New Fort Worth MD School Names Its Founding Dean
Profile — August 2016
Tex Med. 2016;112(8):33-39.
By Amy Lynn Sorrel
The University of North Texas Health Science Center (UNTHSC) and Texas Christian University (TCU) have partnered to launch a new allopathic medical school in Fort Worth, and Texas Medicine talked to the team's newest player. The yet-to-be named school appointed oncologic pathologist Stuart D. Flynn, MD, as its inaugural dean in April, and the Michigan native has a unique vision for the unique project: It is the first partnership of its kind in Texas, and the new MD school will run alongside UNTHSC's 45-year old osteopathic medical school — Texas College of Osteopathic Medicine (TCOM) — while sharing a campus with a history of interprofessional education. But Dr. Flynn says collaboration — not competition — is the name of the game. The physician-educator steps into his new role at a time of transformation in medical education and says he has all the ingredients he needs to foster an education model focused on teamwork.
Texas Medicine: You have a background in medical school start-ups having done this in Arizona, also as a partnership between two universities. Tell me about that experience and what makes you uniquely suited for this job.
Dr. Flynn: I arrived in Phoenix (in 2006) to start at that time what was going to be a four-year branch campus in partnership with the University of Arizona (UA) College of Medicine in Tucson and Arizona State University (ASU) in Phoenix. The UA provost and the vice president of health sciences at the time decided: "Phoenix is the fifth-largest city in the country. We need a separately accredited medical school." That changed the trajectory of our vision, and we went forward. There were some great opportunities. Unfortunately, the geographic disparity between Tucson and Phoenix also resulted in some complexity, being 110 miles away from each other.
Texas Medicine: Can you elaborate on that complexity? Some would say there are some unique and complex things about what you are trying to do here in Texas.
Dr. Flynn: Medical schools are amazing diamonds, but they constantly have to be polished. They are high-demand enterprises, so whoever is involved has to be collaborative and clicking together on all cylinders. When that's not the case, you add even more complexity to what's already a major effort.
UA and ASU are both big universities, both nationally renowned, and they were quite different in their approach to many things. After a reasonable period of time, ASU withdrew from that partnership. (ASU joined with Mayo Clinic to launch a medical school in nearby Scottsdale, Ariz., set to open in 2017.) The Tucson medical school was 40 years old, and the Phoenix school was the distant school that wasn't on the main campus.
In many ways, we did a lot of things on our own. But there also were times when oversight came into play, and from 110 miles away, they really didn't understand the dynamics in the health care system in Phoenix. And the thing you don't want to do to two medical schools is try to clone them, as opposed to advantaging the true assets you have in both of them.
Texas Medicine: What will be different in getting this Texas partnership off the ground?
Dr. Flynn: These are two very different universities. One is basically a graduate university; the other is primarily, but not entirely, undergraduate. However, they both have health science schools, which to me is a powerful glue between the two.
TCU has a nursing school that very much wants to be a major player in the interprofessional care model; an engineering component to its biology and engineering college; and a very renowned business school. UNTHSC has public health, pharmacy, physician assistant, physical therapist, and biomedical sciences schools, as well as an osteopathic medical school. I have the vast majority of the building blocks here to train the next generation of the health care team and address the immense role of technology in this mission, understanding the business of health care and keeping communication and humanism as a centerpiece in all we do.
The beautiful thing to me was, I have all those ingredients to harness. These two universities have worked closely and well together to date, and quite honestly, it's up to this medical school to congeal and collaborate and value what both bring. I'm very comfortable both universities want the same outcome, and that truly is to train the next generation, train it the way we need to train it, and be a phenomenal citizen for Fort Worth, for the region, for the state, and beyond. In my very short time here so far, I've been overwhelmed not only by the receptivity but also by the real passion to accomplish that.
Texas Medicine: For a while now, UNTHSC has focused on interprofessional education. How will that figure into the new school's curriculum?
Dr. Flynn: At the time we were designing our curriculum in Phoenix, it was an imperative to add biomedical informatics, so it was not a foreign language to our graduates. I said, "We'll know we've done it well when our students don't even recognize it's in our curriculum."
That was how we approached it, and that's what we did. I view interprofessional education the same way: We know it's an imperative, we know it's where health care is going, and we know that's how we are going to start to optimize care and outcomes and lower costs.
In Phoenix, I had ASU's nursing school, social work school, and UA's pharmacy school, and we were one of the initial recipients of a very large grant to build our [interdisciplinary] curriculum. Well, that was a decade ago, and a lot has changed. It's almost passé to talk about interprofessional education now. All institutions value this training.
The next big hurdle is finding places that model and deliver care using this team approach so students can actually go out and train and practice that way. That's what I was working on in Phoenix when I left. So back to the initial question, we will do this, and if we do it well enough, it will just become how these students are being trained and how they are going to be delivering care, and they won't talk about it as a separate, soft component of their curriculum.
Texas Medicine: Are you working with the community to develop those team-based training opportunities?
Dr. Flynn: That's an anticipation and immense desire I have, to find where people have the appetite to do this. We know we are going to get there, and we also know it's hard to be the first one to empower substantive change. Just like when the ACGME (Accreditation Council for Graduate Medical Education) competencies came out, they were brand new to all of us, but, quickly, programs started putting means to accomplish and evaluate them into a toolkit, and it was the collective good trying to figure out how to assess best practices for these competencies. I would submit that might be very similar to what's going to happen here. We may do something very well and go on to have great success — share it. We may think something is going to work beautifully, and it didn't — share it, nationally, across the board. I'm not sure the pace we're going to go at this. However, there is a strong passion for many of us to start to advantage and operationalize this approach.
Also, physicians will be the foundation of this medical school, highlighting the immense value of organized medicine and the Texas Medical Association to our future success. I was on the executive board of the Arizona Medical Association (ArMA), and my newly appointed dean of curriculum is the past president of ArMA, and many of my faculty were members. We are very excited now to become valued members of TMA. I also believe that the next generation of physicians, similar to those of us who belong to our state medical associations, must be exposed to the significant value that TMA brings to all facets of their career. Over time, the expectation is that they take the baton and become leaders of the organization for the next generation.
Texas Medicine: What does interprofessional education look like?
Dr. Flynn: First, interprofessional education directly points to optimizing the value of health care delivered by the health care team, with the patient at the center of all we do. This is a shift in training emphasis that for many is relatively new.
Certainly, in clerkships you can have blended clinical experiences. What's becoming pretty apparent is, there are certain things that are conducive to large-group learning, and many things that are not. A classic environment for interprofessional experience in the clinical realm is in a simulation setting. Well, that doesn't lend itself to a roomful of people watching two or three people working. What it really lends itself to is, two or three disciplines being given a scenario and having them work together. That's the way it's going to play out when I go to the emergency room, a code comes in, and I've got seven, eight different sets of hands on the patient. What a beautiful thing to know what each of their responsibilities are and vice versa.
That's the evolution in interprofessional training: You walk in your shoes and someone else's shoes, and you must do this in patient-centered scenarios, not in large lecture halls.
Texas Medicine: The new school's fact sheet also says you plan to "pioneer an education model for the practice and business of medicine." How will you address the business side of medicine, which is becoming a more critical skill these days, and what about this partnership allows you to do that?
Dr. Flynn: TCU has a very established, mature, highly regarded business school. I've been out of medical school for quite a while now, and things have changed. I had an hour lecture that touched on Medicaid and Medicare because it allowed the curriculum to say we talked about these things. I don't believe it was an approach to help me understand this at any substantive level, yet it is critical to all I do. But if we continue to overlook the business of health care, we're doing our profession a huge disservice by allowing others to define it.
But to be perfectly clear, we will not be a medical school-business school. We're going to train the best undifferentiated physicians we can train, and it will include such things as the business of health care, financing, and policy. There are only so many hours in a day, and it turns out we don't need 8 am to 5 pm days, and we certainly don't need lecture halls like we used to.
We can actually do this without having these poor young people up until two o'clock in the morning as we throw the kitchen sink at them. That's the good news. We've become more facile in what we should expect a medical student to know and how we help them assimilate such knowledge at their level, versus a resident, versus a fellow, versus a practicing physician.
Texas Medicine: Your MD school will sit alongside UNTHSC's DO school. Are you concerned about competition?
Dr. Flynn: First of all, TCOM is arguably the best osteopathic medical school in the country. They've had the wonderful advantage of a large metropolitan city where they train their students in a wonderful clinical enterprise, and several osteopathic medical schools don't have that luxury. This city is plenty big for both schools. At the end of the day, we both will be graduating physicians. The community is excited they've had TCOM for approximately 45 years, and they're now excited to have an allopathic medical school. I truly don't see it as a competition. Both will succeed, and this new school will bring some phenomenal opportunity. TCOM has already demonstrated to me that they are very collaborative in how we can do things and how they can help this new school get off the ground.
I do think that we will be able to open some serious doors in regard to GME (graduate medical education). I take that very seriously, and I wouldn't be here if I thought GME had saturated itself in the Fort Worth area, and we couldn't grow it, number one, and make it better, number two. Where we succeed with that, TCOM benefits, so that's a very symbiotic outcome.
And from the discovery side of things, UNTHSC already has an accomplished research focus that truly is nationally known. If we are going to be a research-intense medical school, too, it's a big metroplex; there are opportunities galore, and there's no reason why an allopathic school puts boundaries around that and doesn't share with anybody else. Again, if we set this up as a competition, that's the way it will play out. I don't see any reason to do that.
Texas Medicine: You mentioned GME. What's your response to criticism about starting new schools when GME remains scarce?
Dr. Flynn: This discussion [over starting new medical schools] began nationally well over a decade ago with the projected physician shortage. There are many things about new medical schools I love: They are actually able to be quite nimble in putting curricula together and championing some of the things established medical schools struggle with. Collectively, we all need to get our arms wrapped around the GME issue. Otherwise, we're going to end up with students with MD or DO after their name, $200,000 in debt, and no residency program to practice what they worked so hard to do. That's a national issue. It's certainly not a new medical school issue.
Fort Worth is a great example of a much untapped metropolitan area to really change the quality and number of residency programs. Having said that, we all know that is an expensive endeavor, so I was very pleased to see what the state of Texas has done to start to address this. (Read "Seizing Opportunity," January 2016 Texas Medicine, pages 45–50.)
Texas Medicine: You expect to enroll your first class of 60 students in 2018. Are you on target to begin accepting applications in 2017?
Dr. Flynn: You cannot even advertise you're a medical school until you've received preliminary accreditation. We are on a pretty aggressive timeline. I'm in contact with LCME (Liaison Committee on Medical Education) right now to see exactly where their hard stops are. I'm reasonably comfortable we can put together the accreditation materials [in time], but there is a fair amount of due diligence. I do need faculty, and I need faculty to weigh in on a vision statement, a mission statement, and a curriculum because, of course, this is not going to be my curriculum. I have to get several cogs in this process to start to mesh together, and that's what I'm spending my days trying to do right now.
Texas Medicine: Will there be shared campuses?
Dr. Flynn: What I don't want, nor do the leaders of the two universities, is these young folks going back and forth two or three times a day, or even two or three times a week. We'll get into a cadence and maybe set up half-day scenarios where we're advantaging one campus or the other for the expertise we are looking to garner that day.
Both campuses bring superb training facilities for our mission. If we do this really well, a lot of our time will be spent in the health care district, which is actually where the real, patient-centric learning occurs.
Texas Medicine: How did you get into medicine and education?
Dr. Flynn: I grew up in the Upper Peninsula of Michigan, a pretty impoverished area. Care was delivered in my town by primary care physicians, and we really didn't have any specialists without going six hours in one direction or three hours in another. I grew up watching these primary care doctors, and you couldn't help but be in awe that they could look in a little kid's ears, and in the next breath, be called into the emergency room.
That was where I started the journey of being pre-med (at the University of Michigan) and getting into medicine. And on the education side of it, my entire family are educators. Selfishly, I just love being a teacher. I get to play an amazing role in educating the next generation of physicians and in young people's careers.
Amy Lynn Sorrel can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
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