Hawgood Leads Medical School at Critical Time in UCSF History

When Sam Hawgood, MBBS, came with his wife and 2-year-old son to the University of California, San Francisco in 1981 to pursue his career as a physician-scientist, he thought he would return to the home they had sublet in Australia in two years.

Today, 27 years later, Hawgood officially takes the helm as dean of the UCSF School of Medicine and vice chancellor for medical affairs. In this high-level post, Hawgood leads one of the world’s most prestigious medical schools, as measured by its award-winning faculty, educational excellence, federal funding for research and scientific breakthroughs that have saved and improved lives. Read the news release.

“It’s been a wonderful 27-year career here at UCSF,” Hawgood says. “I look forward to continuing to ensure that we advance our mission as a great public university dedicated to healing, teaching, research and service.”

A specialist in the care of newborns, Hawgood came to UCSF to learn from Professor John Clements, MD, whose work revolutionized the understanding of the lung and led to a landmark discovery that has reduced infant death rates dramatically. He credits Clements — who demonstrated “superb scientific training and quiet wisdom” — and others who have mentored him through the years.

“Academic medicine is never a stagnant career because one has the opportunity to learn from students, scientists and peers to fundamentally change the way we practice medicine,” he says.

Hawgood has achieved an international reputation in neonatology during a distinguished career at UCSF, where he is a professor and chair of the Department of Pediatrics, associate director of the Cardiovascular Research Institute, and president of the UCSF Medical Group, roles that he will relinquish with his new responsibilities.

His wife of 32 years, Jane, has served as a clinical social worker in adult palliative care at UCSF for the past two decades.

In promoting him from interim dean to dean and vice chancellor for medical affairs, new Chancellor Sue Desmond-Hellmann, MD, MPH, said that Hawgood “has proven himself to be a true leader and the right one for the UCSF School of Medicine at this critical point in our history.”

Founded in 1864, the medical school has evolved from a small set of classrooms at the foot of Mount Sutro into an academic powerhouse now occupying seven major sites in San Francisco and Fresno. It consistently ranks among the nation’s best medical schools, and its faculty are known for groundbreaking basic science and clinical research in many areas, including cancer, HIV/AIDS, and fetal and transplant surgery, to name a few.

And while winning nearly $384 million in research funding — the second-highest in the United States — from the National Institutes of Health in 2008 and receiving strong financial support from private donors, the medical school and the entire 10-campus UC system are grappling with the consequences of a state financial crisis of unprecedented magnitude.

The school, which has a $1.25 billion operating budget, now faces a $170 million impact as a result of state revenue reductions and expense increases, such as contributing to the UC retirement system and paying new recharge fees to support improvements to the UCSF data network.

That’s why Hawgood’s short-term goal is to respond to the financial situation by working with a school task force, which also comprises members from the medical center and the Chancellor’s Office, to protect the school’s revenue and fulfill its responsibilities for providing high-quality patient care. He is also working with colleagues from across the University to find solutions to sustain and strengthen the school and UCSF during these tough economic times.

“Working collaboratively with our partners on the campus, at the medical center and in the other schools, we have enormous opportunities for both revenue enhancement and expense reduction,” he says. “I am confident that — working together — we can not only protect, but enhance our ability to advance our missions.”

Over the long term, Hawgood will invite the campus community to help chart a new course for the medical school by developing a schoolwide strategic plan that integrates with the campuswide and medical center strategic plans.

In a recent interview, Hawgood outlined his priorities for the year ahead. They are to continue to lead the school as it:

• reforms medical education through curricular innovation
• transforms translational research through new initiatives like molecular medicine, genomics and stem cells
• builds on partnerships with industry and affiliated institutions
• develops a new business model to fund graduate education, since state support is shrinking
• finalizes designs for UCSF Medical Center at Mission Bay and plans for release of space on the Parnassus and Mount Zion campuses and
• works with the donor community to realize UCSF’s potential

Building for the Future

As Hawgood looks toward implementing his priorities over the year ahead, it has become abundantly clear to him that the philanthropic community will play a critical role in UCSF’s ongoing success. Philanthropy, in the form of gifts and endowment income, represents close to 10 percent of the school’s annual revenue.

In fact, for the past six consecutive years, revenue from private support has surpassed the revenue UCSF receives from state appropriations. In the fiscal year that ended June 30, UCSF received $300 million in private support and $243 million in state appropriations.

“It’s been inspiring to me over the last 18 months to see the tremendous support and passion that the philanthropic community brings to UCSF and particularly the School of Medicine,” Hawgood says. “I have become close with many of the friends of UCSF and look forward to further advancing not only my own vision for the school, but also what has become apparent to me as their vision of what they would like the University to do for the city of San Francisco and for the world.”

Part of that vision is advancing the promising field of stem cell research. UCSF is constructing a $123 million stem cell center on the Parnassus campus, a building that is designed to enhance scientists’ efforts to develop novel treatments for such diseases as diabetes, cardiovascular disease, Parkinson’s disease, HIV/AIDS and cancer. Locating the stem cell program at Parnassus near UCSF Medical Center enhances the opportunities for basic, translational and clinical researchers to collaborate, Hawgood points out.

The building, to serve as headquarters of the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at UCSF, will reinvigorate the Parnassus campus, which has not seen a new research center rise since construction of the Health Sciences towers in the mid-1960s. It also makes it easier to recruit and retain top-notch faculty, Hawgood adds.

Thanks to UCSF’s friends in the donor community, the city and county of San Francisco, and partners in business and industry, the University is achieving its ambitious vision to create a thriving biomedical research campus at Mission Bay, where scientists and scholars work together to better understand the basic biological mysteries of life.

The single largest project at Mission Bay — listed as a priority in the UCSF Strategic Plan — which Hawgood continues to spend a lot of time and energy in planning and fundraising for, is the $1.6 billion UCSF Medical Center at Mission Bay, a 289-bed, integrated hospital complex to serve children, women and cancer patients.

UCSF is raising $600 million for the medical center, which is expected to open its doors in 2014, “giving neighbors access to a world-class hospital right in their own backyard and serving as a valuable regional resource for patients throughout Northern California and beyond,” Hawgood says. The medical center at Mission Bay also will provide health care professionals with facilities that will better enable them to deliver high-quality, patient-centered care that UCSF has provided for the past century.

“I have practiced clinical medicine throughout my career, and for more than 30 years, I have enjoyed providing the highest-quality patient care,” Hawgood says. “Now, as dean, I have an opportunity to work hand in glove with Mark Laret [CEO of UCSF Medical Center] to advance UCSF as one of the true premier health care providers in the world.

“We are at a critical period in the project — the design and construction documents are almost completed,” he continues. “We have a template in front of us to build a state-of-the-art hospital complex for children, women and cancer patients, and we are on target to break ground in 2010.”

UCSF officials will go to the UC Regents next year for final approval to allow construction to begin near the existing teaching and research campus at Mission Bay.

“The Mission Bay specialty hospitals will link clinical care to research at Mission Bay, fulfilling our vision for that campus,” Hawgood says. “The part that is so exciting is that basic science, translational science and clinical care on the campus — which is increasingly being surrounded by biotech companies — will prompt us to think of new ways of forging public-private partnerships to drive improvements in health.”

What this means for the Parnassus campus, he explains, is that “nearly 30 percent of patient care space on Parnassus will be freed up to accommodate other clinical programs, where there is an insatiable demand for our services, and we will be able to improve our facilities.”

Hawgood also plans to explore the options available for addressing the seismic safety and obsolescence issues of research buildings at the UCSF-affiliated San Francisco General Hospital (SFGH) to ensure that it continues to function as a major UCSF research site, as spelled out in the UCSF Strategic Plan.

Considered one of the nation’s best public hospitals, SFGH has partnered with UCSF since 1873, providing “a unique resource for us to train our students and residents in providing care for underserved populations and operating a world-class trauma center,” Hawgood says. “I am very excited that city voters overwhelmingly approved the rebuild of SFGH. We also see that site as a critical site for research, and it’s a high priority for me to work with the chancellor to find solutions to the facilities issues.”

Hawgood also plans on continuing UCSF’s long-standing relationship with the San Francisco Veterans Affairs Medical Center (VAMC), home of the “strongest veterans research program in the US,” where some 200 research scientists, all of whom are UCSF faculty, are engaged in novel studies about post-traumatic stress disorder and traumatic brain injury, among other conditions. “We are intensely proud of the VA and will be working with the leadership to make sure that research [at the VAMC] continues to flourish,” he says.

Other new buildings under construction and program expansion include the $43 million Osher Center for Integrative Medicine, which is expected to open in 2010 at the Mount Zion campus — a growing hub for outpatient care — and the Cardiovascular Research Institute at Mission Bay, which will open next year.

Reforming Education

As health care continues to evolve through biomedical and technological advances and perhaps through national health care reform, so too must the education and training of future health care professionals, Hawgood says.

“It is important to recognize that health care is changing in both the tools that are available to us and scientific advances — such as genomic medicine and targeted therapies — that are becoming increasingly sophisticated,” Hawgood says. “We also are lagging in this country in preventive care, and we need to make sure that our graduates are prepared to serve at the leading edge of health care innovation.”

The UCSF School of Medicine is “extremely well positioned” to lead the nation in teaching and training, Hawgood says. “Over the last decade, our faculty has consistently led the way in innovations in curricula that are sought out by peer institutions as models in medical education. Now is not the time to rest on our laurels, particularly as we face budget challenges.”

The school will have to prioritize the improvements in medical education, making decisions on future directions that are informed by what he calls “a strong bench of experts.”

These experts include longtime medical school faculty members David Irby, PhD, vice dean for education, and Molly Cooke, MD, professor of medicine and director of the Haile T. Debas Academy of Medical Educators, who have just completed a nearly two-year-long review of medical education in the United States in a study sponsored by the Carnegie Foundation for the Advancement of Teaching.

Irby, Cooke and Bridget O’Brien, all scholars with the Carnegie Foundation and UCSF faculty members, studied 14 medical schools and teaching hospitals, making site visits, reviewing literature and consulting widely with national organizations, including the Association of American Medical Colleges (AAMC) and the American Medical Association. Their work, which will be published next year and will be spotlighted at the annual meeting of the AAMC in November, will set the direction for medical education for the future.

“We are extremely fortunate to have two of the most talented people in the country to have just spent significant time reviewing medical education because their findings will be used to spearhead our effort in the School of Medicine,” Hawgood says.

Among the recommendations from the national study on the professional preparation of future physicians are:

• using competency-based assessments to standardize learning outcomes and allowing the pace of learning to be individualized
• integrating clinical experience and science learning, which includes providing earlier opportunities for students to spend time with patients and other health care professionals in real clinical settings and
• promoting habits of inquiry and improvement as in UCSF’s Pathways to Discovery Program
• focusing on professional identity formation and
• incorporating interprofessional education and teamwork into the curriculum.

UCSF is already moving in these directions, Hawgood says. In fact, UCSF is preparing for its fourth year of interprofessional education, an initiative that he and the other deans are committed to expanding, he says.

To this end, representatives from all four schools, the library and the Office of Student Academic Affairs have developed plans to create a new Teaching and Learning Center in the library on the Parnassus campus. The center, which has recently received funding to start construction, will house new tools and technologies for educating future health professionals and scientists while supporting a culture of interdisciplinary, interprofessional and transdisciplinary learning programs for students and trainees.

The center will include the school’s Kanbar Center for Simulation and Clinical Skills Education, which will provide a technology-rich environment for the training of students and practicing health professionals from all four schools and the UCSF Graduate Division.

Irby is optimistic about the future of medical education on Hawgood’s watch. “I am terrifically excited because Sam has been a consistently strong supporter of education,” he says. “He understands the challenges that educators and our institution face, and he is well prepared to lead us.”

Another recent curricular advancement is the aforementioned Pathways to Discovery Program, which helps learners develop the knowledge, skills and experience they need to contribute to health in five key areas: clinical and translational research, global health, health and society, health professions education, and molecular medicine.

“Pathways started last July after almost two years of planning,” Hawgood says. “It was born out of a desire for the students whom we graduate to be prepared to be leaders in the future, including leaders in academic medicine, the Centers for Disease Control and Prevention, health policy in Washington, DC, translational science, or global health. We take a very broad view of leadership, and we believe in building leadership and fostering innovation.”

Hawgood says that the pathways program has two important components: It provides an opportunity for students and trainees from all four professional schools, graduate students, residents and clinical fellows to get in-depth training in addition to core curricula, and it fosters interdisciplinary education “instead of the historic, relatively silo-oriented approach to education.

“We would like to link the training from the day students enter professional school to the day they graduate and take their first career position, so the flame of passion that they bring to UCSF as first-year students is in fact nurtured and enriched throughout their training here,” he says.

To light that fire for learning in the medical school, Hawgood will have to entice more faculty members to teach. That may prove to be more difficult in the year ahead, since some faculty are reducing their teaching hours in the classroom to augment their primary source of income — providing patient care or conducting research. To meet the demand for faculty, the school has previously turned to volunteer clinical faculty, fellows, postdoctoral scholars, and even fourth- and fifth-year medical students who are enrolled in the health professions education pathway, according to Irby.

Another priority for Hawgood is to continue to find new ways to support graduate students, whom he describes as “the fundamental engine that drives our discovery in basic science and translational research.
“We’re as equally proud of our graduate programs as we are of our professional schools,” Hawgood says. “We want to attract the brightest graduate students to work with our faculty, and they also require great nurturing during this budget crisis.”

The Graduate Division is heavily dependent on state funding and is not supported by the same student fee structure, Hawgood explains. “We are working very hard to resolve these issues to come up with sustainable funding models.”

New sources of financial support could come from “capturing the imagination of a new generation of supporters of the University,” in part by showcasing the bright minds of young scientists and demonstrating the benefits of biomedical research that translate discoveries into improved health, Hawgood says.

As the son of parents who were both pharmacists, Hawgood himself was inspired to work in the world of medicine to make a difference. “I chose medicine because of a combination of the ability to work with patients and hopefully improve their lives and the fact that medicine is built on a basis of science,” he says. “That intrigued me as I was making my career choice. It has been such a fulfilling, continually self-renewing profession.”

Photo by Saul Bromberger and Sandra Hoover Photography

Related Links:

UCSF Names Sam Hawgood as New Dean of School of Medicine
UCSF News Services, September 17, 2009

Chancellor Taps Hawgood as Medical School Dean, Appointment Pending Regents’ Approval
UCSF Today, August 10

UCSF School of Medicine

Interim Medical School Dean Convenes Task Force to Guide Implementation of Furlough Plan
UCSF Budget Website, Aug. 5, 2009

Interim Dean Reports on Medical School’s Budget Challenges
UCSF Budget Website, May 20, 2009