Celebrating a decade...

On the anniversary of their White Coat Ceremony, the Virginia Tech Carilion School of Medicine hosted a virtual event to celebrate our very first class and the formation and foundation of our medical school.

We reflected on the last ten years and shared the brand-new history wall recently added to our campus. 

To add comments about this celebration or your experience here at VTCSOM, please open the video in YouTube.

Video Transcript

Extended Interview between Dean Learman and Dean Emerita Cynda Johnson

[Dean Learman]: Cynda, it's so nice to see you.

[Cynda Johnson]: It's really nice to see you too, Lee

[Dean Learman]: Glad we have a chance to do this in this socially distanced setting.

[Cynda Johnson]: It's been a long time.

[Dean Learman]: So I get to go first with some questions.

Thinking about uh 12 years ago when you were recruited as dean, with no building, no faculty, no staff, no students... What was that like?

Cynda Johnson

Daunting. I really had looked forward to the opportunity. I had been a dean before, at East Carolina University, you might recall, and then at the time that new schools were starting, I was actually working for the whole school of ECU as a senior associate vice chancellor, but thought that I might want to be a dean again and was pretty enamored by what I had seen with new medical schools.

For those who don't recall, there hadn't been any new MD schools for 25 years, so this was new and exciting and certainly nothing that I thought, that in my career, I would ever have a part of. So I went for it and wonderful bosses made all the difference. Charles Steger as president of Virginia Tech and Ed Murphy as CEO of Carilion. I had what I needed by two great leaders to work for and with, so it was good.

But there there were hard parts, because I remember a letter I got, [it] was not just to me, it was to the school early on from an important organization, and it essentially said what you just said "so you have no staff, faculty, students, or building. You call yourself a school? So that's how it started and after that I said by gosh we sure do and we will.

[Dean Learman]: Cynda, what was your vision for the school?

Cynda Johnson

It of course wasn't my vision, it was our vision, and really started with Charles Steger and Ed Murphy as I mentioned. I have always been able to create a vision best by hearing others and beginning to feel it myself and putting the thoughts together and then making it mine. But I knew when I came here that I had to understand where we were going, and so I was given some very clear and precise direction.

For example the school was supposed to be, and is I might add, a research intensive focus for the students. It was chosen to be, before I got here, a problem-based curriculum, a small class where students would do their primary rotations at Carilion Clinic, and it was supposed to be a five-year school. The other parts I could resonate with, I was excited about a school with a mission, because East Carolina had a mission, a very different mission, it was rural and primary care, but I knew how a school could really carry out the best of what it was by knowing where it was going and that appealed to me.

Except the five years. So early on as in the first couple weeks that I was here, we gathered together those few people who thought they might have an interest in being involved in the school: physicians and basic scientists were from Virginia Tech and we had a retreat. And out of that retreat came a couple of things that were very important. One was that we believed that we could help the administration understand that we could actually have a focus on research and meet all of the guidelines that were expected in a four-year curriculum. And I thought that was important because of the expense of schools; because what it meant to have five years at that particular time; and now as well. And that's when we decided that our vision mission statement was going to be to educate physician thought leaders through inquiry, research, and discovery, and that really kept me going. We kept our eye on the prize from then on.

[Dean Learman]: Well great, Cynda, and what was it like to recruit the charter class?

Cynda Johnson

It was scary. Everything along the way was scary. The biggest reason being the what-ifs... What if no one applied? What if no one interviewed? and What if no one came? And so each of these pieces was very very important.

So to start out with we had to decide how do you do that? And I must say the thing that I repeatedly learned in starting the medical school was the meaning of team working together. Because we did have our small group of people, and every day, every evening actually, we would get together after the physicians finished their clinics, and we would take a topic and figure out how we were going to deal with that aspect of the school.

And so when we looked into how would we recruit the students we had to determine what kind of students do we want? Well actually, what kind of students would come to a brand new school? And then how would we interview them? And this was this was really key. One of our PhD who became a faculty early on had heard about this technique from McMaster's University in Canada about the multiple mini interview  - the MMI - and it sounded really really good and we wanted to explore that. And she was murdered.

And we hardly knew what to do for so many reasons and where to go from there but to honor her we thought "we must look into this further." We invited McMaster's, the people who started this technique, to the school we learned all about it and decided that was that was for us. And it has been wonderful because what it has allowed is to engage the community, which as you know is something that's very important to VTCSOM from the very beginning, It was their school. And they wanted to be involved and recruiting people to do the interviewing meant everything to us because they were engaged in our school forever after. And so then we we started the process and we found interesting variety of students and we did have applicants and we did interview them and came up with a remarkable group of entrepreneurial students.

[Dean Learman]: It's a great story, the MMI sends such a strong message to the applicants too, that the community is so engaged here in Roanoke with the medical school.

Well every class here is special in its own way, but what made the charter class so special?

Cynda Johnson

Because they showed up. They showed up when that was the final pivotal point to say, are we really going to have students here? And that meant so much. They were special because they were so entrepreneurial, as I said a moment ago. It's a different group of people that will show up at a place with no building, at least. Because in fact the building was just being built when they interviewed, we had them look across the parking lot and say "Imagine a medical school. This is where you're going to be." And they had to take an awful lot on faith, so they were, they were special.

But there was a another piece there that was important to me. I had heard from one of our physician faculty who was at a new school 30 years ago, before, when the last wave of medical schools started, and he said that he was in the first class, but the second class always felt left out or inferior and not important. And so we really focused on that future as well and the charter class helped us. They helped us invent the school in every way, and I think that's what got them to come. These were people who said "We want to be a part of making this happen." And they were tough. They were tough on us, and they needed to be, because if a school isn't great for the students, it's not a great school and they made it great.

[Dean Learman]: What a remarkable group of people.

[Cynda Johnson]: Indeed they still are. 

[Dean Learman]: Well tell me about the planning process for the first white coat ceremony.

Cynda Johnson

The first white coat ceremony was interesting because we weren't sure we were going to have it. There was a real question about "What does this mean? And White Coat ceremonies were starting to get some negative press. Other disciplines besides medicine were doing some sort of ceremonies with white coats, and there was some literature about dirty white coats, and that they weren't pristine. And so we thought long and hard in this same little groups of people that came together to try to figure out what to do.

And as you know, since we've had a white coat ceremony every year, we decided to have one, but we decided this was not to be a photo op. In fact we tell our students the story pretty much every year: Why do we have it? What does it mean to us? And we believed that if we would wait and have a curriculum associated with it - we called it "What's in your white coat?" - that it would be more meaningful and a serious reflection for the students. And so we had both the curriculum which included hearing from senior physicians and it included an essay that the students would write on their reflections after the end of the curriculum on "what's in their white coat."

And so we invented all the pieces. Something that was important to me was that all the deans would be involved, and so we had always done that. It meant a lot to me, and to them, and to the students. It's really has been a special special time.

[Dean Learman]: I've just got to tell you, Cynda, that Aubrey and I are just now looking over all of the essays for white coat coming up and this year about half of them are not only reflective essays, they're poetry, they're works of art, and some of them are extremely moving.

[Cynda Johnson]: I'm jealous that you get to read them.

[Dean Learman]: yeah, I was trying to help trigger memories of the times that you had chance to read them because for me it's only my second time reading through them, and in this particular year, where the students, they don't have much of a chance to get to know each other because of social distancing and concerns about COVID, I hope we can somehow put them together as a compendium, with the students permission of course, for each other, so that they can get to know each other more deeply.

[Cynda Johnson]: I think that's a great idea.

[Dean Learman]: So we're working on that idea. This year more than ever, it's important.

[Dean Learman]: So now retired for almost two years... What are some of your proudest moments from VTC?

Cynda Johnson

It's really hard to choose, but I think that some of the really proud moments are some milestones that have made a difference so in no particular order:

Graduations. So the first graduation... I had done a couple at East Carolina as I said, but in our school, in the regalia that we had designed, just for us, and with every piece of it meaningful to us, to stand on that stage and see this packed audience and try to hold it together to even open my mouth to speak was remarkable for me and I thank for many assembled. Certainly the students, but the community again too, it made a difference to everyone for Roanoke to have a medical school. And then, my last graduation, because I gave my own graduation speech, and it was even harder to open my mouth that day, but it... I was able to reflect on so many things that had come before and that I had thought about for the previous several years so that was good.

The accreditation, which actually came much before... two parts on that. The first one was our preliminary accreditation which, for other people listening, the Liaison Committee for Medical Education, really the first major milestone is preliminary accreditation and what that allows is to recruit a class. And so this happened in June of 2009 - very fast timeline - but what happened that made it so special, besides getting accredited at that level, was that we were all together. That everyone who had been major in starting the school: the deans, and staff, and so forth, even at that time it was like 15 people. We had gotten together for a photo op because we didn't really know when we would hear how accreditation had gone and just as we were getting ready to leave, the phone rang and my assistant said, "Dean Johnson, it's LCME on the phone." And so everyone got to gather around and they allowed us to put it on speakerphone to hear that we had gotten preliminary accreditation. And the other part [of] accreditation was when we got our full accreditation with no citations. That just... that felt wonderful. That was another milestone in a lot of milestones.

And the other piece has to do with our students and that is this fabulous entrepreneurial class, who we thought was doing very well, but until their first test called step one, as a national test, they were doing well on our tests... but where were they nationwide? We had no benchmark about how they were really doing compared to others in other schools and they knocked the socks off it, and that was that was pretty amazing. And then they finished with all matching into residencies in a year when thousands of students didn't match.

So those those were all times that I will never forget.

[Dean Learman]: There's a lot to be proud of.

[Cynda Johnson]: Well, thank you. I'm proud of everyone I've worked for that but I'm bursting with joy today.

So Dean Learman, I'm so happy to be here with you this is this is really special.

Now I want to know I want you to tell others as well: Why did you want to even be a medical school dean in the first place and even more important for tonight, why here at VTCSOM? 

Dean Learman

So without going through the first part of my career, I'll fast forward to the point 25 years in, where I was thinking about, where did I want to invest my energies? After having been at several academic health centers in the past and growing up through the various things that one gets to do in research education and patient care, having been a department chair and having been a senior associate dean, I was wondering where should I be investing my time and energies in the last 10 years of my career? Where I can really make a difference? And so I started looking very seriously at deanships and decided to look particularly at the deanships at schools that were new. And there was a cadre of new schools, many of them looking for their second deans, their founding deans ready to retire, and I noticed something. I noticed that there was a big difference between how far they had come in those 10 years and you spoke eloquently about the beginnings of the VTC School of Medicine. And I'll tell you by the time I took a look at what was happening here in Roanoke, it was very clear that something special was happening here. Something different from the other new schools.

It was remarkable that the vision that brought Virginia Tech and Carilion together and which you joined to develop the school, that had survived through the second leaders of each institution. That is they had turned over to new leaders and by the time I spoke with those leaders, they were singing the same tune, about the shared vision for service to the community, from a land-grant university, and from Carilion Clinic in its service agenda, and to me there was a real sense of shared investment in taking this school to the next level. So starting from the outside in at those sort of structural issues, it was clear that there was an investment that was meaningful and had endured a transition in leadership and was going to be here for a long long time.

And then, my goodness, taking a look at where the medical school had been where and where it was at the time that I looked at it, many of the things you stated which were the vision, and the unique aspects of the school had really come to fruition in ways that were clearly distinctive amongst the medical schools. The science-rich curriculum that achieves graduate student level training in research that generates outcomes that most schools do need a fifth year to achieve, that because of the block, the blocks that we have here, students are able to achieve that in four years. And then the wonderful balance of those critical thinking skills: evidence-based medicine research skills, balanced with a respect for the values of interprofessionalism, of teams, and of communities. I think that those are some of the things that most impressed me about the school and then of course the cultural parts that you can't just put on a checklist.

It's the sense of humanism that comes out of not only the students and how they evolve, but how that's modeled by the faculty and by their investment in the students. So as a small school, the level of engagement with the students and support for them, and helping them develop a sense of a community internally, and to engage with the outside community, that humanism that's modeled in relating to the students is something that helps them to be in touch with their humanism as they go through the curriculum. So in terms of training future thought leaders with incredible preparation to do all of the the wonderful things we do with our heads and our hearts in medicine, very important is to see that, and to feel that as the outcome of medical education. So a lot of wonderful things in the house that Cynda built amongst many others, allowed me to look at this school as a very exciting place to work.

[Cynda Johnson]: well, thank you for that it fills in "where did we go?" I really liked hearing what you said. It gives me a new perspective on the school that is now of my past but not really, still my future.

By all accounts, you have settled well into your dean's job this past year plus. So well in fact that I might mention that I read one of your messages recently that said perhaps you're no longer the "new dean." So tell me at this point, what are those things that you've really come to love? You started some of that, but what did you love so much, that you're sure you wanted to continue, and what things might change?

Dean Learman

You know, there's a very long list of things that really impressed me in theory about the school and then when I came in reality, one of the most unique things that we do is to have a wrap-up session after each PBL case at the end of the week involving a real patient in a discussion that shares that patient's perspective, but also provides time for students to ask questions of the patient, and to really understand the experience of illness the experience of care around that particular case. And to see that come to life is really an amazing thing. It really helps to create a much richer learning experience than a traditional problem-based learning case would. It's very unique in the ability to do this for every case and to accumulate that level of experience with patients in this particular way over time, and even through COVID, we've preserved this. It's just so very important to do for our students. So that is one of the hallmarks of this curriculum which is really amazing and very impressive.

The way that we do interprofessionalism here is unique because of how the school was built, and when it was built. It was possible to align the schedules of the interprofessional partners, and that becomes an enormous barrier at other schools that want to do this, but can't, because the schedules never line up and so here they did align. That allowed for a lot of shared learning experiences, and I think a legacy of that as we look at how we teach health systems sciences through the lenses of interprofessionalism, we preserve that context because of that strong track record. It wasn't just checking a box to do interprofessional education. It was something that was deeply felt and enjoyed through the four-year curriculum. 

And I'd have to say the other thing is the team. The team of colleagues that I work with in the dean's office, as well as our clinical chairs and basic science chairs. An amazing group of leaders who have shown a remarkable degree of flexibility in the transition between leaders and leadership styles, energy to take on new initiatives, experience that gives them the confidence to speak truth around really gathering the best input that they can provide into decision making. And it's just been a pleasure to meet and get to know the team members that are the legacy of your leadership as well. I could go on but I would just highlight those for now.

[Cynda Johnson]: And what about those things that will probably change?

Dean Learman

Well I mentioned one in talking about health system science, and it really is just more of an update than a change. When the school was formed, interprofessionalism was a very hot topic and everyone was trying to do it and do it right, and really make it a solid aspect of the learning experience. And we did, Virginia Tech Carilion did that very very well.

Looking at how it's contextualized now, it's put into an understanding of health system science and of team-based care, which is a part of a larger whole, and I see our students here because of their selection for a research intense curriculum, their desire to be future thought leaders. As I think about that, future thought leaders should be able to have the bandwidth even early in their medical education to start to understand that health care and health outcomes rely not only on outstanding physicians making good decisions, but on systems, and on systems of systems.

It's a little bit Virginia Tech, in terms of engineering, and thinking of it that way. I hadn't thought of it before coming here but in general, health systems helps to contextualize that patient and that patient's experience that may have preceded his or her visit to see us. It contextualizes the incentives we work in and the challenges of care, and so many other things that future thought leaders need to know. They need to know about that so they can advocate effectively for patients in their individual practices, or the leadership roles that they may have moving forward. So I see that more as an update than a change, is to just build out interprofessionalism into this more robust health system science and interprofessional practice domain. We started doing that in July with the incoming class. They seem to be enjoying it and hopefully, we'll continue to build it out into the third and fourth years as well. Next year is already being planned.

What I think we can do uniquely in this space, is that many schools that have started to do health systems have a wonderful curriculum in the first two years. They're very proud of it, they as well they should be, but their health system partner isn't ready to reflect and highlight what's happening in health systems, and I believe Carilion Clinic is going to prove to be an optimal setting for demonstrating what the health systems science principles look like in practice, through highlighting things that happen every day in the clinical learning environment. That if we call them out as such, the students will have aha moments and say "oh that's what they were talking about." So I think that we're going to be able to graduate students that have really learned as much of about health systems as you can without going out and getting a master's degree and we hope to perhaps form master's programs as well in some of those areas. So that's one thing that'll be new.

The other thing that I'm that some of you may have heard about is the growth in class size and so we've talked about the special nature of the small class size, how it leads to cohesion within a class, to close relationships with faculty, to the development of humanism within the culture of the school as we treat and support each other and also as we take that into the clinical environment. It's precious and it is always going to be a value of the school. Having said that, some growth is possible without negatively affecting that. I have a little bit of direct experience with that at the prior school I was at, they happened to choose the number eight for their PBL group size, so they had eight groups of eight or sixty four. I saw lots of cohesion there: 100% match rates, all sorts of things that we're proud of here too, and so I'm confident that growing slowly from 42 to 49 as we just have done with one extra PBL group, and even to one more PBL group of 56 in the coming years will be something we can do without any compromise to the things that we hold dear. So that's another thing that we'll be seeing in the future.

And then I would say that as we look at the department of interprofessionalism, as it takes on this larger task of health system science as well, we're going to think about how to enable that department to be the tenure home for faculty that have research programs that are in the space of health care innovation and implementation science, and the science of healthcare delivery, associated of course with health system science, but more of a research way of looking at it, partnering with outstanding scholars at Virginia Tech as well as at Carilion, to really take a look at how to improve health care delivery and the outcomes associated with care in the hospital and in the community setting.

So those are some things on the horizon that are a gleam. Some of them are happening, some of them are a gleam in the eye, and will hopefully happen in the next few years.

[Cynda Johnson]: Excellent directions but I'm going to make it even harder for you now, because the final question is:

Well what about this next decade and what do you think VTCSOM is going to look like in 2030?

[Dean Learman]: well in 2030, when you come back, in 2030, to what could be my retirement party potentially

[Cynda Johnson]: I'll be there but don't hurry.

Dean Learman

We're going to be looking back together at decade one and decade two and you're gonna, it's gonna be remarkable to you that there's such an obvious line between those decades because the basic strengths and principles, all of that is still going to be what it is today with some building out, right? So it'll be a little bit bigger, we'll have one or more departments that have their own research programs that are more involved in healthcare outcomes and implementation science that have partnerships that help support them, have external funding.

By the time that we get to 2030, we'll have the students that are graduating with certificates in health system science the way they have certificates now in research, to show that they've reached a level of knowledge that distinguishes them among medical students applying for residency. We'll have more of them going off to get master's degrees in related fields as well, and we will just be riding high as we have the same mission that we've had from the very beginning, but we have more opportunities for our students to achieve the vision that we have for them.

[Cynda Johnson]: It sounds exciting. I think there's going to be a lot of people who want to be a part of that.

[Dean Learman]: I hope so.