State of the School AddressApril 2019

Joseph I. Shapiro, MDVP and Dean, JCESOM

Marshall University

JCESOM

• Accomplishments• Challenges• Opportunities

JCESOM

• Accomplishments• Challenges• Opportunities

Accreditation

• LCME• ACGME• CME

Recent History of the JCESOM• The JCESOM was placed on probation by the LCME

June 15, 2011, citing nine standards in noncompliance, one standard in compliance with a need for monitoring and three standards in transition.

• On October 21st, 2013, the JCESOM was removed from probation, determining that the JCESOM was in compliance with all standards.

• We have just completed our site visit (April 1-3, 2019) from LCME and are awaiting evaluation from our accrediting body (fall of 2019).

Excerpt from 2019 LCME Site Visit• During this survey visit, survey team members assessed the medical

education program at the Joan C. Edwards School of Medicine using the elements ….

• The team wishes to express its gratitude to the faculty, staff, students, residents, and leadership team. We understand that the accreditation process requires significant time and effort. Members of the medical education community have gone out of their way to assist us over the past few days as well as during the any days leading up to the visit,

• In addition, the survey team wishes to acknowledge the institution for the collegiality of the medical school environment, the respect with which the dean is held, the commitment of the faculty, and the positive relationship with the clinical partners. The survey team was impressed with the enthusiasm, dedication, and commitment of everyone they met including students, faculty, staff, and administration.

Thank YouFaculty Staff

Students ResidentsAdministration

GME - 2011• Overall program on “warning” (equivalent of

probation)• Repeated citations of overall program for issues of

substance – Central oversight of programs

• DIO• GMEC

• As well as (truly silly) problems with reporting.– Failure to provide dates for signatures on 3 sequential

reviews.– Failure to have required PLAs

Year Events Credit MDs Res Students OMD Others Total

2017 699 726.00 3845 5169 15859 77 296 25422

2016 794 789.75 4835 5924 3097 23 363 14425

2015 711 722.75 4685 5237 2263 7 629 12979

2014 694 690.25 4837 5051 2518 14 434 13077

2013 757 767.75 5434 5439 3143 12 934 14989

D.N. Bailey, MBA, Assistant Dean for CME

Growth• Bricks and Mortar• Medical Practice• Medical Education• Research

New or Enhanced Structures• New Laboratory Space

– Renovated space at Forensics center– “Traded” said space for space in BBRC

• Douglass Building (houses Ebenezer and other activities)

• Teays Valley Physician Office Building – 58 exam rooms– 4 testing rooms– 3 procedure rooms

• P3 Project– Housing for Med/Pharm students– Pharmacy building

Sources of Revenue for JCESOMFive Year History

$- $10.0 $20.0 $30.0 $40.0 $50.0 $60.0 $70.0 $80.0 $90.0

$100.0 $110.0 $120.0

2014 2015 2016 2017 2018

Tuition and Fees

Government

Grants/Contracts

Practice Plan

Hospital

Endowment/Gifts

Sources of Revenue for JCESOMFive Year History

Tuition and Fees201420152016201720188.54350400000000048.40158300000000057.82519899999999969.13002499999999989.6999999999999993Government2014201520162017201817.70945800000000118.56220400000000118.03123318.46965000000000117.8Grants/Contracts2014201520162017201811.61011611.14746610.94561110.09819510.6Practice Plan2014201520162017201868.65866400000000273.44151599999999383.89605899999999498.244245000000006108.9Hospital2014201520162017201849.34246999999999958.54730899999999862.72589099999999776.76018500000000786.1Endowment/Gifts201420152016201720184.0714722.40196299999999981.43336899999999994.86426600000000064.3Year201420152016201720182014201520162017

JCESOM Clinical Productivity by Department

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

200%

FY13

FY14

FY15

FY16

FY17

FY18

Successful Programs• Provider based clinics

– 340B Pharmacy• After hour clinics• Clinical Services

– Dermatology– Psychiatry– Neurology– Orthopedics– Surgery– ……….

• What opportunities will hospital merger bring?

Affiliations• GME ConsortiumMHVHTHS ?Holzer

• Academic Health CenterMHN

• VAMC

• Anti-Addiction Programs PROACT Project Hope Regional Partnership Grant State Target Response Drug Free Moms and Babies Healthy Connections Great Rivers Regional System HRSA Training Grant

• Governor’s Council Brian Gallagher chairman Bob Hanson “drug czar”

Medical School – Graduate School• Increased MD/PhD program• MS in CTS• Increased BMS• PA Program?

Graduation Questionnaire: Overall Satisfaction with Med School Education (JCESOM)

1

1.5

2

2.5

3

3.5

4

4.5

5

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Year

Student Satisfaction with Preclinical Material 2018 GQ

0

0.5

1

1.5

2

2.5

3

3.5

4

MUSOM All Schools

Student Satisfaction with Clerkships2018 GQ

0

0.5

1

1.5

2

2.5

3

3.5

4

EM FM IM Neuro Ob/Gyn Ped Psych Surg

MUSOM All Schools

JCESOM USMLE Performance

82

84

86

88

90

92

94

96

98

100

102

2013 2014 2015 2016 2017 2018

Step1 Step2CK Step2CS

National

GME Programs

Hem/Onc Psychiatry Sports Medicine Nephrology Dental NeurologyPsych Fellowships

0

50

100

150

200

250

2012-3 2013-4 2014-5 2015-6 2016-7 2017-8

4%

Total Percentage of Compliance by Category

Programs Surveyed 15Residents Responded 192 / 198

Response Rate 97%

Survey taken: January 2018 - April 2018

Results of ACGME Resident Surveys

Results of ACGME Faculty Surveys2017-2018 ACGME Faculty Survey –Aggregated Program Data

Survey taken: January 2018 - April 2018

Programs Surveyed 15Faculty Responded 109 / 127Response Rate 86%

Faculty's overall evaluation of the program

On Call Room

Workout Room

Office of GME/ Resident Wellness Center

2012-17 Board Pass Rate (5 year rolling average)

0

20

40

60

80

100

120

FM IM MP OB Orth PED Surg Card Endo Onc Pul

Research Funding to MUSOM 2016• P20 (INBRE) 17.6M• P20 (COBRE) 11.5M• RO1 (3, 1 in MIIR) 5.5M• CTSA 0.7M• R15 (4) 1.7M• VA(MR, CDA) 2M• SBIR 1M• HRSA 0.2M• Other 6.0M (approx.)

– CTSA sub-award– CTSI sub-award

Research Stimuli• Pilot grants from MU to foster clinical-translational

research• Pilot grants from MU/WVU to foster collaboration between

Universities• New CHH/MU program to support pilot projects between

SOM and SOP faculty• Proceeds from some clinical ventures directed to enhance

research/scholarship within departments• Others……

Scholarly Productivity JCESOM

020406080

100120140160180200

2009201020112012201320142015201620172018

ArticlesBook Chapters

Citation byLCME

Year

Updated Feb 3, 2019

Incomplete

Notable Achievements• Papers published in major scientific journals• COBRE grant activated!• Basic science faculty recruitment• Sustained growth of clinical enterprise• Solid board pass rates (both UGME and GME)• Good match statistics• Improved student/resident satisfaction• Good faculty satisfaction• MMO – outreach to Huntington, Honduras, ?Sint

Maarten, ?Panama• BS/MD Program• Marshall Journal of Medicine• Anti-addiction programs ramp up and have effect.

Marshall Journal of Medicine2015 2015-2016 2016-2017 2017-2018 2018-2019 YTD

Total Article Received 30 59 65 100 49

Total Article Published 11 33 53 87 47

Global Readership 42 119 127 169 173

# of Global Downloads 678 6773 13,911 32, 585 37,210

The Turning of the Tide in Our War Against Opiate Addiction in Cabell County

Neonatal Abstinence Syndrome Diagnosis of Opiate Use Disorder

JCESOM

• Accomplishments• Challenges• Opportunities

US News and World Report 2019

• Not ranked for either research (no surprise) or primary care (disappointing).

• Methodology for research involves NIH grant dollars (again, no surprise), but for primary care, we are hurt by several factors….

• 83 in median GPA• 109 in average total MCAT• 106 in residency director evaluation• 108 in peer assessment

US News and World Report 2019• 12th lowest in state tuition in country

• We follow Texas schools, ECU, NMU and WVCOM (by 500 dollars).

• 28th in average debt of students borrowing money.• List is surprising; lowest average debt at very expensive

schools like Harvard, Penn, Stanford, Hopkins. • 17th amongst state schools.• 50K less than WVU (2019).

• 26th in fraction of graduates going into primary care.

Economic Challenges• Heavy, heavy reliance on clinical operation; differs

from usual “tripod” of 1/3 Grants, 1/3 Practice Plan, 1/3 “Everything Else”.

• Risk of health care reform – how will Medicaid expansion population be treated.

• Evaporating state support –de minimis state support anticipated in long run.

• Tuition growth must continue to be attenuated– Core mission– Accreditation

JCESOM 237.4M in 2018

Tuition and Fees Government Grants/Contracts

Practice Plan Hospital Endowment/Gifts

Sources of FundingJCESOM vs All Other Schools

All US Schools JCESOM

More Dependent on Clinical OperationSupporting Hospital with Smaller Clinical Faculty

State Support Still Important

Total US Medical Schools

Tuition and Fees Government Grants/Contracts

Practice Plan Hospital Endowment/Gifts

1: Ahmad T, Valentovic MA, Rankin GO. Effects of cytochrome P450 singlenucleotide polymorphisms on methadone metabolism and pharmacodynamics. Biochem Pharmacol. 2018 Jul;153:196-204. doi: 10.1016/j.bcp.2018.02.020. Epub 2018 Feb 16. Review. PubMed PMID: 29458047; PubMed Central PMCID: PMC6148365.

2: Desai R, Patel U, Sharma S, Amin P, Bhuva R, Patel MS, Sharma N, Shah M, Patel S, Savani S, Batra N, Kumar G. Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States. Cureus. 2017 Nov 3;9(11):e1816. doi: 10.7759/cureus.1816. PubMed PMID: 29312837; PubMed Central PMCID: PMC5752226.

3: Lindberg MA, Zeid D. Tests of the Attachment and Developmental Dynamic Systems Theory of Crime (ADDSTOC): Toward a Differential RDoC Diagnostic and Treatment Approach. Int J Offender Ther Comp Criminol. 2018 Sep;62(12):3746-3774. doi: 10.1177/0306624X17750353. Epub 2018 Jan 5. PubMed PMID: 29303015.

4: Mansoor K, Kheetan M, Shahnawaz S, Shapiro AP, Patton-Tackett E, Dial L,Rankin G, Santhanam P, Tzamaloukas AH, Nadasdy T, Shapiro JI, Khitan ZJ.Systematic review of nephrotoxicity of drugs of abuse, 2005-2016. BMC Nephrol. 2017 Dec 29;18(1):379. doi: 10.1186/s12882-017-0794-0. Review. PubMed PMID: 29287591; PubMed Central PMCID: PMC5747941.

5: Majidi S, Golembioski A, Wilson SL, Thompson EC. Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment. South Med J. 2017 Nov;110(11):727-732. doi: 10.14423/SMJ.0000000000000727. PubMed PMID: 29100225.

6: Zeid D, Carter J, Lindberg MA. Comparisons of Alcohol and Drug Dependence in Terms of Attachments and Clinical Issues. Subst Use Misuse. 2018 Jan 2;53(1):1-8. doi: 10.1080/10826084.2017.1319865. Epub 2017 Jul 25. PubMed PMID: 28742416.

7: Loudin S, Werthammer J, Prunty L, Murray S, Shapiro JI, Davies TH. Amanagement strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic. J Perinatol. 2017 Oct;37(10):1108-1111. doi: 10.1038/jp.2017.101. Epub 2017 Jul 6. PubMed PMID: 28682317; PubMed Central PMCID: PMC5633652.

8: Ahmad T, Sabet S, Primerano DA, Richards-Waugh LL, Rankin GO. Tell-Tale SNPs: The Role of CYP2B6 in Methadone Fatalities. J Anal Toxicol. 2017 May 1;41(4):325-333. doi: 10.1093/jat/bkw135. PubMed PMID: 28184434; PubMed Central PMCID: PMC5412025.

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10: Loudin S, Murray S, Prunty L, Davies T, Evans J, Werthammer J. An Atypical Withdrawal Syndrome in Neonates Prenatally Exposed to Gabapentin and Opioids. J Pediatr. 2017 Feb;181:286-288. doi: 10.1016/j.jpeds.2016.11.004. Epub 2016 Nov23. PubMed PMID: 27889067.

11: Babcock C, Rockich-Winston N, Booth C. Bringing naloxone to ground zero: Huntington, West Virginia. J Am Pharm Assoc (2003). 2017 Mar -Apr;57(2S):S9-S10. doi: 10.1016/j.japh.2016.09.006. Epub 2016 Nov 9. PubMed PMID: 27838389.

12: Lindberg MA, Fugett A, Carter JE. Tests of the Attachment and Clinical Issues Questionnaire as It Applies to Alcohol Dependence. J Addict Med. 2015 Jul-Aug;9(4):286-95. doi: 10.1097/ADM.0000000000000131. PubMed PMID: 25974379.

13: Egleton RD, Abbruscato T. Drug abuse and the neurovascular unit. AdvPharmacol. 2014;71:451-80. doi: 10.1016/bs.apha.2014.06.019. Epub 2014 Aug 22. Review. PubMed PMID: 25307226.

14: Crum ED, Bailey KM, Richards-Waugh LL, Clay DJ, Gebhardt MA, KranerJC. Validation of blood and liver oxymorphone analysis using LC-MS-MS: concentrations in 30 fatal overdoses. J Anal Toxicol. 2013 Oct;37(8):512-6. doi: 10.1093/jat/bkt077. Epub 2013 Aug 26. PubMed PMID: 23980120.

15: Belay TW, Nusair AR. Apparent lisinopril overdose requiring hemodialysis. Am J Health Syst Pharm. 2013 Jul 15;70(14):1226-9. doi: 10.2146/ajhp120734. PubMed PMID: 23820459.

16: Knittel JL, Clay DJ, Bailey KM, Gebhardt MA, Kraner JC. Comparison of oxycodone in vitreous humor and blood using EMIT screening and gas chromatographic-mass spectrometric quantitation. J Anal Toxicol. 2009 Oct;33(8):433-8. PubMed PMID: 19874649.

17: Baxter FR, Nerhood R, Chaffin D. Characterization of babies discharged from Cabell Huntington Hospital during the calendar year 2005 with the diagnoses ofneonatal abstinence syndrome. W V Med J. 2009 Mar-Apr;105(2):16-21. PubMed PMID: 19271694.

18: Terneus MV, Brown JM, Carpenter AB, Valentovic MA. Comparison of S-adenosyl-L-methionine (SAMe) and N-acetylcysteine (NAC) protective effects onhepatic damage when administered after acetaminophen overdose. Toxicology. 2008 Feb 3;244(1):25-34. Epub 2007 Nov 7. PubMed PMID: 18068290; PubMed Central PMCID: PMC2247417.

19: Chandra A, Ozturk A. Health professionals beware of prescription pain medication abuse and diversion. Hosp Top. 2004 Fall;82(4):34-7. PubMed PMID: 15898403.

20: Valentovic MA, Minigh J. Pyruvate attenuates myoglobin in vitro toxicity. Toxicol Sci. 2003 Aug;74(2):345-51. Epub 2003 May 28. PubMed PMID: 12773762.

21: Lehmann JB, Lehmann CU, Kelly PJ. Development and health care needs of lesbians. J Womens Health. 1998 Apr;7(3):379-87. PubMed PMID: 9580918.

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PubMed Searches for Substance Abuse and Marshall University

JCESOM•Accomplishments•Challenges•Opportunities

Clinical Opportunities• Merger of Huntington Hospitals will produce

unprecedented opportunities to develop centers of excellence and new programs.– Cardiovascular– Pediatrics

• Work with government may allow replacement of Medicaid fee for service models with capitated projects.– ENORMOUS potential reward with EXTREMELY high

risk

Partnership with Hospitals• Historical association with VA which

has grown stronger over time– VA Merit grants

• Excellent partnership with CHH (now merged with SMMC as MHN)

• Accountable Care Organization

Mountain Health Network

• Historic combination of our major teaching hospitals

• Vision of many including the late President Steve Kopp

• Involved the work of entire community, in particular, the late Mike Perry, Mike Sellards, Brent Marsteller, Dr. Kevin Yingling and Gary White

• National search yielded Mike Mullins as system CEO.

Educational Opportunities• Controlled expansion of medical school proper.

– Target of 90-100 students per year• Continued expansion of GME programs

– New programs in Neurology, Addiction Medicine– Ultimately expand into Radiology, Anesthesia,

Neurosurgery

• Expansion of MS programs, interface with BS programs

• Excellence in programs

Excellence in Medical Education• Evolving curriculum

– Medical School/Graduate School– Loss of Dr. Laura Richardson

• Predictive analytics– Identify struggling students early and provide

intervention

• Ongoing review of performance– Dashboards

Research Opportunities• Research requirement for some MS students• New pilot grant funding• Federal/Foundation grants that target obesity,

metabolic syndrome, aging, rural medicine and addiction– Focus research on what we do– Major opportunities, especially with rural medicine

and addiction– Marshall now an R2 institution

• Can we become R1 in the future?

Summary• MUSOM is as critical to the region as it is effective at

its (noble) mission.• Growth in all aspects of our tripartite mission has been

remarkable. • We face a number of challenges ranging from financial

to maintaining continued accreditation and relevance.• The traditional Chinese character for “crisis” is often

cited to be a combination of DANGER and OPPORTUNITY.

State of the School AddressJCESOMJCESOMAccreditationRecent History of the JCESOMExcerpt from 2019 LCME Site VisitThank YouGME - 2011Slide Number 9 GrowthNew or Enhanced StructuresSlide Number 13JCESOM Clinical Productivity by Department Successful ProgramsAffiliationsMedical School – Graduate SchoolGraduation Questionnaire: Overall Satisfaction with Med School Education (JCESOM)Student Satisfaction with Preclinical Material 2018 GQStudent Satisfaction with Clerkships�2018 GQJCESOM USMLE PerformanceGME ProgramsSlide Number 23Results of ACGME Faculty Surveys�Slide Number 252012-17 Board Pass Rate �(5 year rolling average)Research Funding to MUSOM 2016Research StimuliScholarly Productivity JCESOMNotable AchievementsMarshall Journal of MedicineSlide Number 32JCESOMUS News and World Report 2019US News and World Report 2019Economic ChallengesSources of Funding�JCESOM vs All Other SchoolsSlide Number 38JCESOMClinical OpportunitiesPartnership with HospitalsMountain Health NetworkEducational OpportunitiesExcellence in Medical EducationResearch OpportunitiesSummary