Training a New Generation of Healthcare Providers

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					Training a New Generation
of Healthcare Providers

      August 2007
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
     Source: Office of the Governor, “Governor Kaine Creates Healthcare Reform Commission.” Press Release, August 6, 2006.

    VCU’s Response: Build an integrated “training
     hub” for medical students, residents, physicians,
     and other healthcare providers to serve
     communities across Virginia.

Medical Education & Clinical Simulation
Building, Phase I
                                                               New 200,000 gsf facility to be
                                                                built on A.D. Williams site
    MSB 1                                                       (corner of 12th and Marshall
                                                                    - 150,000 gross square
                                                                      feet (gsf) of dedicated
                                                                      E&G space
                                                                    - 50,000 gsf of additional
                                                                      research space

                                                                    Estimated Cost:
    Proposed building as viewed from East Marshall Street            $ 70.0 million GF
                                                                     $ 88.6 million NGF
                                                                     $158.6 million total

 Location will be critical.
                                                                                   Current site of A.D.
                                                                                    Williams provides a
                                                                                    central location with
                                                                                    access to:
                                                                                     - Existing Educational
                                                                                       and Research
                                                                                     - Hospital Facilities
                                                                                     - Massey Cancer

                                                                                   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.

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.  Source: Governor‟s Healthcare Reform Commission, Workforce Workgroup Recommendation Presentation, May 2007.

 Time is of the essence.
   - Recent studies in Virginia suggest that current enrollment
     projections will not be sufficient to meet anticipated physician

   - Because it takes 7-10 years post-baccalaureate to educate a
     doctor, today‟s decisions impact patient care well into the
     next decade.
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.

VCUHS provides on-going support
 Health system funding has been essential to the
  success of medical education and physician training
  programs. Between 2003-2007, 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.
  Integrating medical education
        Today’s Approach                           A New Approach
Compartmentalized, teaching                               Interns and
activities and accreditation                               Residents
   2 years basic health sciences
   2 years clinical skills
   M.D. degree
   Typically 1-3 years (or more)
                                     Medical                                             Practicing
   Practicing physician
                                     Students                                            Physicians
Continuing education

 VCU seeks a coordinated approach
 that integrates medical education              Other Healthcare Providers
 across all levels and across                    (e.g., nurses, pharmacists, dentists)
 multiple healthcare professions.

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.
…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
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
    - 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.

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
        - 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.

 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 has become a mandatory
     requirement for practicing anesthesiologist
     seeking obtaining their Maintenance of
     Certification in Anesthesiology.

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

 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

 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

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

              Today‟s Design                      A.D. Williams
                 Standard                            Design
                                                Not enough floor-to-floor height
                                                to fit HVAC, Piping, Lighting


                                                                                   11‟-0 „


  Modern needs cannot be met.
 Closely spaced columns will
  obstruct students‟ view of the front
  of the room, regardless of the room
  configuration or class size.

 With its early 20th 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.

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

 By investing in new construction, the University will gain an
  additional 100,000 gsf – doubling the existing space in A.D.

 In short, the building‟s lack of programmatic flexibility and its
  premium location require that A.D. Williams be replaced.

Promoting economic development
  VCU‟s new medical school will serve as the focal point for
   developing a comprehensive approach to healthcare in the

    - 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.
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

 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

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

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