Leaders in Medical Education

Dr. Jerris Hedges, Dean of University of Hawaii at Manoa John A. Burns School of Medicine

Osmosis Team
Aug 4, 2016

Dr. Jerris Hedges, Dean of the John A. Burns School of Medicine (JABSOM) since March 2008, is known nationally as co-author of one of the leading texts in patient care, Roberts and Hedges’ Clinical Procedures in Emergency Medicine, now in its sixth edition. In Hawaiʻi, he is also recognized as a leader who has strengthened the medical school by building vital bridges between JABSOM’s community partners and collaborators. In 2013, he was named “Physician of the Year” by the Hawaiʻi Medical Association.

From his modest roots, Dr. Jerris Hedges personally understands how important it is that Hawaiʻi’s young people have opportunities to succeed, and how critical is the need to provide physicians and other health care workers in our rural, under-served communities. Dean Hedges and colleagues are expanding the medical school’s research focus on addressing disparities in both access to care and treatment outcomes that disproportionately affect Hawaiʻi’s citizens from certain cultural and ethnic backgrounds, especially the rural, the poor and those of Native Hawaiian, other Pacific Island and Filipino ancestry.

Dr. Hedges earned his bachelor’s degree in aeronautics and astronautics, his master’s degree in chemical engineering, and his medical degree at the University of Washington. He completed his residency at the Medical College of Pennsylvania and served on the faculty of the University of Cincinnati - School of Medicine before joining OHSU. Dr. Hedges also holds a Master of Medical Management from the Marshall School of Business at the University of Southern California.

How did you decide on a career in medicine?
My undergraduate plans were to do biomedical research with my engineering training (aeronautics & astronomics), but I was encouraged by my faculty mentor to become a physician as the opportunities for biomedical research were greater for physicians. The opportunity to apply engineering principles to solve problems in the life sciences seemed like a good fit.

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the University of Hawaii at Manoa John A. Burns School of Medicine?
I stayed active in research throughout all phases of my medical career. Meeting leaders in the field who would mentor a curious young mind was the strongest indicator that I was on the right path. These mentors gave me opportunity to explore and expand the boundaries of the new field of Emergency Medicine. Applying my engineering systems knowledge provided recognition that led to induction into the Institute of Medicine (now the National Academy of Medicine). Understanding the steps from being the person being helped (guided) to being the person who was doing the guiding and eventually being the person setting the vision for the research team and the larger application of the research findings was critical. While much of that transition came intuitively from my servant leader background, learning about Tribal Leadership from David Logan was a key turning point in my path to higher administration.

What is the greatest difference between the clinical side of medicine and the administrative side?
The former is hands on and the latter is working through others. The former requires trust in yourself, while the latter requires trust in others. Both require anticipation based upon experience, but the latter is more challenging in that you do not always understand the values and context of those whom you lead administratively. Where you have the time, you should seek to understand the values and local context of those whom you have been asked to lead.

What does an "average" day look like for you?
Serving as dean is similar to working in the emergency department. There is some preparation and routine activities that must be done. You have a fairly good idea what might come through the door each week, but you cannot always predict the timing, context or the severity of the issues. Many of the issues are fiscal or relate to personnel actions/decisions. Within each week, I seek to teach students, faculty, and their leaders. Some of the education is clinical, but much is about strategic planning, prioritization, resource management, and personnel selection/development. All of these elements have strong corollaries in the systems delivery of emergency care.

What was/were the most memorable experience(s) during your medical education?
As a student, I was always in awe of how much could be done by applying knowledge and experimental technique to clinical procedures. That experience led to my subsequent co-editing of the Roberts & Hedges Clinical Procedures in Emergency Medicine text. Applying scientific principles, physiology, anatomy, and experimental knowledge to the art of procedural technique was an extension of my underlying desire to apply biomedical engineering principles.

What do you think is the biggest challenge facing physicians today?
Many challenges face today’s physicians. These challenges include continued knowledge (information) expansion, regulatory demands (including documentation overload for reimbursement), mismatch of reimbursement & meaningful care delivery, definition & delivery of care quality, and definition of the role of the physician versus other care providers in the future.

In a time where technology is rapidly advancing and there is a push toward “precision medicine” initiatives and moving medical records to electronic databases, how can we best streamline this process while keeping in mind patient privacy?
There is too little time to address this challenge adequately in this Q&A session. Much of what gets documented with today’s electronic health record is meaningless information. Electronic records that are bursting with such meaningless items will lead to greater medical liability risk, reduced time to transfer meaningful information in the desired information rich format that actually impacts future care, and a false sense of understanding. Electronic databases will always be subject to hacking. Patient privacy should be respected, but cannot be guaranteed, given the limitations that come with essential information transfer and storage.

There is an enormous debate these days as to whether resources should be primarily allocated to fighting diseases or the distal causes of diseases. What are your thoughts on this issue of proximal causes versus distal causes?
We do not fully understand the precursors to diseases and hence today’s preventive measures may not be tomorrow’s preventive measures. We will always be faced with the duality of disease treatment and disease mitigation/prevention. The latter is preferred, but will never be complete, so we must remain skilled in disease recognition and its treatment. Nonetheless, we will ultimately know more about the role of interactive genes and epigenetics and how these relate to stress, environmental triggers, inflammation, and our own microbiome to bring about what we label as “disease”.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
Effective test taking is an essential, but represents a threshold phenomenon and not a measure that warrants added weight for selection into medical school with each improvement in MCAT score or GPA. Once a threshold for learning is reached, the interpersonal (soft skills) are more important. That is, the ability to overcome hardship (resilience), ability to empathize, commitment to hard work, collaborative skills, and ability to communicate (not simply to speak or write, but to truly communicate by listening and understanding).

How do you foresee medical education changing in the next few years?
We will rely less on memorization of facts and expect more application of knowledge. We will expect fluid use of electronic media. We will anticipate more high tech to be delivered with high touch. We will emphasize more interprofessional team training and increase the realism of simulation training.