COMMENTARY

How a Medical School Dean Got Ahead of COVID-19

Andrew N. Wilner, MD

Disclosures

November 25, 2020

This transcript has been edited for clarity.

Andrew N. Wilner, MD: Welcome to Medscape. I'm Dr Andrew Wilner, and today I have the pleasure of speaking with Dr Scott Strome, executive dean of the College of Medicine and vice chancellor for health affairs at the University of Tennessee (UT) Health Science Center. Welcome, Dr Strome.

Scott Strome, MD: Thank you.

Wilner: I want to talk about what it's like to be a dean, specifically of a complex institution like UT in the face of a pandemic like COVID. When you signed on for the job in 2018, you likely said, "Well, this is the list of things that I have to do, and it's going to be a big job." Now that list is a lot bigger since COVID arrived. We all look to our leaders in a time like this to help us. Certainly here in Memphis and in the state of Tennessee, we're very lucky that we have a university that is doing exactly that, looking outward to the community. What kind of help have you been able to orchestrate for everyone, including those who are under your leadership as UT dean?

Strome: As dean, your responsibility is to set direction and take a lot of input from a lot of people. We have absolutely fantastic leadership, so let me first say that this is not I; it's really we. We're very fortunate to have incredible partners, and I'm fortunate to be able to capitalize on the intellectual strength of all of those individuals.

Our org chart has a big stamp over it that says, "Best idea in the room." And that best idea always wins, no matter who it came from. That's how we run the College of Medicine, our community outreach, and every single thing we do. I think the first thing you do as a dean is try to hire people who are fantastic, and I'm privileged to have those people.

At the start of COVID we really wanted to figure out the best way that we could help the vast majority of people in our city and our state. Early on, we recognized that there was a paucity of reliable data, so we created a website to begin to disseminate knowledge. We put in a question-and-answer database, which we rapidly translated into Spanish to make certain that all of our citizens could be involved. Then we engaged epidemiologists in our Department of Preventive Medicine to actually begin to map this virus, both in Memphis and around the country. And we partnered with the city and country, who now actually use much of our data points for their own. We publish those data every single day so that our community knows how many cases we have. We also put them on maps so our community knows where the hotspots are.

We also recognized that there was really limited testing in our area, actually pretty close to none, so it was clear that we had to build testing sites to help our communities. There are really two components to testing: The first is the actual test, where you traditionally have the nasal swab, and then the second is the back-end where that gets processed. We had to build both.

[W]e didn't even know how we were going to get paid. We just knew it was the right thing to do.

We partnered with the city and the county to set up the first drive-through site in Memphis, which we called Tiger Lane. We subsequently built Tiger Cub. With that partnership with the city, we set up a lot of the testing around Memphis.

I'm so proud of our medical students, nursing students, and pharmacy students, because, candidly, this could not have been done without them. They provided the person-power to actually staff those clinics. They gave up their time and of themselves to make sure that the people of Memphis were safe. And they did it for free.

I should note that at the beginning when we set up all of these clinics, nobody paid. We charged their insurance if they had it. But we made sure that everything was free so that every single person who needed a test could rely on UT. And we didn't even know how we were going to get paid. We just knew it was the right thing to do. And if we got paid, that would be great; and if not, we'd figure it out. I wasn't exactly sure how we were going to figure it out, but we did.

We also realized early on that people weren't doing the test right, so our ENT department created a video of how to actually do the test, which we then disseminated all around the city.

We also recognized that we didn't have reliable testing, which would be the polymerase chain reaction test that's done in the lab. With our Department of Pathology, we actually built that, which we did differently from a lot of people. Because we were worried about supply chain, we built our own so that we didn't have to rely on the same supply chain as everybody else. So when other people started running short, we were okay.

We went up to about 1000 tests per day and are rapidly expanding that to almost 2000 tests per day.

We were one of the first 12 academic programs in the country to receive CLIA (Clinical Laboratory Improvement Amendments) certification. And throughout this period, turnaround times for our tests at UT have remained at 24-48 hours, when everybody else was at a week or 2 weeks. We really worked very hard to make sure that we could do a quality job and really help our communities.

We've also tried to educate our community. We've put out citywide and countywide educational seminars on Zoom. As an aside, we did the same thing after the murder of George Floyd. We had a discussion about race in Memphis. That was very well attended and I hope it really gave people food for thought about how we can do better.

We've also helped a lot of the businesses in and outside of Memphis. We've helped a number of colleges with their reopening plans and actually helped write a lot of them. I think that's been a pretty successful effort.

We have to make certain that no student doesn't come to medical school because they're afraid of the cost…

The other thing that we've done is on the research side. I believe we have one of only 13 regional biocontainment labs in the country. We've had the virus since February, I think, and have all different strains. We're doing multiple sequencing initiatives. We have the models up for testing different drugs. Then we're collaborating with Oak Ridge National Laboratory on a bunch of different programs around a viral diagnosis, different treatment paradigms, computer-aided drug design. So there's a fair bit going on in terms of all of those different collaborations. We literally get in samples and drugs from around the world on a daily basis to test and to evaluate their efficacy for COVID.

Wilner: Wow. That's definitely a busy day.

I want to ask you a personal question. In preparation for this interview, I looked at your biography going years back. You participated in competitive college sports. You're an ENT surgeon. You're a specialist in oncology. You helped start a company. Obviously, you've been active in academics.

If you were talking to someone with an interest in becoming dean someday, what advice would you give them based on your experiences about how to develop those skills?

Strome: I always joke that there is no school for "deaning," and I don't know if I'm any good at it. All I can say is that I try my best every day to treat people fairly, to listen to people, and to give them a fair shake.

I guess for me, I was fortunate when I was at the University of Maryland that I chaired ENT; but I also ended up chairing ophthalmology for about a year and a half. I chaired dermatology for around another year. I ran a house for the students. I was also very fortunate to co-found their tumor immunology program. I think that diversity of experience in just talking to different people in different [roles] — and really understanding how research works, how biotechnology works a little bit — and then really understanding and having a passion for educating students. All of those things together really helped shape how I view the world.

I would say I do take a very student-centric approach. I know that first we're a medical school. Our job is to train the next generation of medical students and residents and help sculpt their careers. For me, that's incredibly important. We spend a lot of time on our students, with a particular focus on trying to reduce student debt. That's been a big goal of mine, because I want to make certain that every single student who is meritorious has the opportunity to come to medical school. We have to make certain that no student doesn't come to medical school because they're afraid of the cost, or that they don't choose a specialty that they really want to go into because they're afraid that they won't be able to pay back the debt. We think about that every single day.

What's been amazing to me is that we still have students in our medical school who have food insecurity. We have students who don't get three meals a day. So when people think of what a dean does, well, some days the dean tries to make sure that all the students are eating. And some days a dean tries to help a student in crisis.

Those are the things that you don't really see. In addition to directing courses and all of that, really the job is about working with people, enjoying people, trying to help them through difficult phases of their lives, and at the same time, propel the school forward.

That's not exactly the answer to your question, but it's kind of how I think.

Wilner: That's exactly what I wanted to know. It appears to me that being humble is also part of being a very successful dean. You've certainly demonstrated that, and I'm very impressed and certainly feel lucky to be here in Memphis at UT myself.

Strome: The thing about UT is that I really believe it's a wonderful institution. I think we have a lot to be proud of. We are the city, we are the state, and we're the state school. I'm very proud of that. I really wanted to come to a state school because I believe in the mission of state schools.

I want to be able to provide a very affordable medical education for folks and then have them return and give something back to the state and to the community. We don't try to dictate what that something is. I tell all the students, "You have your own special sauce; we're not going to try to tell you what that is. We just want you to be able to go out and do good after we've taught you." And so we're very proud of our school.

Wilner: Dr Strome, I want to thank you very much for spending this time with us and informing me and all of us at Medscape about what it's like to be a dean at UT.

Strome: Thank you so much for having me. I'm very appreciative.

Andrew Wilner, MD is a professor of neurology at the University of Tennessee Health Science Center in Memphis, Tennessee. He is an accomplished SCUBA diver and a long-time Medscape contributor.

Scott Strome, MD, is executive dean of the College of Medicine and vice chancellor for health affairs at the University of Tennessee Health Science Center.

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