Training a New Generation of Healthcare Providers August 2007

2 Virginia Healthcare Reform Commission Goal: Access to quality healthcare that is safe and affordable Governor’s Charge: “…look for creative ways to further improve the delivery of healthcare to Virginians.” VCU’s Response: Build an integrated “training hub” for medical students, residents, physicians, and other healthcare providers to serve communities across Virginia. Source: Office of the Governor, “Governor Kaine Creates Healthcare Reform Commission.” Press Release, August 6, 2006.

3 Medical Education & Clinical Simulation Building, Phase I  New 200,000 gsf facility to be built on A.D. Williams site (corner of 12 th and Marshall Streets) - 150,000 gross square feet (gsf) of dedicated E&G space  Estimated Cost: $ 70.0 million GF $ 88.6 million NGF $158.6 million total MSB ,000 gsf of additional research space Proposed building as viewed from East Marshall Street

4 Location will be critical.  Current site of A.D. Williams provides a central location with access to: - Existing Educational and Research Space - Hospital Facilities - Massey Cancer Center  Allows for future growth on West Hospital site New facility will fully utilize space and accommodate large training spaces not feasible in A.D. Williams.

5 Building tomorrow’s workforce With the new Medical Education and Clinical Simulation Building, VCU could increase medical school enrollments from 730 students to 1,000 over time. Time is of the essence. - Recent studies in Virginia suggest that current enrollment projections will not be sufficient to meet anticipated physician demand. - Because it takes 7-10 years post-baccalaureate to educate a doctor, today’s decisions impact patient care well into the next decade. Source: Governor’s Healthcare Reform Commission, Workforce Workgroup Recommendation Presentation, May 2007.

6 The foundation has been laid At 730 students, VCU has the largest medical school in the Commonwealth. With our existing medical school infrastructure (e.g., large, well established, basic science and clinical faculty, dedicated teaching hospital and clinics, and active accreditation status), VCU could grow the student body up to 1,000. The School would be able to accommodate the related operating costs without any additional operating support beyond the projected increases in tuition revenue and the anticipated state support for medical education provided through the current base adequacy guidelines. With its existing, preeminent faculty, the Commonwealth is assured that the students added to the medical school class in Virginia would be attending one of the top medical schools in the country With its Inova-Fairfax partnership, VCU has expertise in establishing a fully- accredited regional campus. - VCU is exploring opportunities to train medical students in high demand areas throughout the state.

7 VCUHS provides on-going support Health system funding has been essential to the success of medical education and physician training programs. Between , the VCU Health System contributed: - $43M from MCV Hospitals for faculty teaching residents; - $20M from MCV Physicians toward faculty for teaching medical students and residents; - $57M from MCV Hospitals, MCV Physicians and Virginia Premier to the School of Medicine for new faculty recruitment; and - $13M for teaching students in pharmacy, nursing, and other health professions. In total, VCUHS has contributed $133 million over five years.

8 Integrating medical education Interns and Residents Practicing Physicians Other Healthcare Providers (e.g., nurses, pharmacists, dentists) Medical Students A New Approach Today’s Approach Compartmentalized, teaching activities and accreditation 2 years basic health sciences 2 years clinical skills M.D. degree Typically 1-3 years (or more) Practicing physician Continuing education Reaccredidation VCU seeks a coordinated approach that integrates medical education across all levels and across multiple healthcare professions.

9 Growing residency programs... Medical school education and residency training are integrally linked. - Residents in training are often the “first line” teachers for medical school students. As more students complete their medical degrees, additional residency opportunities will be needed in order to impact physician supply. As VCU expands its medical school enrollment, the University’s goal is to increase affiliated residency slots at the same rate.

10 …Through regional partnerships. Through a combination of VCUHS and University- sponsored residency programs, VCU is exploring opportunities to create up to 250 residency slots. - VCU’s partnership with Inova provides an important entry point to the Northern Virginia region. - VCU’s relationships with its 5 Family Practice programs (Riverside, Hanover County, Chesterfield, Inova, Winchester) provide additional opportunities to develop affiliated residency programs throughout the Commonwealth.

11 Addressing pipeline issues K-16 preparation - VCU already plays an active role in cultivating Virginia’s future healthcare providers. Successful programs include: Project Inquisitive Minds, Youthwork Health Occupations Institute, Jump rope to Stethoscope, and Week in Scrubs. - A new $1.5 million grant from the Howard Hughes Medical Institute to enrich the undergraduate life sciences curriculum. Creating “practice networks” - Because of the disjointed nature of medical education, students are often encouraged to seek professional opportunities out of state. - By tracking students into a network of residencies – particularly in primary care -- and providing on-going educational support throughout physicians’ professional lives, VCU will attract and retain a greater number of physicians. - Through continuing education that focuses not only on updates in medicine, but also on new regulatory and practice management issues, VCU will improve Virginia’s business climate for physicians and extend their functional work lives.

12 Keeping more graduates in Virginia VCU is committed to working with the state to improve the retention of medical students and residents who train in Virginia. - The School of Medicine is increasing its guaranteed admissions programs. Options currently under consideration include: - Dedicating a specific number of admissions to students from underserved areas of the state; or - Targeting students with specific interest in primary care; - Partnering with other colleges and universities in the Commonwealth to increase the pool of qualified applicants. - VCU also supports state recommendations to expand loan forgiveness programs and identify new incentives that will encourage medical students and residents to practice medicine in the state.

13 Using simulation to improve clinical skills and patient safety Advances in simulation provide new opportunities to: - Modernize medical education; - Accelerate residency training; - Extend the careers of practicing physicians; and - Improve patient care while minimizing cost increases Over the next several years simulation will likely become standard part of medical accreditation standards. - The American Council of Graduate Medical Education (ACGME) already requires surgery residents to be trained through simulation. - Simulation has become a mandatory requirement for practicing anesthesiologist seeking obtaining their Maintenance of Certification in Anesthesiology.

14 VCU set to lead in simulation… Educational applications: Integrating simulation into the curriculum is essential to preparing physicians to provide care in an increasingly complex medical environment and work in teams with other healthcare professionals. R&D: Through its partnerships with industry in the BioTech Park, VCU’s Schools of Medicine and Engineering will use simulation to advance the research and development of new biomedical technologies and medical treatments for all Virginians.

15 But, why not just renovate? Although operationally well-positioned to expand its class size and transform medical education in the Commonwealth, aging facilities remain a barrier. - A.D. Williams, which sits at the heart of the medical center, illustrates the challenges. - Built in the 1930s, the facility has serious deficiencies, including no fire suppression system. - A.D. Williams cannot be renovated without extensive asbestos abatement, building and energy code upgrades, and replacement of mechanical, electrical, and information technology.

16 The options are limited. The floor-to-floor height is unworkable. Ceiling heights are too low to accommodate contemporary heating and air conditioning systems.

17 Closely spaced columns will obstruct students’ view of the front of the room, regardless of the room configuration or class size. With its early 20 th century design, the building cannot support simulation equipment, educational technology, or classrooms above 60 students – even with renovations. The conventional ductwork unable to fit minimum plenum space available. The column layout impossible for classroom viewing. Modern needs cannot be met.

18 New construction provides a better return on investment. The cost per square foot to renovate A.D. Williams is 77% of the cost per square foot to construct a new facility. - Recent estimates show that the cost to renovate A.D. Williams structure would be $372 per square foot. - The cost for new construction on that site would be $483 per square foot. By investing in new construction, the University will gain an additional 100,000 gsf – doubling the existing space in A.D. Williams. In short, the building’s lack of programmatic flexibility and its premium location require that A.D. Williams be replaced.

19 Promoting economic development VCU’s new medical school will serve as the focal point for developing a comprehensive approach to healthcare in the Commonwealth. - With a state-of-the-art educational center, VCU will help local communities create new jobs in the healthcare industry and meet the demand for physicians, nurses, oral surgeons, pharmacists and other health professionals. - Through community and regional partnerships like Inova, VCU can raise the skill and competency levels of healthcare professionals in all regions of the state. - In partnership with the biotech industry, VCU’s Schools of Medicine and Engineering can be on the forefront of discovery in biomedical research and application.

20 Leveraging NGF support As part of this initiative, Massey Cancer Center will partner with VCU to support additional research space in the new facility. - With support from MCC, up to three floors will be dedicated to research in cancer prevention, diagnosis, and treatment. By leveraging almost $90 million NGF, the Commonwealth, in partnership with VCU, can develop a comprehensive, cost- effective approach to meeting future healthcare workforce needs. Under the state’s funding conventions for higher education facilities, the proposed project would be eligible to receive $115 million GF. With support from private sources, however, VCU’s is requesting that the state contribute $70 million to this project – reducing the state’s anticipated contribution by $45 million GF.

21 Meeting Virginia’s needs Goal: Access to quality healthcare that is safe and affordable Governor’s Charge: “…look for creative ways to further improve the delivery of healthcare to Virginians.” VCU is positioned to respond. Emerging leader in integrating education across all levels of training (i.e., students, residents, physicians) Focused on team-based training and the use of simulation to improve patient outcomes Capable of significant enrollment growth at lower cost Strong community support from Massey Cancer Center Track record of community outreach and economic development across the Commonwealth