East Carolina University
Program Prioritization
Program Data Report
College/School:
Brody School of Medicine
August 29, 2011
The entire community of the Brody School of Medicine (BSOM) takes great pride in its unparalleled
achievements since the School’s inception. The School has demonstrated outstanding success in each of
the dimensions of the mission provided by the North Carolina General Assembly in the mid-1970s: to
produce primary care physicians for the state; to provide healthcare careers for minority and
disadvantaged students; and to increase access to health care for the people of eastern North Carolina,.
Indeed, a study of medical schools published in the June 2010 issue of Annals of Internal Medicine
ranked BSOM #7 in the nation for achievement of social mission, defined in the study as the same goals
as provided by the General Assembly.
Productivity
The faculty, staff, students, and graduates of the School contribute to the productivity goals of ECU in a
wide spectrum of activities. The School has tremendous strength in medical education.
- Each year, 60% or more of the graduate medical class enter residency training in a primary care
discipline.
- In 2010, Academic Medicine reported a study showing that Brody ranked #9 in the nation for the
percentage of graduates practicing in rural areas.
- More BSOM grads stay in the state to practice medicine (60%) than for any other North Carolina
medical school, with UNC Chapel Hill the next closest (49%).
- U.S. News & World Reports’ 2012 ranking of medical schools placed the School in the #10 spot
for primary care.
- In 2011, the American Academy of Family Physicians (AAFP) recognized Brody as #1 in the
nation for sending more graduates into family medicine over the past 10 years.
The Department of Public Health graduated 35 students in the summer of 2011, the largest number since
the program started in 2003. This increased the total number of MPH graduates to more than 150; the
graduates have a job placement rate of more than 95% at the time of graduation. The number of students
in the MPH Program peaked in 2010-2011 with an enrollment of 122. In FY2011, the department
provided 1901 SCH for the MPH program, plus the equivalent of 975 SCH for medical students.
The faculty of the School serve as the program directors and teaching/precepting faculty for 350 resident
physicians and fellows enrolled in 30 different graduate medical education programs sponsored by Pitt
County Memorial Hospital. These young physicians are critical for providing care to our patients,
teaching medical students, and populating clinical practices in the state for years to come.
For FY2010 (most recent year available), Brody produced 36% of the total PhD graduates at ECU,
demonstrating that we have the most robust programs at the university.
Faculty at the School are also essential for the education of thousands of ECU students outside of Brody.
Foundational courses in pharmacology, physiology, gross anatomy, research ethics, public health, medical
physics, and clinical disciplines are taught in the Colleges of Allied Health Sciences, Arts & Sciences,
and Nursing, as well as the School of Dental Medicine. The degree programs offered in these other
components of ECU rely profoundly on the scientific expertise and pedagogic talent of Brody faculty.
Program Prioritization Report: Brody School of Medicine
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Extramural funding continues to grow at the School. The great success of the graduating students in
Physician Assistant Studies and from the College of Nursing reflects the excellent foundation afforded by
this teaching.
For FY2011, nearly 70% of all funding from the National Institutes of Health coming to ECU was
awarded to investigators at Brody. For overall research funding coming to ECU, the School’s faculty
brought in 60% for FY2011, compared with 52% of total ECU funding in FY2010, 58% in FY2009, and
64% in FY2008.
While the clinical enterprise of ECU Physicians lies outside the mainstream of activities at ECU, it
greatly enhances the profile and stature of the University across eastern North Carolina. With over 350
physician faculty, 350 resident physicians, and 75 advanced practice providers, ECU Physicians cares for
patients in over 350,000 clinic visits, more than 105,000 emergency services encounters, and in excess of
100,000 hospital days each year. The direct patient care aspects of this work are enormous in their own
right, but it is vital to understand that the vast majority of these interactions also provide an essential
platform for learners from the full diversity of health care professions at ECU and Pitt Community
College.
Centrality
Every major accomplishment at Brody can be directly tied to fulfilling the ECU Strategic Action Plan
2010-2013. To cite a few relevant examples of this important work:
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ECU Physicians showcases the most sophisticated clinical informatics system in the country from
Epic Systems. This system, conducted in partnership with UHS, provides a robust platform for
our clinical work, as well as supplying medical students, resident physicians, nursing students and
the full spectrum of health professions students with proficiency in information technology
appropriate for their discipline (Strategic Direction (SD) 1.1.5).
The enduring success of the School with extramural funding demonstrates our efforts to create an
environment that is highly conducive to research (SD 1.3.4 and 3.1.1).
Although a lack of funding precluded offering the Summer Program for Future Doctors in one
recent year, the program this summer enrolled dozens of highly motivated learners intent on
careers in medicine (SD 1.4.5).
The School continues to fund biomedical doctoral graduate students to support our graduate
programs; in FY2012, that direct funding from the School is expected to reach nearly $750,000
(SD 1.4.8).
The opening of the new Family Medicine Center and Monk Geriatric Center provides tremendous
facilities for caring for patients of all ages while teaching learners of all disciplines about
innovative service models that address major health disparities, such as the Patient Centered
Medical Home (SD 3.2.3).
The Leo Jenkins Cancer Center joint venture with Pitt County Memorial Hospital was launched
in June 2010 with the commitment to bring the latest in multidisciplinary care to cancer patients
throughout our region (SD 3.4).
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Medical students at Brody are encouraged to enter primary care careers throughout the
curriculum. The continuing success in graduating physicians entering family medicine, as
evidenced by the American Academy of Family Physicians year after year, demonstrates our
devotion to improving workforce capacity in primary care and rural health (SD 3.4.4).
Quality
Medical schools across the nation use the United States Medical Licensing Examination (USMLE) as a
gauge of each student’s progress through the curriculum, readiness for residency training, and as a
comparator to other schools. Step 1 of the USMLE is traditionally taken by students at the end of their
second year of medical school. The mean score for the most recent group of students (Class of 2013) on
Step 1 was 231, as compared to a national mean for all students of 222. This is a powerfully positive
indicator of both quality of learners enrolled and the faculty leading them through the curriculum.
The most recent data from the Cecil G. Sheps Center at UNC-CH shows that Brody outshines the other
three medical schools in North Carolina for some vital indicators of quality and success:
- For physicians who graduated from BSOM and did their residency training with PCMH, 75%
remain in the state to practice medicine;
- 34% of BSOM graduates practice primary care in North Carolina, compared with 23% of UNCCH graduates, 19% of Wake Forest graduates, and 9% of Duke graduates; and
- 28% of BSOM graduates practice in rural areas of the state, compared with 19% of UNC-CH, 7%
of Wake Forest, and 3% of Duke graduates.
The 2011 Mission Management Report from the Association of American Medical Colleges (AAMC)
showed Brody was the:
- Highest ranking school in percent of graduates from 1996-2000 practicing in rural areas;
- Highest ranking school in percent of graduates from 1996-2000 practicing in under-served areas;
- Highest ranking school in percent of graduates from 2004-2009 who are American Indian or Native
American; and
- Highest ranking school in percent of graduates from 2004-2009 who are Black or AfricanAmerican.
The overall medical student attrition rate is low. Retention data for the time period 1994-2009 reveals the
following:
- For African American Students, 94.4 % of the matriculating students completed or are still
progressing through the program. Average loss is less than one student per year with no losses
for nine years; and
- For all other Students, 97.5 % of the matriculating students completed or are still progressing
through the program. Average loss is less than one student per year with no losses for four years.
In the recent AAMC report entitled “Exemplary Practices in Primary Care Training: Patient-Centered
Approaches to Clinical Care Delivery and Education”, the Department of Family Medicine was
recognized as having exemplary institutional commitment to primary care. This commitment, coupled
with medical student-led promotion of primary care and the adoption of patient centered medical home
principles in practice and teaching, have made the School an excellent model for peer schools worldwide.
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More than 40 physician faculty members were named by their peers to the Best Doctors of America list in
2010. The list encompasses faculty from nearly every clinical department.
Among biomedical scientists, the annual funding awarded by the National Institutes of Health (NIH) is a
leading barometer of the overall accomplishment of a medical school’s research programs. In this
analysis, it is important to understand that the nation’s leading science universities bring in $300 million
per year or more. Equally important is the perspective that community-based schools typically place a
higher premium on education and patient care than the research powerhouses. When viewed within the
cohort of community-based schools’ NIH funding for the past five years of available data, Brody has
moved from #13 to #11 in the rankings and increased funding from $5.6 million in FY2006 to $7.6
million in FY2010.
For doctoral students beginning this fall, the School’s programs accepted 18% of applicants,
demonstrating high selectivity and the wide respect held nationally for our programs.
The Department of Obstetrics & Gynecology’s Reproductive Endocrinology Clinic was ranked #4 in the
nation for success with in-vitro fertilization (IVF) in helping women become pregnant by the Society for
Assisted Reproductive Technology.
Opportunity (SWOT) Analysis
Just prior to the downturn in the state and national economies in 2008, Brody developed comprehensive
proposals for increasing the medical student class size by 50% to 120 matriculants per year. Realizing this
growth opportunity when state appropriations are available will make a tangible impact on the health and
welfare of people across the state. To maximize the potential for this impact, there must also be major
new streams of funding for specialty residency education (graduate medical education, GME) in a full
spectrum of disciplines; this need for enhanced GME funding will require collaboration with academic
centers across the state and the nation to access more federal funds or an entirely new funding model.
Further development of the recent efforts to strengthen existing relationships and build new partnerships
with other healthcare entities will provide essential venues for improving the delivery of healthcare in our
region. This could include a new governance model for the clinical enterprise, selection of specific
clinical services for privatization, or expanding the scope of specialties provided by ECU Physicians.
One example of these strengthening partnerships is the burgeoning working relationship between our
cardiovascular specialists and UHS, including their new President, Dr. David Herman. The special
combination of a strong primary care network with world-class cardiovascular specialists at Brody
enables us to partner with UHS for the clinical practice of cardiovascular diseases with great effectiveness
at the East Carolina Heart Institute (ECHI). In another partnership, the ECHI is collaborating with the
East Carolina Diabetes and Obesity Institute (ECDOI) to develop a basic science research center for
faculty with either extramurally funded or fundable research.
Finding the right ways to meld selected aspects of the curricula of Brody, the CON, the CAHS and the
SODM in interprofessional education venues will not only graduate healthcare professionals more
capable of adapting to the ever-evolving world around them, but also achieve an important plank in the
ECU Strategic Action Plan (SD 3.4.3).
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The recurring challenges for funding of graduate student assistantships and out-of-state tuition remissions
place very real limits on the size of Brody’s graduate programs. Either expansion of the total funding
coming to ECU or recalibration of the existing funding amongst the colleges/schools at ECU must occur
to provide this vital resource.
Since its inception, Brody has maintained an extremely low tuition for medical students, typically the
lowest or second lowest in the nation. Coupled with a relatively low cost of living in Greenville, this
strategy allows our graduates to complete medical school with arguably the lowest average debt of fresh
grads in the nation. The significance of this is that higher debt all too often pushes the individual’s
decision of specialization, i.e., the higher the debt, the more likely to enter a more lucrative specialty
(read: Not primary care).
Consistent with the School’s tripartite mission statement, many of the medical students entering Brody
are not as scholastically prepared as students at some other medical schools. Our basic science faculty
spend untold hours individually tutoring and assisting students in the first two years of the medical
curriculum to support their ability to succeed. This “value added” aspect of the curriculum enables the
School to graduate highly prepared physicians from disadvantaged backgrounds who have a strong
likelihood of practicing in an underserved area.
The opening of the School of Dental Medicine this fall presents wonderful, distinctive opportunities for
Brody to closely collaborate with another health professions school. The dental students will receive their
education in the Brody Medical Sciences Building for at least the 2011-2012 year. Basic Science faculty
from Brody will provide the essential foundation for dentistry-specific education in the unique curriculum
used by the SODM. The faculty, students, and administration of Brody are honored to have this
opportunity to support the launching of a new professional school at ECU.
In this era of tightening healthcare spending and emphasis on health care reform, the need for public
health professionals becomes increasingly obvious. The young public health program at ECU has
demonstrated great success in its efforts to focus on meeting population needs by graduating professionals
ready for the regional workforce. It is imperative that the university move forward with plans for doctoral
programs in public health and the full spectrum of resources necessary to launch a school of public health.
Conclusion
The Brody School of Medicine is a vibrant, highly successful, and widely respected young medical
school. Its graduates are making a tangible difference across North Carolina. The faculty contribute in
essential ways to the education of undergraduate and graduate students through foundational courses
across ECU. The research productivity eclipses the efforts of all other colleges and brings special
recognition to the university. Our clinical programs bring vital services to all corners of the region on a
daily basis.
Every segment of the School is essential to create the successes inventoried in this report and to prepare
for the future. No single component can be eliminated, relocated, or down-sized without directly and
definitively harming all the outcomes generated by Brody. Each department and service is making a
contribution to the core programs and is critical for the future of BSOM and ECU.
Program Prioritization Report: Brody School of Medicine
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Addendum: Selected Excerpts from Departmental Reports
(Note that a citation in one category often is equally applicable to another category, e.g., productivity in
NIH funding, peer review publications, and scientific presentations, are also indicators of quality.)
Productivity
Anatomy & Cell Biology: of the 9.5 tenure track faculty, six have active research programs, 5 of those 6
faculty members are NIH funded. Three NIH R03 grants and four NIH R01 grants were awarded to the
department’s faculty in the years between July 1, 2008 and June 30, 2011.
Cardiovascular Sciences: Faculty members authored or coauthored 77 publications printed in peer
reviewed scientific journals in FY2011 and 15 book chapters. They made 25 research presentations at
national and international scientific meetings during the academic year and had 29 active grants and
clinical trials that are externally funded.
Microbiology & Immunology: During the 3 years under review, the department had highly productive
research programs with more than 125 peer review research articles and $6.4 million in extramural
research grants.
Pathology & Laboratory Medicine: Forensic pathology subspecialty certified faculty provide medical
examiner services to over 20 counties in eastern North Carolina and exceed National Association of
Medical Examiner benchmarks in number of cases performed.
Pharmacology & Toxicology: The department’s external awards per FTE ranged from $83,000/FTE in
2008-2009 to $237,000 in 2010-2011. This value per faculty FTE considerably exceeded the average for
BSOM ($59,000 per FTE) which was, by far, the largest in the university.
Centrality
Biochemistry & Molecular Biology: Recent advances in biochemistry have commercial applications,
particularly in the expanding genetic engineering field (SD 1.1, 1.2, and 1.3). Increased public awareness
and interest in preserving the environment and finding cures for such diseases as AIDS, cancer, heart
disease, and arthritis will provide the stimulus for increased spending by private pharmaceutical and new
biotechnology companies. Graduates have been very successful, such as: Russ Price is a Professor at
Emory and director of an interdisciplinary graduate program; Jackie Stephens is a Professor at LSU
Baton Rouge and holds an endowed chair; and Renu Jain is Program Director, Clinical Development at
Talecris Biotherapeutics and was named one of the “Top 100 Women of ECU”.
Bioethics & Interdisciplinary Studies: ECU proudly proclaims its role as The Leadership University. This
department typifies the leadership and diversity of professions that is exhibited throughout Brody (SD 2.3
and 2.4.2). The department’s faculty come from multiple fields: law, education, philosophy, nursing,
medicine, and history. They hold many university leadership roles: ECU Ethics Liaison, BSOM
Associate Dean for Diversity, Research Associate for Agromedicine, Special Projects Officer for the
Division of Health Sciences, BSOM Health Policy Director, BSOM Compliance and ECU HIPAA
Privacy Officer, and Director of the Office of Interdisciplinary Health Sciences Education. In addition,
members of the faculty chair the Brody Women’s Council, serve as BSOM Faculty Senator, chair the
Program Prioritization Report: Brody School of Medicine
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Laupus Friends organization, chair the PCMH Bioethics Committee, and direct the PCMH Bioethics
Collaborative.
Internal Medicine: The department oversees the largest cohort of GME at ECU, presently graduating 31
residents and 18 fellows annually with programmed growth to 36 residents and 22 fellows per year in the
near future (SD 3.2 and 3.3.2). Over the 20 year history of this department, the majority of our graduates
have returned to eastern North Carolina. Several areas of medicine in eastern North Carolina who had
significant manpower needs only a decade ago now are full, many with Brody graduates. Moreover,
considering the first Brody graduates are only entering their fifties, the full impact of this school on
eastern North Carolina is yet to be felt.
Pediatrics: The department provides several totally unique and mission-centric clinical services for the
region (SD 3.2.3): TEDI-BEAR-CAC is the only full service child abuse assessment and treatment center
in North Carolina; the Center for Children with Complex and Chronic Conditions (C5) supports
community pediatricians by focusing the expertise of myriad subspecialty faculty on children with unique
needs; and the first comprehensive oral health clinic embedded within a pediatric practice promotes an
early emphasis on oral health and preventative care.
Public Health: ECU’s UNC Tomorrow Response Phase I Report (May 2008) noted “Development of a
School of Public Health at East Carolina University is important to meeting the future public health needs
of North Carolina.” (SD 3.2.2, 3.3.2 and 3.4.4) The response from UNC General Administration
recognized the MPH Program was nationally accredited and that a future school of public health at ECU
was important.
Quality
Comparative Medicine: The animal care and use program at ECU has been fully accredited by AAALAC
International with an “exemplary” descriptor since 2007. The 2010 AAALAC site visit team found no
deficiencies and had no suggestions for improvement - an extremely rare occurrence among the over 800
accredited units worldwide. (AAALAC = Association for the Assessment and Accreditation for
Laboratory Animal Care International)
Obstetrics & Gynecology: Over the past ten years, 73 Brody grads have entered specialty training in
ObGyn; of these, 80% trained at university-based programs and 36% at top tier university programs, both
measures of the quality of the graduate. For the dpeartment’s residency program over the past ten years,
50% have begun practice in the state, with 42% in eastern North Carolina, and 23% are entered
fellowship training programs.
Surgery: The department has developed a Division of Clinical Effectiveness, a collaborative effort
between the School and PCMH with the goal of defining, capturing and translating data to improve
quality and guide clinical service development. Results to date: a formal means of performance
benchmarking established and linked to physician credentialing; an improved, timely peer review process
established; and efforts have led to reduced hospital and surgical infection rates with national recognition.
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Opportunity
Emergency Medicine: Patients across eastern North Carolina turn to the nearest emergency department
(ED) for a wide variety of injuries and ills. Many of the physicians staffing those EDs are board certified
in emergency medicine, but many are not. In addition, there are not uniform protocols for transferring
patients to a tertiary care center, support for working with local EMS squads, or provisions for continuing
medical education. The Department of Emergency Medicine, with appropriate assistance, could bring its
expertise to bear on these and related issues, resulting in a more cohesive regional approach to emergency
care.
Family Medicine: The opening of the new Family Medicine Center and Monk Geriatric Center brings
unprecedented opportunity for the department to build upon recent successes. The facility is truly a
showcase for clinical care and education in primary care. This creates an excellent venue for working
with PCMH on providing timely follow-up care to patients after hospital discharge, which has recently
been shown nationally to be a vital determinant in whether patients will require (preventable) readmission to a hospital soon after discharge.
Physical Medicine & Rehabilitation: Plans for radical expansion of the Veterans Administration clinic in
Greenville call for the start of construction in the near future. This new 110,000 sq. ft. facility will bring
excellent new opportunity for joint appointments of physician faculty between the School and the VA.
Among the most important of these opportunities will be Physical Medicine & Rehabilitation physicians
due to their great expertise in the full spectrum of neuromuscular, pain management, wound healing, and
rehabilitation disorders.
Radiation Oncology: The department performed over 14, 500 treatments from October 1, 2009 thru
September 30, 2010 using two conventional linear accelerators, as compared with the North Carolina
Department of Health and Human Services measure of full utilization is 6,750 treatments per machine per
year. This equates to an average of 60 patients/day. Using this metric the department exceeded full
utilization capacity by 7% on each accelerator. This volume is reflected by frequent extension of clinical
operating hours to accommodate the patient demands and in the complexity of procedures offered, such as
Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiotherapy (IGRT). Faculty and
staff also provided professional services (3,458 treatments) for Beaufort Regional Medical Authority and
the new radiation oncology program at Onslow Radiation Oncology. This growth in the need for
radiation treatment for cancers demonstrates the strain that numerous clinical services in ECU Physicians
face on a daily basis. The costs of replacing or adding new machines can be staggering, especially with a
linear accelerator.