Healthcare extremes inspire healthcare excellence

Q. How has your background prepared you for your new role as Chair of Internal Medicine?

A. My career journey provided me the opportunity to have a wide variety of experiences in diverse environments. I received my undergraduate medical education in a resource-limited environment that forced learners to depend more on history and clinical examination and less on laboratory or imaging data. My Internal Medicine residency at the University of Connecticut was my first experience with the U.S. medical education and healthcare, and I simply fell in love with the U.S. system.

Practicing traditional internal medicine in rural West Virginia, I saw how social determinants of health impact the healthcare of U.S. citizens. Serving several years at Johns Hopkins as an academic hospitalist and clinical researcher, I developed research skills and proficiency in data analysis and grant writing, guided by dedicated mentors, and mentored junior faculty. I was fortunate to be given the opportunity to establish an academic Division of Hospital Medicine at Virginia Commonwealth University. This allowed me to simultaneously oversee the clinical operations, medical education, academic research and faculty development of a very large faculty. We developed several successful new clinical and research programs within the division and across the Department of Internal Medicine.

By exposing me to diverse settings, my career journey has brought me to a place where I can relate easily with clinicians with a variety of professional interests. In other words, I have developed a balanced and healthy view of each component of the quadruple aim of academic medicine: providing excellent patient care; preparing a capable and agile workforce of future physicians; discovering new treatments, therapies and innovations in clinical care; and paying close attention to faculty wellbeing and development.

Q. At VCU, you were the inaugural Chair of Hospital Medicine. What is hospital medicine and how will this experience benefit the work you do at EVMS?

A. In simple terms, hospital medicine is a specialty of internal medicine focusing on the care of hospitalized patients. Hospital medicine practitioners, called hospitalists, are experts in not only treating hospitalized patients but are also well-versed in navigating the complex transition of patients back to their home environment. While most specialists focus on a disease or an organ, hospitalists focus on the healthcare delivery processes — processes that result in the admission of a patient to the hospital, treatment, recovery during hospitalization and safe discharge from the hospital. In other words, hospital medicine focuses on improving the delivery of healthcare to the sickest of sick individuals.

Today’s hospitals are extremely complex operations requiring seamless collaboration of several diverse clinical and non-clinical teams. When taking care of patients, hospitalists interact with a wide variety of other healthcare team members, including other specialists, social workers, nursing staff and pharmacists. Thus, hospitalists are team leaders and team players, collaborating widely to lead the speedy recovery of their hospitalized patients. Teamwork and collaboration are ingrained in every aspect of a hospitalist’s daily work.

As Chair of Hospital Medicine, I depended on teamwork and collaboration to build and refine effective relationships and partnerships between various teams based on patient focus and mutual benefit and respect. Schools of medicine are large institutions requiring collaboration between a diverse clinical faculty from a wide variety of disciplines. EVMS is a unique institution that focuses heavily on collaboration between a wide variety of partners — local community, community physicians and regional hospitals. I believe that my experience in developing collaborations and partnerships will help me nurture existing relationships and identify new areas for collaboration benefiting EVMS in depending on its community roots.

Medical education and research are integral parts of the EVMS mission. In academic centers, hospitalists have additional responsibilities for clinical teaching and research. Hospitalists are often the main faculty providing medical education to internal medicine residents and medical students. In my role as Division Chair, we expanded our traditional role in the medical education of residents and medical students while developing peer-education and lay-public education programs. My experience in nurturing traditional and nontraditional education methods will benefit EVMS in continued innovation in medical education delivery. Similarly, we developed areas of clinical research in the Division of Hospital Medicine. Generally, hospital medicine research focuses on issues such as readmissions, patient satisfaction, end-of-life care, the value of healthcare and hospital throughput. In my role, I encouraged and enabled the faculty to pursue research interests and develop programs. Initiatives, such as the Rising Scholars program, were geared to help faculty in pursuing a research-focused career and resulted in external grants and high-impact publications. This is another skill that is transferable to EVMS, helping to enlarge its clinical research footprint.

Q. What is it about academic medicine that you enjoy?

A. So many aspects of academic medicine are attractive and bring joy. It’s the ability to provide care to some very sick and complex patients; it’s the satisfaction that comes with teaching medical students and residents and seeing them grow into fabulous clinicians; it’s the thrill of discovering new aspects of human biology and pathology; and the capacity to enhance the delivery of healthcare. There is never a boring moment in academic medicine and there is always something exhilarating that keeps me engaged and attracted.

Q. With all the challenges presented by the pandemic, how do we ensure that medical education doesn’t suffer?

A. Like everything else, the COVID-19 pandemic has affected all types of education, especially medical education. Although the pandemic has brought several challenges, it has also allowed us to re-examine how we educate our future clinicians. This pandemic is expected to be over in the next several months to a year or so. Having said that, we cannot discount that other disruptions are possible in the future. What this pandemic has done is to force us to think creatively and identify innovative ways in which we can incorporate technology into medical education. Some possibilities include simulation and the use of virtual reality to deliver standardized education. There is no substitute for working and learning from real-life patient-encounter experiences — however, we can and we should identify ways through which we maximally capitalize on each real-life encounter for our medical students.

Q. What’s the primary focus of your research endeavors?

A. Over the 20 years of my career, my research focus has continued to evolve. Very early in my career, I was interested in assimilating evidence using the tools of systematic review and meta-analysis. Soon after joining Johns Hopkins, I became interested in the genetic epidemiology of cardiovascular diseases, in particular, platelet biology as it relates to the development of arterial occlusion. This interest led me into the exciting field of pharmacogenomics of anti-platelet drugs, in particular aspirin. Some of the exciting work we did includes developing adult-induced “pluripotent” stem cells. The biology behind the development of adult pluripotent stem cells is fascinating. Each mature human cell contains a complete copy of every human gene. In each cell, some genes are turned on while others are turned off. This combination of on and off commands gives mature cells their unique characteristics. If we can remove these on and off commands from the genes, we can convert a mature adult cell into an undifferentiated cell similar to an embryonic stem cell and capable of developing into any other cell of the body. We differentiated pluripotent stem cells into megakaryocytes — large cells that reside in the bone marrow and release platelets into the blood.

Effectively running a large division during the past few years required that I forgo my research interests. My current research interests stem from mentoring junior faculty and have focused on patient satisfaction, physician wellness, engagement, burnout, and patient-centered outcomes to help reduce readmissions. Looking back, one thread that is common across all my research endeavors has been my interest in working with data and applied biostatistics, and I see myself continue to remain engaged in working with large datasets.

Q. What attracted you to EVMS?

A. EVMS is one of the only medical schools that was founded by a community grassroots effort, remains deeply rooted within the community and works hard to improve the healthcare of the local community. EVMS has remained focused on fostering a diverse and cohesive faculty and student body while adhering to the highest ethical standards.

EVMS has continued to thrive in always-changing healthcare and medical education environment. This speaks highly of the dynamism in faculty and forward-thinking of the leadership. Once I met the Dean and faculty, I was thoroughly impressed by their warmth, collegiality and transparency — a reflection of the culture at EVMS. The more I learned, the more I became interested and, ultimately, I was convinced that this was the right place for me.

Q. What are your goals as you assume leadership of the department?

A. My goal is to lead the department in a way that meets the mission of EVMS and strengthens the core values. We will continue to provide excellent medical education to our medical students, residents and fellows while at the same time innovating in the delivery of medical education. We will continue to do cutting-edge clinical research while expanding our research portfolio. We will continue to provide excellent patient care while strengthening our bonds with our local community and regional health systems. We will continue to excel as a strong academic center while addressing the challenges of the present but preparing ourselves for the opportunities of the future. And my goal is to do all this while being a good steward of the resources available to us.

Q. During your free time, what hobbies or interests do you pursue? How do you relax?

A. In my free time, l like to read and spend time with my family. I like most books – fiction or non-fiction. My family and friends are my biggest source of joy, fun and relaxation.