Leaders in Medical Education

Dr. Francisco González-Scarano, Dean of The University of Texas Health Science Center at San Antonio

Osmosis Team
Jul 2, 2016

Francisco González-Scarano, M.D. was educated at Yale (BA 1971) and Northwestern (MD 1975). He received his medical training as an intern in Medicine and resident in Neurology at the Hospital of the University of Pennsylvania and postdoctoral fellowship in the Department of Microbiology at Penn between 1979-1981, following which he spent a year as a visiting worker at the National Institute for Medical Research in London, UK. Dr. González-Scarano became the Dean of the School of Medicine and Vice-President for Medical Affairs at the University of Texas Health Science Center in San Antonio in August, 2010. He is now Executive Vice President for Medical Affairs.

How did you decide on a career in medicine?
I was fortunate to see two outstanding pediatricians, my mother's brother and sister, as they practiced old-style, 'house call' medicine in my hometown of Ponce, Puerto Rico. They were totally committed to their patients, and had palpable fulfillment and joy in their profession. In college, it took me a while to come to the conclusion that I would in a way, follow their footsteps, but I am glad I took this time as it was in fact my own decision, and not one that was 'expected' by my family.

As to my chosen specialty of neurology, I was enthralled with the nervous system and its complexities as soon as I took the first neuroscience course in medical school.  I found an outstanding laboratory mentor: Howard Lipton in the department of Neurology at Northwestern. Then a junior faculty member studying the effects of a mouse polio-like virus, he had an infectious passion for science and the role of the clinician investigator in biomedicine. In the end I also spent my entire academic life prior to becoming a dean studying inflammatory and infectious diseases of the nervous system. So it is safe to say that my medical school experience put me on a path from which I did not really diverge.

Since research was such an exciting part of my medical school experience, it was only natural that gravitated to academic medicine.

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the University of Texas School of Medicine, San Antonio?
I would start at an earlier point, and say that a key step was choosing - or actually being steered toward - the intellectually rich environment at the University of Pennsylvania, where I spent 35 years as a faculty member and chair of Neurology. Although I did not give up my laboratory until I became a dean, as chair more and more I realized that as I grew older my biggest excitement was in creating an academic environment where others succeed, the most important aspect of academic administration. After 10 years I felt I had accomplished most of what I wanted to do as chair, and wanted a different challenge. I never set out to become a dean; as I interviewed and explored possibilities, a deanship seemed to be the most interesting and rewarding way to grow as an administrator. Arthur Rubenstein, the dean at Penn during most of my time as chair, helped me analyze some of those opportunities and feel comfortable that I was up to the challenge.

San Antonio, with its diverse and bilingual population, is an excellent fit for me. I will let other analyze my accomplishments in the future.

What is the greatest difference between the clinical side of medicine and the administrative side?
I guess the greatest similarities are that an analytical mind and experience are as important in clinical as in administrative medicine. The biggest difference is that administration is a bit more about the capacity to understand others and their drives than clinical medicine, not to say that this is not all important in clinical medicine. I think it would be very difficult to be an effective administrator of a medical school without first being a good clinician and without an understanding of medicine.

Of course, the daily activities of an administrator are very different than those of a full time clinician. Nevertheless both are open to all kinds of disruptions because of emergencies of one type or another.

What does an "average" day look like for you?
I am sure that you put average in quotation marks because you realize there is no such thing as an average day; of course that is what makes this such an interesting and rewarding job. On a typical day I meet with members of the dean's office staff to discuss issues in their areas of responsibility, either as a group early each week, or less frequently or as needed one-to-one. I meet with the department chairs, clinical and basic as groups regularly, and with the clinical chairs individually every few months. They come for advice regarding issues in their departments, and often for specific requests for either moral or monetary support. Because medical schools are 'flat' organizations, deans have many more direct reports than administrators in corporations or most other areas of activity.  I am usually reminded of that during the budget season, since I have to meet with each of 25+ units; that consumes large portions of many days for a couple of months.  Problems – and I had no idea the breadth of issues that make it up to the dean's office – come at regularly irregular times. Some of them require them completely clearing my calendar for a whole day.

We are usually in the process of recruiting for one or more leadership positions and of course I meet with all of the candidates. Choosing excellent individuals is probably my most important job; allocating resources the second most important, but the two are very much interrelated. I also meet with many other potential faculty members at the request of chairs and I consider that one of the most fascinating aspects of my position. Most if not all of the candidates are much younger than I am, and I keep up with the 'on the ground' advances in technology and how they are influencing scientific discovery. I treasure that, since I do not get to read the literature as broadly as I used to. I also regularly invite faculty members to lunch so that I can get their input into the school of medicine activities, again to learn about the breadth of work in the school.

I usually see students informally in addition to formal occasions such as the white coat ceremony or the first days of certain milestones. Sometimes in the morning coffee line, or when it is my turn to teach the neurological examination, or when I am in one of the two outpatient venues that I alternate every week. Seeing my own patients (they all either have multiple sclerosis or are being evaluated for it) keeps me grounded as a physician.

I also have a lot of formal activities associated with our hospital partners, alumni, and donors. These are more common in the evenings and on weekends. Being a member of the community is very important in a city such as San Antonio.

What was/were the most memorable experience(s) during your medical education?
Like most or even all medical students, I have fond, fun, interesting, and scary memories. One that I sometimes relate to our medical students took place during my OB-GYN rotation in a Chicago community hospital. A patient came up to the floor with a simple written note that she was in pain, potentially due to a ruptured ectopic pregnancy. I went to see her, and as the only medical person on the ward and probably the emergency room who spoke Spanish I realized during my interview that she was experiencing very severe pain and was scared, and that she was about to go into hypotensive shock. I immediately called the house staff and the nurses and we started the process of transferring her to the operating room, saving her life. I use it as an example for the students that you do not have to have a great deal of knowledge in a specific field to be a contributor to medical care. You just have to listen carefully, and sometimes even having a non-medical skill such as speaking another language is critical.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
Medical school applicants must meet certain thresholds for grades, MCATs, etc.; after all our profession is one that requires the ability to understand enormously complex and often only ambiguously understood systems. After that threshold is met, we are looking for individuals who will be members of an effective team. Often it is the post-undergraduate experiences – and many medical students do something else between their undergraduate degree and matriculation in medical school – that are the most maturing, or that provide evidence of these qualities.

How do you foresee medical education changing in the next few years?
First, I would say that medical education is more pedagogically sound than it ever was. We spend more time looking at how we can make learning and teaching more effective, and how we can ensure that students have all been exposed to critical fundamental elements that make a good physician, let alone prepare for lifelong learning. The new curricula are more patient and disease oriented, focus on analysis, on teamwork and integration of care, and are less emphatic of memorization. They also acknowledge that without good communication skills, even the most knowledgeable physician will not be effective. Our own new educational spaces have tables in large rooms rather than amphitheater-like spaces. Furthermore, we are using electronic images to refine knowledge of anatomy, relying less on traditional dissections. I would expect these trends will continue. There will also be some movement towards cutting back the length of medical schools, and many schools are already doing that with a subset of their students. Simulations and standardized patients are now almost the norm, and they will expand.

What I think will not change is the essence of the clerkship experiences. Interactions with patients are the core of a medical education, and that should never be altered.