In recent years, the School of Medicine has made impressive strides in strengthening its basic and clinical research programs while sustaining a distinguished tradition in physician training. The Envision session explored ways to further these achievements, including interdisciplinary initiatives and other innovative measures. The discussion also examined major barriers to progress, such as insufficient research space and growing time demands on faculty, and it identified the essential values and characteristics that must be preserved as the school moves in new directions.

Barriers to Progress
The School of Medicine has expanded its research capabilities substantially in recent times. It has recruited first-rate investigators, it has experienced a 125 percent increase in NIH funding over the past four years, and it has expanded its laboratory space by 51 percent during the past decade to more than 435,000 square feet. Nevertheless, the school continues to be stymied by insufficient space and other vital resources for research, according to Envision participants.

New facilities such as MR-5 and the endocrinology building at Fontaine will help to address this issue, as will the proposed MR-6, but in the meantime, space deficiencies create an atmosphere in which programs place their own interests ahead of those of the school and the University. As one participant observed, lack of space was a key reason two Nobel laureates went elsewhere after conducting their groundbreaking research at the University, and it continues to make it difficult to retain top-flight scientists. "We can recruit outstanding young stars, but we can’t keep them here," said one Envision participant.

Although it is most evident in the research area, space deficiencies also affect the quality of teaching, clinical care, and the sense of community. Among the needs cited in the discussion is more meeting space where students and faculty can interact and perhaps share meals. It was also suggested that the school acquire a better sense of place, with a commanding edifice that announces to the public that this is the School of Medicine.

Multiple Demands on the School and on the Faculty
Faculty cited the warring demands on their time as a source of dissatisfaction. The school faces the challenge of reducing the tension between its academic and clinical activities and finding creative ways to bring them together synergistically. Clinician-investigators say the time they can devote to research and teaching has been eroded due to increased patient-care responsibilities and the attendant paperwork. This is an especially severe problem in small departments that do not have the capacity to spread their patient loads.

Envision participants described patient care as a sacred duty that cannot be neglected. They called for an effort to decrease the required paperwork associated with clinical duties, and it was suggested that in certain units it may be possible to assign more patients to certain faculty to give other faculty more time for research. To do this fairly, annual evaluations must give as much weight to patient care as they do to a faculty member’s research productivity. "We became doctors because of the humane side of medicine," said one of participant, "but it’s not what’s rewarded."

It also was noted that young clinician-investigators are "struggling in the current environment" and more needs to be done to keep them on board. This is vital to sustaining the future of the school. It was suggested that better efforts be made to ensure that clinician-investigators have the tools they need to thrive. As one participant said, it is better to help clinician-investigators fulfill the potential that was seen in them when they were hired rather than expend energy on bringing in new people.

The School of Medicine’s Core Values
As it works to resolve such issues, the School of Medicine will also work to maintain a core set of values and distinguishing qualities that faculty agree must be preserved. These include:

		Contiguity: The School of Medicine’s proximity not only to clinical areas but also to other parts of the University is seen as one of its most valuable characteristics. Promoting both formal and informal collaboration and intellectual cross-fertilization, contiguity with the heart of the University is one of the school’s key advantages over those that are removed from their main campuses.
		Collegiality: This is one of the school’s most precious assets. Participants who have joined the School of Medicine in recent years have been impressed by the warm and supportive nature of interactions among faculty and between faculty and students.
		Extraordinary Students: Although the applicant pool is falling nationally, the school continues to attract outstanding students. The class entering in the fall 2001 was the strongest ever.
		Commitment to Teaching: Guided by Jefferson’s vision of the educated citizen, the School of Medicine will continue to emphasize the importance of teaching and will use its rich intellectual environment to further enhance the classroom experience.
		The Intersections of Science and Society: The school has been a pioneer and a leader in the field of biomedical ethics and in the integration of the humanities into the study of medicine, and it intends to maintain its special strengths in these areas.
		Integration of Basic and Clinical Research: The school is committed to bridging "both sides of the street," establishing stronger synergistic links to ensure that investigators in the basic and clinical areas inform each other’s work. As was noted, "relevance" is no longer a word to be avoided when discussing the basic sciences.

The Vision for the Future
The aspirations expressed in the Envision session correspond in many ways with the goals outlined in the Virginia 2020 planning process, particularly in the areas of science and technology, public service and outreach, and international activities. Participants also urged the school to redouble efforts to recruit and retain women and minorities and to ensure that young clinical investigators, particularly young women in these positions, have the time and the tools to be successful.

Other goals and strategies enunciated in the discussions include the following:

		Enhance the school’s capacity to recruit signature scientists. Several times it was pointed out that the school currently has no members of the National Academy of Sciences or Hughes Investigators on its faculty. On the other hand, some questioned whether making high-profile faculty hires is the most effective strategy for raising the stature of a program. A better or at least complementary approach, they suggested, would be to build from the bottom up by hiring outstanding young scientists, giving them the resources they need to be productive, and rewarding them to ensure that they remain on the faculty.
		Set up a dual mentoring system for new faculty hires. Each new faculty member, especially at the junior level, should be connected to at least one mentor in the clinical area and another in the basic sciences. While a clinical investigator is working in the lab, he or she will be encouraged to think about clinical applications, and vice versa. Such dual mentoring will foster collaborative relationships and will promote the transfer of scientific discoveries from the lab bench to the bedside.
		Make strategic faculty hires that benefit more than one program. Many top scientists are working at the intersections of multiple disciplines. As departments consider new hires, they should examine each candidate’s ability to strengthen research and instruction in other programs within the school and elsewhere at the University.
		Create a science advisory board of Nobel Laureates and other distinguished researchers. As the school determines where to target resources and where to build new research strengths, a panel of distinguished scientists could bring a valuable, objective perspective to the decision-making process.
		Speed the translation of new discoveries into new treatments. When a discovery shows strong potential for reducing the effects of injury and illness, the school should push hard to launch clinical trials and to begin benefiting patients as soon as possible.
		Expand the school’s involvement in clinical trials. By offering promising new agents and new treatments early in their development, the school can give patients access to cutting-edge care not available in other clinical settings.
		Make greater use of interdisciplinary centers and institutes and give them the resources to chart their own course. It was noted that entrenched departmental structures may be the greatest obstacle to success. Centers and institutes can be created to capitalize on promising new directions in research, and they can be decommissioned when conditions and priorities change. At the same time, Envision participants pointed out that departments cannot be allowed to wither. Teaching and house staff training are department-based, and national rankings tend to be focused on departments.
		Reinforce collaborations with Arts & Sciences, Engineering, and other schools. The complexity of current research problems often demands drawing on the expertise of multiple disciplines. The School of Medicine should take greater advantage of the store of knowledge in neighboring schools and departments. The College’s South Lawn project holds promise here, forming a physical and intellectual bridge linking Medicine, Arts & Sciences, and Engineering.
		Place greater emphasis on public health and disease prevention. The lack of a public health program is seen as a glaring weakness at the University. Rather than establish a new school of public health, the School of Medicine should collaborate with the School of Nursing, Arts & Sciences, and other areas to build a program.
		Prepare students for leadership in a new era in health and health care. It was emphasized during the discussion that the most significant advances in medical science in the coming decades will occur at the crossroads of biology, information, and values. Taking advantage of its proximity to other schools on the Grounds and fulfilling its Jeffersonian charge to produce educated leaders, the school should require courses that combine elements of medicine, law, ethics, and other fields to give students the analytical tools to grasp the complexities of health and health care in our society. With this background, they will have the capacity to redefine public health in the 21st century and to make health a basic human right in America and abroad.

Imagining Transformational Ideas
Participants were asked to imagine transformational ideas that could be realized if funding were available from the Commonwealth or from exceptionally generous donor support. The greatest potential threat to the school, it was noted, is not competition from other institutions, but the failure to envision "big ideas."

Discussion of the public health initiative led several at the table to suggest creating a Commonwealth-wide School of Medicine, with branches based in cities and other institutions around the state. Such a move would preempt possible attempts by schools such as George Mason and Virginia Tech to form their own medical schools.

In Northern Virginia, the school could establish a disease prevention and informatics satellite. Branches of the Cancer Center could serve areas stretching from Southwest Virginia to the D.C. suburbs. This expansion would open the school’s research and clinical activities to a much broader population, creating a richer environment for training physicians and generating new discoveries. It would also provide the critical mass of patients that star recruits often look for when considering offers from the School of Medicine.

When asked where transformational support should be invested, the Envision participants suggested the following areas:

		Chromatin and gene-expression research, linking fundamental discoveries to the prevention and treatment of disease.
		Cell signaling, building on advanced work under way on the chemical messages that determine cellular functions
		Cardiovascular medicine and cardiovascular imaging
		Endocrinology, expanding groundbreaking work in such areas as hormonal control of blood pressure and kidney function, and growth hormone analogs in the prevention of cardiovascular disease
		High-throughput proteomics, encompassing techniques for identifying disease-related proteins that can be targets for vaccines and other treatments
		The women’s cancer initiative
		Studies of science and society (including bioethics and professional responsibility)
		Adenosine and its role in various organ systems
		Drug discovery and chemotherapeutics
		Infectious diseases and geographic medicine, including the global health initiative
		Cellular morphogenesis and biodifferentiation, including research on how developmental processes could be tapped to repair tissue damaged by injury and disease

Noting that these suggestions focus on well-established strengths, several participants urged the school to be open to novel ideas from areas that have yet to achieve national eminence. In other words, the school should create excellence, not just reward it. In recent years, some of the school’s most successful new ventures have been in areas where there were only modest capabilities to start. Examples include the world-class programs in molecular genetics and cell adhesion/motility, which were largely built from the ground up with School of Medicine support.

Serving the Needs of Society
The Envision discussion revealed the School of Medicine’s eagerness to create new strengths in the basic sciences and clinical care, and above all, to create the ideal environment for training the physicians of the future. With its Jeffersonian heritage, its service-oriented culture, and its leadership in collaboration with colleagues across the Grounds, the School of Medicine recognizes that it is uniquely positioned to prepare leaders in medicine who can forge meaningful connections between science and society and who can set the pace for health care in the 21^st century.