The Impact of COVID-19 on Academic Medicine with Steve Garfin – Compassion Forum

(mellow instrumental music) – Greetings, Bill Mobleyfor the Sanford Institute for Empathy and Compassion.

Very pleased to betoday with Steve Garfin, Dr.

Steve Garfin, who's Deanof the School of Medicine at UCSD.

He plays an extraordinarily important role for medical student education.

And the Institute is veryfocused on understanding the neurobiology ofempathy and compassion, but also how we use what we learn to help our students, our faculty and others, to basically harness andhold on to that empathy and compassion, to enhance it if possible when they're caring for patients, which can be verydifficult, very challenging.

So Steve, welcome to the Compassion Forum.

And I thought maybe we'dask you to give a little bit of background about yourself and your job and how things are going now, especially during thisvery difficult time.

– Okay.

So I'm an orthopedic surgeon.

I did my training at UCSD.

I have been on the faculty since 1980 and was appointed, I literally voluntold, I would be Dean, almost three years ago by the chancellor, without a lot of preparation.

He did give me a week to decide.

Yes, he didn't give me no as an option.

So it was sort of a slower rampup for me than maybe others, in terms of learning the job, and learning what has to be done and all the components of it.

I think I'm maybe slowly getting there, maybe feeling a little bit, maybe confident andcompetent in this role, which really takes a lotof preparation to get there in the normal cycle of things.

The normal work involves responsibility through a Vice Dean for medical education for the medical educationand medical students of graduate students.

All the faculty and all the departments report to a number of people, but I'm responsible for them, particularly the faculty academic part, their research part, their teaching part, and their promotions and advancement, as well as new hires and retentions.

And participate in theexecutive governing board of the hospital, the hospital system.

Though there's not a directreporting line to me.

So all that is a lot of workwith a lot of surprises daily.

Academically, retention, legal issues, acting out issues, diversity, a plethora of areas for 1600faculty and 800 trainees.

All complicated now by COVID, and having in one and a halfweeks to close down essentially the first two plusyears of medical school.

And creating online courses, which we've never had before.

Of having everybody go home, of dealing with the protectionof patients and employees, faculty, nurses, staff, students, many of whom are fearful to be there, and don't want to be thereand go home to families of varying ages with elderlyparents or young kids.

It has made it very complicated.

The campus is doing the exact same thing, and as Dean I have to bein all those meetings, not so much overseeing what'sgoing on in the main campus, but participating and knowingwhat's happening there.

So it's in sync with what we're doing.

So it's an immense job thattakes a while to learn.

– Let me just make thecomment from the outside, that I think you're doingmore than a competent job, you're doing great.

And I think the sense you have of yourself and just who you are, and the genuineness of your character makes allthis much more possible.

You're being honest about how challenging the whole thing isunder normal conditions, much less with the pandemic.

And I've seen you operatein these meetings, and you've been a greatfacilitator of discussion.

But are there things thatare especially difficult right now, are there concernsthat really are greater than others in your mind as you kind of look at the next few monthsof a different sort of style of life here atthe School of Medicine? – Well there's lots.

Not just a couple.

I think one of the big onesthat I've been bringing up in national dean meetingsand state dean meetings, is I think the medical students are gonna be a different breed.

Particularly, if we get traineescompleting medical school in New York or New Orleansor Chicago or Detroit, they're not gonna comehere with the enthusiasm and confidence of whatwe did, you and I, Bill.

Or even last year.

If they're from those cities or states, they're gonna have dealt with death.

Which you don't, as amedical school student.

And in fact you don't usually as a doctor, depending on your specialty.

But they're gonna have been with patients that are dying, or familiesthat can't see them, or are incubated.

That's gonna bring adifferent person to medicine than we're used to.

One of my concerns is dowe have the resources, and the Sanford Groupmay have those for us, to deal with these studentsthat are coming here with the virus still out there? Maybe being fearful or afraidor not as compassionate, or maybe more compassionate, dealing with patients and others.

– I think this is a remarkable time.

And just to sort of stay with that idea, none of us have been throughanything like this before.

I mean, there was 9/11and we were all concerned and there have been otherdisasters we have seen, but on this scale, never.

And specifically, onthis scale with respect to the medical students andresidents and faculty, never.

In a way, it really is like a war.

And we're gonna haveto adjust our footing, I think it's a huge challenge.

And I don't know howbest for the institute to make this work.

But I know it's gonna take a collaboration with your good offices andwith our vice chancellor and the chancellor andthe CEO of the hospital.

We're gonna have to work together on this.

Because it may be kind of, you know, building the airplane aswe fly it or something, but we need to find a wayto deal with the stresses and anxieties that arecertainly gonna come along with our new learners.

Again, agree with you, I started residency was withthis enormously fresh attitude, anything was possible, the world was good, and all I had to do was to learn my job and to take good care of the people that I was supposed to take care of.

Now, one has this lingering kind of cloud of “Oh my gosh.

” Some people are really, really sick, some people die, andsometimes they don't have the control over my lifethat I'd like to have, so I agree, Steve, we need tocollaborate with you on this.

– So that's one of them.

I think the other is the job itself, the university job, withpeople losing salaries, staff losing jobs, faculty cutting salaries, maybe the patient flowwill never be as high, what is their quality of life going to be, and we have, just likein society right now, a bit of a polarizationwith those coming in to work daily, I'm talkingabout faculty right now, coming in to work daily, and others who don't want to come in at all? And aren't? And that puts us against them, whoever us is, and whoever they are.

But if you're in the hospital, you know who's not in the hospital.

And is the former group going to accept the other ones who's stayed home and not, I don't want to say puttheir life on the line, but put their life on the line? So I think that's a whole other arena we have to think about andnot just open the doors and say, come in.

Hopefully that'll happen.

And hopefully it'll teachus a a different degree of togetherness, I mean working together.

It's not all about ourown individual careers and finances.

But there is truly a bigger picture, particularly at the universitywhen the stresses are high and patients are complex.

The interactions are complex.

– Understood.

And it is a challenge, I'm thinking that whereas the challenges that we hadto meet in getting into the early phases of the pandemic are probably only goingto get more complicated as we emerge, hopefully, from sort of the surge, the post-surge period, and we're going to have to work together.

I thought, as a kind of last question, Steve, what do theviewers need to know about you and the other leadersof this organization? About your passion forthe great work that we do? What do they need to knowabout your dedication and your colleagues'dedication to the very best in medical care for ourpatients, but also obviously the care for our fellow workers? – That's a tough question.

I guess a simple answeris we're here for you, whoever you are.

I go in, I'm still seeingpatients in the clinic.

I make rounds to be seenand see if I can help people more than me to be seen, but just to see whatkind of help they need.

Patty Maysent, our CEO, shemust be working 26 hours a day, eight days a week, literally, to get the equipment we needto re-direct the finances, correct the finances.

It's a daunting task, but we've all been here.

Yes, it's many on Zoom, some in person.

The infectious diseasefaculty that are involved with this and the commandcenter, which includes the hospital staff andSchool of Medicine staff, and other faculty haveliterally been working night and day to try andmake this a tolerable, if not exceptional place to return to.

Maybe exceptional's a strong word.

But let me say safe.

It is safe.

At least as safe as we can make it, we have as much gear as we feel we need, and we're here to help.

That's all I can say.

– Well that's a lot to say Steven, we thank you for your leadership and for your terrific spirit together with our other leaders in getting through this.

And as you said, just being here, and being available, and doingour best to help our patients and our colleagues.

Steve, thank you forcoming on the program.

And we wish you all the very best.

– Thanks Bill, and we allappreciate what you're doing and what the institute is designed to do.

It's marvelous.

– Thank you.

(mellow instrumental music).