavioral commitments much more than financial ones. Yes, we desperately need a variety of upgrades in our inpatient, operating room and ambulatory environments that require capital expenditure as well as personnel re-structuring and/or expansion. And we are working to implement these needed upgrades. But even if they were all in place right now, patient-care quality improvements would still require that everyone in the clinical environment – faculty, residents, fellows and staff – work together in ways that involve behavioral change but little financial cost. What follows reflects the work of many Strategic Plan workgroups, refined by Vizient recommendations. For example:

• Risk-adjusted mortality rates can be improved if we uniformly adhered to evidence-based, standardized protocols across all medical disciplines, sacrificing some measure of professional autonomy for high-reliability and better outcomes. We discussed this issue in the January, February and September issues of Aiming High in 2023, and demonstrated a marked reduction in sepsis-related mortality as a result. Whether Medicaid cuts occur or not, we should adopt behaviors that produce high reliability in our diagnoses and treatments, and thus better patient outcomes.
• The same is true for a variety of other patient safety indicators such as hospital acquired infections, pressure ulcers, patient falls, etc.
• There are also opportunities to improve our workflow and decision-making and thus improve our markers of efficiency and effectiveness in patient care. Specifically, we can take identified steps within our teams of faculty, house officers and staff – behavioral and process-based steps, not financial ones – that would reduce diagnostic tests, imaging studies, lengths of stay, hospital re-admissions and ED visits, and improve the throughput of our operating rooms and clinics. All of these steps – which involve some financial investment but a great deal of behavior change – would improve patient care timeliness and centeredness and reduce expenses at the same time.
• And finally – and most important when it comes to our reputation in the region as a health care provider – there are opportunities to improve patient experience. Hospitality, hotel and hospital have the same Latin root. Patients typically don’t judge their experience based on their doctor’s scientific knowledge and clinical skill; these are “behind the scenes” aspects of quality that are taken as a given. Rather, those of us who have had serious interactions with all aspects of a health care system as a patient know that our experience is judged by the level of hospitality and service shown to us by all the people in the health care system with whom we have interacted.

Just like hospitals, where patient satisfaction is measured by metrics like Medicare’s “Hospital Consumer Assessment of Healthcare Providers and Systems” (HCAHPS), hotels have customer satisfaction indices. In J.D. Power’s 2024 North America Hotel Guest Satisfaction Index, out of a 1,000-point index, Ritz Carlton scores 769 while Motel 6 scores 508. Similarly, the HCAHPS scores (as well as our patient satisfaction scores on outpatient experience) reported by our patients are based on the hospitality and service that are shown to them by every single patient-facing individual across LSUHS and OLHS – from the person who answers the first phone call, to the degree of patient-centeredness and timeliness shown by each of the individuals involved in providing care, to the staff providing follow-through after that care is completed – all reflect behaviors, not finance. In hotels, your experience depends on the hospitality and service provided by hotel staff, with marked differences in experience as reflected in the J.D. Power results. And so it goes with health care systems. Every one of our patient-facing employees – whether clinical faculty, residents, fellows or staff – make a difference in our patients’ experience.

Education

Our efforts in student education should not be impacted by cuts in Medicaid or NIH. Most of our $40 million direct costs for student education comes from tuition and philanthropy-based scholarships, with only about one-quarter coming from the State General Fund allocation to LSUHS. These estimates from our mission-based budget pertain to programs at the Schools of Medicine, Allied Health Professions, and Graduate Studies. All of the costs of Graduate Medical Education are paid by OLHS pass-throughs to the School of Medicine, mainly funded by Medicare but supplemented by OLHS revenues.

Just as in patient care, the quality of the education we provide is based on factors that are largely behavioral, not financial. Of course, the curricula developed at our three schools (including GME curricula developed by clinical departments in the School of Medicine) depend on some level of financial investment, especially regarding appropriate space and equipment. For the most part, these capital investments are behind us. But the experience of our students and house officers depends on how the curriculum across all the educational programs in each school is delivered by our faculty and staff. As in patient care quality, this is dependent on behavior.

PhD students in the basic sciences receive one year of stipends from LSUHS (which is contained with the overall $40 million education budget), but subsequent years are dependent on the number of students whose support is included in federal research grant budgets. Theoretically, if NIH budgets were to decline significantly, there might be some decrease in the number of grants, and therefore in the number of basic-science doctoral students. But this consideration leads into the next and final section, which focuses on research.

Research

Research is the component of our academic health center that makes the largest contribution to our national stature, and to economic development in our region. Through uncertainty and potential adversity, this is where we remain steadfast in our commitment. While other institutions might grow overly cautious during this period of uncertainty, we have the opportunity to 'dare and endure' by continuing to attract and recruit top-tier scientists from leading institutions nationwide, as we have successfully demonstrated in recent months. So long as we adhere to our guiding principle of reaching for excellence, I am confident that we will emerge from uncertainty and adversity in a much stronger position. We have the resources to implement this strategy over the next several years and will rely with confidence on our ability to retain and recruit excellent scientists, and ultimately on continued national commitment to NIH, which has been the basis for our country’s longstanding international leadership in biomedical research.

In conclusion, my message is this: Per ardua ad astra!

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

What’s one thing that is on our critical path for success? It all starts with patients in our region having ready access to our clinical faculty when they need medical attention.

Put simply, in order for us to achieve our collective goal of becoming a high-performing academic health center (AHC) following the guiding principle of high-quality patient care, patients need to be able to see our primary care, specialist and sub-specialist physicians in a timely manner. Indeed, timeliness is one of the key quality tenets articulated in the Institute of Medicine’s “Crossing the Quality Chasm” 2001 report, which was incorporated into the Vizient quality metrics that we use today.

Access to our clinical faculty as a whole begins with access to primary care. Important aspects of primary care in our AHC are provided by general internal medicine, pediatrics, and ob-gyn, but a major share of primary care visits are the responsibility of the Department of Family Medicine. Up until recently, access to our family medicine physicians was, frankly, poor. In recent months, however, Peter Seidenberg, MD, Chair of the Department of Family Medicine, and his faculty members made a number of changes that yielded excellent results: the wait time for a new visit to one of our family medicine physicians is now essentially zero! If needed, you could have an appointment tomorrow.

In this edition of Aiming High, we will outline the changes that have been made to achieve this goal and show the before-and-after data, which are stunning. But first, let us take a step back and consider how fundamentally important primary care is to our stated mission of improving health care and health in North Louisiana. Primary care is a specialty that:

• is the starting point for comprehensive care, serving as the entry point for patients in our AHC.
• is a major contributor to the goal of improving population health, by addressing preventive, acute, and chronic health needs, which are so prevalent in our region.
• emphasizes preventive care, which helps reduce hospitalizations and healthcare costs, contributing to improvements in the overall effectiveness and efficiency of our AHC.
• provides care in settings in which there can be diverse, hands-on experiences for medical students, residents, and other health professionals.
• encourages teamwork among healthcare disciplines, promoting holistic care and producing a workforce capable of addressing community needs.
• provides a rich setting for studying health care delivery, population health interventions, and patient-centered outcomes, including implementation science studies that can test and implement evidence-based practices in primary care to improve scalability and effectiveness.
• serves as a referral base for our other specialists and subspecialists, helping to create a destination AHC at LSUHS.

Thus, by integrating primary care into our AHC structure, it can help us achieve a balanced approach to education, research, and service delivery while addressing the needs of both patients and our community at large.

But it all starts with access. If you cannot get an appointment, then none of the above benefits will follow. Let’s look at some metrics for access to the Family Medicine primary care clinics over the past year.

One metric used for patient access is “TNAA” – Third Next Available Appointment. It tells us how quickly established and new patients can get an appointment with a doctor.

Graph Description. Title: "Days to Third Next Available Appointment" with x-axis being months and y-axis being days, comparing established with new patients. March, 2024 shows 40 days for established and almost 60 for new. April, 2024 shows 20 days for established and over 100 for new. May, 2024 shows 80 days for established and almost 100 for new. June, 2024 shows 95 days for established and 100 for new. July, 2024 shows 85 days for established and 90 for new. August, 2024 shows 60 days for established and 110 for new. September, 2024 shows 0 days for established and almost 0 for new. October, 2024 shows 0 days for established and almost 0 for new.

The graph shown above demonstrates that the “TNAA” for a family physician in the Department’s community clinics (i.e., outside of Kings Highway) was quite high in March 2024 – 40 days for an established patient and almost 60 days for a new patient. These already too-long wait times worsened significantly from April through August: in August, TNAAs reached 60 days for an established patient and 110 days for a new patient!

In September and October, however, TNAAs fell essentially to zero. What happened? A number of changes were instituted by the Department of Family Medicine to achieve the sharp, downward inflection point in TNAAs between August and September: 

• Three new family physicians were added to the faculty.
• Two new advanced practice practitioners were also recruited.
• Several initiatives were taken to optimize provider schedules:
  • Visits were scheduled in a manner that ensured providers would have appropriate numbers of new and established appointments,
  • Same-day appointments for sick/acute visits were added to provider schedules.
  • Dedicated wellness visits were allocated to emphasize health prevention.
• Three primary care clinics were consolidated into two. Specifically, providers of the Community Care Clinic (in the Comp Care Building) began transitioning to the Spring Lake and Prescott (Jewella) clinics, allowing for:
  • A modern clinical environment
  • Staffing efficiencies
  • Fully utilized clinical spaces
  • Prevention of clinic closures due to provider leave or illness 

These initiatives significantly increased the number of available appointments for our family medicine patients. By combining efforts to recruit new providers, including physicians and APPs, with the optimization of all providers' schedule templates, timeliness has been significantly enhanced. Taken as a whole, these measures have profoundly improved our ability to optimize the health of the families in the communities we serve.

That said, even when the next available appointment to family medicine physicians – and/or other specialists in the Ochsner LSU Practice Group (OLPG) – is available in a timely manner, several additional access impediments remain to be addressed in order for us to state that patients have ready access to our clinical faculty. The availability of a physician appointment is of little value, for example, if patients cannot reliably reach our access center by phone to find out about an appointment. And when a patient is seen by one of our faculty who concludes that a specialist consultation is needed, timely care is not achieved if a multi-specialty clinic for the patient’s medical condition is not in place, or if the consultant’s schedule cannot be readily accessed to make the appointment.

We are committed to resolving these and other issues that constrain our ability to provide timely care to our community – and to doing so in short order. But meanwhile, please join me in congratulating the Department of Family Medicine for doing its part so well! 

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

 

Achievement in academic medicine is recognized in different ways: by discovery of a new clinical treatment or paradigm-shifting research finding; publication of papers in high-impact journals; recognition by peers of clinical excellence, as reflected by a large referral practice; or election to prestigious academic societies. 

For any physician or physician-scientist who has devoted their professional life to their clinical specialty, however, another important achievement is recognition by your specialty society. A crowning achievement would be recognition not just once, but multiple times over many years, ultimately resulting in selection to the “Hall of Fame” (or equivalent) in that specialty society.

That is exactly what happened at the recent meeting of the national ENT Academy – i.e., the American Academy of Otolaryngology–Head and Neck Surgery and Foundation. (Quite a mouthful; we’ll call this the “Academy” for short).  At this meeting, Cherie-Ann Nathan, MD, Chair of the Department of Otolaryngology-Head and Neck Surgery, was recognized as one of six otolaryngologists to be inducted into the Academy’s “Hall of Distinction. Living Legends.”

The “Hall of Distinction” recognizes otolaryngologists who have made long-term, exceptional contributions to the Academy and the specialty of otolaryngology. Academicians, private practitioners, and researchers who have advanced the practice of otolaryngology and care of patients by distinguishing themselves through advocacy, education, humanitarianism, innovation, leadership, or research from around the world are eligible for consideration. Meritorious service includes elected and appointed leadership, committee and section participation as well as innovative education and clinical work and inspirational ideas with measurable impact. Some of Dr. Nathan’s national positions, awards and achievements are listed at the end of this newsletter.

How did Dr. Nathan make this journey from India, to the U.S., and finally to Shreveport? And –despite many headwinds along the way – how did she manage to reach the heights of her profession? As anyone who knows Dr. Nathan would confirm, we start with a very highly talented – indeed multi-talented – individual. But there are many such individuals in every profession. The story of how Dr. Nathan rose to the top of her profession is one of deep passion for her chosen field of head-and-neck cancer, the desire to make a fundamental difference in the quality and longevity of  the lives of patients afflicted with these conditions, hard-work, confidence, strength as a woman in a field dominated by men, a bit of serendipity, and – as she puts it – “a belief … in the powers above.”

Let’s start there. Born in India and trained there in medicine, Dr. Nathan states: “I personally believe that I owe all my fortune and achievements in medicine to the powers above. As we know there are so many unknowables when it comes to emergent phenomena in Nature and so many intangibles that play a role.”

Dr. Nathan grew up in Mumbai, India with two other siblings. Her childhood was special as a place and time for her, and she is still friends with many students from her kindergarten class. Her earliest passion was music – a passion she also instilled in her two sons, Sean (age 29) and Neil (age 27). Dr. Nathan started piano lessons as a toddler and became proficient enough to win an international competition at age 15.

But Dr. Nathan’s attention was also drawn to medicine. Specifically, as a child her hero was Dr Ernest Borges, a renowned cancer surgeon in Mumbai. He was so influential in her life as a child that since 3rd grade, her career goal was to be a cancer surgeon. Dr. Nathan attended medical school at University of Bombay and recounts an important experience that influenced her career and life: “As a medical student in India, I volunteered at Mother Teresa’s Home. Every year on the 8th of January she came to a home for the disabled and destitute in Mumbai known as “Asha Daan” as that was the opening day of the home. My friend Trudy Ann and I helped the cerebral palsy children put up a concert for the event. After the concert the lines were long to be blessed by Mother Teresa and so I had to leave, as I had to attend my class. The nuns saw me leave and were saddened that I could not meet Mother Teresa. They whispered to me that at noon she would leave the crowds and go into the chapel to pray in silence, and they would let Trudy and me in. So, they did, and we knelt on either side of her. Before we knew it, she held our hands and asked me what I did and then prayed with me that I would become a good doctor. I felt very fortunate to be blessed by a saint.”

As a medical student Dr. Nathan was drawn to the field of head-and-neck cancer, because 40% of the malignancies in India are head-and-neck cancers. After one year of residency in otolaryngology at University of Bombay, Dr. Nathan was a finalist for both a Rhodes Scholarship and an Inlaks Scholarship. She chose the Inlaks scholarship because it gave her the opportunity to be a post-doctoral research fellow in otolaryngology - head and neck surgery at the Johns Hopkins University School of Medicine, one of the premier Head & Neck Cancer programs in the world. At Hopkins she got to work with outstanding researchers and Surgeon-Scientists. This experience was not only the foundation for her subsequent basic-science research as an independent investigator, but the surgeon-scientists at Hopkins served as important career role models.

Of her Hopkins experience, Dr. Nathan describes the environment and it impact on her career this way:

“Believe it or not, many of the giants in our field at Hopkins would walk into our lab late at night to see how we were doing. I was blown away by their work ethic and realized what it took to be successful.  The genuine excitement about science was contagious. What was even more humbling was that all these giants took time to sponsor you and from them I learned humility. Dr. Johns, who was the chair of the dept. and then became Dean, wrote a letter of recommendation and encouraged me to apply for a residency even though the chance of an FMG matching in Otolaryngology was slim.  Unbeknownst to me, I learned on the interview trail that he had included a newspaper article from Mumbai with his recommendation letter, showing that it had been my desire to be a cancer surgeon as a kid. Having seen how those simple acts of sponsorship propelled my career has instilled in me the desire to give back in a similar manner to our faculty, residents and medical students and friends and colleagues here in Otolaryngology.”

“That was the best move,” she says; “I believe my time at Johns Hopkins shaped who I have become today.” (As an aside, the writer has the same belief about his time there as a resident.)

From her Hopkins experience, Dr. Nathan reached the conclusion that the only way to improve the survival and quality of life among head-and-neck cancer patients was to conduct research that might someday make a difference.  This became the passion and driving force for her love of research and surgery. She decided to remain in the U.S. as the opportunities for research in India 30 years ago was non-existent. Indeed, her goal of making a difference through research and clinical practice has been amply achieved, right here at LSU Health Shreveport, where she has been since 1995.  Dr. Nathan obtained her first NIH/NCI grant as Principal Investigator in 2002: “Molecular Analysis of Surgical Margins in Head and Neck Squamous Cell Cancer.” Continuously funded by NIH for the subsequent 22 years, she is very proud of taking her research from the lab to the bedside. Having conducted a multi-institutional clinical trial based on a quarter-century of her work, the results of this trial – published in Clinical Cancer Research – could materially improve the outcomes for patients with HPV negative, p5 mutated, advanced stage head and neck cancers.

How did Dr. Nathan make her way from Hopkins to LSU Health Shreveport? Here’s the story:

Based on her research at Hopkins and the recommendations from her mentors there, as well as from faculty at her internship in general surgery at Michigan State University, she was accepted to the highly competitive ENT residency at UCSD. Notably, she was both the first woman and first FMG to complete the UCSD residency program.

Dr. Nathan tells an instructive story about being a female surgical resident 35 years ago: “I realized earlier in my career as a resident that if one has a strong work ethic and integrity one could never lose. Let me explain that statement. I started my residency in a program where I was going to be the first woman resident surgeon to graduate. The first day on service the chief resident said, “What are you doing in this program? This happens to be an all-male program.” Now not only was I a woman but an Indian woman who had not grown up in the US. I worked hard and never complained and it seemed like all was going well. A couple of months later this same chief resident was walking back from lunch with our team and there was a puddle of water on the ground. Before I knew it, this strapping man had picked me up and held me above his head saying, “I cannot let my Indian princess walk through this puddle of water” and carried me across. I knew right then that there was something special to being a woman surgeon and even the harshest critics can be won over if one carried one’s share of responsibilities with dedication and fortitude.”

Dr. Nathan met her husband, Raghu Nathan (a Pulmonary Critical Care physician) in medical school, and they got married during her Residency at UCSD. After marriage, finding opportunities as sub-specialized MDs in the same city was a challenge but also a priority. Dr. Raghu transferred his Fellowship from the Mayo Clinic to UCSD. After residency, Dr. Cherie-Ann completed a fellowship in Head and Neck Cancer surgery at UCSD. After seven years on a J-1 visa we owed the federal government a year of service and the only city in the country that had positions for both Drs. Nathan was Shreveport-Bossier.

They came to complete their one-year responsibility at the VA Medical Center here, planning to return to San Diego the following year. But Shreveport had so much to offer: Dr. Raghu’s practice grew rapidly and Dr. Cherie-Ann’s research and surgical schedules took off.  As Dr. Cherie-Ann states: “We realized southern hospitality was a real thing and never left!"

I mentioned that serendipity played a role in Dr. Cherie-Ann’s journey: Her INLAKS scholarship at Hopkins was as a student. But to do her residency, she needed to change her student visa to a J-1 training visa for residency and fellowship. But the Indian immigration office bureaucracy was so slow that there was no response to her application despite numerous phone calls. Her visa was expiring in two weeks and Dr. Cherie-Ann was on the verge of giving up her residency and going back to Mumbai. She was depressed but was still working late in her lab to finish her research project. She got into the Hopkins shuttle late one night close to midnight to return to her apartment. Dr. Cherie-Ann tells the story as follows: “There was an Older Sikh gentleman on the bus, and I sat next to him. We started talking and I told him my sad story about having to give up my surgical residency because I couldn’t get a signature from the Immigration office in New Delhi. He looked at me strangely and said, “it’s my signature you need.” Turns out he was the immigration minister on a sabbatical to do an MPH at Hopkins!! My mom was shocked when I walked in around midnight with this tall Sardarji in a turban - he made one phone call and here I am.”

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

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Here are some of Dr. Cherie-Ann Nathan’s national leadership positions and associated awards and achievements:

• As stated, Dr. Nathan has a 20+ year history of NIH funding, doing research that has changed clinical practice.
• She started the first Head and Neck Cancer Survivorship Conference in the USA for patients when she was President of the AHNS and co-sponsored it with the Alliance. At this year’s Conference in Philadelphia, there were 250 head and neck survivors in person and 750 survivors who signed up virtually. Their stories warmed the heart. Dr. Nathan is so proud to have initiated this conference.
• As the first Woman President of Academic Chairs in Oto/HNS in the U.S., she played an instrumental role helping initiate a coordinated Core curriculum for all Otolaryngology residents in the U.S.
• She was the second woman President of the American Head and Neck Society; in this role, she created the Women and Diversity division, allowing for more opportunities for minorities and women in leadership positions.
• Awards for women in ENT: The Margaret Butler Award from the American Head and Neck Society and the Helen Trailblazer award from the ENT Academy.
• Served on the American Cancer Society and CDC HPV Steering committee and on the Executive Board of the Head and Neck Cancer Alliance. Together with the Alliance, played a role with promoting FDA approval for boys to be vaccinated for HPV.

As part of the joint strategic planning process between LSU Health Shreveport and the Ochsner LSU Health System to create an integrated academic health center (AHC), one outcome was clear for both the clinical enterprise and our research program: we desperately need more space for expansion.

The clinical need focused on outpatient practice. The overall direction of medical treatment is shifting from the inpatient setting to outpatient. That is, there will be less need for hospital beds across time, and more need for outpatient facilities. It was further recognized that, as we become a destination AHC, we would need to create attractive, modern facilities in a convenient location. Moreover, in both Monroe and Shreveport/Bossier, it would be beneficial to create additional outpatient facilities in areas where there is growth in the local population. For example, in Shreveport/Bossier, OLHS owns a prime parcel of land in North Bossier; in Monroe, parcels for development are being considered in several candidate areas removed from Monroe Medical Center.

At present, faculty in most of the clinical departments of our medical school see patients in dated facilities on the main Kings Highway campus. While some of this space has been updated, in many cases our patients experience crowded, uninviting clinics for which parking is difficult. There is clearly a need for newly constructed outpatient facilities, with modern architecture and technology, removed from the “mothership.”

Regarding research, we are proud of our faculty who have created an upward trajectory in grant funding, and we are fortunately in a position to recruit many more grant-funded scientists. Since I arrived, we have been gradually “right-sizing” the amount of lab space allocated to faculty. This allocation is based on their space needs, as reflected in their level of grant support. As we do this, some renovation is typically required (more so in the medical school than in the Biomedical Research Institute). All that said, projections based on the planned pace of faculty recruitment indicate that we will be out of research space in 1.5 to 2 years.

Modern research laboratories are designed in open spaces without walls. There are rows and rows of lab benches – a configuration that encourages collaboration while at the same time ensures efficiency. For example, suppose that one lab contracts somewhat because of an expired grant, while another needs more space because of a new grant. In a system where the labs assigned to investigators have four walls and a fixed number of benches, the lab assigned to the former researcher would have more space than needed, while that of the latter would be quite cramped, hindering research productivity. By contrast, a modern lab is more like an accordion: changes in grant funding can be accommodated simply by reassigning a bench or two, up or down.

This past year, we investigated the cost of a new research building containing 50,000 sq ft of laboratory space. Building such a facility from scratch was estimated to cost $100 million. The only way we could do a project of this magnitude was to appeal to the same source as Chancellors do for all LSU buildings throughout the system – the capital outlay mechanism of the state legislature. But this would entail a multi-layered approval process that may or may not be successful; and even if we could ultimately obtain approval and funding, we would not open the doors of a new research building for many, many years.

We do not have that kind of time. We need more research space soon. Where can we turn?

Enter Sears at Mall St. Vincent, a building that has been vacant since bankruptcy in 2018. Consider this: A department store like Sears has wide open spaces without walls, just like what is needed for modern labs. Check. The building is immediately available. Check. It can be purchased at an inexpensive price. Check. And in terms of our need for off-campus clinics, Sears contains 160,000 sq ft of space, more than enough to accommodate future research needs for many years, with enough space left over to build several outpatient clinics. A big check.

OK … Sears is off campus, has a large amount of the raw space needed to build out research laboratories and clinic space, and is relatively inexpensive. But how will we pay for the cost of design and construction?

Enter the LSU Health Shreveport Foundation. Although the Foundation’s sole mission is to support LSU Health Shreveport, it is a legally distinct entity from LSU as a private entity, and thus can be more nimble in the marketplace than a state institution. The Foundation has now purchased the Sears building and property (which also includes 800 parking spaces and a number of the mall’s retail spaces in proximity to the Sears interior entrance). Presentations from architects will soon be heard and evaluated by pertinent scientists, clinicians and Foundation executives and board members, followed by design and construction. We have asked our clinical departments, including those in the School of Allied Health Professions, to submit proposals on clinic facilities that could potentially be housed in this facility. The Foundation will finance the construction of both research labs and clinics, and then lease the completed space back to LSUHS (laboratories) and OLHS (clinics).

The main floor of the Sears building is continuous with the long hall of the mall’s retail outlets and contains an entry that we envision would serve as the entrance to the clinic component of the reimagined building, which would be built on this main floor. Shifting to the Southern Avenue side of the building, there is an entrance to all three floors of the building. We envision research labs, offices and conference rooms to occupy the remainder of the main floor that is not clinic space, as well as the lower and upper floors. One idea of what the exterior of the building might look like is shown below. (The project’s architect will compose the actual design, which might look quite different.)

 

Finally, I have been making the case that high-performing AHCs can not only continually advance their tripartite missions of patient care, education and research, but serve as an economic engine for their communities and regions. The Sears project will do just that for us and Shreveport/Bossier: The hiring of research scientists and clinicians will bring these new faculty members and their families – along with their staff and their families – to our community; the economic impact of all these newcomers will have a multiplier effect as their local spending ripples through our regional economy; and the revitalization of Mall St. Vincent will bring in new retail tenants, more mall traffic, and more ripple effects.

That is the power of our AHC. We not only provide exceptional patient care, train the next generation of health care providers and scientists, and contribute to new knowledge and discoveries that can extend life and its quality, but aid in the economic development of the community in which we live.

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

Although “medical education” is understandably focused on medical students in the minds of the general public, at LSUHS we have as many trainees in our residency and fellowship programs as we have students in medical school. In many academic health centers, there are far more trainees in “Graduate” medical education (i.e., house officers) than in “Undergraduate” medical education (i.e., students).

Resident training is the heart and soul of a clinical department. The residents are our future. They begin their training bright eyed and excited to be on a steep learning curve in their future specialty, and with a keen understanding that their residency training will be the foundation of their clinical practice for the rest of their lives. Across time, our residents are eager to absorb each new clinical experience: each new variation of how a patient with a given diagnosis presents; each new pearl of wisdom about how to treat such a patient; each new diagnostic or therapeutic procedure; and each new idea about how their patients may have better outcomes in the future due to advances in biomedical science and their clinical translation.

Many of our faculty are drawn to academic medical practice specifically to be involved in training the next generation of specialists in their field. This is a major part of the virtuous circle of an academic health center. In some cases, a faculty member may become so successfully engaged in residency education that their impact extends far beyond their “home” residency program. At LSUHS, we are lucky and privileged to have such a faculty member: Steven Flynn, MD, PhD, Associate Professor of Ophthalmology, who has been on faculty at LSUHS, and in practice in Monroe Louisiana, since 2005.

Dr. Flynn’s story is fascinating. I recently had the opportunity to sit down with him for an interview about his extraordinary journey in Ophthalmology education. Here it is:

Dr. Flynn, you were a teacher in a different field before you became a doctor. What did you teach? Were there any lessons that you took away and applied later when you started with Ophthalmology teaching?

Yes, medicine is a second career for me. My PhD is in Experimental Psychology with an emphasis on Cognitive Psychology, specifically the psychology of perception. In my former life I taught in the Psychology Department of Northeast Louisiana University (now University of Louisiana at Monroe).

I do have a lesson from that period. One of the senior faculty told me something early in my teaching career that’s stuck with me. He said, ‘In every class there are three camps: The teacher, the students, and the material. And during the course, these camps will divide themselves into two teams. Always make sure the students know it is you and them against the material, not you and the material against them. Because while students will not run through walls for you, they will run through walls with you.’ I think about that all the time.

Why did you leave this career to enter the world of medicine?

While I loved psychology, I soon discovered that my career options were limited by what was then a surfeit of experimental psychologists—there were too many of us vying for too few academic positions. I realized I would have to go a different direction entirely if I wanted flexibility in my work future. I had always entertained the possibility of Medicine as a career, and with the support of my wife and family decided to give it a go. So, I taught myself organic chemistry, earned a respectable MCAT score, and the rest is history.

In medical school, which was right here at LSUHS School of Medicine, what influenced you to choose Ophthalmology as a specialty?

Despite my background in Perception, I never entertained Ophthalmology as an option—that is, until I did my required one-week rotation as an MS3. It took only a day or two for me to fall in love with the field. I thought everything about it was cool—the technology; the exam; the profound impact ocular surgery can have on a patient’s life. I fell for ophthalmology like a lovestruck teenager.

You had a “Eureka” moment in conceptualizing how people learn and how material could best be presented to them in helping them learn. Could you describe this idea and how you translated this into your teaching modules?

As a medical student and resident, my most effective learning experiences involved Q&A sessions with the faculty. My ‘Eureka’ moment occurred when I realized I could re-create this sort of interaction in PowerPoint—question on one slide, answer on the next. Over time these PowerPoints have grown into a semi-comprehensive review of the major basic-science and clinical concepts in ophthalmology—298 slide-sets in all. The shortest sets contain a few dozen slides; the longest, 955. I’m not sure how many slides there are in total but would ballpark it at 32,000. I am the sole author.

Tell us the story of how this idea, which started out as a way to teach our own residents specific topics in Ophthalmology, was gradually expanded to reach wider and wider audiences, including national and international audiences.

After much prodding from my residents, I decided to make the PowerPoints widely available. Since 2020 the slides have been hosted on the website of the American Academy of Ophthalmology (AAO). The slides are free and available for anyone to access. (I have no financial interest in the website or slides.) The AAO Online Education team has done a fantastic job hosting the PowerPoints. Without them, the slides would exist only on my hard drive. (The same is true of my department chair and the leadership at the Monroe Medical Center—their support has been indispensable.

https://www.aao.org/education/okap-study-presentations

Your teaching modules in Ophthalmology on the AAO website get upwards of 20,000 hits per month, including internationally. How does that make you feel?

It is so gratifying and humbling to know that my work is helping residents across the nation and around the world. I have received ‘thank you’ emails from trainees in most states and on every continent (well, except Antarctica). It’s amazing to contemplate such a wide swath of the world’s ophthalmologists being influenced by my work.

Ophthalmology has a January match, so you know 18 months in advance who will be entering our residency. The first few months of residency are always difficult because there is so much to absorb so quickly. Explain how you lessen this burden with “pre-residency” education.

All resident education faces a dilemma—the amount of information expands year-over-year, but the time allotted to learn it remains the same. The dilemma is especially acute for procedure-heavy specialties such as ophthalmology in which residents must master an ever-expanding palette of surgical procedures in addition to a burgeoning fund of knowledge. Residents today are expected to learn so much more than I did back in the day—but they are expected to do so in the same amount of time I had. Clearly, something must be done. That said, there is no appetite for lengthening residency. What to do?

We (our department) decided that if we couldn’t extend residency education on the back end, we would extend it on the front. So I developed another series of slide-sets tailored for MS4s/interns—a little less detail, a lot more explaining. This series is entitled New Ophthalmologists—Overviews and Basics (NOOB) and can be found on the AAO website. The NOOB series covers the most fundamental concepts in clinical ophthalmology—Glaucoma, Macular Degeneration, Diabetic Retinopathy, Cataracts, Optics, etc. We employ this material using an Inverted Classroom Model of learning. Literally the day after the Match, I contact our matches and say ‘Congrats on matching at LSU. Here’s a link to the material we expect you to master before you start residency with us. Learn it at your own pace; just make sure you know it when you join us on PGY2 Day 1. You have 18 months; reach out if you have any questions.’ We’ve only just implemented this PGY2D1 approach to residency education, but we are excited about how it is going thus far.

Thank you, Dr. Flynn, for educating our Ophthalmology residents – who will be providing eye care to the population of North Louisiana and beyond – and for educating Ophthalmologists around the world every day. We are so proud of you!

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

In several previous issues of Aiming High, I have told the stories of LSUHS investigators who have developed mature research programs and/or who have recently won large extramural grants. To reach this level of recognition for their science, however, faculty typically must pass through a process of mentoring and early research experience that sets the stage for future success.

An important formalized structure that embodies this process is the Career Development Award, funded under different names by a variety of sponsors. This issue of Aiming High tells the story of Deborah Gurgel Smith, PhD, MPH, BSN, who is an Assistant Professor of Public Health in the School of Allied Health Professions, and who recently won a LA CaTS Roadmap Scholar Award. The Louisiana Clinical and Translational Science (LA CaTS) Center is a U54 NIH-funded grant under the Institutional Development Award Program Infrastructure for Clinical and Translational Research.  The LA CaTS Center (P.I.: John Kerwin, PhD, Executive Director, Pennington Biomedical Research Center) was originally funded in 2012, and is currently in its third funding cycle. The LA CaTS Center combines 10 major Louisiana academic, research, and health care delivery institutions across the state, with the goal of transforming the clinical and translational research efforts of our region away from operation in isolation and towards a cohesive, mutually supportive enterprise for clinical and translational research. 

As part of her LA CaTS award, Dr. Smith will conduct a study among non-Hispanic Black and Hispanic adult women to (1) assess the associations between social determinants of health factors and cervical cancer prevention and (2) examine the association between levels of health literacy and willingness to undertake HPV vaccine and cervical cancer screening. According to the World Health Organization, cervical cancer is the fourth most common cancer among women worldwide. In the Southern United States, the incidence rate (8.5 per 100,000), death rate (2.7 per 100,000), and percentage of women who had not been screened in the past five years (12.3%) were the highest in the nation. Within the Deep South (Alabama, Georgia, Louisiana, Mississippi, South Carolina, and Tennessee), non-Hispanic Black and Hispanic women have a higher incidence of cervical cancer than non-Hispanic White and Asian American women. Additionally, the HPV vaccination rates among minority groups are low. A study based on national data revealed that 18-26-year-old women from non-Hispanic Black and Hispanic backgrounds who have received at least one dose of vaccine are 38.1% and 30.9%, respectively. Dr. Smith’s goal is that “findings from this study will inform strategies that advance health equity and improve outcomes for minority and underserved communities in the South of the United States.”

In addition to supporting her research, this career development award will provide advanced training opportunities, helping Dr. Smith to acquire new skills and methodologies that are fundamental for conducting rigorous and innovative research. Furthermore, Dr. Smith states that the mentorship and networking opportunities associated with such grants will be invaluable, providing guidance and support from established researchers in the field.

What is the story behind Dr. Smith’s journey from her birthplace in Brazil to her faculty position at LSUHS and her research in women’s health? Growing up in Brazil, Dr. Smith states that she had “a big heart for my community and the people around me. I was moved by watching my parents work in health care (her mother is a nurse and her father is an OBGYN physician), helping patients fight diseases and breaking barriers from health inequities. Their dedication to making a difference in people's lives inspired me to pursue a healthcare career, specifically in nursing, where I could directly interact with patients and provide the compassionate care they deserve.”

After receiving her nursing degree, Dr. Smith worked as a clinical nurse and “encountered countless health inequities.”  She “witnessed firsthand the devastating impact of preventable diseases” and “saw patients suffer and even die from conditions that, with timely intervention and resources, could have been avoided or managed effectively.” These experiences exposed her to the realities of a healthcare system struggling to provide equitable access and quality care. During her nursing career, she was a nurse manager in a male state prison in Brazil, where she implemented a statewide HIV program. This role allowed her to see the unique challenges faced by incarcerated individuals and the critical need for targeted health interventions. She also worked in an adult emergency room/ICU and a public health clinic, where she encountered various medical conditions and health disparities. These diverse experiences further fueled her desire to address systemic issues on a larger scale. She expounded further that each day she worked as a nurse, she interacted with individuals whose lives were deeply affected by the lack of preventive measures and early detection, stating “I met mothers who lost children to preventable illnesses, families torn apart by diseases that could have been treated, and communities impacted by health disparities.” These systemic issues ignited a profound desire in her to address them on a larger scale.  She explained, “I realized that to make a lasting impact, I needed to focus on prevention, education, and policy – areas where public health plays an essential role.”

With this mindset, Dr. Smith pursued and completed her Masters of Public Health (2013) and PhD in Public Health with a concentration in Epidemiology (2017) from the prestigious Federal University of Ceará in Brazil. During her PhD, she achieved a significant milestone by securing two national grants from the Brazilian government. These grants allowed her to conduct the first nationwide research project on female health in prisons in Brazil. She carried out this research in 15 prisons across nine states in Brazil, leading to publications in peer-reviewed journals and presentations at national and international conferences. In 2015, she received a scholarship to study abroad at Tulane University, where she met her husband, Corey Smith, who became a medical student at LSUHS and is now a resident here in internal medicine.  The couple was married in 2017, and Dr. Smith moved to the United States. For several years, she faced a number of challenges pertaining to her immigration status and COVID-19. In 2021, however, Dr. Smith was hired as an Assistant Professor in the MPH program at LSU Health Science Shreveport, which she described to me as her “dream job.”

Dr. Smith’s long-term career goal is to “become a recognized leader in epidemiologic, clinical, and translational studies, focusing on the impact of health promotion and prevention among minority and underserved populations in the United States.” I have no doubt that she will achieve this goal. Please join me in congratulating her on receiving an LA CaTS Career Development Award, an important step in her academic and public health journey.

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

On June 7th, we announced a restoration of the basic science departments back to the medical school, and of the consolidated position of Chancellor of LSUHS and Dean of the School of Medicine. Since then, we have held two campus-wide Town Hall meetings, as well as smaller meetings with specific groups such as department chairs, scientists, and graduate students. In this edition of Aiming High, I will summarize the rationale for these changes, and provide answers to some commonly asked questions that have been brought forward by faculty, staff and students.

The rationale for returning the basic science departments to the School of Medicine from the School of Graduate Studies is that:

• It is consistent with the LCME accreditation standard that the medical school dean has authority over all of medical education – i.e., both clinical and basic science education.
• LSUHS was alone in the nation as the only health science center in which basic science departments were housed in the School of Graduate Studies and not in the School of Medicine.
• From the inception of LSUHS until 2017, basic science departments were housed in the medical school, like all other medical schools and like LSU Health New Orleans.
• Housing basic science and clinical chairs and faculty under the medical school, with regular joint meetings and other coordinated activities, will promote synergy between basic scientists and clinical investigators, and thus greater collaboration in research and an increasing focus on how basic science discoveries can translate to clinical practice.

Consolidated leadership of LSUHS Chancellor and School of Medicine Dean was instituted at the time of the appointment of the first Chancellor and Dean, John C. McDonald, MD, on November 3, 2000, a position he held until his retirement in 2009. The rationale for returning the roles of chancellor and dean to a jointly held position is that:

• Once the basic science and clinical departments are jointly housed in the School of Medicine, the positions of LSUHS Chancellor and School of Medicine Dean largely overlap.
• This type of joint position is common in health science centers where there are a small number of health profession schools.
• When the LSUHS Chancellor and School of Medicine Dean is held by the same individual, the 1-on-1 relationship established between the Chancellor/Dean and the CEO of the Ochsner LSU Health System (OLHS) facilitates alignment between LSUHS and OLHS. This will significantly advance the LSU Strategic Framework and the LSUHS/OLHS joint strategic plan to build an integrated academic health center for North Louisiana and beyond.

Here are some of the questions that have been frequently asked, and my answers:

Having consolidated basic and clinical departments under the medical school, and the positions of Chancellor and Dean, what are your main goals as Chancellor and Dean for LSUHS over the next year?
I will state one overall goal and then one goal for each of the three missions across LSUHS.

• My overall goal is to complete our joint LSUHS/OLHS strategic plan, TogetherStronger, such that all members of the LSUHS community get behind and live by the plan in their day-to-day work. The overarching goal of the plan is to foster integration between LSUHS and OLHS to create a powerful positive feedback loop between patient care, education and research, and thus create an integrated academic health center. The theme of the strategic plan is quality, in all we do, and there are 1-year and 5-year goals for each of a dozen areas of focus. We begin by working together to achieve as many of the 1-year goals of TogetherStronger as possible.
• My top goal for patient care is to improve the quality of care – in all of its dimensions – such that our own LSUHS and OLHS employees will choose our health system for the medical care of themselves and their families at twice the rate as at present.
• My top goal for research is to grow the funded research portfolio significantly and have a new research building under construction to accommodate future growth.
• My top goal for education is to meet the LCME standards for accreditation without probation, and to exceed them to then set the stage for becoming known nationally as a medical school with an innovative and truly effective educational program.

Will there be any other major actions taken with regards to the organizational structure of LSUHS?
No.

Will the PhD programs in the School of Graduate Studies be consolidated into one degree program in “Biomedical Science” rather than distinct programs in specific disciplines?
No. We believe that the first-principles knowledge and focused laboratory experience gained in a discipline-specific PhD program provides the best scientific foundation for a career in science that may continue to focus on that discipline or broaden to include other fields.

Separate parking lots are now assigned for each of the three schools at LSUHS. The lot assigned to graduate students is across Kings Highway, which entails a potentially dangerous road crossing and has proximity to an unsafe environment. Some research experiments require staying late at night or arriving early in the morning, which exacerbates the safety issue. What can be done about this?
We agree that the current parking lot assigned to graduate students carries safety concerns. We will assemble the individuals most knowledgeable about parking at LSUHS to address these concerns and include a graduate student representative in the process of coming up with a solution.

Will the new medical education building be expanding its access to residents, faculty, students in the two other schools, and to LSUHS and OLHS staff?
Yes. Since June 3rd, all employed personnel on campus – residents, faculty, students and staff – have been able to join the fitness center. Similarly, the new dining facility – which will feature multiethnic, healthy food choices, coffee and espresso drinks, and on-site catering – is scheduled to open in the October/November time frame and will be open to all employed personnel on campus. The simulation center is open to residents and faculty for training. This can be scheduled during the didactic time set aside for residents; if a time after 5 p.m. is desired for a particular simulation exercise, including laparoscopic or endoscopic surgery, this can be scheduled by contacting Elizabeth Young, M.Ed., Elizabeth.Young@lsuhs.edu; a faculty supervisor will be required for these after-hours simulation activities.

Are there plans to improve the postdoc salary structure?
Yes. Conceptually, postdocs who are here for more than a specified number of years (to be determined) will be transitioned to a non-tenured faculty position.

If you have any other questions related to the consolidation, please send them to https://forms.lsuhs.edu/Forms/ChancellorSurvey.

We will be pleased to respond in a timely manner.

In closing, let me again express great appreciation on behalf of LSU Health Shreveport for the dedication and service of David Lewis, MD, and Chris Kevil, PhD, who played central, critical leadership roles in successfully navigating this institution through difficult times, including Covid, and in creating a strong foundation upon which we can now build.

Aiming High,

David S. Guzick, MD, PhD
Chancellor, LSU Health Shreveport
Dean, School of Medicine

In April of 2022, Oren Rom, PhD, RD, received the Research Rising Star Award at the LSUHS’s 4th Annual Research Celebration. A short two years later, we can safely say his star has risen. While just recently appointed as Associate Professor with Tenure in the Departments of Pathology and Translational Pathobiology, and Cellular and Molecular Physiology, Dr. Rom already has more NIH R-series grants than any other faculty member at LSUHS. And a few more are in the hopper.

Like many faculty at LSUHS, Dr. Rom’s path to scientific achievement involved a journey that meant leaving his country of birth for the U.S. to pursue his research. Despite this major disruption for Dr. Rom and his family, his passion for his research question and desire to improve human health – matched by his trained, inquisitive mind, relentless hard work, and investigational creativity – won out. I recently had the opportunity to interview Dr. Rom for this month’s edition of Aiming High; you will see what I mean.

Dr. Rom, you were born and raised in Israel, obtained your first degree as a bachelor of science in nutrition, and then became a registered dietitian. What initially motivated your interest in nutrition?

Since early adolescence, I have been fascinated with healthy activity, exercise, nutrition, and lifestyle choices and how they affect the human body and quality of life. Already at this early stage of life, I came to realize that we have little control over our genetic signature, but our lifestyle choices, particularly what we eat, have a major influence on our health and quality of life. This understanding has led me to devote my life to improving human health through clinical practice in nutrition and metabolic research.

Three years after you became a Registered Dietician you obtained a PhD in Medical Sciences from the Technion – Israel Institute of Technology. Why did you decide to pursue your PhD? What was the topic of your doctoral thesis?

In fact, obtaining a PhD was not my original plan. In the Israeli healthcare system, after completing a bachelor's degree in Nutritional Sciences, you need to wait one to two years before starting a clinical internship program. I decided to make the best out of this waiting period, applied for the Master’s program in Medical Sciences at the Technion – Israel Institute of Technology, and was thrilled to learn that I was accepted to one of the leading research institutes worldwide. In line with my passion for exercise and metabolic research, my Master’s, and later my PhD thesis, focused on protein metabolism and biochemistry in skeletal muscle. My PhD studies, published in leading journals in the fields of redox biology and substance abuse, identified novel mechanisms by which specific components of cigarette smoke induce muscle protein catabolism. I also demonstrated, for the first time, the beneficial effects of smoking cessation on skeletal muscle in clinical studies.

Your PhD was followed by less than two years as a post-doctoral fellow in the Lipid Research Laboratory at Technion – Israel Institute of Technology. Did you continue with the same line of research as your thesis or move in a different scientific direction?

Driven by my dedication to improve human health through metabolic research, I next directed my attention towards atherosclerotic cardiovascular disease (ASCVD). Atherosclerosis is the underlying cause of most cardiovascular diseases, which are the leading cause of death worldwide. I started my postdoctoral training in 2015 with Dr. Michael Aviram, a pioneer in the field of lipid metabolism and redox biology in atherosclerosis. In Dr. Aviram’s laboratory, I acquired unique expertise in the biochemistry of lipid metabolism, where I conceived and developed the idea to study the interaction between amino acids and lipids in atherosclerosis and cardiometabolic diseases. Beyond publishing a series of first-author articles, these provocative studies earned me competitive research fellowships from the Israeli Atherosclerosis Society and the Israel-Michigan Partnership for Research.

You and your wife Inna then journeyed to the University of Michigan with your children, Ethan and Natalie. It must have been an extraordinarily difficult decision to leave your homeland. What drew you to the U.S. and to the Michigan lab specifically?

The fellowship awarded by the Israel-Michigan Partnership for Research brought me to the Cardiovascular Center at the University of Michigan in 2017 to fulfil my long-standing goal of becoming an independent investigator in cardiometabolic research. In the outstanding environment of the University of Michigan, and under the mentorship of Dr. Y. Eugene Chen, a world-renowned investigator in cardiovascular research, I received the best training with state-of-the-art techniques in translational cardiometabolic research, genomics, and metabolomics. With my prior experience in biochemistry, redox biology, and lipid metabolism, I applied these new techniques to advance ongoing projects, resulting in new discoveries and impactful publications, while establishing my independence and carving my own niche in the study of amino acid-lipid interactions in metabolic dysfunction-associated steatotic liver disease (MASLD) and ASCVD. The hard work and dedication during my postdoctoral training at the University of Michigan culminated in my receipt of the American Heart Association (AHA) Postdoctoral Fellowship in 2018, and the NIH/NHLBI K99/R00 Pathway to Independence Award in 2019. I am very grateful for the strong support I received from the AHA and NHLBI, which allowed me to launch my career as an independent investigator in cardiometabolic research.

We were smart to recruit you from Michigan to LSU Health Shreveport! In a few short years you have created a vibrant lab and research team, supported by several NIH and other grants. You and your team are now producing publications with wide impact and numerous citations by peers. Broadly speaking, your lab is working to elucidate metabolic and molecular mechanisms of cardiometabolic diseases to identify targets for new treatments. One of the main diseases you study is metabolic dysfunction-associated steatotic liver disease (MASLD), more colloquially known as non-alcoholic fatty liver disease. While perhaps not widely appreciated, MASLD is the most common cause of chronic liver disease and the leading cause of liver-related morbidity and mortality. Obesity and obesity-related diseases, including MASLD, are leading threats to public health, especially in North Louisiana. How did you get interested in this area of research?

My passion for MASLD research stems from the current challenges in treating cardiovascular disease. Despite the remarkable advances in interventional and pharmacological therapeutics, ASCVD remains the leading cause of death worldwide. While the overarching etiology largely arises from dyslipidemia, the imbalance of cholesterol and triglycerides and numerous comorbidities complicate and exacerbate atherosclerosis. Of particular significance are metabolic- and obesity-related diseases, which have globally increased in prevalence since the 1970s. Particularly, MASLD incidence has increased dramatically and is now affecting over a third of the global population, with limited pharmacological therapy available. While MASLD is associated with increased risk of liver-related mortality, the most common cause of death in patients with MASLD is ASCVD. The focus of my laboratory is to shed light on yet undefined metabolic pathways linking MASLD with ASCVD with the ultimate goal of identifying novel therapeutic targets for simultaneously treating both diseases.

To this point, you are studying several biochemical mechanisms of MASLD, an understanding of which might lead to new treatments. What seems most promising?

To achieve our ultimate goal of developing simultaneous treatments for MASLD and ASCVD, we established a multidisciplinary research program. This program involves human specimen biobanks, genome‐wide association studies, and novel animal models, combined with multiomics tools such as metabolomics, transcriptomics, and genomics, as well as pathophysiology, biochemistry, and molecular biology. This multipronged approach uncovered novel dysregulated pathways linking amino acid and lipid metabolism in MASLD and ASCVD, resulting in impactful publications, patent applications, and evaluation through clinical and preclinical trials. Our recent string of studies on nonhuman primates and mice, published in Cell Metabolism, Science Translational Medicine, and Redox Biology, uncovered a glycine-based therapy for MASLD and atherosclerosis. Another line of work, supported by the K99/R00 from the NIH/NHLBI and an R01 from the NIH/NIDDK, was recently published in Cell Reports and is currently in revision in Nature Metabolism. These studies have identified genetic and pharmacological strategies to inhibit oxalate overproduction in the liver as another approach to mitigate MASLD and atherosclerosis. Moreover, work in our lab supported by other R01 and R41 grants from the NIH/NIDDK has identified a novel class of endogenous and synthetic fatty acids conjugated to amino acids that potently lowers MASLD and atherosclerosis by modulating lipid metabolism and the inflammatory response.

These lines of your research relate to other scientists at LSUHS who study cardio-metabolic disease. How are you supporting the development of this field of research and how do you see it evolving?

I established the Cardiometabolism & MASLD group in July 2021, two months after my arrival at LSUHS. This group currently includes numerous investigators and their trainees from various departments at LSUHS. In our monthly meetings, faculty and trainees present their progress in cardiometabolic research to promote collaborations, funding, and publications. The extensive productivity and collaboration among group members has been demonstrated through four awarded R01 grants, six submitted or pending multi-PI R01 grants, 3 awarded AHA Postdoctoral Fellowships, and 13 publications in leading journals. These accomplishments were made possible through unique friendships and collaborations with outstanding investigators at LSUHS including Dr. Art Yurdagul, Dr. Wayne Orr, Dr. Nirav Dhanesha, Dr. Chris Pattillo, Dr. Matthew Woolard, Dr. Tarek Magdy, and many others. I feel that these achievements in such a short period of time clearly indicate the interest and enthusiasm for cardiometabolic research at LSUHS and highlight our strong potential to make seminal contributions and become a leading institute in this field of study.

The theme for research in our Strategic Plan is “reaching for excellence.” I’m sure that readers will agree that Dr. Rom exemplifies this theme! I will close this newsletter by conveying another important component of the Rom lab, which is its focus on education and mentorship. Dr. Rom is educating and mentoring a talented group of students and post-doctoral fellows, who are achieving their own recognition, as listed on his website. All in all, that is what “Aiming High” is all about.

David S. Guzick, MD, PhD
Chancellor

In early April, we were honored to learn that Ochsner LSU Health Shreveport - St. Mary Medical Center has earned an "A" in the Spring 2024 report from the Leapfrog Hospital Safety Grade survey, a widely recognized measure of patient safety for U.S. hospitals.

Congratulations to the leadership and staff of St. Mary Medical Center! They aimed high and achieved a lofty patient-safety goal. Indeed St. Mary Medical Center is the only Leapfrog “A” hospital in North Louisiana.

This “April, 2024” edition of Aiming High is being posted today, May 1, because news on our Leapfrog safety grade was embargoed until now. It was heartening to read the commendation from its source; thus, the letter to St. Mary’s from Leapfrog summarized its grade “A” rating as follows: “Your track record for keeping patients safe is a tremendous achievement shared by few hospitals across the country, and this accomplishment underscores your reputation as an organization focused on patient safety … [Y]ou put patients first … and achieved this milestone by doing the right thing for patients. Your "A" grade reflects your institutional culture and tells prospective employees and interested clinicians that your hospital is a leader in keeping patients safe.”

St. Mary Medical Center celebrated its 4th anniversary yesterday, April 30, 2024. It is hard to believe that it was only four years ago, during the height of the COVID-19 pandemic, that the collective efforts of LSU Health Shreveport, Ochsner LSU Health System and various state agencies yielded a new hospital in Shreveport. This hospital would become indispensable in answering former Governor John Bel Edwards’ call to create more critical care capacity at our Ochsner LSU Shreveport Academic Medical Center hospital, while also fulfilling a long-term community goal of a separate facility for women’s and children’s services. All of this work to launch St. Mary Medical Center was accomplished over the span of only 45 days, an absolutely amazing feat!  

Over the last four years, the Ochsner LSU Health Shreveport - St. Mary Medical Center campus has experienced unprecedented inpatient and outpatient growth. St. Mary Medical Center is now the largest birthing center in north Louisiana and the third largest in the state, with over 2,400 births last year. In addition to inpatient growth, the campus has enhanced outpatient services through the addition of new clinics, operative suites, and imaging modalities. The hospital’s large ambulatory footprint has been integral in creating greater access for new and existing patients. There is no doubt the future will continue to be bright for St. Mary’s!

Leapfrog calculates its safety grades for 3,000 hospitals in the nation, using data from its own hospital survey, as well as public databases from the Centers for Medicare and Medicaid Services. Twenty-two patient safety measures are scored for each hospital, including process measures such as physician computerized order entry and nurse and doctor communication, and outcome measures such as hospital acquired infections and retained foreign objects; the score on that measure for each hospital is then compared to the mean scores for all hospitals. The extent to which the hospital’s score is better or worse than the mean is statistically standardized, and these standardized scores are then aggregated across all safety measures to get an overall safety score – which for St. Mary Medical Center was Grade A!

Achieving this level of quality over 22 different safety measures reflects the efforts of the entire St. Mary Medical Center staff. As stated by Chasity Teer, RN, Chief Nursing Officer: “We are so happy to celebrate this recognition with our team!  Everyone involved in our health system played a role in making this achievement a reality.” This sentiment is shared by LaTasha Upton, MD, Chief Medical Officer: “This is quite the achievement!  Our hospital team is fully dedicated to providing consistent, equitable, high-quality care to the patients we serve. We are honored to receive this recognition, highlighting our commitment to quality standards of patient safety.”

Riley Waddell, Chief Executive Officer, provides an excellent summary statement of the patient safety honor bestowed on St. Mary Medical Center: “LeapFrog A signifies our team’s commitment to providing efficient and effective care in the most compassionate manner.  This award exemplifies our team’s devotion to ensuring our patients are at the center of everything we do.” 

Aiming High,

What we have come to know as residency training dates back to the late 19th century. At that time, the first medical and surgical residencies were started by Sir William Osler, MD, and William Halsted, MD, two of the “big four” founding professors of The Johns Hopkins Hospital. Before residencies, medical and surgical training was a haphazard series of apprenticeships without a defined endpoint. The new residency programs at Hopkins in the late 1800s – a system soon to be duplicated elsewhere in the U.S. – were based on the principal that post-medical-school training should be accomplished in a set period of time, rooted in scientific knowledge, and structured with a progressive increase in responsibility and clinical experience.

While residents benefited from supervised clinical training, hospitals also benefitted from the clinical service provided by residents. In the early days, the cost to the hospital for this quite substantial amount of clinical service was room and board, along with a set of white coats, but little or no salary. Trainees literally “resided” in the hospital taking call almost every night, or in nearby houses – the origin of the term “house officers.”

As hospitals expanded dramatically during the first half of the 20th century, due to advances in medicine and growing insurance coverage, fierce competition among hospitals for interns (i.e., first-year residents) led to earlier and earlier offers to graduating medical students. As Alvin E. Roth, Ph.D. recounts in a history of the resident match: “By the 1940s, appointments were often made as early as the beginning of the junior year of medical school,” He goes on to say that “hospitals had little information about students' performance, and students frequently had to make a final decision to accept or reject an offer without knowing which other offers might be forthcoming.” Moreover, students often felt pressured to take a position offered by a hospital that was below their first choice, as they were often given a very short deadline (e.g., 24 hours) by the hospital to make a decision. On the hospital side, they often “had to scramble for available students, since if an offer was rejected, it was often too late for hospitals to reach their next preferred candidate,"

Enter the National Resident Matching Program (NRMP), a private, non-profit organization created in 1952 to match U.S. medical school graduates into U.S. residency training programs. After a couple of alternative algorithms were tried, the one implemented (and fundamentally still in use) can be thought of as equivalent to a “deferred acceptance” model. In effect, the computer has hospitals make offers to students in their rank order, and (in the computer algorithm) each student holds on to the best offer they receive, but later rejects it if a better offer is made. The nature of this algorithm is why it’s best for students to create their residency program rank list in the order of their true preference, even if they think they won’t match to their first choice.

At exactly 11 am Central Time on the third Friday in March, every medical student across the country receives electronic notification of where they had matched for their residencies. Across the country, at that exact moment, in events that can be likened to a mix of the Oscars and a Harry Potter Sorting Hat ceremony, loud shrieks are heard. At LSUHS, on March 15th students gathered on the ground floor of the Biomedical Research Institute, anxiously awaiting for 11 am to look at their phones. Family and friends filled the balconies of the BRI for many floors above. Anticipatory excitement filled the room. As was the tradition before electronic notification, once 11 am came and went, students were called to the stage by our clinical chairs, handed an envelope, and shouted out the field of medicine they were entering and the residency program they will be attending.

Of the 2024 class, 28.9% will be staying at LSU Health Shreveport for their residency, 43% of graduates have matched to an LSU residency site, and 51% of the graduates will be staying in Louisiana. Moreover, 45% have matched in primary care residencies comprised of Internal Medicine, OB/GYN, Pediatrics, Family Medicine and Medicine-Pediatrics.

Since students who complete their residency in the State they call home are more likely to remain in that State, these results are critical for addressing what is a growing shortage of physicians in Louisiana. This shortfall is occurring because of the double whammy of short supply and increasing demand. On the demand side, our population will require more health care because we are getting older and because of advancements in biomedical science and technology that have translated into new and more effective treatments. And on the supply side, maintaining (or increasing) the size of the physician workforce in the state is a challenge because of the number of baby-boom physicians projected to retire. 

Also of note, LSU Health Shreveport medical students matched to highly competitive residencies and will train in prestigious programs around the country including: Mass General/Harvard, Wake Forest, Emory, University of Alabama-Birmingham, Baylor, UT Southwestern and others.

On the other side of the coin, Match Day also revealed that LSU Health Shreveport School of Medicine successfully filled all 138 of its residency positions. Adding in fellows, a new group of 180 trainees in 45 specialty and subspecialty programs will be welcomed to LSUHS and to Ochsner LSU Health Shreveport.

With best wishes for every graduate of the Class of 2024 as they transition to the next chapter of their medical career.

Every decade, like other institutions of higher education in the South, LSUHS undergoes a rigorous reaffirmation of accreditation process conducted by an organization called the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC), commonly known as SACS. This process ensures compliance with a comprehensive set of principles encompassing over 70 standards, addressing various aspects of higher education. Our last accreditation review occurred in 2014, and we have submitted our materials to SACS for reaffirmation of our accreditation in 2024. Their preliminary review of our report on these standards, submitted in September 2023, identified a few minor issues, which we believe have been satisfactorily addressed. An in-person SACS site visit to our campus is scheduled for March 25-28, 2024.

Amidst this process, an important aspect of SACS accreditation involves the implementation of a five-year Quality Enhancement Plan (QEP) across the entire institution (SACSCOC Standard 7.2). We have chosen interprofessional education (IPE) as the QEP topic for LSUHS and have worked on its development over the past year. Our plan was submitted to SACS on February 12, 2024, and it will be a major focus of the upcoming SACS site visit.

An interest in IPE at LSUHS is not new. Beginning with the School of Allied Health Professions in 2017, and then as part of a broad-based, institution-wide strategic planning process in 2019, a focus on IPE across all three schools at LSUHS was recommended as a major educational objective at that time. Thereafter, an event focused on the roles and responsibilities of different health professionals has been held each fall, primarily engaging students from the School of Medicine and School of Allied Health Professions.  However, a comprehensive IPE program across all schools, including the School of Graduate Studies, has not yet occurred.

STRIPE aims to accomplish these goals and outcomes by embedding interprofessional education in selected small-group, problem-based learning (PBL) modules.  These modules will occur at four specific points throughout the yearly curricula of all three schools, introducing the core concepts of IPE. During these PBLs, students will gain a foundational understanding of interprofessional collaboration, the importance of effective communication, and the ethical and professional responsibilities that come with it. STRIPE thereby sets the stage for further development of interprofessional competencies and fosters a mindset of cooperation and mutual respect among future biomedical and health care professionals. Subsequently, students will apply their skills in school-specific activities that encourage interdisciplinary teamwork, helping students appreciate the synergy of diverse skill sets, nuances of interprofessional communication, and effective sharing of responsibilities within a team.

To measure the success and impact of the QEP, validated assessment tools will be employed, evaluating students' progress in terms of interprofessional competencies, their readiness to engage in collaborative practice, and the effectiveness of the educational strategies employed. For example, student learning outcomes will be assessed by comparing student scores on several validated IPE survey measures before and after each PBL learning module, using an adequately powered design and conducting multivariate statistical analysis for comprehensive evaluation.

The current 2023-2024 academic year is being devoted to planning the details of specific small-group IPE learning modules and conducting a test run of several modules to refine their implementation. Full implementation of STRIPE is scheduled for the 2024-2025 academic year, utilizing a consented student sample of adequate power. Over the next five years, efforts will revolve around executing PBL learning modules across diverse student cohorts, assessing student learning outcomes, and fine-tuning activities based on assessment findings and statistical analysis. Continuous monitoring and evaluation will ensure ongoing adaptability and effectiveness, culminating in a comprehensive assessment of the QEP at the conclusion of academic year 2028-29. In March 2030, a QEP Impact Report will be submitted to SACSCOC, summarizing the journey and achievements of this transformative educational initiative.

In summary, LSUHS’s commitment to academic excellence is exemplified through its strategic focus on interprofessional education (IPE) as its QEP, known as STRIPE. Through diligent planning and collaboration across the institution's three schools, the STRIPE initiative aims to prepare students with the essential competencies and values necessary for collaborative professionalism. With a clear roadmap for implementation and assessment, LSUHS is poised to make significant strides in advancing IPE, fostering a culture of collaboration, innovation, and lifelong learning. Please visit our QEP webpage for more information and updates.

On Friday, January 12th, 67 chairs, division directors, and research and education leaders from LSU Health Shreveport (LSUHS) joined with 54 executives, administrators and clinical leaders from the Ochsner LSU Health System (OLHS) to launch a joint strategic planning process that will result in a written plan for our functionally integrated academic health center. We expect to complete this plan with a written report on July 1, 2024.

Called Together Stronger, this strategic plan will focus mainly on the next five years, but will also include aspirations and strategies for the next 15 years, recognizing that we are aiming high for a long-term transformation that will impact not only patient care, research and education on our campuses, but also the healthcare workforce, economic development, and population health of North Louisiana.

Why do this? Why now? One answer is based on practical considerations and timeliness. A Louisiana statute states that University campuses must create a strategic plan, with revisions at a minimum of every 3 years. The last strategic plan for LSUHS was done in 2019, so it’s time for a new plan. But there is a more important reason, which relates to our collective aspiration to transform ourselves from a relatively small health science center and health system into a functionally integrated academic health center that grows in size, scope and stature over the next 15 years to become a powerful economic engine for the I-20 corridor and North Louisiana generally. As noted in a previous edition of Aiming High, successful academic health centers are characterized by the tenets of joint governance; common missions, vision and values; goal setting; and decision making. What better way to implement these tenets than to develop and implement a joint strategic plan?

The launch of the Strategic Plan took place in the LSUHS Center for Medical Education, taking advantage of our wonderful new facility. After some introductory commentary on history and the state of affairs in 2018 prior to the OLHS partnership, we reviewed the tremendous progress that has been made regarding each of the challenges facing the partnership in the clinical enterprise, and also advances in research and education, which have been substantially supported by the partnership.  

One important foundational area that was highlighted at the meeting was the joint statement of mission, vision and values. Of note, when the language used to describe the mission, vision and values of LSUHS is compared with that of OLHS, it is remarkable how closely aligned they are.

The bulk of the 4-hour work session at the launch was devoted to (1) a preliminary assessment of our strengths, weaknesses, opportunities and threats from the perspective of our integrated academic health center; and (2) a preliminary effort at setting 1-year and 5-year goals. This process was conducted in small groups devoted to various aspects of patient care, education, research, facilities, communication, community engagement, finance, and other key areas.

A calendar has been developed with specific deadlines to ensure that all stakeholders have the opportunity to provide input into the plan, as well as frequent back-and-forth feedback between the planning subgroups, leadership, students, community leaders, and the broad LSUHS and OLHS communities. This process will include a series of town hall meetings in April, but your input at any stage in the process is welcome. OLHS and LSUHS intranet websites will provide a resource to provide feedback.

The OLHS partnership has resulted in tremendous progress over the past five years, as was summarized in a recent edition of Aiming High; however, the best is yet to come! We are excited to create a roadmap with you that charts our aspirations, as well as current and anticipates challenges, for the next 5 years, and identifies strategies to help us meet these challenges and aspirations. This is a critical step on our way to a 15-year time horizon in which our academic health center will be pivotal in transforming North Louisiana into a more vibrant region that attracts population, builds a workforce, promotes economic development and improves the health of its population.

We are confident the joint strategic plan will be successful if approached with data, objectivity, honesty and commitment; so know that we look forward to hearing from you in the weeks and months ahead.

Aiming High,

Aiming High at LSUHS: 
A Year-End Review and A Look Ahead at 2024

With this year-end newsletter, I extend my best holiday wishes to our faculty, staff, students, donors, and other supporters who made 2023 an extraordinary year for our academic health center.

There is much about which we can all be proud. Here are some 2023 highlights and 2024 goals from those who lead the component parts of our AHC – the dean of each of our three schools, and the CEO of our Ochsner-LSU Health System.

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Having now had the privilege of being Chancellor of LSU Health Shreveport for almost a year, I want to express my deep appreciation for how welcoming and supportive everyone has been. Step by step, we are building an integrated academic health center that begins with an increasingly robust clinical enterprise at OLHS and then circles around to research and education in a positive feedback loop. This past year has been one of assessment, and of positioning for the future. While that is still a work in progress, enough has been accomplished to proceed with a formal strategic planning process as an AHC, conducted jointly by OLHS and LSUHS. This will launch in January, 2024 and be completed by July 1, 2024. We look forward to input and engagement from our entire AHC community.

Meanwhile, enjoy the holidays and have a great New Year!

Aiming High,

David S. Guzick, MD, PhD
Chancellor

Aiming High in Leadership

Introducing Corwin Harper, MBA: CEO of Ochsner LSU Health System - North Louisiana

Corwin Harper, MBA, joined OLHS as its CEO on November 1, 2023. You may have read about him from the press releases and internal communications that were distributed at that time, and many of you have met him already. I thought that it would be important, however, for the LSUHS and OLHS community as a whole to learn more about Corwin as we forge together this 50:50 North Louisiana partnership between LSU and Ochsner Health in patient care, research and education. I therefore asked him if he would sit for an interview, and he graciously agreed.

Based on my personal interactions with Corwin thus far, and in my observations of Corwin’s interactions with hospital executives, faculty, staff, here are the words that come to mind in describing him: inspiring, experienced, data-driven, quality focused, staff champion, family-centered, big-hearted.

An insight into who Corwin Harper is can be gleaned from his “life quote,” which he penned in 2016: 

"I am one human being, 
Living in one human race,
Working to Create one Humane World" 

Here is my interview with Corwin: 

Where did you grow up, and how has this shaped your life? 

I grew up in Allendale, South Carolina, a small rural town with a population of less than 10,000 people. Allendale County is located on the Georgia and South Carolina border along the Savannah River. My life and career have been significantly shaped by my upbringing, as my parents were both educators and raised me as an only child to be independent, hardworking, and wise to the ways of the world. My parents exposed me to efforts in academia to prepare me for the future and life beyond Allendale, SC. As an example, when I was in the 7th and 8th grade, I would sit in class with my parents when they were getting their master's degrees at South Carolina State College.  It helped me appreciate the learning experience and the importance of education. 

I know that you had a career in the military. Tell me about that and how it was formative in your choice of healthcare administration as a career.

I attended The Citadel - The Military College of South Carolina and obtained a BS degree in Biology. I was Pre-Med. My goal was to become a surgeon. While at The Citadel, however, a board member of the university shared with me the career of healthcare administration.  Additionally, one of my college classmate’s father was a Brigadier General in the US Army Medical Service Corp, and he also recommended that I consider a career path in healthcare administration. So, from 1986 to the present, I have been a healthcare executive, assuming higher level and more complex responsibilities in uniquely different healthcare environments. 

I spent eight and a half years in the US Army as a commissioned officer in the Medical Service Corps.  I served in Korea at Camp Casey, in Georgia at Fort Gordon (recently renamed as Fort Eisenhower), and in Texas at Fort Sam Houston (now part of Joint Base San Antonio). During that time, I supported the fighting force of the Army in overseas assignments, participated in a family practice residency program, was the unit CEO and provided leadership to multiple disciplines of the military, created a new model of preventative care called the “Fit to Win Center,” provided strategic planning for the military to include BRAC (Base Realignment and Closure) and much more. 

Additionally, the Army provided me the opportunity to attend the US Army Baylor master's degree program in Healthcare Administration, in which I have subsequently been a preceptor to 6 residents and was named Preceptor of the Year for the program in 2020. 

You spent 25 years at Kaiser-Permanente, a pioneer in the field of pre-paid health care systems. What was the progression of positions that you held at Kaiser-Permanente, and what were some of your accomplishments about which you are most proud? 

KP’s Northern California Region has 4.5 million members and an approximately $40 billion book of business. I had the opportunity to work in a variety of roles at KP Northern California (1996-2021): Medical Group Administrator (1996-2002); Medical Group Administrator/COO of Hospital Operations (2002-2004); Senior Vice President/Area Manager in three different markets for KP, including Fresno, Central Valley and Napa Solano (2004-2021); and a regional role as the Senior Vice President/Chief Diversity and Inclusion Officer for KP Northern California(2016-2017).  

I am proud of several accomplishments: 

• Built a $454 million medical center in Modesto. This was the first new hospital in Central California in over 40 years. 
• First Gold Seal of Approval (perfect) score for Joint Commission Survey results in 2004 for KP 
• Developed a Quality and Patient Safety program for KP NCAL called the 3 P’s- Pause, Plan, and Prepare 
• Founded and executed a joint venture, Port City, LLC with a Common Spirit Health Hospital in Stockton, CA, which exceeded all financial, quality and access expectations of the central valley of California. This is now one of the models for how KP will partner with other hospitals. 
• Built and opened at least 10 medical office buildings and clinics across KP Northern California 
• Led the Trauma Verification process for KP Vacaville 
• Provided executive leadership for the ED residency program development in the KP Central Valley area 
• Led the financial turnaround of three different markets for KP 
• Led the strategic growth of the Central Valley from 225,000 members to 425,000 members. 

When and why did you join Ochsner Health, and what was your role prior to taking on this new role as OLHS CEO?

I joined Ochsner Health in October 2021 after I retired from KP. I held the role of Regional CEO of the Northshore and subsequently the role of SVP/Chief Growth Officer for Ochsner Health System. 

How do you see the OLHS partnership working operationally?  

I see the OLHS partnership working interdependently to fulfill the mission and vision of the organization. The potential and power of our functionally integrated academic health system must be unlocked by all of us. This will allow us to fulfill our vision of being a global academic leader, transforming care for our patients and communities, while achieving new heights in academia. We have the potential to improve the economic outlook for the I-20 corridor and the Arkansas, Louisiana, and Texas region and beyond. 

Can we close with a couple of fun facts about Corwin Harper? 

In 1995 while in Chicago, I danced with Natalie Cole, I played trumpet in a concert band while backing up Dizzy Gillespie in the 8th grade, and I enjoy vacationing with my wife sailing across the Mediterranean Sea and Jamaica. 

In September 2020 over the Labor Day weekend, I walked 54 miles in 4 days in honor of John Lewis and the many leaders who walked for Humanity from Selma to Montgomery, AL in 1965. I also had over 200 friends join me across the country to walk in their respective communities, which led to my personal brand of 54forHumanity. 

Aiming High,

David S. Guzick, MD, PhD
Chancellor

Aiming High in Clinical Partnership

Fifth Anniversary of the Ochsner LSU Health System

October 1st was the fifth anniversary of the Ochsner LSU Health System (OLHS)! While this special occasion was wonderfully celebrated at Monroe Medical Center, I thought that it would be fitting to highlight OLHS in this edition of Aiming High.

The clinical partnership between LSU Health Shreveport and Ochsner Health has been transformational for LSU Health Shreveport and for the communities of Shreveport, Bossier City and Monroe. In this edition of Aiming High, we will summarize the origins of OLHS, review its vision and achievements, define “what it really is,” and look ahead to the future.

Origins
The origins of OLHS are rooted in the history of the LSU Health Sciences Center in Shreveport and its main teaching hospital. This history was recounted based on library archives and other sources on the occasion of the School of Medicine’s 50th anniversary in May 2023.

Regarding OLHS specifically, its origins begin with Governor John Bel Edwards, who in mid2017 began to explore the possibility of bringing the Ochsner Health System to North Louisiana. Ochsner agreed in principle but wanted to do so as a partnership with LSUHS, believing that collaboration with the physician group was essential for the success of the endeavor. A 14-month discussion ensued, involving leaders of both organizations. On October 1, 2018, this process resulted in the legal entity whose 5th anniversary we are now celebrating – the Ochsner LSU Health System. This new health system, forged as a 50:50 partnership with 50:50 governance, was designed to oversee and coordinate activities between LSUHS and a healthcare delivery system that would include the teaching hospitals on Kings Highway (Academic Medical Center hospital) and Monroe Medical Center and eventually St. Mary Medical Center.

OLHS vision and achievements
At its start, the stated vision of OLHS was to “improve the health and well-being of its communities; provide access to care; expand patient-centered technology; support the growth of the medical school; and enhance research.” Here is a list of achievements, among many others, which demonstrate this vision is being realized:

• Invested $245 million in capital improvements across our hospitals and clinics, with new infrastructure, technology, equipment and locations.
• Implemented an electronic medical record system across all hospitals and clinics.
• Doubled the number of physicians to over 500 faculty members, who practice in 70 specialties and subspecialties increasing clinical faculty from 250 to 500.
• Improved the quality of care: for example, reduced hospital-acquired infections from 156 to 61 annually across all three hospitals and reduced the mortality rate by 30 percent.
• Improved access: We began our partnership with just two hospitals and seven outpatient locations in Shreveport and Monroe. We now have three hospitals, a behavioral health facility and more than 20 outpatient locations across the region including primary care, community health, urgent care and specialty clinics.
• Experienced an increased demand for our services: Visits to our outpatient clinics increased from 320,000 visits in the first year of OLHS to more than 650,000 visits currently.
• Partnered with Oceans Healthcare to open a new behavioral health facility – Louisiana Behavioral Health – expanding both inpatient and outpatient services to significantly increase capacity for all of North Louisiana’s mental health needs.
• Awarded the Press Ganey Human Experience Guardian of Excellence for outstanding patient experience (St. Mary Medical Center).
• Began a Hospitalist program at all three campuses, improving 24/7 care for patients.
• Ensured that our communities are served with regional centers of excellence to treat high-acuity medical conditions: a Level 3 Trauma Center in Monroe and a Level 1 Trauma Center in Shreveport; a Primary Stroke Center in Monroe and a Comprehensive Stroke Center in Shreveport; a Comprehensive Atrial Fibrillation Center of Excellence, Burn Center, and Level 4 Epilepsy Center in Shreveport.
• Opened a 130-bed hospital for women’s and children’s services at St. Mary Medical Center, renovating more than 250,000 square feet, including a 40-bed level III Neonatal Intensive Care Unit (NICU) and a Pediatric Intensive Care Unit.
• Increased the annual number of deliveries in Northwest LA from 1748 to 2418 (38.3%). This dramatic growth has occurred mainly at St. Mary Medical Center, which opened its Labor and Delivery unit in April of 2020, and which now houses the largest maternity unit in the Shreveport/Bossier area. During this time period, the number of babies treated in the NICU increased from 546 to 664 (21.6%).
• Increased the number of residents and fellows from 560 to 631approved positions, across 45 ACGME and 2 CODA accredited fields of specialty and subspecialty training, including a novel dental residency program, clinical informatics, neonatal-perinatal, sports medicine, and surgical critical care fellowships.
• Contributed a total of $15.5 million towards construction of the Center for Medical Education and Wellness. (OLHS contributed $10.5M and Ochsner contributed an additional $5M)
• Doubled financial support to LSUHS for its research program.
• Promoted a workforce that reflects opportunity and inclusion in our communities, with hospital staff comprised of 46 percent African Americans and an additional 7 percent who identify themselves in other non-white categories.

What exactly is OLHS?
As explained in the June 2023 edition of Aiming High (“Aiming High for Our Academic Health Center”), high performing academic health centers have a governance structure that fosters joint decision-making between LSUHS faculty and the hospital system. That is exactly how OLHS was set up – a 50:50 partnership between LSUHS and Ochsner Health that is legally distinct from LSU Health Shreveport and from Ochsner Health.

OLHS is a non-profit corporation with its own bylaws, governing board, operating financial statements, balance sheet, and bond rating. The OLHS board is split 50:50 between appointees from LSU Health Shreveport (LSUHS) and Ochsner Health, and the OLHS board chair alternates every two years between the CEO of Ochsner Health and the Chancellor of LSUHS. Within OLHS is the Ochsner LSU Physician Group (OLPG), led by the medical school dean and the OLHS regional CEO.

Ideally, this 50:50 partnership means that we come together to define common goals and then make joint decisions on the basis for what is best for the AHC as a whole, as opposed to what might be best for the hospital or the clinical faculty. While this is a work in progress, that is the ideal towards which we are working.

The future: a functionally integrated, regionally dominant, academic health center
A high performing academic health center (AHC) creates a virtuous circle of patient care, research and education, expanding its size, scope and stature over time. Moreover, important spin-offs of a high performing AHC are economic development for the region and improved public health.

OLHS has been transformational in the sense that its accomplishments listed above embody all of these missions; indeed, the positive feedback loop of patient care, education and research has come alive in Shreveport/Bossier and Monroe over the past five years. We now have a strong foundation on which to build a more functionally integrated academic health center.

How will this be done? It starts with leadership. We are fortunate to have strong support from LSU President Bill Tate, and from the LSU Board of Supervisors. There is also strong support from Ochsner CEO Pete November and the OLHS Board. Dr. David Lewis, Dr. Charles Fox and Dr. Leo Seoane also have been a vital part of this partnership, from their involvement in creating the initial structure to the ongoing collaboration that is necessary for the success of OLHS.

More locally, we now have a leadership transition in the position of regional CEO of OLHS. Having celebrated the transformative change brought to North Louisiana healthcare by Ochsner LSU Health on its fifth anniversary under the energetic and thoughtful leadership of Chuck Daigle, we now welcome Corwin Harper to this role. Corwin brings a wealth of experience to OLHS, having worked in a wide range of healthcare environments over several decades. He has been consistently successful in enhancing patient care quality, employee engagement, value-based care, strategic growth, and financial success. I am excited about partnering with him as we build an integrated academic health center that serves patients in the North Louisiana region and beyond, while also becoming a national leader in biomedical research and the training of the next generation of health professionals.

Although leadership is important in defining a vision and setting a path to get there, it is our faculty and staff members who advance this vision day to day: working together with commonly held values towards common goals; and participating in positive change in their own area, buying in to the idea that operational integration of the hospital system with the schools of medicine, graduate studies and health professions will improve the care we deliver, the education and training we provide, and the new scientific knowledge we discover.

Towards this end, OLHS has created a transformational framework, which deserves to be celebrated. Happy 5th Anniversary, OLHS!!

Aiming High,

David S. Guzick, MD, PhD
Chancellor

Aiming High in Saving Lives

Great news! By following standardized protocols, we are saving the lives of many of our patients with sepsis.

As noted in my February 2023 Aiming High newsletter, the death rate from sepsis in Louisiana is 19.9 per 100,000 population, the highest among all states in the nation. Indeed, about one-third to one-half of deaths in hospitals nationally are due to the devastating consequences of sepsis. While outcomes from sepsis at Ochsner LSU Health System (OLHS) were within this national range back in February, we knew we could do better. Therefore, as reported in the newsletter, we initiated a plan that encouraged clinical faculty to forego some measure of professional autonomy in managing patients with sepsis in exchange for consistent adherence to international guidelines on the evaluation and treatment of their patients. This was a tremendous team effort involving faculty clinicians, nursing staff, and LSUHS and hospital leadership.

The results have been truly remarkable. Combining the Academic Medical Center (AMC) and Monroe Medical Center (MMC), there are about 250 inpatients per quarter who have a diagnosis of sepsis. In the three-month period from December through February, there were 40 deaths from sepsis at AMC+MMC, which annualizes to 160 deaths per year. But in the three-month period from May through July, 17 deaths from sepsis occurred at AMC+MMC, which annualizes to 68 deaths per year. The implication of these data is that, in a few short months once the sepsis mortality reduction program was started, we were able to reduce the number of sepsis-related deaths at OLHS by more than 50% per year. (Note: Inpatients at St. Mary are primarily obstetrical or pediatric; fortunately, there are so few deaths in this population that mortality metrics are not pertinent.)

“By putting our patients first and adhering to standardized protocols, we are continuing to improve outcomes,” says Laurie Grier, MD, MHA, Professor of Medicine, and Chief Quality Officer for OLHS. “I look forward to reviewing the next quarter’s results.”

Although these results were obtained by improved adherence to standardized Early Detection of Sepsis order sets and implementation of a standardized sepsis order “bundle,” we still have room for improvement in achieving even greater adherence to these standardized protocols for sepsis evaluation and management. Hopefully, the markedly improved patient outcomes already seen will motivate clinicians who have remained skeptical of the standardized order sets and treatment bundles to join in. As we improve in our consistency – i.e., in fostering a high-reliability environment of care – sepsis mortality should decline even further.

As stated by Michael Sewell, MD, Professor of Medicine, and Director of Hospitalist Medicine at AMC: “Improvements in timeliness and accuracy of diagnosis and documentation by providers regarding sepsis have been key in bettering our outcomes. Increased awareness and utilization of order sets per providers in the emergency department, critical care, and inpatient hospital medicine settings have all played a major role in our success.”

Nurses have played a key role in utilizing Epic and other resources to facilitate this transition to a more repeatable, consistent approach to patients with sepsis. As summarized by Kimberly Mandino RN, Performance Improvement Coordinator, “the Early Detection of Sepsis tools in Epic are resources available to both our ED and inpatient nurses, to aid in early identification of sepsis. This includes sepsis screening in the ED and inpatient areas, and options for nurses to utilize a nurse driven lactate panel, a sepsis timer and checklist to track and organize sepsis care. Based on certain criteria, the system will trigger a sepsis alert for nurses and provide step by step instructions to help guide early interventions for our patients. Our Information System and Education departments teamed up to provide inperson training for the Early Detection of Sepsis tools, to ED and inpatient nurses at all three of our campuses in North Louisiana in May 2023.The Education team in Shreveport has also created a Sepsis Escape Room from all new nurse hires in the Nurses Rock program. This is a fun, interactive way for our nurses to learn more about sepsis.”

And there is more encouraging news: since sepsis-related hospital mortality is such a major component of all-cause mortality, and because of greater consistency in some other initiatives focused on mortality, all-cause mortality at AMC and MMC have also declined significantly between January and July of this year. Using the major outcome metric of the “risk-adjusted mortality index” (RAMI), which is the observed number of deaths divided by the number of deaths that would be expected based on the risk status of our patients, a RAMI of 1.0 means that the hospital is performing about average, i.e., as expected. “Aiming High” means that our goal is to be well below 1.0. Indeed, this has occurred: At AMC, all-cause RAMI declined from 1.18 in April 2023 to 0.59 in July. At MMC, all cause RAMI declined from 1.08 in April to 0.35 in July. These results put us in the best tier of performance among hospital peers nationally.

“The collaboration and hard work we have seen around the improvements with our Risk Adjusted Mortality has been incredible,” says Sheree Stephens, RN, MSN, Regional AVP of Quality, OLHS. “We are truly saving lives and that’s what quality patient care is all about.”

These are truly extraordinary improvements in a brief period of time; the story on sepsis is testimony to what can be achieved if we all work toward implementing quality-enhancing measures across the institution. Faculty leadership in all clinical services are now working towards implementing these measures more broadly; in addition to mortality reductions, our goal is also to improve our performance in other key quality domains such as safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. Quality across the board is Job 1; as we continue to aim high, I am confident that we can achieve our goal of being in the top tier of peer hospitals nationally in the quality of patient care provided.

Aiming High,

David S. Guzick, MD, PhD

Aiming High - "The Undergraduate Research Apprenticeship Program"

LSUHS serves a highly diverse community. Not only is Shreveport a majority-minority city, but the patients we serve speak 26 different languages for which we have interpreters. A similar number of languages are spoken by our faculty.

Because of their scientific knowledge, clinical training and experience, health care professionals have an asymmetric relationship with their patients in terms of information about diagnoses, potential treatments, and the likely benefits and risks of treatment alternatives. Moreover, in their role as their patients’ agent, health care providers provide advice about different courses of action, ideally based on all aspects of a patient’s circumstances that will affect clinical outcome. Besides their specific illness, these circumstances will likely entail factors related to education, culture, religion, family and community. Achieving the goal of serving fully as the patient’s agent – i.e., taking all medical and non-medical considerations into account – can be challenging when providers have different backgrounds and experiences than their patients. These differences can create several obstacles: creating a therapeutic alliance of trust, ensuring truly informed consent about a treatment plan that is in accordance with beliefs and values, and promoting adherence to the treatment plan.

For these reasons, accreditation standards across all health profession educational programs include: (1) training on the recognition and impact of non-medical factors in disease onset, care-seeking behavior, adherence to treatment, and long-term treatment outcome; and (2) enrolling and educating a diverse group of students who, across time, will reflect the diversity of the population at large for whom care will be provided.

The problem of minority representation in American medicine is longstanding and persistent. Jackie Robinson broke the color barrier in baseball in 1947, but until the 1970s the vast majority of African American medical students in the US attended either Howard University College of Medicine (founded 1868) or Meharry Medical College (founded 1876). Louis Wade Sullivan, MD, was the only black student in his class at Boston University School of Medicine. In 1975, he became the founding dean of what was to become the Morehouse School of Medicine – the first predominantly black medical school opened in the United States in the 20th century.  Later, Sullivan served as secretary of the U.S. Department of Health and Human Services.

Most non-HBCU medical schools didn’t start admitting black medical students until the 1970s. For example, in 1970 Levi Watkins, Jr., MD was the first African American to graduate from Vanderbilt University medical school. I know this story because he was a celebrated figure at the Johns Hopkins Hospital as the first black chief resident. In 1980, Dr. Watkins was the first surgeon to implant an automatic heart defibrillator in a patient with life-threatening ventricular fibrillation. Since that operation, this technology has saved countless lives.

A parallel story can be told regarding Hispanic physicians. Up until the 1970s and 1980s, a large percentage of Hispanic physicians practicing in the U.S. were graduates of the University of Puerto Rico School of Medicine. This included trailblazers such as Helen Rodríguez-Trías, MD, a pediatrician who, in 1993, became the first Latina to preside over the American Public Health Association; and Antonia Novello, MD, who in 1990 was the first woman and first Hispanic to serve as Surgeon General of the United States.

And yet, in many U.S. medical schools, progress in medical school enrollment of minorities has been slow. As recounted in the last edition of this newsletter (“When I Was an Intern, Part 2,” July 2023), Evelyn Pryor, MD, Associate Professor of Medicine, reported that she “was the only black medical school graduate out of 200 at Medical College of Georgia in 2000.”  In a recent study published in the New England Journal of Medicine (2021; 384:1661-1668), first-authored by Devin Morris, an African American medical student at Brown, it was found that, indeed, not much progress has been made in minority students at U.S. medical schools since the time of Dr. Watkins. While the percentage of U.S. medical students who were African American or Hispanic increased to about 6% each in the 1980s, over the past 30-40 years it has stalled at about the same percentage.

Shown in the bar graphs below are the distribution of underrepresented minorities at the two schools that educate clinicians at LSUHS: The School of Medicine and the School of Allied Health Professionals:
Click graphics to enlarge.

Under the leadership of Toni Thibeaux, EdD, the Office of Student and Community Engagement has created a number of pipeline summer programs at LSUHS to augment the enrollment of underrepresented students in the educational programs of our three schools. One of these is the UnderGraduate Research Apprenticeship Program (UGRAP), which is tailored to college students interested in Medicine, Biomedical Research or Allied Health Professions. UGRAP provides area college students the opportunity to participate in eight weeks of hands-on research activities mentored by LSU Health Shreveport faculty. Students who are African American, Black, Hispanic, Latinx or reside in a rural area are strongly encouraged to apply. Accepted applicants must have a 3.3 GPA or higher and be a college sophomore, junior or senior. A $2,500 stipend is provided. Each summer, about 20 students participate and represent an array of colleges such as Centre, Grambling, Howard, LSUS, LSU-Baton Rouge, McNeese, McGill, Southern University, University of New Orleans, Tulane and Xavier.

Here are the stories of two UGRAP students:

In a sense, the summer pipeline programs at LSUHS follows the spirit of Za’Christanae’s efforts to teach science to 7th graders who live in a community that doesn’t produce many health care professionals. At every step of the educational process, from elementary school through college, community and institutional initiatives that provide opportunities for underrepresented groups to engage in science education and pre-professional training not only opens options for the next generation that they may not have thought they had, but ensures a cross-section of working health care professionals that mirrors the populations they serve. At LSUHS, we are proud of our Office of Student and Community Engagement and others for the invaluable summer programs that they have created.

Aiming High,

David S. Guzick, MD, PhD
Chancellor

Aiming High - "When I Was An Intern" Part Two

With the arrival of new house officers, July 1 is an important milestone at all teaching hospitals. The “graduating” chief residents move on to the next chapter of their lives, and we welcome new interns. In Part 1  of this Aiming High newsletter, entitled “When I Was an Intern,” I recounted a bit of my own experience, commented on how residency training has evolved over the years, and included the tale of internship by one of my mentors. In Part 2, below, we will hear “When I was an intern” stories from three LSUHS faculty members, and three PGY-2 residents who just completed their internship year.

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LSU Health Shreveport PGY-2 Residents

    

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LSU Health Shreveport Faculty

I hope that you, dear reader, enjoyed hearing these internship stories from some of our faculty and residents. Residency training, in my humble opinion, is the heart and soul of any clinical department. As these stories attest, internship doesn’t always start out completely smoothly, but ultimately a physician’s experience as residents in a particular specialty forges his or her identity as a physician and prepares them to become confident and highly skilled in their field. Judging from the PGY-2 stories above, we’re doing a good job in achieving this goal, but I’m sure there are many areas in which we can improve. Part of aiming high as an academic health center is to achieve excellence in all of our residencies and fellowships, training the next generation of doctors to take good care of us all! Aiming High

David S. Guzick, MD, PhD Chancellor

Aiming High - "When I Was An Intern" Part One

I am finishing up this issue of Aiming High on the afternoon of July 2, 2023 at about 6 p.m. At 6 p.m. on July 2, 1979, I was finishing up my first 36-hour rotation as a new intern. I vividly remember arriving at my apartment completely exhausted, and feeling anxious. Could I make it through four years of this medical boot camp? Did I want to? Well, at some point during that first rotation as an intern everything seemed to click. I found my steep learning curve to be exhilarating; I was hooked on clinical medicine. With this initially turbulent but ultimately transformative experience, I became focused during my residency on making sure that I took advantage of everything my program had to offer – experientially and academically – to become the best doctor I could be.

Now, in 2023, July rolls around once again. Although the calendar tells us that summer has begun, the beginning of a new residency year feels more like spring in the world of health-care training — a time of renewal and a time of new growth. A fresh cadre of residents and fellows commence training in their chosen specialty or subspecialty. Such an important event demands a special two-part edition of Aiming High!

While my own experience is briefly referenced above, I will conclude Part 1 of this newsletter with the intern experience of an important mentor, Howard W. Jones, Jr., MD. And in Part 2, I will post some stories from LSUHS faculty members, and from PGY-2 residents who have just completed their internships here. But first, some background.

Although internship has become more “civilized” in recent years, and appropriately so, the process of transforming fledgling, newly minted M.D.s into skilled, confident physicians remains, at its core, essentially the same. There is some level of tension in this process, however, because of a peculiar intergenerational phenomenon among physicians: each generation believes their successors have it too easy. “When I was an intern…,” the seasoned attending physician would say, beginning a rant about how tough things were. “Don’t start with ancient history again!” the beleaguered intern would think, outwardly showing a faint, polite smile.

Across time, the structure of residency education has, indeed, changed. There was a time when being a resident meant literally living in the hospital (as in the story of Dr. Jones’ internship to follow). This gave way to every-other-night call, every-third-night call, etc., and finally (horror of horrors to those who believe that continuity-of-care experiences for residents can only occur in a traditional on-call system) a contortion called “night float.” Grafted onto this process of gradual change was a watershed event. In 1984, when a patient at New York Hospital died in the care of a resident who had been on call the previous night, the issue of resident work hours caught the public eye. In 1989, after a publicly aired ordeal that was as much political as medical, New York State set work rules for house staff — no more than 80 hours on site per week, and no patient care the day after an overnight shift.

New York’s approach led to national changes in resident work hours. In July, 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited the number of work-hours to 80 hours weekly, overnight call frequency to no more than one overnight every third day, a 30-hour maximum straight shift, and 10 hours off between shifts. While these limits were voluntary, adherence was essentially mandated for the purposes of accreditation across the nation. Further changes to work hour rules for residents have since been implemented.

Debate over duty hours will continue, hopefully informed by data. Meanwhile, our new interns will be living, in real time, their own “when I was an intern” experiences, to be handed down to their successors.

Howard W. Jones, Jr., MD, was a general surgery resident at The Johns Hopkins Hospital in the late 1930s, having received his MD in 1935. (After serving as a surgeon during WW II, he returned to Hopkins for an additional residency in Gynecology.) In 2001, when I was chair of the Department of Obstetrics and Gynecology at the University of Rochester, I invited Dr. Jones, then age 90, to an end-of year event in which there were both departing residents and entering interns. Here is Dr. Howard Jones’ “when I was an intern” story.

Dr. Jones began by explaining that he received no pay during his training as a house officer, but didn’t need any: after all, he was a “resident” of the hospital, living full-time there. On the day before his internship began, he received a 2-hour orientation and five pairs of white pants, five white shirts and five white coats, all of which were laundered on his behalf. (These uniforms were replaced yearly. He had to supply ties.) All of his meals were taken in the “Doctor’s Dining Room,” which was adjacent to the hospital cafeteria. The food was the same as for staff, but it was served on tables set up with linens and place settings. A small bedroom was provided in the Hopkins dome. Food, shelter and clothing … all that he needed was provided.

Dr. Jones spoke of his internship year, beginning with the indelible significance of going to the hospital’s tailor to have his name hand-stitched on his white coat. He remembered the names of his first three patients, and cared for them not only for the several days of that hospitalization, but for many subsequent visits over succeeding years. He knew them well, and told their story not only from a medical standpoint, but also in terms of their families, and the community and social culture in which they lived. Dr. Jones also remembered the names of the nurses in the operating rooms and wards with whom he worked every day, and commented extensively on how they served as role models for the level of skill, attentiveness and caring that they gave to each patient. Finally, he talked about colleagueship — the bonds created by this experience that lasted for decades.

Few residents married during residency in those days. (This was allowed occasionally by special consent of the department chair!) Georgeanna Seegar was a Hopkins medical student whom Dr. Jones met in July of his intern year. He asked her if she would go out on a date with him during his first night off, which would be in late September. She agreed. As Dr. Jones tells it, the date consisted of meeting at the hospital where they looked at pathology slides together. Georgeanna Seegar went on to marry Howard Jones and become a prominent gynecologic endocrinologist in her own right. (Dr. Georgeanna’s first discovery was that the hormone of pregnancy — now recognized as hCG — was produced primarily in the placenta, not the pituitary gland.)

Together, after leaving Hopkins in 1979 because of age-related mandatory retirement, they spent time in England learning in vitro fertilization (IVF) from Drs. Robert Edwards and Patrick Steptoe, who brought into the world the first IVF baby in 1978. (A few years earlier, Dr. Edwards was a visiting Professor at Hopkins to collaborate with Dr. Jones on early aspects of IVF in mice.) In 1981, Dr. Howard and Dr. Georgianna achieved the first successful IVF birth in the United States at Eastern Virginia Medical School. They continued to be active in what became, over the next decade, the most prominent IVF program nationally. Dr. Georgeanna Seegar Jones died in March 2005 at age 92. Dr. Howard Jones, Jr. died in 2015 at the age of 104, contributing to academic life until his death.*

In the next edition of Aiming High, later this month, we will feature stories about “when I was an intern” from three faculty members, and a recounting of experiences from three LSUHS PGY-2 residents who have just completed their internships. Stay tuned!

David S. Guzick, MD, PhD
Chancellor

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*In 2014, at age 103, Dr. Howard published In Vitro Fertilization Comes to America: Memoir of a Medical Breakthrough. In 2013, he published Personhood Revisited: Reproductive Technology, Religion and the Law. In 2010, he published Legal Conceptions: The Evolving Law and Policy of Assisted Reproductive Technologies. In 2005, he self-published “War and Love” about his WW II experience as a surgeon and his correspondence with Dr. Georgianna (actually, their love letters).

Aiming High for Our Academic Health Center

What is an Academic Health Center (AHC)?  One answer is that an AHC includes a university and a hospital that come together with a mission of teaching, research and patient care. So far, so good. But under what circumstances can an AHC become highly functional and successful in achieving its tripartite mission?

I would answer that this can only happen when the two major components of an AHC – the university and the hospital system – make decisions jointly based on the greater good of the AHC as a whole. For example, when considering the establishment of a new clinical program or expanding an existing program, there may be a benefit to the faculty practice plan but a liability to the hospital. Or vice versa. In a highly functional AHC, the decision about whether to proceed would be made not on the basis of the individual goals of the university or hospital, but for the net benefit to the AHC as a whole.

Such decisions require transparent data from both organizations, informed analysis of these data in the context of the many variables that pertain, a lack of bias and pre-conceived agendas among the decision-makers, and – most importantly – mutual trust and respect between university and hospital leadership.

An important driver of this joint decision-making process is the structure and governance of the AHC. An AHC can be fully integrated, as would occur when the university owns the hospital, or functionally integrated, as may occur when the university and hospital are two distinct legal entities, but with the university’s full or shared governance of the hospital.  OLHS has 50:50 shared governance. When the university lacks governance, functional integration is more difficult because university and hospital leadership are more likely to focus on their individual interests.

A highly functioning, successful AHC is a powerful force for patient care, research and education. This is because it creates a positive feedback loop between the three missions, as illustrated on the left side of Figure 1 below. Job 1 is the clinical enterprise -- high quality patient care based on the most robust evidence and knowledge, delivered with technical skill, and provided in an environment of hospitality and service.

Figure One

This type of clinical service will be a magnet for patients and produce a financial margin that permits investment in research and education. Growth in the quantity and quality of research and education will, in turn, attract talented faculty who will attract more patients and patient referrals, thus completing the positive feedback loop. As this virtuous circle of patient care, research and education feeds back on itself over many iterations, the AHC grows in size, scope and stature, as shown in Figure 1.

Figure 2 illustrates an expanded view of the AHC virtuous circle, in that investment in education and research by the clinical enterprise is supplemented by additional funding from private (philanthropic) and public (State) resources. Figure 2 also illustrates that important spin-offs of a highly functioning AHC are economic development for the region and improved public health.

Figure Two

The extent to which an AHC can replicate the growth and economic impact shown in Figure 2 depends on many variables. These include baseline resources, history, culture, geography, the local and regional competitive environment, and unforeseen external circumstances. Fundamentally, however, the potential of an AHC depends on the structure of the organization and, most importantly, on people.  To what extent does the leadership of the two organizations buy into truly joint decision-making? And, critically, to what extent can the leadership transmit this spirit to faculty and staff in a way that everyone in the organization embodies this spirit as their own? Will we all aim high for excellence in our own work, which collectively will promote organization-wide excellence in patient care, education and research, and which then will complete the loop by creating the organizational stature needed to attract more talent to our own discipline?

The academic health center at LSU Health Shreveport is comprised of our schools of Medicine, Graduate Studies and Allied Health, and our hospitals – the Academic Medical Center, St Mary Medical Center, and Monroe Medical Center. How do we measure up against the above questions? I believe that the answer to the first question, as it relates to joint leadership of OLHS, is a resounding “yes;” and I am very optimistic that the answers to the second and third questions about faculty and staff buy-in will also be “yes” as momentum visibly and palpably develops.

The reasons for my optimism about the potential for LSUHS to become an AHC of consequence is that we already have many of the pieces we need to build the virtuous circle:

• We are the only AHC for hundreds of miles around, extending into Eastern Texas, Southern Arkansas and Western Mississippi. And it is reasonable to posit that our catchment area extends south to Alexandria.

• We are about to open a new $79 million Medical Education and Wellness Building, which will house an exciting new medical school curriculum along with amenities that include a spectacular fitness center and a culinary program that is focused on healthy, restaurant-quality offerings that reflect the international diversity of our faculty and staff.

• Our research program is experiencing significant growth this year. NIH awards in Fiscal Year 2023, projected to be $19.1 million, is 57% above the annual awards in Fiscal Year 2022. We can build on this momentum.

• Our partnership with Ochsner Health, creating the Ochsner LSU Health System (OLHS) in 2018, has 50:50 governance: there are equal numbers of board members from LSUHS and Ochsner, and the Chairman of the Board alternates between the two.

• Operationally, the joint management team of OLHS meets formally three mornings per week to review current issues as well as longer-term strategy, and is in frequent communication with one another each day. There is mutual respect and trust.

• The OLHS partnership has resulted in a doubling of clinical faculty (from about 200 to 400), and significant improvements in the breadth and depth of services and of patient care quality metrics.

• Since 2018, a portion of the financial margins produced by our OLHS partnership has been transferred to LSUHS. These funds can now be used to invest in research, while also funding capital hospital projects that will advance patient care and training, thus capturing the essence of the positive feedback loop.

Here are the two key take-aways: (1) LSUHS is an academic health center with a governance structure and leadership that is creating a virtuous circle of patient care, education and research. (2) We have demonstrable momentum in all three missions.   

The pieces are in place. Let’s Aim High! Let’s Geaux!

David S. Guzick, MD, PhD
Chancellor

Aiming High in Clinical Research

Biostatics

Momentum continues to gather in externally funded research at LSUHS. This year, we have increased funding by 25 percent over last year. As I have conveyed in previous editions of Aiming High, however, our research portfolio is heavily weighted towards wet-bench basic and translational science. This is a critical focus for us, but LSUHS and Louisiana would benefit from diversification towards clinical research.

One of the key building blocks of clinical research is biostatistics. Biostatisticians not only do their own methodologic and applied research but consult with faculty in all biomedical disciplines to ensure that their research designs are sound and that the method of data analysis is most appropriate and powerful to address the research question at hand. Moreover, in an academic health center like ours that takes pride in educating students, residents and fellows, an important part of their clinical training is learning how to interpret the results of clinical research studies, and how to conduct such studies themselves.

We are blessed to have a young, highly energetic biostatistician who is blazing a path at LSUHS in all these areas. Mohammad Alfrad Nobel Bhuiyan, PhD, is an assistant professor in the Department of Medicine who was appointed to the faculty in 2021, with a PhD in biostatistics (Big Data Track) from the University of Cincinnati in 2019. He has been amazingly productive as a researcher and mentor in the short time since his arrival. I had a chance to sit down and talk with him about his academic background and how he manages to work successfully with so many students, residents and faculty members. Here is a summary of that interview:

1. Your undergraduate degree was in Applied Statistics. This is a very focused major! How did you become interested in this field?

   Yes, most people would not think of something this specialized as an undergraduate major! I always had a natural affinity for numbers, patterns, and logical thinking. I enjoy looking at data and drawing meaningful insights from them. But then there is the “applied” part – in applied statistics, my natural inclination towards mathematics and analytical thinking can also satisfy my desire to solve real-world problems through data-driven decisions.
    

2. Statistics itself is often considered applied mathematics. How do you think about the interplay between mathematics and statistics? Are there any aspects of this interplay about which you are particularly interested and that drives the direction of your research?

   Mathematics and statistics are closely intertwined disciplines that share a symbiotic relationship. Mathematics provides the theoretical foundation and rigorous framework for statistical analysis, while statistical methods apply mathematical concepts and techniques to analyze and interpret data in the real world. Mathematical modeling is fundamental to statistical methodologies. I am highly interested in spatial disease modeling, Bayesian modeling, and deep learning, which are becoming buzz words in these early days of AI, but which all rely on a strong mathematical and computational background.
    

3. You have been at LSUHS for less than 2 years, but already have been mentor for 5 residents/fellows, 11 medical students, and 1 MD/ PhD student. How have these relationships come about, and how do you have time to work with so many students/trainees?

   I joined LSUHS on August 9th, 2021. Right from the beginning, I met with the chiefs of different Internal Medicine sections, and asked how I could help their faculty, residents and fellows solve research problems. The residents and fellows began to flow in, asking for help with statistical analysis. Some students also came to me with their research interests. I meet with them bi-weekly and get project updates based on their availability. So far, two students secured 1st and 2nd best poster awards in the CCDS poster symposium, and one got the best poster award at the Annual Internal Medicine Research Day.
    

4. These collaborations have produced 32 publications in 2022 and 2023, with 11 more under review. Describe how you work to develop ideas for studies with these students, residents and fellows, work through the research design, and distribute the effort to do the research and writing?

   I help select the projects based on the interest of the students, residents and fellows. We discuss their future career interests and potential research ideas. I then generate a research paper skeleton for the students, and request that they do a literature review and write an introduction. Once this is done, I work with the students to develop the research design and statistical methodology. My analyst helps me complete the statistical work, and then we share the results with the students. Once these results are understood, we write the remainder of the paper. I always put the student or resident as the first author for their projects.
    

5. Of these publications, what are the 2 or 3 you are most proud of and why?

   I am very proud of a paper titled "Disparities in Prevalence and Trend of Methamphetamine-Associated Cardiomyopathy in the United States," which was published in the Journal of the American College of Cardiology. This article showed the disparity of cardiomyopathy-associated hospital admissions among methamphetamine users in the USA. So far, this is one of the largest databases ever used to analyze the disparities in the prevalence and trend of methamphetamine-associated cardiomyopathy in the USA over the last decade.

   The second paper I would like to mention, "COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation," was published in Critical Care. In this paper, we collaborated with UAB and used machine learning models to validate community-acquired bacteremic co-infection in the context of COVID-19, using both LSU and UAB data.

   A third paper, "Using the social vulnerability index to assess COVID-19 vaccine uptake in Louisiana," was published in Geojournal. We performed spatial analysis using data from the Louisiana Department of Health and showed that social vulnerability is linked with COVID-19-related vaccination and mortality rates.
    

6. You have a particular interest in machine learning and artificial intelligence. Big picture, how do you envision AI will change biomedical science and clinical practice? What AI projects are you working now?

   AI has the potential to revolutionize biomedical science and clinical practice by enhancing research capabilities, improving diagnostic accuracy, enabling personalized treatments, and optimizing healthcare delivery. We are currently working on Deep Learning models to propose multiple transformer methods for 3D MRI image classification, especially as applied to patients with Alzheimer’s disease. Our model performed better than a convolutional neural network. We are also working on image-based disease classification using Deep Learning.
    

7. What is your advice for students, residents, or faculty who wish to become involve in clinical research?

   Clinical research is a multidimensional field, and statistical expertise plays a critical role in ensuring the validity and reliability of research findings. A statistician can help you choose the most informative research design and lead you towards the best statistical analysis for that design. Students, residents, or faculty who wish to become involved in clinical research should think about the patients they are seeing in their own specialty, and the day-to-day clinical situations that often occur in which the best treatment is ambiguous. The next step would be to follow your curiosity and do a review of the existing literature on the alternative treatments for the condition in question. All of this would hopefully prompt some ideas on what kind of study would bring clarity to the ambiguity. That’s where a consultation with a statistician could help construct the design of a study to answer the question.
    

8. Final thoughts?

   I’m pleased to say that with help from LSUHS, we have a Biostatistics and Bioinformatics lab, with one post-doctoral fellow and one statistical analyst (Lab Website: https://www.lsuhs.edu/departments/school-of-medicine/internal-medicine/research/nobel-bhuiyan-lab). We can help design clinical trials, perform statistical analysis, and help with publication in high impact journals. We are expanding and open to collaboration, so let us know if you have some research ideas that you would like to pursue!

I think you will agree that we’re lucky to have Nobel on our faculty! He has joined us with his brother, MD Shenuarin Bhuiyan, PhD, associate professor in the Department of Pathology and Translational Pathobiology, and his wife, Most Alina Afroz who works as a database programmer in the office of research. Nobel and his wife are blessed to have a ten-month old boy (Neevan Umair Bhuiyan). We wish the Bhuiyan family all the best for the future, professionally and personally!

Aiming high,

David S. Guzick, MD, PhD
Chancellor

Aiming High in Research

New Initiatives and Building on Momentum

In this edition of Aiming High, I will take a stab at what it means to “aim high in research” at LSUHS, at least from the vantage point of a newcomer to our academic health center (AHC) with experience at several other AHCs. In addition, I will outline three initiatives towards our “aim high” research goals.

First, let’s consider the broad characteristics of a successful AHC and the role played by research. Successful AHCs create a positive feedback loop between patient care, research and education. This positive feedback loop generates a “virtuous circle” that distinguishes AHCs from community hospitals; as this loop between missions turns, the AHC grows in size, scope and stature. When this process successfully unfolds, the size, scope and stature of each mission is iteratively enhanced, further contributing to overall growth of the virtuous circle. 

LSUHS is the only AHC for hundreds of miles around. We can become a truly robust AHC of consequence that serves our region and beyond. Where does research fit in? While AHCs make important direct contributions to their localities and regions through their missions of education, patient care and community service, regional and national stature depend upon research prominence. There are several measures of research performance that should be tracked, such as scientific impact, technology transfer/commercialization, and faculty recognition by scholarly societies. But the main measure used for rankings by US News and others is grant funding from NIH.

LSUHS has shown excellent momentum in this regard. NIH and other federal funding to LSUHS over the past several years has shown substantial percentage increases; on an absolute level, however, total NIH and federal research grants and contracts are low relative to other AHCs and represent a tremendous opportunity. Indeed, this is a good time to invest in resources that will grow NIH funding: although there was a 10% decline in inflation-adjusted NIH funding nationally between 2003 and 2015, NIH funding began to grow in 2016, and had a $3B increase (7.3%) in FY2022. While all the measures of research success listed above are important, one overall aiming-high goal would be to double annual federal external funding in the next 4-5 years.

To achieve this goal, I am announcing three broad initiatives:

1. Support existing researchers at LSUHS: To build on the momentum created by LSUHS investigators, funds will be made available as follows:
   1. Support for holders of existing federal (or equivalent) grants. Faculty members who hold an existing research grant or contract from NIH, another federal agency, or equivalent funding entity, can apply for up to $100,000 of support from the Chancellor’s office to generate the data needed for another grant application.
   2. Support for faculty to revise a grant that was scored but not funded. Faculty members who received a score that was not in the funding range on a grant or contract to NIH, another federal agency, or equivalent funding entity, will be approached about the resources they need to respond to reviewer critiques.
       
2. Recruit new faculty members with expertise in emerging pathogens research: Currently under construction is a specialized set of laboratories in which research on viral threats and other emerging pathogens can be performed. This facility is scheduled to be completed by November. There is no other area of biomedical research that will have a greater stream of research funding – through NIH, the Department of Defense, other federal agencies, and private pharmaceutical and other sources. As a benefit of the successful virtuous circle achieved by the Ochsner LSU Health Shreveport partnership, sufficient funds have been transferred to LSUHS to support the recruitment to our campus of an established senior scientist in the area of emerging pathogens, as well as a team of investigators whom she or he will recruit. With advice from national leaders in the field, we are embarking on this process now. If readers of Aiming High know of a potential candidate, or wish to provide other input into this process, please let me know!
    
3. Assess the current state of clinical research and create a strategy to support its growth: The spectrum of biomedical and health care research includes basic, translational, clinical and population areas. The research portfolio at LSUHS leans heavily on basic and early translational investigation. While we have excelled in vaccine clinical trials, funding of clinical research more broadly is a growth opportunity. To balance our research portfolio, and to address more directly institutional goals around improving patient care and population health, we will invest in clinical research. But where do we start? Should we emphasize epidemiology, or biostatistics, or informatics and artificial intelligence, or patient care outcomes research, or implementation science, or population health? Over the next several months, under the leadership of myself, John Vanchiere, MD, PhD, and Chris Kevil, PhD, we will work with a task force of LSUHS faculty currently engaged in clinical research to identify and consult with national academic leaders in each of these areas. If readers of Aiming High know of a nationally recognized clinical investigator who might be able to help guide us, or wish to provide other input into this process, please let me know! Out of this academic consultative process will emerge what we believe will be the best path forward for LSUHS. Our sky-high goal for clinical research at LSUHS – which will take a number of years – is to bring an NIH Clinical and Translational Science Award to this campus.

I hope you share my excitement about how high our aim can be when it comes to research at LSUHS. With your active engagement, we can make it happen!

Aiming high,

David S. Guzick, MD, PhD
Chancellor

Aiming High in Research

Hui-Chao (Reggie) Lee, PhD

According to the American Heart Association’s Heart and Stroke Statistics - 2022 Update, cardiac arrest has been – and remains -- a public health crisis. Out-of-hospital cardiac arrests (OHCA) strikes nearly 1,000 people each day.  Of the more than 350,000 OHCA cases that occur annually in the U.S., only 8-10 percent survive, even when the cardiac arrest is treated by Emergency Medical Services.

Among people who have experienced cardiac arrest and are fortunate enough to get through this physical and emotional ordeal alive, more than half don’t return to their previous level and quality of home and work activities, due to a variety of functional impairments. These include cognitive deficits, anxiety, depression, post-traumatic stress symptoms, and severe fatigue. This all adds up to a reduced quality of life and shortened life span.

Can the after-effects of cardiac arrest be significantly reduced? To accomplish this goal, a causal biochemical mechanism in the brain would first have to be identified; and then molecules that could in some way counter the trouble-making pathway would have to be developed and tested. Enter Hui-Chao (Reggie) Lee, PhD, Assistant Professor of Neurology, and winner of this year’s LSUHS Research Rising Star Award.

Needless to say, few things -- if any -- are more complex than the human brain, so the biochemical mechanism in question is likely not to be simple and straightforward. Indeed, Dr. Lee knew that the after-effects of cardiac arrest are physiologically complex, involving reduced blood flow to the brain’s neuronal cells, inflammation of these cells, and some added measure of dysfunction of their intracellular machinery. In trying to identify those factors that ultimately determine whether the brain cells remain alive or die off following cardiac arrest, Dr. Lee discovered a novel enzyme in the brain that occurs much more often in brain neurons that are susceptible to reduced blood flow. In studies of rodents that were successfully resuscitated after experimentally induced cardiopulmonary arrest, he was able to show that when these animals were treated with a drug that specifically inhibited this enzyme, many of the after-effects of CA -- reduced blood flow, neuronal inflammation, neuron cell death, and learning/memory deficits -- were alleviated. (Am J Physiol Heart Circ Physiol 319: H1044–H1050, 2020. doi:10.1152/ajpheart.00399.2020.)

This line of research provided the data that earned Dr. Lee a $1.83 million R01 award from the National Institutes of Health, entitled “Kinase regulation in cerebral ischemia,” for a five-year study that began on April 1, 2022. Hopefully, if one of the molecules that Dr. Lee is investigating is shown to be successful in lessening the after-effects of cardiac arrest in rodents, it can represent the start of a research program in which this discovery can be translated to the management of cardiac arrest in humans. Regarding Dr. Lee and his research, the chair of neurology, L. Dedrick Jordan, MD, PhD, states that “Dr. Lee’s lab is doing critically important research using innovative techniques to better understand why the brain cannot tolerate even short periods of decreased blood flow without permanent damage. This fundamental knowledge will enable him and others to develop targeted therapies that could dramatically reduce brain injury after stroke or cardiac arrest. Furthermore, access to research participants through collaborations with clinicians in our department will enable Dr. Lee to validate and translate these discoveries more rapidly.”

How did Dr. Lee find his way to LSUHS to do this work? Born and raised in Taiwan, he was exposed to the world of illness, science and medicine throughout his childhood by often accompanying his father, a neuroradiologist, to the hospital where he worked. One revelation was that many illnesses affecting the brain lacked effective treatments. Along the way, he decided to pursue a career in scientific research with a plan to focus on basic and translational studies that relate to neurologic illness.

Towards this end, Dr. Lee obtained a Ph.D. in pharmacology under the mentorship of Dr. Tony Jer-Fu Lee, a world-renowned neuropharmacologist. His graduate studies were at Tzu Chi University in Hualien,Taiwan, where he met his wife, a fellow graduate student. In 2013, he and his wife, Yin-Chieh (Celeste) Wu, PhD, moved to the United States to pursue post-doctoral studies at the Cerebral Vascular Disease Research Laboratories in the Department of Neurology at University of Miami. In 2016, Drs. Lee and Wu moved with their post-doctoral supervisor, Kevin Lin, PhD, to LSU Health Shreveport. After two years as an American Heart Association Postdoctoral Fellow at LSUHS, Dr. Lee was appointed as Assistant Professor on the tenure track. Since then, he has been very productive with over 20 original peer-reviewed publications, many invited lectureships nationally and internationally, journal editorships, and mentorship of medical students, graduate students and post-doctoral fellows. Dr. Lee and Dr. Wu have two daughters, Victoria (age 8) and Viviana (age 5); they are greatly appreciative of the opportunities that LSUHS has provided, and of the family-friendly environment that Shreveport offers in which to raise their children.

Of course, Dr. Lee’s R01 didn’t materialize out of the blue; he was diligent in pursuing his science and funding opportunities, supporting his earlier research at LSUHS with grants from a variety of sources, including a Postdoctoral Fellowship and a Career Development Award from the American Heart Association. (Both were given a priority score in the top one percentile!). Please join me in congratulating Dr. Lee on his “Rising Star” award; we look forward to hearing about the progress in his lab, which will hopefully lead to effective treatments of cardiac arrest.  

Aiming high,

David S. Guzick, MD, PhD
Chancellor

Aiming High in the Delivery of Quality Patient Care

Reducing Mortality from Sepsis

This installment of Aiming High is Part 2 of our discussion regarding the tension between professional autonomy and high reliability. We will use sepsis as an important example.

Sepsis is the body’s extreme response to an infection. It is a potentially life-threatening condition that occurs when the body's response to an infection damages its own tissues. Infections that lead to sepsis most often begin in the lung, urinary tract, skin, or gastrointestinal tract, usually before a patient enters the hospital. But when these infections become more severe, especially in individuals who have other medical conditions that limit their intrinsic infection-fighting processes, a chain reaction can occur.  Without early diagnosis and treatment, sepsis can lead rapidly to shock (a profound drop in blood pressure), failure of multiple organ systems, and, ultimately, death.

Nationally, about one-third to one-half of deaths that occur in hospitals are due to sepsis and septic shock. In Louisiana, the death rate from sepsis is 19.9 per 100,000 population, the highest among all states in the nation. Aiming high at the Ochsner LSU Health System (OLHS) means being a national leader in outcomes from sepsis, which would hopefully set an example for other hospital systems in Louisiana so that they follow our lead, resulting in a statewide improvement in outcomes for these very sick patients. 

Based on evidence in the medical literature about how to diagnose and treat sepsis, international guidelines have been published and are updated annually. Based on these guidelines, OLHS has developed guidelines for diagnosis and treatment, including standardized order sets. Many clinicians, however, base their evaluation and treatment of septic patients on their clinical experience and earnestly held opinions about what would be best for individual patients. While there is relatively high usage of diagnostic guidelines at OLHS, adherence to the standardized order set for treatment has been relatively low and uneven.  There is good reason to believe that uniform implementation of the international guidelines for both diagnosis and treatment would result in better outcomes. Such an approach has been referenced in the international study group’s recommendations as a “performance improvement program.”

The quality of evidence for highly specific aspects of a performance improvement program is variable, since the evidence is based mainly on observational studies rather than randomized controlled trials. Yet there is general agreement about the main components: early identification of sepsis, serum lactate (a biomarker of septic shock), cultures for bacterial and/or fungal infection, antibiotics, and fluids. These components make up the “sepsis bundle.” A meta-analysis of 50 observational studies found that performance improvement programs increased compliance with sepsis bundles and were associated with about a 40 percent reduction in mortality in patients with sepsis and septic shock. The specific components of performance improvement did not appear to be as important as the presence of a program that included the sepsis bundle and metrics.

On February 16, 2023, faculty, staff, and OLHS leadership involved in the care of sepsis patients, especially from the Departments of Medicine, Emergency Medicine and Surgery, met to finalize the following performance improvement program:

1. Most high-risk, acutely ill patients who present to the E.D are screened for sepsis using a statistical algorithm that uses the international criteria. To ensure high reliability of early sepsis diagnosis in patients entering the E.D., leadership in this area will work with their faculty and staff to achieve as close to 100 percent implementation as possible. Patients identified as having sepsis by the algorithm will be assessed clinically, to verify that the diagnosis of sepsis is correct based on the international guidelines.
    
2. To ensure high reliability of early sepsis diagnosis in patients already admitted to the hospital, leadership in key inpatient areas such as hospitalist services and ICUs will work with their faculty and staff to identify statistically —and clinically confirm—patients who develop sepsis.
    
3. When sepsis is suspected in the ED, the triage nurse notifies the attending; the attending then evaluates the patient and, if appropriate, initiates the ED Sepsis Order Set.  On the floor, a Code Sepsis can be called by the patient’s nurse and/or the hospitalist on call, eliciting the Rapid Response Team to evaluate the patient and, if appropriate, initiate the Inpatient Sepsis Order Set.
    
4. Data will be collected on the percent of patients in whom early diagnosis of sepsis was “missed” by the statistical and clinical screening protocol, and the percent of septic patients in whom the standardized order set was not implemented. Across time, both of these percentages should approach zero.
    
5. The major outcome metric that will be followed is the “risk-adjusted mortality index” (RAMI), which is the ratio of the observed number of deaths from sepsis in the hospital to the number of deaths that would be expected based on the risk status of the patients (“O/E ratio”). Risk adjustment and RAMI calculations are as reported by Vizient, a performance improvement company in which 97 percent of academic health centers are members, including OLHS. The goal would be a RAMI score ≤ 1.0.

If the above performance improvement program for the diagnosis and treatment of sepsis were followed uniformly, the autonomy of individual physicians in the management of their patients with this condition would be reduced. But uniform practice would likely lead to earlier diagnosis of sepsis and to more timely and effective treatment. In the language of Part 1 of this Aiming High newsletter, this trade between prerogative and reliability is one worth making.

Aiming high,

David S. Guzick, MD, PhD
Chancellor

Aiming high in the delivery of quality patient care

The tension between the autonomy of health care professionals and high reliability

“The patient comes first.”

This is a core value in the mission statements of academic health centers and hospitals across the country. If "the patient comes first," consider what does not come first: not the doctor, nurse or other health professional; not the computer screen, documentation, coding or reimbursement rates; and certainly not academic or health-care administrators!

“Because I want to help people.”

This is the answer most medical school applicants give to the question: "Why do you want to become a doctor?" Similar sentiments motivate applicants to other health science schools. Thus, virtually all of us enter the health professions with a strongly held view that the patient comes first.

Just as it is a short distance from "Because I want to help people" to "The patient comes first," most health professionals easily translate "The patient comes first" to a desire to provide the highest-quality healthcare possible. This translation is no longer that simple, however.

When I was growing up, the physician who treated all members of my family, Dr. Berman, was a general practitioner (family medicine was not yet a specialty) He had a small office with no receptionist and a nurse who assisted him on some visits. He took our blood pressure, took our temperature and drew our blood himself. He saw to the routine healthcare needs of our family, set my arm in a cast when it was fractured during a high school basketball game and also diagnosed early breast cancer in my grandmother. (I vividly recall that he admitted her to the hospital, chose the surgeon and made post-op rounds in the hospital and subsequent visits to our home). Dr. Berman, to me, exemplified the "patient comes first" view of high-quality healthcare, and profoundly influenced my choice of medicine as a career.

But half a century later, health professions are not the same. Explosions in scientific knowledge and medical technology have occurred. People are living longer and often develop more complex multisystem conditions. And healthcare teams are required to provide care that can best take advantage of new and constantly evolving knowledge and technology. Patients appropriately expect evidence-based decision-making, with documentation of what was done and why. The few scratches that Dr. Berman scribbled in his chart would

no longer pass muster. In retrospect, I recognize that our family had no way of knowing whether his decisions to treat (or not treat) a condition, and how to do so, were correct based on the best scientific evidence. We trusted him, and I like to think that we did so with good reason.

From a broader societal perspective, however, we cannot simply "trust" an entire profession. As the years pass from completion of training, intuitive decisions made by practitioners based on their "clinical experience" may or may not be informed by current medical literature. In hospital practice, clinical outcomes are not optimized when the varied intuitions and clinical experiences of a dozen specialists in a particular field lead to a dozen different ways to approach the care of a given patient.

As an individual patient, I must trust my doctor and other health professionals to do the right thing. After all, I am confident they believe my care comes first are committed to providing the highest-quality care and are governed by the ethical principles of their profession. What does this imply, however, about their professional autonomy? Taking medicine as an example, as individuals we take comfort in the idea that our doctor considers our particular medical situation in the context of his or her broad clinical experience and is devising an individualized plan. From a societal perspective, does that mean that physicians, based on their clinical experience, should make individualized decisions about diagnostic tests and treatment plans regardless of the medical literature or cost? Given a patient who presents with a specific history and set of symptoms, is it sensible for each of the ten specialists in a hospital to make autonomous – and potentially highly variable – decisions about such a patient’s diagnostic evaluation and treatment?

Autonomy in the health professions is prized by clinicians but also valued by patients. We think of our doctors as wise individuals who can combine knowledge and instinct to land on just the right treatment. Our fictional doctor heroes – from House to Meredith Gray to Max Goodwin – are iconoclasts who do not go by the book. They chose to discard bureaucracy and lean on their intuition all in the name of helping their patients. Make no mistake, intuition is often a good thing – especially when borne of experience.

Indeed, across generations of medical students and house officers among attending physicians in practice styles” have been accepted and even celebrated. While there are many ways of performing a certain surgical procedure or taking care of a particular type of medical patient, there always seems to be an institutional “way.” Moreover, within each institution there is variation between physicians. Being trained in reproductive surgery – whether laparotomy, laparoscopy, or robotic surgery – I learned that each of my teachers had their own suture technique, their preferred draping method, their favorite instruments, their personalized set of steps in a surgical sequence, their own variation on pre-op and post-op orders, etc. One had to learn the “institutional way” as well as its modifications by various faculty surgeons.

All of these variations seemed to work reasonably well, although experientially (but without data) some seem to work better than others. I learned that what you did as a surgeon was built on the basic “way” of doing surgery at your institution of training, and then choosing what you perceived to be the very best combination of surgical techniques from your myriad of experiences under different faculty surgeons, making that unique combination your own.

Alongside the science of medical and surgical practice, what I have described above is the “art” of medicine. It will remain alive and well, as it should. As we aim for optimal patient outcomes, we must ask ourselves whether the level of autonomy described above is always in the best interest of our patients. I will give an example from my own experience that has influenced my thinking more broadly on the issue of standardization vs. physician autonomy in clinical programs. In 1986, a year after completing my fellowship at UT Southwestern Medical Center in Dallas, I moved to Pittsburgh to become the division director of reproductive endocrinology in the Department of Obstetrics and Gynecology at UPMC. This sounds like quite a privilege, and it was, but it was a division of one faculty member — me. The previous director had left to explore new horizons, and the other faculty member in the division also left leaving me with a fellow and a superb ovarian physiologist and embryologist (Tony Zeleznik, Ph.D.). The field of IVF was young and exciting. While this era preceded e-mail, text messaging, Facebook and Twitter, news of day-to-day developments on a variety of IVF fronts (culture media and methods, embryo transfer catheters, medication regimens, etc.) moved quickly across an international network of highly motivated clinicians and scientists.

Consider that there are about ten broad steps in the IVF procedure — about five clinical and five laboratory. For each of these steps, I had my way of doing things and, Tony had his way and there were credible reports in the literature on several other ways. One strategy that we considered with a goal of delivering the optimal outcome for the patient was to choose the "best" way for each step based on our experience and the literature. If there were five possible alternatives for each of the ten steps, however, there were almost 10 million possible combinations of ways to do the ten steps of IVF. We could have picked the combination that we thought would be best, but this would have been a totally unique approach that would have never been previously tried in its entirety. Moreover, if we individualized each case, using a substitute for certain steps to tailor the regimen to a particular patient, we would essentially be trying out a new way to do IVF for each patient.

We decided that it wasn’t right for our patients and referring physicians to test a new protocol when some extant IVF programs had already demonstrated excellent success. Therefore, we decided to copy – exactly, step-by-step – the entire IVF protocol of a program producing world-class results. At this early time in the maturation of the field, pregnancy rates in good programs were in the 15 percent to 20 percent range, with the best programs approaching 25 percent. Due to our scientific relationship with the laboratory director of the Hammersmith Hospital program in England, Steven Hillier, Ph.D., we were lucky enough to convince Dr. Hillier to spend two weeks in Pittsburgh taking us through the highly successful Hammersmith protocol.

When we opened our program, with a trial of 10 patients, we followed each step of the Hammersmith IVF program exactly to the letter: the drug regimen, the criterion for dosage increases or decreases, the culture media (from England), the embryo transfer catheters (from Germany), etc. Of our first ten patients treated, four became pregnant yielding a 40% success rate which validated our carefully chosen program. As new faculty and embryologists were recruited, they performed the steps of the procedure exactly the same way, so that our patients were treated in an identical manner regardless of who was "on call." When protocol changes were introduced across time, we only permitted to change one variable at a time to ensure continuity and an informative way of evaluating the protocol change.

Should it be any different for the steps used in a hospital to start a central line, manage patients on ventilators to avoid pneumonia, diagnose and treat sepsis or develop a protocol for blood transfusions? Insisting on uniformity in each of these protocols, and many others, reduces physician autonomy but also reduces line infections, septic shock, ventilator-assisted pneumonia and unnecessary transfusions that increase cost and sometimes produce adverse clinical outcomes.

In a 2008 lecture to the Royal College of General Practitioners titled "The epitaph of profession," Donald Berwick, M.D. spoke eloquently about the professional life of his father, one of two general practitioners in a rural Connecticut town. Dr. Berwick’s father sounded much like his son - a supremely dedicated physician who selflessly practiced medicine with great skill and autonomy, but who would no doubt be confused and concerned about the direction of current medical practice and its implications for the profession.

Dr. Berwick described his father as someone who insisted that every physician should be committed to provide the benefit of the best possible science to every patient. He did so with the full understanding that it inevitably places the autonomy of the individual physician in some jeopardy. New professionals must make the choice: either treat the patient according to your own store of knowledge and facts or give up total self-reliance so as to promise your patient treatment according to the entire world’s store of knowledge and facts. “That promise, the promise of science, is a different kind of promise from the one my father made. He promised to do his best; the new professional promises to do the world’s best,” stated Dr. Berwick.

Such is our challenge. While we as health professionals have been somewhat slow to adapt thus far, I am confident that we can resolve the tension between the science and art of clinical practice, between prerogative and reliability, and between practice standards and innovation. The example set by airline pilots who follow standard operating procedure in all circumstances while constantly availing themselves to new technologies and procedures as innovation continues is worthy of consideration as this model can easily translate to success in patient care.

The patient should always come first.

Aiming high,

David S. Guzick, MD, PhD
Chancellor