EVCP Expresso – March 2018

March 1, 2018

Dear Colleagues:

Last month, on February 14, our country was shaken by yet another national tragedy, the result of gun violence. We grieve and are outraged. The frequency of these incidents is heartbreaking and troubling. The victims and their communities are forever changed, and the collective cry to move beyond just thoughts, words, and prayers is loud and clear. Gun violence is a public health failure, but the timely action, #WhiteCoatsAgainstGunViolence, taken by our UCSF students brought me solace.

To prevent more senseless loss of life, we must continue to care and advocate for change while supporting the individuals and communities devastated by these attacks. Progress toward changing gun control laws has been frustratingly slow, but I encourage you to stay engaged in the debate and speak your mind, both in words and through your ballot.

Many think the solution to these tragedies is more support for mental health, not gun control – but this approach stigmatizes individuals suffering from mental illness. I’m glad that UCSF experts are weighing in on this issue. Please read this editorial by UCSF medical resident Matthew Hirschtritt and Renee Binder, professor of Psychiatry, published in JAMA Psychiatry yesterday, February 28: “A Reassessment of Blaming Mass Shootings on Mental Illness.”

Meanwhile, I am thankful for the progress that we consistently make at UCSF that affects daily life, research, and education. The following stories are only three examples:

Amidst horrific events that we struggle to understand and explain, we must strive to stay true to our mission to improve health and reduce suffering.

Please keep sending your ideas and comments to me at [email protected].

In peace,



UCSF’s Unsung Heroes: Our volunteer faculty

One of my favorite mantrams is “It’s all about the people.” Meaning, UCSF would not be the top health sciences university in the country without, first and foremost, the remarkable people who come here to work and study every day. In addition to what happens on-site, however, our students gain valuable experience out in the real world under the guidance of practicing clinicians, many of whom give generously of their time and expertise as volunteer faculty, as a way of paying it forward to the next generation.

No one would argue with that, but I reached out to the four schools for more details:

The School of Dentistry singled out one of its superstars, Pamela Alston, who also is dental director of the Eastmont Wellness Center in Oakland, a part of the Alameda Health System. Pamela grew up with her eight siblings in Emeryville, impoverished financially. While their mother impressed upon them that they were rich in other ways, their economic situation had an impact on their lives, including access to health care. After some unfortunate childhood dental experiences, Pamela made the decision to become a dentist and has dedicated herself to caring for communities similar to the one in which she was raised.

With her incredible energy, Pamela bounds around the former department store turned clinic that now offers an array of health services to disadvantaged, under-resourced members of the community. The patients, who come needing complex care including crowns and root canals, often present with a backlog of treatment need, and they represent a diverse population that speaks thirty different languages, often necessitating the use of interpreters over video. The students learn to educate patients on dental care and personal oral health needs in ways that are not judgmental, and they focus on convincing and motivating patients to make positive changes. Pamela points out display cases created by UCSF dental students who worked with her, aimed at educating people about the risks of sugary drinks and the importance of exercise. It remains a tough neighborhood: someone stole the brains from third-year dental student Jessica Baisley’s educational display on brain health.

The students get a terrific hands-on experience, but Pamela gets something out of it, too. “They extend my reach to my patient population,” she says. “That means more patients have access to care, and we get access to the students. They have introduced new techniques to my clinic. They keep me contemporary. I learn from them.”

Fantastic! That’s certainly something we aim for in the volunteer faculty program. “Our goal is a win-win, so that the students are providing a value to a site,” says Valerie Clinard, director of experiential education in the School of Pharmacy. Valerie says 30 percent of the curriculum is experiential, with students placed in hospitals, clinics, pharmacies, and industry. The School of Pharmacy alone relies on over 600 volunteer faculty members around the state.

Volunteer faculty serve as hands-on preceptors in their community settings and also come to UCSF to teach in our classrooms. They’re involved at every stage of education, although they become even more critical as students move through the curriculum, according to Margo Vener, vice chair of education in the Department of Family and Community Medicine.

“We see the most dramatic impact in the third year,” Margo says. Every student in the School of Medicine does a rotation in family medicine, winding up in a clinical setting under the tutelage of volunteer faculty.

Margo concedes it’s hard to quantify the impact, but she takes a stab at it: The average preceptor teaches for half a day, twice a month, about five hours each session (not including preparation or charting). Those ten hours per month equal 120 hours per year. Multiply that by 100 volunteer clinicians in the clerkships, and you get 12,000 clinical hours per year. And that’s only for third-year family medicine clerkships!

“They are incredibly committed folks,” Margo adds. “They have been extraordinary role models in terms of patient care and their humanity and professionalism. They teach what it’s like to have a sustainable medical career, and play a pivotal role for students.”

And the students give the faculty rave reviews! Margo cites the feedback for Roger Pitzen, who has a family medicine practice in Sebastopol. One student wrote, “Over the three years that I’ve worked with Dr. Pitzen, he has been a phenomenal teacher and mentor. His enthusiasm about working with students to improve their medical knowledge and skills is simply unmatched. His tremendous dedication to his patients is evident, as is their adoration of him as their physician. I only hope that I can one day excel as a clinician and educator like Dr. Pitzen.”

Every school at UCSF relies on these generous individuals. “Students see real-life experts in practice and work side-by-side with them, growing more independent and confident as their assignments continue over a quarter or longer,” says Catherine Waters, interim associate dean for academic affairs in the School of Nursing. “We would neither be able to meet our accreditation requirements nor our professional obligations, were it not for these volunteers!”

So – to all our volunteer faculty – 10,000 times over, thank you!!!

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2025: An important year for carbon neutrality and addressing hunger

Our collective daily activities have a significant impact on our planet. Most of us are becoming more thoughtful in our choices and are trying to reduce our carbon footprint. We are well beyond the question, “paper or plastic”? And we now understand the direct correlation between the foods we choose to eat and how they make their way to our dinner table – including food provided to confront the challenges of food insecurity. And 2025 is a big year for these seemingly disparate initiatives that are actually quite interconnected. UCSF is participating in both in a big way, and here’s an update on the Carbon Neutrality Initiative (CNI) and more detail about the Global Food Initiative (GFI).

The University of California takes these issues seriously. In April 2017, I wrote about why UC President Janet Napolitano instituted the CNI, aiming for the UC system to be carbon-neutral by 2025. She also has taken on “one of the critical issues of our time: how to sustainably and nutritiously feed a world population expected to reach eight billion by 2025” by launching the GFI.

In both initiatives, UCOP offers annual student fellowships, and some of our most forward-thinking students have participated over the years. Selected for CNI fellowships, pharmacy students Hugo Aguilar and Yaser Khoshal are developing a course related to climate change and health; Gabriela Weigel and Carolyn Rennels in the School of Medicine have a project on women, the environment, and physician activism; and resident Clifford Bielinski is looking at improving energy efficiency in the operating rooms.

Meanwhile, under GFI, J. Daniel "Dan" Kelly is studying food security in parts of Sierra Leone hit hardest by the Ebola epidemic; master’s student Tammy Nicastro is examining the ties between HIV care, agriculture, and food security in western Kenya; postdoc Emily Tuthill is taking a deeper dive into the impact of food insecurity on depression and emotional mental health among women living with HIV in the U.S.; and Jason Parad and Briton Lee are working toward making the UC system “beef-free,” given the effect of raising cattle on the environment, as well as the consequences of eating beef for heart health. (I know you burger lovers are cringing, but it’s a serious issue!)

UCOP allocated money to each campus to address the issue of food insecurity within our UC student populations. Think about it – many UCSF students carry tens of thousands of dollars in undergraduate debt, and the vast majority take on more debt to fund their higher education…often while trying to support a family. Barbara Smith, a financial analyst in Student Academic Affairs and the co-chair of Basic Needs and Food Security at UCSF, tells of several great programs we’ve launched to help students who otherwise do not have access to affordable and healthy food. The UCSF Food Security for Students web page describes the resources available to students.

Perhaps best of all, through the program, we’re tackling the issue of food waste and hungry students with an innovative Food 4 UCSF Students app that was the brainchild of Elizabeth Watkins, dean of the Graduate Division and vice chancellor of Student Academic Affairs. Its simplicity is genius! Between marathon meetings, conferences, and special events, there’s a lot of catered food served at UCSF. Most of the time, there are a lot of leftovers. Why not alert students? So, the Student Academic Affairs team launched a text messaging system. I’ve seen it in action – impressive.

More than sixty event planners and food providers have signed up on the app, and we’d love to have more. Hundreds of students receive those texts, and when the call goes out, they flock. “It’s truly amazing,” says Alece Alderson, director of student success and first generation programs, “The food is often gone in less than ten minutes. When meeting students you hear their stories of how they got to UCSF. You see them smile and express their appreciation for the programs and services and it is a reminder of why our work is so impactful.”

We can and we must meet the 2025 CNI and GFI challenges. Read more about our commitment to the environment on the UCSF Office of Sustainability website. And remember, UCSF gives its own sustainability awards: Chancellor Sam Hawgood presented the most recent ones last July. Nominations are being accepted this month, so nominate someone or a program today! Write Gail Lee, our sustainability director, for information.

Thanks for doing your part – our planet depends on it.

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A Higher Rate: Reimbursement for facilities and administration expenditures – it’s good news

Recovery of Facilities and Administration (F&A) expenditures is vital to our ability to perform our research, and how these dollars are recycled to further support the research mission is among the most commonly misunderstood aspects of a research university. In the current federal climate, as recipients of these funds, it is imperative to take the time to understand F&A. Over the last two years, we’ve made available several useful, instructive resources – starting in November 2016 with an entire Expresso dedicated to indirect costs, followed by Dean Talmadge King’s overview as part of his Dean’s Forum series, and last fall, UCSF produced a marvelous video that explains this complex issue in an easy-to-grasp way. It’s well worth the five minutes to watch!

Rates are negotiated annually, and we were concerned about the direction being taken by the current administration in Washington. While some want to reduce the government’s role in reimbursing universities for F&A costs, UCSF has countered that such a reduction would harm our ability to provide and maintain the critical infrastructure needed to support sponsored research. This includes buying specialized equipment, hiring certified research administrators, purchasing state-of-the-art computers, and most importantly, building and maintaining facilities where research can occur. Thankfully, our team presented a persuasive argument and did a great job negotiating the new federal rates, so we did very well.

Here’s what happened – UCSF’s negotiators were successful in convincing the federal government to raise the rates at which it reimburses us for F&A costs. This rate negotiation is very important not only because the federal government is such a significant source of F&A recovery – providing $196 million of our total recovery of $252 million last fiscal year (2016-17) – but also because these F&A rates are used for many industry-funded contracts as well.

In December, Teresa Costantinidis, our vice chancellor and chief financial officer, sent an email announcing the new rates for this fiscal year. She wrote, “The key item in the agreement is the on-campus organized research rate, which will rise from 58.5 percent to 59.5 percent this year and then gradually to 61.5 percent in 2020-21. The change in the 2017-18 rate will be effective for grants and contracts awarded on or after November 27, 2017.” Teresa adds, “From UCSF’s perspective, it’s a great rate. We want to see the federal government pay its share of the cost of doing research here.”

UCSF endured a particularly strenuous and lengthy negotiation cycle, as the Department of Health and Human Services came back with three rounds of multi-page questionnaires, in addition to conducting a three-day site visit and interviews with faculty and senior campus staff. Our effort was rewarded with the rate increases described above. The improved reimbursement level will provide needed funds to support UCSF’s mission and standing as the preeminent health science campus.

The new federal rates apply to UCSF on-campus and off-campus activity. For off-campus research, the administrative rate of 26 percent will continue to apply.

It’s still very challenging to put together all the resources to cover our basic infrastructure needs. Unsurprisingly, UCSF has the highest federal F&A rates in the UC system, reflecting the higher costs of supporting research here due to both the intensive scientific work we do and the higher cost associated with our location in San Francisco. But we are in a much better position than we might otherwise be, and we owe an enormous debt of gratitude to the team who accomplished this on our behalf.

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Dan’s Tip of the Month

Keep calm and stop saying umPublic speaking is an important skill in our line of work but an insidiously common problem is unconsciously relying on filler sounds and words (“um” and “like” and “you know”), which can be very distracting, if downright irritating, to an audience. I recently found a great app that addresses this habit – it’s called Ummo. It’s a customizable, mobile speech coach that will track ums and uhs, pace, word power, clarity, and more – anywhere, anytime. A real game changer! In fact, I found that, like, purchasing the app and, uh, having it on my phone has made me, um, much more aware of, you know, those filler words! Note – if you prefer human feedback, check out one of the Toastmaster groups at UCSF – UC Oracles, Toastmasters for Health, or Toast of the Mission.

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