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President Sands and Provost Clarke

April 26, 2023

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[Dean Lee Learman]: So many people here in person, not to mention all the Zoomers who are going to be with us today. What a rare opportunity President Sands and Provost Clarke have arranged for us to have a great interaction with them. To hear things going on in the university. To talk about VTC. To answer the questions some of you have posted in advance and others that may come up in the course of the meeting. It's a real pleasure. This is a busy time for everyone, particularly busy in a limited understanding of the President Sands and Provost Clarke's calendars. We're extremely grateful that they're spending this time with us this morning. Without further ado President Tim Sands at Virginia Tech. Welcome, Tim. 

President Tim Sands [0:00:40]

Thank you, Dean Learman. It's great to be here with you today. It shouldn't be a rare opportunity, but I will admit we used to visit every college every year and have a really very extended conversation. Dog and pony show the whole thing, meet with students. Loved it, but the pandemic interrupted that flow and now we're trying to slowly work our way back into it. Both Cyril and I do spend quite a bit of time in Roanoke. This isn't a strange crowd to us at all, but we do appreciate the opportunity to have a dedicated period, to have a conversation with all of you. One of the things that I noticed when we just went through the questions that we received in advance and they look more like answers that were then have questions around them to see if we can guess what the answer is. I look forward to hearing those answers from you and then we can structure some questions around that. But I thought I'd start off just with a brief overview of where we've been and where we're headed with Virginia Tech as a whole. Not specifically about VTCSOM, but more where the university is going. I think that provides some context for the way that the school of medicine can fit in with the vision going forward, but also influence it. I'll say a little bit about that at the end.

Slide 1 [0:02:05]

It's more of a timeline discussion here. When I started in 2014, and I'll try to be quick about this because this is more like a level setting conversation, but I started nine years ago. Naturally the history that I am most familiar with is 2014 on. But there was a great history especially for the school of medicine before that. I've been able to watch the school of medicine develop and really get some momentum behind it. Now, of course, we're envisioning a bigger Virginia Tech Carilion School of Medicine. We're looking at the bigger ecosystem around it, which is where the vision is needed. But back in 2014, I had the opportunity to talk to hundreds, if not thousands, of stakeholders at Virginia Tech students, faculty, alumni, partners, folks in Richmond, DC, all over the place. Trying to understand where the stakeholders of Virginia Tech wanted the institution to go. In my installation address in October of 2014, I just basically recounted what I heard. That was my first experience really getting in deep with Virginia Tech. I loved what I heard. It did resonate with me, and I'll talk a little bit more about that just to remind everyone. There's a lot left on that agenda, even back from 2014 that has not yet been accomplished, but where we've seen some progress. In 2016, I started a process called Beyond Boundaries 2047 Vision. The reason for the 2047, it's not really a magic number. It happened to our 175th anniversary as an institution. We just finished our 150th. I wanted to put it far enough out there that the conversation was not constrained by the limitations that we see today, but by just the imagination that our folks would have. I think that process was very successful. The document that came out of that is on the website still. I encourage you to look it over and partly because we're going to be revisiting it this coming year. But I also think that there are things in there that resonate, there are things that at least with me still today, they still seem ambitious. But as I will mention a little bit, things have changed, landscape has changed, and it's time to look at that vision again. In 2019, we started our current campaign for Virginia Tech, called Boundless Impact. I'll say a little bit about that in a moment, but that started up four years ago. It's got another three years to run and it's achieving its goals even more so. We also instituted our strategic plan. We want to make sure we had a vision, a North Star, before we started doing planning. When I came to Virginia Tech, we already had an active plan, but it had gotten a little stale and that happens with strategic plans. We had a chance to revisit that. I hope many of you were involved in that process. It's a living process and we've recognized in the very beginning it need to be a continuous planning process. I have been in this work with strategic plans for 40 years or something like that. The big frustration as you develop this beautiful plan and then 2,3 years in you realize that the metrics that you had identified, the key KPIs, whatever you want to call them, the milestones didn't make any sense anymore because the world around you had shifted. But that North Star should still be in place. The vision needs to be something that has some lasting value, but the strategic plan needs to adapt to the surroundings. You don't want to change it too fast because then you lose lock on what you're trying to improve and you lose the ability to measure. But on the other hand, you've got to balance that with the fact that if you keep measuring things that you're not at all interested in anymore, [LAUGHTER] which is typical of strategic plans, then why are you doing it? We committed to a continuous process. We did a round of continuous planning in 2022 or a refresh of the metrics and milestones and some thought about changing the priorities. We identified some strategic investment priorities. The reason for mentioning that is you will see that strategic investment priority label and they wonder what it is. It came out of the board of visitors tuition setting process. They rightfully asked us to instead of giving us a budget projection every year for one year and talking about the impact of tuition and fees on that budget to be explicit in indicating what short and midterm projects and investments we needed to make toward our strategic plan that had to be built on multiple years. So not just one year. But what were the biggest needs, especially for resources that come in through tuition and fees, to advance the institution. We identified eight of those and they are moving forward and we keep them in front of the board each year when they make those decisions. Those will be refreshed as well, so they're not static. When we feel like we've ramped up in an area that's critical to the institution, we may stop adding additional investments to it if we've got it to the point where we need it. We may fold in another one. If you see the term strategic investment priority is typically tied into a board conversation around tuition and fees. Just want to be clear on that. Those are not our only priorities or our only way of funding things. In this year, 2023, the goal is to revisit and update our vision. Again, that is recognizing that the world around us has shifted.

Slide 2 [0:08:05]

So just to quickly go back over each of those different time horizons and each of those projects, and I won't go into a great detail that you scan them. The emerging themes that came out in my installation address in 2014 that were really picked up from the folks that I talked to and just to get a sense of where people thought the future was for Virginia Tech nine years ago. You can see them here. I look down this and I don't see anything in here that I wouldn't keep on that list. You might shift the order. These are not in priority order, but you might add some other things, but it's amazing how static that is in my view. That those are still priorities and recognition of our strengths that hold true today even though the institution is very different.

Slide 3 [0:08:53]

In the Beyond Boundaries vision. Again, I just remind you to take a look at that when you have time and refresh your memory on that, you may not have been involved in it, you may not never read it. I think 80% of you have either don't know what it is or read it but forgot it. But I just encourage you to go back and look because we are refreshing it. I think there's an opportunity actually for the school of medicine to be part of that conversation in the fall.

Slide 4 [0:09:21]

In 2019, again, just the strategic priorities that came out of the strategic plan for the Virginia Tech difference advancing beyond boundaries are listed here, again, I won't go into them. You can go onto the website for strategic affairs and find these and also all the metrics and KPIs associated with them that gives you a sense of where we are and I'm going to go through a few of those. And in the philanthropic priorities are being refreshed as we speak. Those came out of 2019. These are the high level ones that came out of the overall effort, but there's a lot at each college, each unit has its own priorities that are folded into that that boundless impact campaign. I shouldsay the boundless impact campaign is ahead of schedule. It was originally supposed to be 1.5 billion goal, 100,000 Hokies engage. And one thing we do, I think more than most institutions is we focus on engagement as opposed to just the dollars. That's been something that's been a theme for the last several years. We're at 88,000 Hokies that have been engaged in a meaningful way since the start of the campaign and we're getting close to the 1.5 already. So we moved it to 1.872 billion, for in 2027. So we're even ahead of that schedule, but it's looking good. I think we're going to get there, and thanks to all of our donors, thanks to all of you who contribute to that, but more importantly who engage with Virginia Tech and who encourage others to engage because that's our future. One thing I would say about that that you'll hear from our VP for advancement all the time is that we are unusual compared to other land grant institutions in that we are rather young. Most land grant research universities started in the 1860s, 1870s, and fairly quickly became large institutions and developed research profiles in the early 20th century. We were through much of that history a small military land grant with a very small student population, and some scholars, no doubt, some really incredible scholars, but we were not a research engine. I looked at the very first ranking of research universities from 1911, and we were all the land grants that you're familiar with, the big ones, were top tier. In Tier 1, we were somewhere in Tier 4. If we had stayed on that track, we would be VMI number two today. And there's nothing wrong with VMI. It has its mission, but that was what we were more like than any other peer. So we're relatively young, maybe 50 years of experience as a large land grant research university now. And so our alums, or also, if you look at the demographics, the people that have been contributing to Virginia Tech from a philanthropic point of view over the last decade or two were really in that first-class of early alums who are really coming out of the era of VPI moving into the era VPI and SU essentially when we became a state university in 1970. But those numbers are screaming up in terms of people were now of giving age and that will continue to grow with time. So in a ten or 20 years, we will look a little bit more like the big land grants in terms of the numbers of alums who are actively engaged, and so we need to be doubling down now on engagement and one of the most important features, and I'll talk about that in a minute, is that the number or the percentage of our alums who give, and we'll get to that in a second.

Slide 5 [0:13:12]

So there are some mini milestones that we've achieved, and I wanted to talk about a few of those.

Slide 6 [0:13:22]

Undergraduate applications, which actually is not a KPI for us, but it's something that's just a general indicator of student interests, it also reflects growing numbers of students, undergraduates who apply to a lot of schools and there's a common app factor in here, but over the last five years we're up about 65%, which we're up about 100% over the last decade in terms of applications. It's really just UVA and Virginia Tech that are in Virginia that have that growth, and momentum is a great indicator of future success. Undergraduate enrollments grown 12% over the last five years. That it currently limited at 30,000 give or take because of infrastructure. So we've had about four years where we've been held at about 30,000 intentionally. That was the intent back when we set that goal of 30,000 in 2017, that we would get to 30,000 in 2023 and hold until we had had chance to assess our infrastructure both on and off campus in Blacksburg, and we got there in 2019 instead of 2023. So we did grow quickly in the beginning and now we've leveled off and we're working on infrastructure. So if you go to the Blacksburg campus, you'll see that it's a construction site right now, and that probably will not stop for a while until we've caught up. Next phase is really student housing that we need to grow dramatically in order to keep up with or even our current size. Graduate enrollments are an opportunity. It grew about 5% over that five-year period. It could have grown a lot more. There's a lot of backstory here. The momentum is really good right now, but I think that is our future where we have opportunity to grow enrollment. It's mostly at the graduate level, whether that's professional master's, professional programs, PhD programs. That's where we can grow and where we should grow. Undergraduate, URM, underrepresented minority enrollment, grew dramatically in the last five years up 61% and that's intentional. Virginia Tech look nothing like Virginia a decade ago. It still doesn't quite look like Virginia. Our students come from, for the most part, much more diverse areas of the world and the Commonwealth. You probably don't spend as much time at Blacksburg as I do, but the field has changed. It's a very different place than it was a decade ago. A lot of that's because we brought in talent from pools of students that didn't consider Virginia Tech and it has created a different environment on campus, so that work continues, but we've got good momentum there.

Slide 7 [0:16:05]

Underrepresented minority or underserved students, this is combining underrepresented minority, first-generation, low-income, and veterans. We set a goal back in 2019, I guess, to hit 40% of our incoming class being URM or underserved. We hit that in 2022, right on target. It's now about 10,800 students have grown about 36%. This has created both huge opportunities for us. Again, the pool of talent we're recruiting from is much bigger than it was a decade ago. But it also creates an obligation on our part to support those students and to make sure they're successful and that work is hard work and good work and it's interesting. But we're not there, we're making progress. I actually thought we were making great progress in terms of closing gaps across the board until the pandemic hit and then you saw the gaps open right back up again. We do have work ahead of us, there's a lot of reasons for that, but it is alarming how delicate that is. You think you've achieved, you've closed gaps in graduation rates, retention rates, student's success measures, and then a little thing like a pandemic [LAUGHTER] throws you back half a decade or so. But we'll get back, I feel like the momentum is good there too. Four-year graduation rate is creeping up, you often hear for undergraduates, six-year graduation rates quoted, those are in the 85-86% range, which is good. But really the focus for us is on the four-year graduation rate, mainly because it's related to the amount of money that the student and their families have to pay to get their degree. The more students we can graduate in four years while maintaining the quality, that's an indicator of efficiency and return on investment and keeping debt low. Undergraduates and living learning communities. This is something that we focused on closely because of the evidence out there, in our own evidence and also national evidence that students who live in learning communities on campus tend to be more successful than those who do not, in terms of their outcomes. We've gone from 34% of our undergraduates who live on campus being in living learning communities to 51% and that is intentionally growing at this time as well, we're not done there yet.

Slide 8 [0:18:44]

Extramural research expenditures, an area where we have great potential. We've been slow growth, I would say 24% over the last five years. But looking good coming out of the pandemic, we took a dip because of all the human factors research that we do during the pandemic in terms of expenditures, not awards. But that's picking up and of course, units like Fralin Biomedical and many of our institutes, some of our colleges and schools have really taken off in the last couple of years. I think we are going to be looking good there in the next few years. We had about 590 million in fiscal year 2022, in overall research expenditures. I think that will continue to grow based on the momentum that I'm seeing. That's exciting to see because that's a rather indirect proxy for our research impact. It's not the same thing, but it's an indicator and it needs to be growing. Well, let's see, Virginia Tech and Utah were the fastest growing institutions in terms of research expenditures between 2000 and 2012. We then slowed down. We had outstripped our capacity to support that research and we were in a slow-growth mode. I feel like the inflection point was maybe a year or two ago for the next growth wave and we're certainly setting up for that. Endowment has grown tremendously. We're up 69% over the last five years. We've more than doubled it since 2014. We're still small. The number here 1.68 billion is a decent number, but it's probably half of what it should be for a large land grant institution, if not a quarter. We have more work to go there, but we've made good progress. New gifts and commitments, this is so the annual amount of new gifts and commitments for gifts that are made each year. We used to be at about 70 million, we're between 70 and 80 million for a long time, for probably a decade. We're now at 268 million last year. Don't know where we're going to come in 2023, because there's still a lot pending, but we've certainly shifted, we've gone up a level or two. Charlie Phlegar's organization and all the work that you do has really changed our profile in terms of the amount of philanthropic funds we can raise. This is really critical to a university, you all understand that. We get certain amount of money from the state and we get a certain amount of money from tuition fees, which is very restricted in its use, well, I should say we can use it in different ways, but still there are boundaries. But the philanthropy makes the difference. It really is what makes a program successful. If they can bring in philanthropic support and the alumni engagement or partner engagement that comes with that, you're going to have a strong program. That's a great indicator. I mentioned earlier the alumni giving rate is really important for Virginia Tech, even more than other institutions that are more mature. We were at 13% of our undergraduate alumni giving to the institution back in 2017. We're now at 22% and we're committed to hold it above 20 going forward, which is hard because each year you get another group of alumni joining the ranks. You got to make sure you're keeping them engaged. Probably I don't know the exact, I can't say for sure, but I believe it's a top number for a land grant institution in the country. The 22% is really high, 8% would be about expectations or 8-10, 13 was a little lower given Virginia Tech's strong alumni attachment, 13% was not a stunning number, it's what you'd expect. Twenty-two percent is real work and real effort and bodes well for the future.

Slide 9 [0:22:49]

Last slide, I believe, or maybe there's one more just on the same topic, just an invitation as you see the opportunities come up. We're going to be working hard on this new vision for Virginia Tech or modifying the old one based on the realities of the shifts in the landscape around us over the last couple of years. Whether it be the pandemic, the new global world order, the way things have shifted. It's just a very different landscape than it was back in 2017, 2016. We need to take a look at our vision, make sure it's still the North Star we want to go for. I think there's a huge opportunity to use that as a vehicle for having the conversation around the future of our academic health enterprise and in Roanoke and throughout the country, really, of course, inclusive of our operations in DC. Just an invitation, be on the lookout for that. We're going to put some structure around that. We've already started this process. We had the President's Council had a chance to do a retreat in this area. We've got the board starting to be engaged. We're now entering summer, but in the fall we'll pick it up again in a big way. There are two big priorities, one is a top 100 global research university. We can discuss that later. I'm happy to provide some contexts. The other is access and affordability, which we're now calling the Virginia Tech Advantage and I'll be happy to talk more about that.

Slide 10 [0:24:23]

These are the three folks that are structuring this updating of our North Star, France Belanger, who's the University Distinguished Professor at Pamplin, Julie Ross, Dean of Engineering, and Sylvester Johnson, Center for the Humanities. They're the ones who are going to be organizing these gatherings to take an input to develop that next vision. I will leave it at that. I talked probably longer than I had to, but just wanted to give you a sense of where the university is coming out. Turn it over to Cyril, talk a little bit more about school of medicine, and then we'll open it up for the dialogue. Thank you. 

Provost Cyril Clarke [0:25:00]

This is a hot line. Good. Thank you. I really appreciate this opportunity just to share a few comments. I think you all are aware of what the history of the school of medicine is. Established now over 10 years ago as a separate entity through a partnership between Virginia Tech and Carilion Clinic. Over the period of that first nine or 10 years, the school really established a fantastic educational foundation that the Commonwealth, the University, that we all benefit from right now. An educational foundation that had many positive and distinctive elements, but in particular, a foundation that was anchored in a commitment to student-centered education, exemplified through a problem-based learning approach. A foundation that was committed to a interprofessional commitment to educate physicians in the context of the environment in which they will work, and an educational program that was extraordinarily committed to real direct engagement in research, not just on a one-off basis, but actually as a curricular entity that continued through several years of that educational experience. You can see the benefit of that simply in the data in regards to, for example, the retention rate of students over four years, which is close to 93 percent, to the very high matching rate of graduates in terms of residency programs and particular residency programs that constituted their first choices. Those are just two examples of some outcomes that we use to estimate or to evaluate whether an educational program is really doing what it was intended to do. Certainly, the School of Medicine has done fantastically.

But now we've reached a point where the School of Medicine had been brought into Virginia Tech as a true college, the ninth college within our institutional academic college. Now's the opportunity to take that next step. As you are all, I assume, aware, we're in the process of doing that. What does that next step involve? Essentially, that next step involves getting bigger and getting more engaged in research and scholarship. What are the elements within those next steps? Well getting bigger really has to do with enrollment. This is important. The school was first established as a relatively small School of Medicine, and by increasing enrollment, not only do we approach a more cost-effective model, but of course, more importantly, that fantastic educational program that I just described, that has the opportunity to graduate more physicians who are desperately needed, both within the state and the nation.

The school, of course, is in the process now of expanding enrollment, but there are certain limitations in terms of continuing there. We need more space, so we need more money, to put it simply. In regards to space, I hope you are aware that a new School of Medicine building is the Number 1 capital priority of Virginia Tech. As long as it stays in that Number 1 position, and I certainly personally anticipate that will be the case, it'll get built. We tend to get our Number 1 priorities done. We're not quite sure when, but it'll get done. That'll give us the opportunity not only to increase, expand the space to accommodate this next stage of development, but that, of course, goes hand in hand with an opportunity to increase space committed to research that allows further expansion of the Fralin Biomedical Research Institute.

It's not all about space, it's about money as well. Because you grow enrollment for any professional programs such as this one, tuition revenue is a very important source of financial resource. But in addition to that, it's important that we create the opportunity for Virginia students to have a discounted medical education. To do that, we need to be able to provide an in-state tuition for Virginia residents. To do that, to discount the educational cost in an appropriate way, the Commonwealth of Virginia will have to step up. The university actually is in a process of building that legislative support that we hope in the not-too-distant future will result in operational support for the school. That will allow us then to offer an in-state tuition.

It's about tuition revenue that is dependent on enrollment. It has to do with state-level operational support. But frankly, building the financial resources will depend also on further expansion of successful philanthropy. I'm delighted that the school is experiencing success in that area. It's also going to depend on building extramural grants and contracts so that we can drive those extra mural resources that are really important for that second element that I mentioned, which is to grow the research and scholarship portfolio.

Well, really to make progress there, we had to do some things to allow the school to grow in terms of its research-based faculty. When the school was first brought into Virginia Tech, there was only really one tenure that was available. That was tenure to title. A very important kind of tenure because it provided an opportunity for us to connect with a hundreds of physician faculty, were absolutely essential for the education of our students. But without tenure to employment, you really are limited in terms of growing the research portfolio because tenure to employment has many definitions, but in my mind, it is distinguished mostly why identity that allows that faculty member to engage in really substantive research and scholarship. That is the defining identity of what tenure to employment is. Through the normal governance process, we were able to have the Board of Visitors indeed approve the school of medicine going forward by making tenure to employment, appointments that then serve to support the broader context of tenure to title. The school indeed is in the process of growing its tenured positions absolutely essential to that research portfolio.

Then beyond that, you need a research strategy. Now, the School of Medicine is inextricably bound to the Fralin Biomedical Research Institute. That research portfolio, the incredible expansion of Health Sciences and Biomedical Research that you see in the institute is directly relevant to the School of Medicine. But it's important also that the School of Medicine have the opportunity to grow research that is not necessarily contained or integrated into the research institute. The school is moving forward particularly in the area of a health system implementation science which I believe is a high potential area of research growth, in particular, because of the manner in which it resonates with our clinical HealthCare Partner Carilion Clinic. It makes sense. Now, for this really to work, and this is another opportunity for me to encourage further development and thinking around this, the analysis. We need to be sure that everybody understands exactly what health system implementation science is beyond this community. I've encouraged the school to do that, and indeed now they have an opportunity to do that. Because as we expand and I move to the next phase of the Virginia Tech destination area program, this particular domain of research has now been selected as one of four research areas for further development. It will compete with the other three for substantive funding as we go forward within the next year or so. It's an opportunity really to understand and define what those constituent elements are within this particular research area.

In summary, talk about Virginia Tech being a new university, the school is really new, and the educational program, its development and its excellence is extraordinary. The next step now is to grow the program and to better define and expand its research and scholarly portfolio. Which is really the avenue, I think, to really being a true partner in a context of academic colleges at Virginia Tech. With that summary, Lee, I don't know how you want us perhaps to respond to questions. Would you like to select some or would you like us to take them from the top or perhaps take questions from our colleagues here? 

Questions from the audience [0:34:27]

[Lee Learman]: [inaudible].

[Cyril Clarke]: We're on Zoom just I'm not sure where the camera is or what mics we'd like to use.

[Lee Learman]: [inaudible] asked my colleague to help with this and it covers our room better. Remember there are no bad questions.

Melanie Prusakowski [0:35:21]
I don't think this will be prolonged answer, but you mentioned that 51% of students are living in living learning communities, 51% of undergraduates.

[Melanie Prusakowski]: Is that primarily driven by the fact that people choose Living Learning Communities as freshmen or is that something that you find develops over the course of their education when they delve into their majors?

[Tim Sands]: That's a great question. I just want to clarify, it's 51% of those students who are living on campus undergraduates. Most of them are freshmen, but they are second year, third year and fourth year students built into the living-learning environment so they're multi-generational, is a term we use. There's a dance between trying to understand what would be attractive to the students and getting organized around presenting those opportunities. You'll see new Living Learning Communities with new themes some of them directly tied to their academic interests, some of them tied to other interests and expertise and passions. They're all over the map. There's 20 of them, I think, 20 different. There's the Corps of Cadets. That is a really important Living Learning Community.

[Cyril Clarke]: [inaudible]

[Tim Sands]: But it's a model that we've committed to and I think even more so than other institutions. I guess the real question is what percentage of our students should be in them? Whether it's 60% or 2/3, I don't know, but a lot of students have good reasons why they do not want to be in Living Learning Community so we want to leave that option open. Other questions? I would say one other comment on the Living Learning Communities, I personally, when I look at the themes of them, there are five of them that I would love to be in. There's one that forgetting the name of it, but each hall has a different language so each part of the Living Learning Community. Is it Mosaiko? If you want to speak Arabic, if that's your passion, they may not be a major but just something you want to know. Everybody on that wing speaks Arabic as their first language when they're in the building, or French or whatever it may be. But there are a lot of really interesting themes that have been developed. 

Audience Member [0:37:50]

Dr. Clarke, you mentioned about in-state tuition. Can you maybe give us an idea briefly, what control the state has over that and what issues Virginia Tech might face for us to get that approval?

[Cyril Clarke]: The basic concept here is that if a state really wants to contribute to the education of a particular type of professional, then the expectation is that the states subsidize that educational process. If we look at the College of Veterinary Medicine would be an example because that's the direct correlate within the Virginia Tech system. Our College of Virginia Tech is actually the Virginia Maryland College of Veterinary Medicine. Both the Commonwealth of Virginia and the state of Maryland actually provide funding to support that DVM educational program. That allows the college then on that basis of that discount to provide a resident tuition rate, as it turns out 50 Virginians and 30 Marylanders. That college also has non-residents who pay a substantially higher tuition rate because it's not being subsidized by the state. The control that the state essentially has is a decision on whether they would like to provide direct operational support to the school of medicine, which would enable the school then to provide an in-state tuition rate. Other questions?

[Tim Sands]: I can just add to that that we are working hard on this. We make good progress I think this session. Next session, we're going to double down on it. The thing is a little irksome is that the publicly supported medical schools in Virginia are all in what is called the Golden Crescent. There are two more that want to become publicly funded medical schools. We don't have a publicly funded medical school for the western half of Virginia, except for this one which is publicly funded only in the sense of the buildings, which the state has been very generous with construction but really ultimately, it needs to be operating. We're continuing to make that case, I'm pretty confident we're going to make it there. The other thing I would say, just add to a comment that you made earlier Cyril, that just to give a little detailed background, but we do have planning authorization for non-general funds for the new medical school, building and the renovation of the remainder of what is now the medical school for Fralin Biomedical, which would allow us to double the size of the medical school. That planning authorization is in what's called the skinny budget, which is the active budget in Richmond right now. It's not as much money as we would like for planning so we are advocating for and I think we're going to get ultimately, the additional funds we need or the authorization to spend. We actually spend that money. It's Virginia Tech money and then we get reimbursed when we construct the building. I just wanted to indicate that it is actually in the current budget even though the process in Richmond isn't done. We will get the planning started.

[Dean Learman]: That's great. That's a newsworthy item for this group, I would say. Well done. Other questions before we go to the zoomers. Other questions in the room? 

Audience Member [0:41:40]
I'm just curious with your comment about the growth of the medical school, are there plans already in place, formerly at the undergraduate level to create pre-med programs or some formal program that supports the growth of the medical school?

[Cyril Clarke]: There are already a wealth of undergraduate pre-med programs at Virginia Tech and they're distributed across actually a number of different colleges and departments. Having said that, I think it is important for there to be a really well qualified pipeline of applicants into the School of Medicine. The School of Medicine will continue to offer opportunities across the Commonwealth but across the nation. I think I'm correct in saying that currently there are about 100 times higher number of applications as people accepted into the school, is that about right?

[Dean Learman]: I think we were at about 100 for awhile and then it bumped now to this year, even though you can't just file an application and be interviewed remotely. Now, that you have to come in person. We had about 6,100 or so applicants for the class we're about to matriculate. Our maximum when you didn't have to come in person with 6,900 last year. That's much more than the baseline of about 4,000-4,400. We're now more 150% I should say.

[Cyril Clarke]: The point I'm making is that while it's really nice to have a pipeline of talent from the undergraduate programs at Virginia Tech and certainly it ties the school closer into those undergraduate programs, the school has no shortage of really highly qualified applicants.

[Dean Learman]: If I could just add in, our schools already laying a very strong groundwork in the new College at Virginia Tech really make sure we're in the right places to participate in pre-medical and pre-health advising. Our admissions team and DEI teams work together to do that in various colleges with the pre-health advisory system as well as the Living Learning Communities that are most interested in pre-health careers.

[Audience Member]: [inaudible]

[Dean Learman]: Current state of affairs is that we have an EIP program which isn't a promise of admission. It's not an early acceptance program. It allows people to identify their interests, to participate in getting to know us a little bit better, and have a position where they can interview potentially for the school. We haven't gone to an EAP system yet. But that is something we might consider in the context of growth. 

Audience Member [0:44:47]
Right now probably the biggest problem with more physicians in America, it's really not an undergraduate level, it's at the graduate level, because those are not expanding nearly as fast.

[Audience Member]: As a program director who gets to see 1,300 applications for five spots. You can see that's part of the bigger problem. Without expansion of graduate medical education, really have trouble expanding undergraduate medical education. My question is, are there any strategic thoughts on how we do that? We do have opportunities to do that, but is the University looking at that as something that we need better aligned. Right now we're aligned, Carilion is the sponsoring entity for all of the graduate programs and without them those residents also teach the medical students. I think there's been better alignment in the last couple of years than they've ever been, but we still have a lot of opportunities for alignment at that level.

[Tim Sands]: Just generally speaking, when we talk to the folks in Richmond about expanding medical school, we also talk about expanding graduate medical training because they go hand in hand. The folks in Richmond are aware of that. They always say we were talking about doubling the medical school. That's a multiyear process that's not going to happen overnight. The first question I have is what about graduate medical education? We're trying to link those two conversations. Carilion self funds a lot of those and we're lucky that way, but we need some help from the state as well.

[Dean Learman]: Your saying other rooms that I've been in, I'm seeing a lot of echoing of what we've been talking about in Richmond when Carilion and VTC folks are coming together to panel discussions and other such events. We're always emphasizing the importance of GME and the power of having someone from Virginia who attend college in Virginia, go to medical school in Virginia, have a residency position in Virginia, and have a higher than 65% chance of staying in Virginia based on statewide workforce data. That's the powerful combination we'd like to create over time. Doing our shares of medical school, but also making sure there are more GME slots. Think it has been good coordination there with growing on it. 

Melanie Prusakowski [0:47:21]
Provost Clarke, I believe the reduced tuition for Virginia residents will be incredibly helpful in this front. But can we ever envision a time when we can set the cost of tuition for the medical school, one year in advance so that financial aid packages can be shared with people who have been accepted earlier in the admission cycle.

[Melanie Prusakowski]: I find that we often and for a number of reasons, matriculate people who are accepted later in the process, I think because they aren't getting their financial aid packages until all of them together. Whereas people who've been accepted by our school early, who wait a long time to find out their actual cost of tuition are often lost to other institutions.

[Cyril Clarke]: That's a really interesting question. I hadn't thought about that. Currently, we actually do have to manage the cost of attendance in regards to undergraduate students, because the cost of attendance for the undergrads is established sometime around November or December of the calendar year before they actually start their programs. We do that at a time before tuition has been set by the Board of Visitors, which in turn tries to take into account as much as possible what the state appropriation is going to be. Actually for several years, we've tried to manage the challenge around having our cost of attendance established and then having to reassess that at a time when it's actually too late in many cases for students and parents to go through the financial details. The problem that you're encountering actually isn't unique to professional students. But the question is an interesting one because I wonder if we could do that. Because certainly at this point in time, the tuition rate, of course, has to be set by the Board of Visitors. That's the level of authority necessary there. President Sands may be able to answer this question, but the School of Medicine tuition rate is not directly dependent on the State appropriation.

[Tim Sands]: Well, there's nothing to prevent us from setting tuition if that's the question earlier than we do for School of Medicine. The main as you said, it's not dependent on the Commonwealth so much. It may be in the future, but even then, I think you can always go early. For example, the University of Virginia sets its tuition every two years for the next two years. They have the great advantage of a huge endowment to buffer them. There may be a little less sensitive to where the Commonwealth ends up but nevertheless, it's helpful for families to know what they're going to be paying for students. It's a good idea.

Mike Friedlander [0:50:35]
Thanks very much Cyril for all that. I want to follow up on this slide on the graduate student numbers. 

[Mike Friedlander]: We've had many discussions over the years about growing that. As we look at the global 100 aspiration, there's probably, well, maybe not nothing but not many things that surpass the relationship between the numbers and the quality, of course, of graduate students in the research enterprise and top universities around the country. But I'll throw into that mix as we just talked about GME, postdoctoral fellows on the research side, which is equivalent in that regard. My question is, I know there's a lot of interest, and we've looked at the numbers, but it takes money, it's big investment. How high on our priority list right now is growing the graduate education enterprise? Related to that on the postdoctoral side, I know we're doing a lot of things with offices for support for the fellows, but in terms of making that a major priority for investment and growth, where does that say?

[Tim Sands]: High [LAUGHTER] Cyril.

[Cyril Clarke]: Actually the answer is high, high [LAUGHTER] high for graduate education, high for post-docs. What is our guide? What is our rubric or standard that we're using really to drive the further strategic development of the university? Well, we use several but one important one are the AAU membership indicators. If you take a look at the categories of membership indicators under the AAU, in addition to things such as extramural grants and contracts, expenditures and faculty distinction and so on and so forth is graduate education and postdoctoral training. For Virginia Tech it can't be one or the other. It's got to be both. When you talk about graduate education, it's of course, inclusive. Very much so of what I would call research-based graduate programs. Most of those are doctoral, but we have master's programs that are also focus on that area. But in graduate education is also really important for us to grow the so-called professional master's programs such as the Masters of Public Health or the Masters of Engineering or the MBA. It's all of the above approach and so while we haven't yet finished our recruitment and admissions cycle for this year yet, the early indication is that Virginia Tech would experience a substantive growth in graduate enrollment going into fall of this year.

[Tim Sands]: Well, there are a couple of things intention, but there's an interplay obviously with our success in extramural funding and the more successful we are with that, the more ability we have to grow graduate and post-doctoral fellow opportunities. The other challenge that all of our institutions across the country are having and we're certainly having it as well as affordability and the ability for our graduate students to support themselves in a rising inflation environment and especially in Virginia Tech and I think Roanoke feels this as well. But certainly Blacksburg has seen huge spikes in the cost of housing and certainly cost of foods, so this doesn't impact just graduate students, it impacts professional students like our MD students, that affects our faculty and especially our staff and we're right in the middle of trying to deal with that. But we do need to support our graduate students and that's something we've been focusing on. We have a task force that finished their work what last several months ago and recommendations are active and we're going through them and we hope to be able to make progress on them. But there's an interplay there because obviously those costs go up, then the number of graduate students we can support might go down in the short run but it also makes us more competitive for graduate students so that's another factor there. It's an interplay, but we're committed to growing and improving the quality of both and the support that we provide for both postdocs and graduate students. 

Lee Learman [0:54:55]
Here's a question in the chat which I believe is motivated by a continuous professional development, a zeal for continuous professional development, any plans for tuition support for SOM faculty who are Carilion employees? [LAUGHTER]

[Cyril Clarke]: Not currently [LAUGHTER]

[Tim Sands]: I mean, it's a conversation we should have. There's no question about that, but it is complicated and it's part of what we had to figure out. Who's the employer, what's the responsibility and how do we work together because it's a good idea.

[Dean Learman]: There are a lot of things that are happening as integration continues to occur with Carilion based physicians who are Virginia Tech Custom and Faculty. But the one that's the hardest to crack so far, and I would say this in the reciprocal direction as well, are the things that are HR benefits, the things that are bucketed as such are the most challenging things to access from one institution to the other at this point but it sounds like we have a commitment to start thinking more about these opportunities. Thank you. 

Mary Wesley [0:56:05]
I was wondering if you could talk a bit more about your interest in health systems and implementation science and what advancing that research in that area would look like. 

[Cyril Clarke]: My understanding of that domain at a very high level is that it is calibrated and designed to facilitate the transfer and implementation of research, outcomes, learning and discovery in a manner that those elements can be directly applied to the benefit of patients individually and population health at large at a high level. The next question is, what are the particular elements, what are the building blocks that you need to develop from a programmatic viewpoint to make that possible? The two questions that I have posed to our colleagues working on this area that I think will facilitate not only their thinking but their communication of the realm. The two questions are the following. Firstly, if you're in the process and will be in the process of recruiting faculty to this particular research area, tell me what disciplinary background and expertise such faculty are going to have. If you have five, or maybe 10 faculty positions, what are you going to recruit for? Which you're not going to recruit necessarily for health system implementation scientist but it's going to be someone in what? What is that disciplinary contexts that's an essential ingredient that goes together in this particular research domain. The other question I pose, which I think may be helpful perhaps, is in the design of a curriculum, what are the specific courses that you're going to identify and select to be part of that broader curriculum that in the collective is going to produce a particular graduate outcome, those particular integrated competencies that make a difference here? I don't know the answers to those two questions, but I'm confident that our colleagues are working on that. They will need answers to those questions I think to move forward. 

Leslie LaConte [0:58:42]
Thanks so much for your comments, particularly as they relate to health systems and implementation science. 

[Leslie LaConte]: I've enjoyed working with Dr. Parker on the DA2.0 planning and in that process, we had the opportunity to integrate with faculty at Virginia Tech in Carilion Clinic and it's been great forum for us to come together and see where the strengths are that we can blend across are Carilion Clinic faculty, as well as our Virginia Tech faculty and industrial and systems engineering and business and in many of our clinical departments. What I've observed as I've gone through that process is that a lot of what we're doing is educating both parties so we're talking at Virginia Tech about who VTCSOM is, what our place is, we're talking at Carilion Clinic about from Virginia Tech is and how we're connected. I'm wondering what strategies we can take, as well as Virginia Tech and Carilion Clinic can take to get everybody on the same level about what our partnership looks like and how we can develop a more seamless partnership across these three areas at the moment.

[Tim Sands]: Well, it sounds like you're doing it. I think the missing piece I alluded to this a little earlier. We've done a great job over the years, was almost 15 years or so of work that has gone into creating this partnership. We have a very strong Biomedical Research Institute and a very strong medical school. What we don't have yet is the clinical translation piece. We don't have a seamless, easily described model for the way that all the parties interact. The next step, I think, is to develop a longer-term vision. Much along the lines of what I discussed for the university as a whole. Where we don't get hung up in where we are at the moment, but start putting our focus 5, 10, 15 years into the future. What do we want to look like then? Then we can work backwards. We are having those conversations at various levels almost continuously. I'm beginning to think we needan organized process to get there. Until we have that, those conversations are going to be a little complicated. I'm looking forward to the day when they're really straightforward, but for now they are complicated. Keep doing what you're doing. But we need to help from institutional point of view in terms of creating that process with other partners to make sure that our visions are aligned. In the end, these partnerships are about alignment and trust, and the alignment pieces is good in the short run, and vague in the long run. Those are things we have to work on.

[Cyril Clarke]: So as I mentioned before, I think the School of Medicine has done a fantastic job in establishing and growing and a professional educational program. That is spectacular. I can have an opinion on that, but there data actually, I think to back that opinion up. If you take that then and try and fold it into the broader context of Health Sciences strategy. That strategy at the university level, particularly in regards to what President Sands mentioned earlier about our priorities that are inclusive of top 100 global. Essentially what he's saying there is that Virginia Tech is a great university and from a reputational viewpoint, we want to be even better. We have some guidelines in terms of how to accomplish that. Those guidelines are very inclusive of continuing to expand our research and scholarly portfolio. To do that, as a university, we absolutely have to pay attention to Health Sciences and Biomedical Sciences. It's our biggest opportunity gap.

Virginia Tech has a well-established reputation of legacy and science, technology and engineering, and some additional areas. We are behind our competitors in terms of our Health Sciences. We're growing rapidly. So biggest opportunity gap in terms of the availability, not of federal funding, but the opportunity for technology development and our discovery and our research output really to have impact on the communities that we serve. You come down into this broader context of Health Sciences. What is the piece that we really need to advance? Well, that's, we've got a great educational program that is going to expand is going to get even better as it goes forward. But the research and scholarship piece. The research and scholarship piece, how that works with Health Sciences at Virginia Tech is that we don't have a traditional academic health system, as you will see in many other land grants that have medical schools that were established decades ago. We have a system that actually works for us because it's integrated and distributed across the university, every college, some more than others, are involved in Biomedical and Health Sciences research. They  are connected very much so with Fralin Biomedical Research Institute, but also with other institutes like the Life Sciences Institute and ICTAS and others. That's the system that we have.

The question then is, how does the School of Medicine grow and develop into this particular Health Sciences environment? The way it does that is exactly what you're doing right now. Which is to start off by creating the ability to grow our research mission through tenured and in future, I hope the research positions to collaborate and partner very closely with the research institutes. But also to grow a domain of research that is owned by the college, by the school, which brings us to the health system implementation sciences. It's a process of continuing to develop that with a strategic focus and to do it in such a way that we take every opportunity that we have to collaborate and develop our partnership with our principal healthcare entity, which is Carilion Clinic.

I'm optimistic that the health system implementation science will provide a particular opportunity to do that because of the nature of the health care that is characteristic in terms of Carilion Clinic and its position. It's not limited to that in any way. As we go forward, I hope that we will continue to expand and collaborate and partner in other areas. But frankly, this further development that needs to happen there. 

Audience Member [1:06:06]
For years I've been recruiting people to a surgery program and everyone who is an engineer knows Virginia Tech because of the outstanding school. 

[Audience Member]: The question has been for years is what opportunities do they exist to collaborate? Everyone in this room may not be aware, but in July 1, we're going to have a Biomedical Fellowship which is a partnership between the Department of Surgery and the engineering school and has been the work David Salzburg, modeled after the Stanford program which David participated in. This is the one that I know about because I'm in the middle of it, but I'm curious, are there other ones of these starting up that you guys are already aware of because while Health Science is a wonderful thing. Playing to the strength of Virginia Tech is the engineering program. Are there other collaborations that maybe other people in this room would know about that I don't know about because I'm curious because that's seems like one of the biggest places or so opportunity. 

[Cyril Clarke]: Do you mean collaborations in terms of disciplinary areas represented at Virginia Tech? Yeah. Of course, a wealth of opportunities there. But I guess what I'd like to make clear is that while the College of Engineering is a huge asset and has enormous potential in terms of expanded collaborations. Virginia Tech has much more than the College of Engineering in terms of the partnership and the resources and collaborative expertise. One only has to take a look actually at the tenured faculty, or tenure track faculty within the Fralin Biomedical Research Institute and look at what their academic homes are. You'll find engineering represented there, but you'll find science in particular, physics represented there. The College of Veterinary Medicine is well represented there too, but it goes even beyond that. For example, the College of Agriculture and Life Sciences has, has substantive collaborative opportunities, particularly in the area of exercise, physiology, nutrition, infectious diseases and so on. That's actually happening right now. You may not see that from a particular disciplinary context. But the connections that bring together Health Sciences across the university are enormous, if you take one area cancer and then look at the faculty that had extramural funded grants across the university. You will see them in multiple departments and multiple colleges. Mike, you may be able to add some more context there. 

Mike Friedlander [1:09:00]
To Cyril’s point at Fralin Biomedical. We have appointments and a lot of colleges including the liberal arts and human studies, human development, Ag, and Life Sciences.

[Mike Friedlander]: As several mentioned, human nutrition, biomedical engineering been working with the chair of chemical engineering on joint recruitment is right now. Cancer space is a big area as well. There's a lot of that going on. But to be maybe more specific to your focus on engineering for a second, a couple of examples I could cite that are, I think very exciting and promising in a particular technological area of using non-invasive methods to either do a tissue oblations or modulation. We have in the College of Engineering and Biomedical Engineering, several faculty working on that in the College of Veterinary Medicine at Fralin Biomedical Research Institute and working with several physicians at Carilion Clinic in that space right now on projects. There's extramural funding through NIH for that. There's opportunities for recruitment. As matter of fact, as we speak, recruiting additional faculty with the College of Engineering appointments in that space. Another area that Leslie may want to comment, and there has been a very rich and robust discussion going on for the last couple of months between at least the chair of the Department of Biomedical Engineering Mechanics and several physicians at Carilion and about getting together, exchanging information, looking for opportunities, particularly Surgery and Biomedical Engineering. I don't know if you want to add anything to that, Leslie, but there's somebody who put those in that space as well.

[Leslie LaConte]: I would want us back to the desination area 2.0 grant that Sarah Parker in the health systems and implementation science department and I are leading along with multiple individuals. I see doctor Trestman back here and John Epling, Justin Price, working with our industrial systems engineering partners from the College of Business. There's intentional efforts to build these teams across the enterprise, not in the College of Engineering, but across the college. A lot of focus on building those bridges.

[Tim Sands]: We'll add that in that additional context here. Mike wears multiple hats. You may know him mainly as director of Fralin Biomedical Research Institute, but he's also the vice president Virginia Tech Vice President for Health Science and Technology. Mike's a good go-to person if you want to look for where those connections might be happening. Thank you for adding your piece. 

Lee Learman [1:11:44]
Just a comment in the chat, as they're listening to the conversation. It would seem that a very integrated faculty recruiting effort between Carilion Clinic and VTSOM is really needed to achieve the goals that were stated by Cyril.

[Cyril Clarke]: Yes. [LAUGHTER] We were making just extraordinary progress in growing research and scholarship in the health sciences area, and we'll continue to make great progress there. But the area that we need to develop further is just that integrated commitment between Virginia Tech and Carilion Clinic. The piece that we need to grow there is the physician scientist or the scientist physician depending on how you'd want to emphasize one over the other. I can tell you through my experience of decades working in colleges of veterinary medicine that of course, are much smaller than human health programs, but actually are structured in very similar ways. That to accomplish that particular role, the physician scientist has to have enough time outside of the clinic actually to commit to research. The clinical experience and interaction is absolutely essential because it informs the scientists in terms of those projects and ideas that are most compelling and allows that person in interactive and reflective way to keep connected. Ultimately, with that person's aspiration is, which is patient care. But to accomplish that clinical endpoint, you have to have enough time within your assigned position to actually commit to the research and scholarly effort. That's not easy, because that time has to be funded. The way funding works in terms of health care entities, and academic institutions creates some tensions in terms of salary scales. It's a complicated area to work out, but absolutely has to be worked out and further expanded for us to make the progress that we need to accomplish in developing partnership in support of health sciences research and scholarship.

[Lee Learman]: If I could just add a couple of comments to Cyril. I know some of you in the room have worked at what we would call traditional or fully built academic health centers. You know, but for those who don't know, many of the highly productive research academic health centers, it isn't as if every position in a department has the research phenotype. It means that there's a core and a critical mass working within departments and across departments of people who commits a substantial amounts of time. The recipe is about 80 percent time spent on scholarly activity, some of the surgical specialties go more with 50/50, but have enough of them that you create an ecosystem of clinical research by having people who are scientist physicians or physician scientists. Just to give you a vision of what that looks like. It's not a wholesale difference amongst all of the faculty, is a critical mass that creates the momentum and partnership in team science that yields for the medical school.

[Cyril Clarke]: Just to give you an example of an absolute minimum standard and this is, in my view, my personal view an absolute minimum. Using the correlate of the College of Veterinary Medicine right now, which of course has a clinical delivery program that's essential for its educational mission, but it's research and scholarship too. I mentioned earlier that the tenure to employment, while it has many different aspirations and definitions, is absolutely wrapped around a commitment to scholarship and developing not just scholarly works, but a body of scholarship, a line of inquiry, that establishes a base for that individual, the college and the university to attain reputational excellence. The College of Veterinary Medicine right there if you want to be tenured, you want to be appointed to a tenured position, there needs to be at least 30 percent of your time committed to research. That's a minimum standard in my view. 

Helena Carvalho [1:16:26]
Expanding Beyond Boundaries to South America or Europe

[Helena Carvalho]: It's very interesting to see all the are for increased the partnership between Virginia Tech and Carilion and then among the several schools in the Virginia Tech. But I want to ask a question that goes a little bit offside. Because when I hear President Sands addressing beyond border and reinventing medical education, I wonder what is the vision to expand it to South America or even Europe? Where do you begin expand our creativity and do a variety of Staff. He combined learning and exchange experience with automagically schools, educational research places.

[Cyril Clarke]: Thank you so much for that question and I'm aware of the opportunity that we may have in Brazil. Virginia Tech, this whole idea of a land grant started over 150 years ago, was to establish institutions within the state with a somewhat regional perspective. That has changed dramatically. That's no longer the case. Land grants like Virginia Tech are global universities. There isn't anything that happens either at our back door here in Roanoke or elsewhere, that doesn't matter to us in terms of our education and our research program. Faculty individually at Virginia Tech have probably hundreds of international collaborations and partnerships, and I encourage those, not for a moment would I discourage them. But at the university level, we are in the process of establishing core areas that represent not just research or education or outreach, but actually integrate all elements of our tripartite land-grant mission.

I'll give you an example of that, we have a particular commitment at the moment to India, to any other country but India specifically in terms of partnerships, we have a partnership with a private institution that has principle based in Mumbai and then other campuses elsewhere in India. That's an educational partnership that involves a program whereby Indian students start their education and finish that at Virginia Tech and go into a graduate degree at Virginia Tech. We're working on a system of reciprocity now where Virginia Tech students can go to India. But it's not just education there, there's a research mission, although that currently is based principally in Chennai with an opportunity in Calcutta as well.

The point I'm making is that at a university level, we would never discourage an individual faculty member from doing anything. But if ever a program develops around an individual person, often when that person is actually from that country, there's a certain instability that you build into programs like that. Because when that person retires or leaves, for whatever reason, that program implodes. When you think about international programs, whether they be in Brazil or India, or what we're working on now is actually Botswana, think about it, encompassing all elements of the tripartite mission. Make sure that while there is a particular aspirate driver which is important that it involves more faculty and most students; that is a system of reciprocity; that what you're doing in the country can, in most cases only be done there, or at least can’t be done at Virginia Tech. That all parties, in a sense have skin in the game, that the resource base is coming from multiple sources. Those are the programs that tend to grow and endure over the longer period. The particular partnership that you're considering in Brazil looks very interesting actually. But I'd like to see how that is really expanded and explained further in terms of how that could be a Virginia Tech commitment over and above an individual faculty one. 

Audience Member [1:20:46]
Oncology fellowships

[Audience Member]: Thank you for this conversation. To get real granular and oncology. I spent a life work doing cancer care and now with growing clinic and the School of Medicine see this amazing opportunity to teach the next generation of oncologies providers. We don't have medical oncology fellowships, surgical oncology fellowships. My goodness, that's needed, and that just ties right into everything happening at the medical school. We're about to build a destination cancer center just right here yards away envisioning a sky way system right over to Fralin so we can connect over to the medical school. I'd really like to see this health science implementation science focus get us to that place where we can all work together.

[Cyril Clarke]: Thank you for bringing up that topic. It's really exciting for us. Virginia Tech has a significant commitment and engagement in cancer research as I mentioned earlier, across multiple colleges. We're particularly excited about the commitment, the strategic alignment, and I think we can benefit from in terms of what Carilion is planning to do. I'd be interested though, if you perhaps share with us the concept around the description of destination. What do you mean by destination in the context of that entity?

[Audience Member]: Actually wrote that down. We envision a cancer program where anybody who came to it would not want to leave it, nor need to leave it. It's clinical excellence would be just what would make people say I really feel wanted and cared for here. But they don't need to leave it because in my field, there's often a second line, third line, fourth line, fifth line of care. I need the next coolest thing for those patients. That's going to come right out of Mike's work. He's already got a sky way to the medical students. I want the sky way over to the Cancer Research Building, and the reason it'll be destination is because I'll have that fifth line care. That's what it means.

[Cyril Clarke]: No, thank you. That's actually what I suspected that you meant, and so the word destination to me conjures up an image of a patient in need seeking out care at the center to the extent of driving past other opportunities. But choosing to be here because of the distinctive and specialty care provided. I think you addressed in your comments what I suspect is an essential ingredient in that, and that is I don't know if that can be accomplished without having a very closely align a well-integrated translational and clinical research program. I don't know of any cancer centers that don't have. This could be a great opportunity for us to perhaps work on what I shared earlier on in terms of what I think some of our important goals should be as we continue to grow a scholarly portfolio, and certainly one that's not… Fralin Biomedical Research Institute has already been very much engaged in that. But there's an enormous opportunity for the school of medicine as well. 

Closing comments [1:24:33]

[Lee Learman]: Well, almost at time. Anticipation of any closing comments you may have. I just wanted to thank you on behalf of all of the faculty here and by Zoom for really answering questions and being willing to take on questions no matter how specific or obtuse they might be, and as I think about the original list, I think we've covered nearly every important theme that was submitted in advance. I don't think we left anything on the table, but thank you so much for being here. Did you have any closing remarks to make before we wrap up?

[Tim Sands]: I didn't see any questions about parking. Which in Blacksburg, that would be the number one question. But we're getting there. [LAUGHTER] But I do appreciate the opportunity. I think we touched on some themes. I think that are really important going forward. The Virginia Tech Carilion School of Medicine is something that all of Virginia Tech and all the commonwealth is very proud of. But it's achieved despite its boutique scale. It is just setting the pace for, I think, medical schools around the country, and that's why we want to grow. We want more of what's good and while preserving the culture that you're building, and I think it's just exciting. But we do need them to, and you're already in the midst of this, tie it together with our biomedical research, bringing the research which Dean Learman is doing into the medical school in cancer our partnership with Carilion Clinic and other clinical providers, and it's an ecosystem that we're building.

One charge I would just add to the list while I mentioned it already, but I think let me be a little more specific. It would be very helpful if the School of Medicine faculty, staff, students would start a process of envisioning, and maybe you've already doing this. Where do you want to be in 10 or 15 years? The reason I say that is because we're going to bring that together with the larger ecosystem. The more you can involve Carilion and the more you can involve other parts of Virginia Tech, the better. But that will line up nicely if you can get some momentum going in that area. When we converge in the fall and start to imagine a new Beyond Boundaries vision, which I don't think it's going to be radically different from where we are now, but it's going to be refined and there's an opportunity to bring in what we're doing here in a more explicit way, and so I just charge you to start that process if you haven't already started it. Not strategic planning but visioning, and that has to involve ultimately the entire community and certainly has to have Carilion Clinic involved in other parts of Virginia Tech. But I think that I'd love it if you can take a lead on that because the summer is coming and because in the fall we will tie into that.

[Lee Learman]: Handoff accepted. [LAUGHTER] We didn't rehearse this. This is actually happening right now. Handoff accepted in order to do that strategic vision and particularly for research and for cranium, Virginia Tech row is going to work together on that 10 to 15 year Vision Challenge accepted. When in the fall can we get in?

[Tim Sands]: Probably pretty early in the fall because the work is going to continue over the summer is just sit. We're probably not going to be having large gatherings of people, retreats, that thing until the fall. But we could do that. I hadn't thought about it, but we could do it in the summer if you want to get it started earlier. We can discuss that offline.

[Lee Learman]: Well, we're looking forward to next steps. There's a lot of collaborative energy in this room and a real feeling of opportunities. What a wonderful way to end this opportunity to be with you both today. Thank you both so very much, and if you don't have to leave right away, many people would like just to maybe shake your hand and say hi, if you can wait a couple minutes.

[Tim Sands]: Sure, and Happy Denim Day.

[Lee Learman]:  One more round of applause. Thank you so much.