Academic Medicine’s Vital Role in Pandemic Response: Dr. LouAnn Woodward, University of Mississippi Medical Center

Shiv Gaglani: Hi, I'm Shiv Gaglani. For those Americans who live in urban areas, there's usually a choice of nearby hospitals capable of providing advanced critical care, including for COVID-19 related illness. But for many rural Americans, there may be only one facility of that type in their region, and it may be a long-distance away. As leader of the University of Mississippi Medical Center and dean of its medical school, Dr. LouAnn Woodward knows the special responsibilities and opportunities that come with being that state's only academic medical center. Mississippi is a state that struggles in many areas that affect residents' health status and is ranked last in the country for the number of practicing physicians per capita. 

Dr. Woodward is a trained and experienced emergency medicine physician and a national leader in medical education. I'm looking forward to learning more about her, the medical center and medical school, lessons learned from COVID, and the state of medical education in the U.S. 

Dr. Woodward, it's an honor to have you on today. 

Dr. LouAnn Woodward: Thank you. I'm so glad to be with you. 

Shiv Gaglani: I'd like to start first with learning more about you and what got you interested in health care, and particularly emergency medicine. 

Dr. Woodward: I was a child that grew up and loved science. That was really sort of the beginning. I don't have a lot of health care professionals in my family. In my generation, there are a number of nurses, but nobody was a physician in my family. But I love science, and that was really, like I said, the spark that got me interested. Once I came to medical school and had an opportunity to see all the specialties, emergency medicine just felt like an opportunity to provide care and to take care of people when they were really sick, and really hurt and vulnerable, in a way. That appealed to me. 

I also really liked the range and the variety. There are no two days that are alike in the emergency department. You walk into the day, and you never really know what the runway is going to look like. Some people find that exciting and interesting and then there are some that don't like it at all. For me, that was a very fascinating part of the specialty.

Shiv Gaglani: I can definitely relate to that. When I was in medical school, that was what I was leaning towards. When I go back, I think it still will be. My best friend from medical school actually finished his fellowship in EM recently. , I know a good amount about the field at this point. Before we dive into the COVID experience, can you give us a bit more of an overview of the University of Mississippi Medical Center and its mission? 

Dr. Woodward: Sure. The University of Mississippi Medical Center is the only academic medical center in the state. When you look at a lot of places, they have hospitals that provide tertiary and quaternary care. They have another hospital that might be the cancer center, and yet another hospital that's the children's hospital, and yet another hospital that serves the safety net mission. 

For Mississippi, we are all of those things. It's a bit of a schizophrenic mission, sometimes. We have the only Level 1 Trauma Center, the only children's hospital, the only transplant program. There's a very long list for which we are "the only." For the state of Mississippi, we are the only game in town when it comes to a lot of the subspecialty care and as you mentioned in the introduction, some of the really high-level critical care that was needed for some of our COVID patients. 

It's a great responsibility, really. But it's also a great opportunity, and we take that role in the state very seriously. What really drives our mission here is what do we need to do for the state of Mississippi? Whether it's on the education side, the research side, or the clinical side because in many cases, we know that if we don't take it on, if we don't do it, it won't happen here and the citizens of our state will have to go out of state. 

Shiv Gaglani: Absolutely. That actually is a good transition to the next question which is, you, personally, and your team have been treating critically ill people from communities all over the state during the COVID crisis and obviously, before then. Can you talk to us a bit about what that experience has been like? Obviously, we're sixteen months into the pandemic now and things are hopefully returning to normal even in Mississippi. Can you tell us a bit more about the response and maybe some of the lasting changes that your medical center is making?

Dr. Woodward: Certainly. In a way, looking back on the COVID experience...it's not over. We still have COVID patients in the hospital here, just like we do all around the country and we're working hard on the vaccine message and encouraging people to get vaccinated. So, it's not over. But we've learned so much. I feel like we are now in sort of a maintenance phase as opposed to the acute response phase. We had the opportunity here, because we were not on that leading edge for the U.S., to have very intense and very regular communications with some of our colleagues in the Northeast and our colleagues on the West Coast who got hit harder early on to learn from them. 

So we took advantage of that opportunity. Here at the medical center, disaster response actually is a large part of what we do for the state of Mississippi. We have an official ESF-8 designation under our statewide disaster response reactions. We are very accustomed to ramping up and responding to tornadoes and hurricanes and other types of disasters that may occur across the state. We've got the infrastructure to turn on for that kind of a disaster. This was very much a different disaster. We had to manage not only our own internal disaster -- how are we going to address supply chain; what are we going to do about N95s; how are we going to manage these patients within our own four walls -- but we were also an important part of the statewide disaster response team in the way of educating, in the way of setting up transfer systems, much like the trauma system. We worked with hospitals all across the state. We worked very closely, literally, day by day by day with our Department of Health. 

We had daily calls. How do we set up a statewide vaccination website? How do we set up a statewide testing website and organizing testing for the state? How do we set up this patient transfer process so that small hospitals could continue to care for the patients that they had the resources to care for, but when a patient exceeded their resources, what's the next level? Which patients do we need to take here? We were able to draw on the experiences that we already had and the expertise, that I feel we have, over the years, very finely tuned around disaster response and now apply that to a pandemic, which is a different kind of disaster than we have had to respond to before.

Some years ago, we stood up an Ebola unit here at the medical center campus, but never actually had any Ebola patients. This really challenged us. But we pledged early on to the citizens and the state of Mississippi that we would bring all of the resources to bear that we possessed. In fact, one of our very early successes was, in a matter of weeks, our microbiology and pathology faculty and all of the teams in those departments, developed an in-house test for COVID. 

If two years ago I had said to the same group of people, "We are going to need, in very short order, a test for a virus that is really not on our radar at all and we're going to need to be able to ramp it up and provide testing for hundreds of thousands of patients" they would have explained to me how that would take at least a year. But in fact, they responded in a matter of weeks. Now that it's in the rearview mirror, that acute phase, it was honestly an inspiring and awesome experience. 

Shiv Gaglani: That's amazing. Thanks for sharing all that. I didn't realize that you are already so equipped for disaster response in general, but it makes total sense given the hurricanes and tornadoes. It's really cool how are you able to repurpose some of that infrastructure. And I like also the analogy that you're alluding to of the innate response, the acute response you all had for COVID or any disaster that existed, and now you're in this maintenance phase or this adaptive immunity of what are the lasting changes that we're going to have. 

Turning from how you all went from responding to the COVID pandemic for your patients in Mississippi, can you talk to us a bit about how the medical school itself adjusted to COVID? How this academic year is going to be different? Hopefully, are you going to keep some of the things, maybe like the telehealth that you may have educated your students on? Just those kinds of examples would be great.

Dr. Woodward: Absolutely. We've had a number of internal conversations about, "Everybody's ready to get back to normal and get back to the way things were." I've said many times to our teams, we're not going back. We're never going back. We have learned that we can respond quickly, and move quickly. Academic medical centers are not known for being nimble and being able to pivot very quickly. But we said, "Okay, we're not going back." Yes, we want things to get back to normal and we want to be able to do those normal things and have celebrations, and do all of those things. But we're not going back to the way things were. 

Before the pandemic struck, we were one of two centers of excellence in telehealth in the country. We are one of only two of those. So, telehealth has been for a long time an important part of the fabric of who we are. Being in such a rural state, it has been a way that we've been able to extend our expertise across the community. But we ramped that up during the pandemic. Some services and some physicians and some programs that had not used it before found it, in fact, very helpful and very usable. Patients who had not been exposed to it before liked it. So, we have new expectations on the clinical side around what we're going to do and how we're going to use telehealth now.

In the education space, after Spring Break, like most of the schools in Mississippi, we told the students, "Don't come back. Shelter in place for the time being. We're not coming back." We realized, however, very quickly, within just another week or two, that the students were not listening to us. [laugh] The students wanted to be involved. So, we said, "Okay, if the students are going to volunteer, then let's try to do it in a way that it's as safe as it can possibly be and we get them the protection that they need" because they were volunteering at our drive-through testing stations, they were volunteering up in the micro lab making test kits when we couldn't get kits, the students were finding ways to plug in and volunteer. 

We decided, okay, let's put some structure around it. At least that way, for those that decide to volunteer, there will be a way that they can do it safely. We developed a disaster medicine elective that had some core didactics and reading for all the students who did it. It was a way that whether they were volunteering in a drive-through testing site or making test kits or doing whatever they were doing to help, they could get some academic credit for that work. So at the end of the day, they've got an item on their transcript that says disaster medicine elective -- that they participated and that they did it. The students have been very involved all along. 

Early on -- earlier than many academic medical centers -- we brought our students back, officially back to school last summer. We did that under the following kind of construct. We said, "Okay, we're going to bring you back, but these are the parameters. If we get into such a crisis with PPE that might mandate, in fact, that you have to again step back. We want you to be there. We want you to learn, but it's got to be safe." If, in fact, a whole lot of the class got sick, then we would rethink this. But as long as we feel like it's safe, and the students are healthy, we wanted them to be in the clinical setting. 

They've been a tremendous part of our response. We will -- as this next academic year begins in the Fall, especially for the preclinical students -- we will bring what we felt like were the wins, bring some of the positive things that we found from the pandemic and then also bring back the things that we missed from the more traditional curriculum. We'll have the students back in person but will have many more virtual options. Some activities will continue to be virtual or something that is other than in-person.

We ramped up our use of simulation, as you might imagine. There are some things that we found that could be done just as well and maybe even better in a non-in-person setting. We're going to try to marry up, really, the best of both worlds. We do a lot of, just like all schools, there are a lot of in-person celebrations, in-person orientation. We have a family day. We have a lot of different things like that. And this year, in some cases, we were able to livestream those different activities so that families that normally attended in person now, at least, had the option to view a live stream. 

What we found was, we had much broader participation from families. We have family members from all over the country that were able now to see their nephew, their niece, their grandchild participate in some significant event. We thought, wow! Even when we bring these things back in person, and we perhaps have a small contingent of the family actually present, wouldn't it be fun to continue to livestream it, so that family members all across the country can be a part of it if they choose to? I don't think we have the 100% what's it going to look like when we get back to normal view, but we are trying to merge the positive silver linings that we learned from the pandemic with what we feel like were the things that we lost, and we really want to bring back. I know medical schools all across the country are working to do this. I think medical education on the other side will be greatly enhanced. 

Shiv Gaglani: I think those are wonderful examples, especially the academic credit, and what you were just saying about getting more extended family members involved in these milestones, like Match Day and other things like that, especially because I think society has an even greater respect for the healthcare heroes and things that their family members and friends are doing in this space. 

One thing I didn't share in the introduction is also your role in national leadership in medical education. You're previously chair of the Liaison Committee for Medical Education -- which is the accrediting body for all medical schools in the U.S. and Canada -- and you're currently board chair-elect of the Association of American Medical Colleges. One of our previous guests was Dr. David Skorton, actually, on the podcast, who I know you know well. There's probably no one with a better grip on what's happening with the state of medical education as a whole, beyond even Mississippi. How do you think medical schools as a whole handled COVID overall? And what do you think some of the lasting national changes would be? I mean, is this something you all have discussed at the national level at this point? 

Dr. Woodward: Of course it is. You've done your homework. Dr. Skorton, actually, is a wonderful human being. He has played such an important national role that I think has just been fascinating. I would say, when it's all said and done and history is being written about this pandemic, there are some things that we could have done differently and we could have done better. But in the context of this being a virus that we were not familiar with, and there were so many unknowns and had such variability in its presentation...two or three people with basically the same phenotype could get exposed to the virus and have completely different courses of illness. Everything from not sick at all to critically ill and die. So academic medicine was called upon to figure a lot of things out. The research mission of academics has never been so critical. What is this? How do we test for it? Why is it doing the things that it's doing? How can we treat it? We need a vaccine. All of these were pressing and urgent demands. 

At the same time, we had to continue to educate the healthcare professionals because you know, oh, my stars, everybody needed nurses and we needed nurses urgently to take care of these patients. All of the missions of academic medicine were stressed in different and new ways. And you think about academic medical centers all around the country...there are some that are community-based, public institutions, private institutions, research-focused, part of a larger academic, either university or organization, some that are not, some that have been around for hundreds of years, some that are ten years old. But I have never seen, with all these disparate characteristics, academic medicine as an entity come together around a singular focus like we did for these last eighteen months.

I think we've been able to respond in the way that we have because people have been communicating and sharing information. I mentioned earlier how early on, before we had the first COVID patient, we had already talked to our colleagues across the country, and they were saying, "You need proning teams. You need to do this. You need to prepare in these ways." People were sharing information so willingly. Sometimes, in academic-type societies, there's a sense of, "This is my top-secret information and I might not share it." People were sharing so willingly because we were all in the same boat. To see all the organizations in academic medicine come together around that multifaceted but singular focus was thrilling, honestly, and just amazing. 

And the Council of Deans...we in the AAMC have a group called the Council of Deans. We were getting together weekly -- virtually of course -- and just talking about things like, are you requiring vaccinations for all these people? How are you doing the testing? What are the visitor policies in your hospitals? That was a pain point, not being able to have people visit and be with patients like we were all so accustomed to doing. Everybody played a different role from their own organization, but all efforts were pointed toward a single focus and a single goal. I think when it's all said and done, considering all of the shifting that we had to do and had to do quickly, this has been a golden moment for academic medicine. 

I think we have really been able individually, but yet collectively, to show our value and for people to understand the importance -- maybe in a way they had not before -- of the research that goes into academics and into advances in healthcare and the need for physicians and nurses and people to be inspired and to want to be part of that work. I feel like academic medicine has had one of its finest hours, probably, that will ever occur at least in my lifetime. I can't say for the history of the world, of course, but at least for now. I think we responded as an entity very well and did a lot of good things for the country. I think in different states and in different communities, the leaders in academic medicine were really looked to as the experts. So while we were figuring it out, we also had to give advice and make very critical decisions with incomplete information. 

Shiv Gaglani: Yeah, I know. I couldn't agree more with all of that. We've been fortunate to have a number of your fellow COD members on the podcast too. You were actually nominated by Dr. Larry Chin of SUNY Upstate which is why we invited you and Dr. Peter Buckley, who I know also was a chair of COD. 

I think you've done a great job of explaining some of the lasting changes that are going to happen. Hopefully, the collaborative aspect is one of those, overcoming the "not-invented-here" phenomenon.

Dr. Woodward: Taking care of patients in different ways, sharing information in different ways, collaborating. But I hope that as a country, a big lesson we've learned and something that we will do to position ourselves to be prepared in a different way for the next pandemic -- because there will be another one, probably in the next decade -- is an emphasis on and an investment in public health. This pandemic exposed our weak points, and being prepared from the standpoint of public health is a weak point for our country. 

Shiv Gaglani: Absolutely. Hopefully, our memory isn't so short-term that we don't forget to keep investing and then growing that infrastructure. So, COVID is still very much here globally and certainly in the U.S. There's a lot of work that you all have been doing at the University of Mississippi outside of COVID to improve the overall health of the state's residents, something I know you care deeply about as a native of Mississippi. I want to give you an opportunity to talk about some of that work. What else has got you excited in addition to all the work that you do to raise the line in Mississippi? 

Dr. Woodward: We are very invigorated and excited right now at this organization. Some of the changes that we have made that were driven by the pandemic -- and there are so many in the clinical part of our mission, in the research side, in the academic side, and just in how we do our own business side -- we are going to continue and we are going to maintain. 

People will ask me all the time out in the public, "Why are you doing this?" Growing the class size in the medical school. We've had an aggressive growth timeline. Just as you mentioned earlier, we're last in physicians per capita. I'm not sure who'll be in my job twenty years from now, but they will not have to say we are last in physicians per capita. We are growing all of our health professional schools, every single one of them. We are growing with an eye toward what are the workforce needs in Mississippi. We opened up in November, in the midst of the pandemic, a new children's hospital facility. It is fabulous, it is beautiful, it is wonderful. And people say, "Why are you doing that? Why are you doing the research in these particular things? Why did you open a clinical trials unit? Why are you doing these things?" 

And what I tell my leadership team is, "This is the easiest question ever because it doesn't matter what the question is, the answer is always the same. And that is to improve the health of Mississippians." That is "the why" behind everything that we're doing. So we are working to grow our clinical footprint. We're partnering with others all across the state, establishing pediatric clinics on the Mississippi Gulf Coast. In the northern part of the state, we're the only pediatric hospital and in many cases, the only one doing these specialty programs. We are working with others to partner around transplant and a number of these things. Like I said, we're growing our class sizes. It's all based on what are the needs in this state. 

We just opened about a year ago a new home for our Mississippi Center for Emergency Services so we can grow and expand that footprint in emergency response and in disaster response. We're working hard to provide all the programs we need for the education of our students, but also to answer the unmet needs for the citizens in Mississippi. 

Shiv Gaglani: That's awesome. I love that concept of your North Star. Everything you do, from the clinical trials unit, to expanding your class size enrollments, is about improving the health of Mississippians, which is wonderful. 

Dr. Woodward: That's right. The answers are very easy. It's all about that. 

Shiv Gaglani: So we're recording this just as you're about to enter or welcome a new class of students, residents and other trainees. What advice would you give to young career healthcare professionals in our audience about meeting the challenges of the pandemic and beyond?

Dr. Woodward: So a lot of us have talked about, is this a good time to be in medicine? Is this a good time to be in health care? The last year and a half has been very stressful. We've all seen the photographs of nurses and respiratory therapist with the pressure sores on their face from the N95s. It has been a very, very stressful year and a half. But I would also say there has never been a more exciting time to be in health care and there's never been a greater need. Despite the pandemic that we have lived through, it is rewarding every single day. It is meaningful every single day. You never have to close your eyes and think, did the work I have done today, did it make a difference? Does it matter? The answer is yes. 

Especially when you're in a place like Mississippi, the stakes are high. But there are many places like this around the country where the stakes are high and the need is great. It is rewarding if you love it. It would be a terrible thing to do if you didn't have the passion for it. But if you have the passion for it, it's rewarding. This last year, as we were going through the pandemic, several times I had those fleeting senses of fear and uncertainty, thinking to myself, is this pandemic going to scare away applicants to medical school, to dental school, to nursing school, to physical therapy school? What's going to happen to our applications this cycle? Are people going to be scared off by the pandemic and just think to themselves, I'm a smart kid...I'm going to go do something else. 

One of the most amazing things is that in this year when there were so many, quite frankly, just scary stories that were out there and we were all dealing with our own uncertainty --and people who are in healthcare typically are type A folks and don't like the unknown -- what we saw was that these smart, motivated, intelligent young people who could do anything with their life that they wanted to do were choosing healthcare and choosing medicine for all of our professional schools here on this campus. We have six. We had record application numbers. 

So when people could have turned their back and said I'm going to go do something else, they instead chose to look at this and say, "I want to be a part of this. I want to make a difference. I'm walking toward this." And that has been one of the, perhaps the most gratifying and just inspiring things of the whole year for us. 

Shiv Gaglani: That's so great to hear. I know there was some publicity around what was called "The Fauci Effect" seeing all these inspirational clinicians and public health figures and researchers being part of why people wanted to apply to medical and other health professional schools. But then, obviously, having leaders like yourself who are able to step up and make sure that they have the infrastructure to do so, that the curriculum continues and actually improves because of it. Is there anything else that I haven't asked you about that you'd like to share with our audience today?

Dr. Woodward: I think we've touched on most of the things. I think, when we get five years down the road, the pandemic will be determined to have been a very important point for the country and for medicine in general. It felt like we saw medicine merge a little bit and coalesce, come together. But as a country, in many cases, I saw people not coming together. I saw people being more fragmented. I think as a country, we failed to come together against a common enemy. I feel like, at least from my perspective in medicine, we did, in many ways, come together against a common enemy. Perhaps not as perfectly as we could have. Nothing was perfect. But I hope that as we go forward, we examine this and we look for those opportunities where we could have done better and that in fact, when we have to face the next pandemic or the next crisis as a country and as a group of medical professionals, we learn from this. 

But I think that it really exposed some of our strengths and some of our weaknesses. We do have that opportunity to learn and to rally. I'm proud of what we have done. When I say we, I mean, certainly, this organization. But I also mean medicine as a larger community and academic medicine. I'm very proud of what we've done. Now, the challenge is don't relax. Don't stop. Take what we've learned and keep pushing, and let's make it better for the next generation, and for the next round. And we can do that. 

Shiv Gaglani: Those are some certainly inspiring words to end on. So Dr. Woodward, I really want to thank you for not only taking the time to join us on the Raise the Line podcast, but more importantly, for the work that you and your team are doing to actually raise the line and train more healthcare providers. 

Dr. Woodward: Thank you. Thank you for having me. This has been fun.

Shiv Gaglani: Likewise. And with that, I'm Shiv Gaglani, thank you to our audience for checking out today's show. And remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.