- Associated Press - Sunday, February 8, 2015

SIOUX FALLS, S.D. (AP) - South Dakota’s highest-paid state employee loves a good hockey game but refrains from pressing her face to the glass and screaming at the players to maim each other.

“My husband,” Dr. Mary Nettleman deadpans, “thinks that’s undignified.”

Killjoy.

Actually, the first woman in the 108-year history of the Sanford School of Medicine of the University of South Dakota to serve as its dean could wade into her own scrums if she wanted. Local health systems competing with each other, teacher-physicians unhappy with a new and radically different learning structure at the medical school, legislators wanting to know why a constituent’s son didn’t get into the program - all are fertile ground for conflict.

Except unlike hockey players, that’s simply not Nettleman’s style.

What people who know and work with the 59-year-old Michigan native see is a woman who can be forceful but not strident.

“I can’t think of a time in a meeting where she has inappropriately raised her voice,” USD President Jim Abbott said.

Nettleman as a leader is not strong-willed but thoughtful and committed, said Dr. Dave Kapaska, regional president and CEO at Avera McKennan Hospital.

At the Michigan State College of Human Medicine, where she was chair of the department of medicine before leaving for South Dakota, “She could be ferocious in making sure that the needs of the department were appropriately represented,” said Dr. Francesca Dwamena, who followed Nettleman as chair. “At the same time, she has this nice, gentle way about her when she is dealing with faculty and staff in general. She listens a lot, but when she finally makes a decision, she is very direct about it.”

It’s a demeanor that has been on full display during the Sanford School of Medicine’s transition to what is known locally and nationally as the Yankton Model Program.

For 20 years now, even before schools such as Harvard University claimed the model as their own, Yankton has led the transformation in medical school education. Instead of a traditional model that sends students off in their third year for a series of weeks-long learning blocks - say, six weeks of pediatrics, then eight weeks of internal medicine and then four weeks of obstetrics and gynecology - now they spend time in each area every week, all year long.

It has been shown in the Yankton curriculum that students end up being treated more like junior doctors, Nettleman said. They feel more responsibility toward their patients because they’re with them longer. They develop important and longstanding relationships with the primary physicians with whom they work.

“We know that they integrate the knowledge better,” she said. “At the end, they remember more about the curriculum because they’ve been doing it all the time. And it’s also in the studies that we’ve done that it allows students to retain what we call empathy.”

Empathy. That’s an important word in medical school education. When she was teaching, students weren’t allowed to present cases to Nettleman on “the foot ulcer in Room 201” or “the diabetic in 316.”

“I always said to my students, if they came to me to give a presentation, ‘Tell me one personal thing about this patient,’” she said. “If they couldn’t do it, send them back.”

While the Yankton model has been around for several decades, it’s only recently that the medical school campuses in Sioux Falls and Rapid City have begun to adopt it. The accreditation bodies don’t like it when there are significant differences between a school’s campuses, Nettleman explained. So under her watch, the transition has begun.

It hasn’t been uniformly embraced, said Dr. Gene Hoyme, chief academic officer for Sanford Health. Sioux Falls, for example, is a much larger community than Yankton, and much different in terms of more highly specialized physicians.

“There was a concern that (the Yankton model) wouldn’t translate well here,” Hoyme said. “To be frank, there was a lot of resistance from physicians who are the teachers.”

There’s still resistance, Nettleman said. But to those people who come in and insist that the medical school must revert back to the old ways, it isn’t going to happen, she tells them. This school, she insists, is going to remain a highly accredited institution.

“So then if they say, ‘Well, I don’t think this surgery slot at half a day a week is working out, how about if we do a whole day every other week,’ I’ll say, ‘OK, we could probably work that out,’” she said.

Simply put, a dean has to be willing to listen, she said. That means you start with a vision and work your way toward a common understanding of that vision.

“One of my most recent favorite quotes is, ‘If you want to build a ship, don’t gather people together and put half of them sawing wood and half of them measuring,’” Nettleman said. “Bring them together and teach them to long for the vastness of the open sea, and they will build you a boat.”

That’s a philosophy that works fine for her when the primary focus is medical education. But the state’s 14th medical school dean and its highest paid public executive - at $538,147.91 a year - travels down many other roads as well.

There’s her legislative duties, trying to convince lawmakers that the medical school needs more slots for students or describing for them the work that needs to be done to increase the number of medical residency positions in a state and country where there aren’t enough.

Those legislators want to know how the taxpayers’ dollars are being spent. They want to know how legislation would affect their constituents. They heard a story and want to know more about it. They want know what kinds of students the medical school rejects, why somebody’s son or daughter wasn’t admitted into the program, and whether the state needs another medical school.

Until she arrived in South Dakota three years ago, Nettleman said she never had to deal with that before.

“I’m still learning, but I do like it,” she said. “It’s a new skill to learn.”

Former state Health Secretary Doneen Hollingsworth, who worked with Nettleman on Gov. Dennis Daugaard’s primary care task force, was impressed with how quickly the dean picked up those skills.

“I was impressed with how, as a newcomer to our state, she seemed to quickly know the geographics, the players, the importance of rural health care,” Hollingsworth said.

The rural aspect of medicine required no education on Nettleman’s part. She grew up in Coldwater, Mich., a town of 9,000 people. Her father, William, didn’t plan on becoming a doctor when he went off to World War II. But that all changed when his mother, stricken by rheumatic fever, eventually died of a massive stroke.

Her father came home from war to become a small-town doctor. His black bag sits today on the shelf of Nettleman’s Sioux Falls office, near a cast of a giraffe’s cervical vertebra.

“That’s a whole other story,” she said and laughed.

As her father’s secretary and helper, she came to love solving the mysteries and figuring out what it was that ailed people. That passion propelled her through an undergraduate degree at Ohio University and on to medical school at Vanderbilt in Nashville, Tenn.

Nettleman became a national expert on infectious diseases and infection control, so much so that media giants, including ABC News, regularly put her on to discuss everything from pandemic flu outbreaks to Legionnaires’ disease in the Playboy mansion.

One of her areas of expertise is Gulf War illnesses. Yet here in Sioux Falls, when she finds a little bit of time to step out of her dean’s role and actually practice medicine, it’s patients with adult cystic fibrosis that she sees at a clinic in Sanford Health.

When Nettleman was in medical school, all cystic fibrosis children died before they became teenagers. Now, the average life expectancy is 40.

“It’s a very important area, and it’s not one that people were taught to take care of,” she said. “There are more living adults with cystic fibrosis than children, so it’s kind of a new area, and they needed help. And I like seeing patients.”

Even if it is for only part of a day, one day a month.

The dean of a medical school, you see, is very busy. Though she once was involved in research through National Institutes of Health grant funding, her schedule has reduced her to what she calls survey research now. She’s trying to learn how other places reward clinical teaching physicians. That’s a big deal here in South Dakota, where almost all physicians do some teaching and earn virtually nothing for it.

Of course, keeping them all happy could be complicated by the fact the medical school draws on Avera and Sanford physicians both, and, of course, there is a bit of a rivalry between those two systems.

The truth is she navigates that territory well, Kapaska at Avera McKennan said.

“The competition in Sioux Falls between Sanford and Avera, and effectively having us work toward the same ends on the medical school, is not a small thing to ask of anybody,” he said. “She’s done a good job.”

A good job? “We can’t have the medical school without all our systems and their physicians,” Nettleman observed. “My job is not to screw that up and not to let anybody else screw that up.”

It is a full-time mission, one that takes her many directions at all hours. So it’s only occasionally that she can slip away for a hockey game or an hour of hiking in the Black Hills when she is out there fulfilling her duties as a dean.

In those precious moments when she’s not being Dr. Mary Nettleman, she’s potting flower bulbs in the fall, setting them in a cold place and then bringing them out three months later so that her house erupts in February with tulips, daffodils, crocuses and hyacinths.

She’s falling out of an airplane, tethered to a parachute and another skydiver, and dropping over the sailboats and the white sands below in the Caribbean.

She’s tending to her husband, Scott Maxwell, who had injured his foot before they were to fly out to a conference in California she was chairing. It was a very human moment, her friend, Dr. Dwamena back in Michigan, recalled.

“She was trying to get him breakfast, too,” Dwamena said. “I’ll always have that image stuck in my mind … just her incredible devotion.”

If you ask her, Nettleman will confirm her connection to Amelia Earhart, a second cousin to her father.

That’s another fascinating chapter in the Mary Nettleman story. And one, those who know her say, that South Dakota should feel fortunate to share.

“In my experience with deans, I would give Mary an ‘A,’” Hoyme said. “We’ve been lucky in recruiting her here. She’s a good leader … the right person at this time for our medical school and all it’s going through. So yeah, I think we’ve been very fortunate.”

___

Information from: Argus Leader, https://www.argusleader.com


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