Author: George Weiner
Date: 2013-08-15 13:33:17

Role models in medicine and biomedical research from the last century included the lone country doctor with a black bag making house calls and the researcher struggling alone to make a scientific discovery in a back-room laboratory. Such individuals had a thorough knowledge of what was then the state of the art in their field. When combined with creativity and passion, this familiarity with a topic allowed them to provide the best possible medical care available at the time, or make breakthrough discoveries, on their own.

Oh my, how times have changed.

Even the most well-educated, brilliant, and hard-working physicians and scientists in our modern world can’t come close to keeping up with the depth and breadth of knowledge and expertise required to succeed as an independent clinician or researcher. State-of-the art clinical care and research are both dependent on interdisciplinary interactions, including interactions with others from very different disciplines. Internists, surgeons and pathologists need each other’s expertise, as well as the expertise of pharmacists, biologists, geneticists, biostatisticians, epidemiologists, informatics experts, and many others. Indeed, a key to success in biomedicine today is the ability to be successful and creative in identifying the best possible collaborators who bring different backgrounds, knowledge bases and perspectives to the bedside and research lab.

A major goal of a successful comprehensive cancer center is to encourage and support such interactions. This effort is not facilitated by a strong top-down, one-dimensional organizational structure with a single boss telling everyone what to do. Success requires that we support quality people and facilitate their ability to develop novel collaborations and interactions with a broad range of colleagues.

Organizationally, the Holden Comprehensive Cancer Center does this through a matrix structure. Our talented faculty, staff and students interact in multiple dimensions.

• They interact as members of a Department and College within the University. This is the traditional academic organizational structure, and is still incredibly valuable. Members of the Department often share a similar educational background, yet focus their efforts in different ways on patient care, research and education. 
• They interact as members of a Research Program within the Cancer Center. Research programs are composed of physicians and scientists with different backgrounds from different departments who share an interest in a particular scientific field related to cancer such as Cancer Genetics, Immunology, Therapeutics, Imaging, Epidemiology, or Free Radical Biology. 
• They interact as members of the Cancer Center’s Multidisciplinary Teams (also known as Multidisciplinary Oncology Groups or “MOGs”) centered on specific cancer types such as breast cancer, lung cancer, etc. Members of these Groups come from multiple Departments and multiple Programs, and include medical, pediatric, surgical and radiation oncologists as well as pharmacists, nurses, geneticists, laboratory researchers and epidemiologists among others.

Let’s look at where I stand (as an example of more than190 members of our Cancer Center) in this three-dimensional matrix of Departments, Programs, and Groups. 

• I am on the faculty in the Department of Internal Medicine and Division of Hematology, Oncology and Blood & Marrow Transplantation. My Departmental home allows me to take care of patients and teach in collaboration with outstanding Medical Oncology colleagues and students at various levels of training. 
• I am a member of the Cancer Immunology and Immunotherapy Research Program. My Programmatic home allows me to have collaborators with varied educational backgrounds (MDs, PhD, etc) who are interested in research extending from basic laboratory research to clinical trials exploring use of the immune system to treat cancer such as with monoclonal antibodies and cancer vaccines. 
• I am part of the Lymphoma Multidisciplinary Group. My Multidisciplinary Group home allows me to interact and collaborate with clinicians with different backgrounds who participate in the care of lymphoma patients, such as pathologists, radiation oncologists, nurses, and pharmacists so we can determine what therapy is best for a given patient. It also supports my interactions with basic laboratory, clinical and population researchers doing lymphoma research and working to discover new ways to improve outcomes in lymphoma.

Each of these interactions helps me collaborate with outstanding individuals who bring skill sets and a perspective I lack. Together, we come up with ideas none of us could have reached alone. This leads to better cancer care and faster progress in cancer research.

Maintaining a three-dimensional matrix is complex, and sometimes messy. We have to identify and empower the right people in the right positions. Recruiting a single outstanding individual who fits our needs in all three dimensions at the same time can be difficult (if you know of someone at another institution who might be interested in moving to Iowa and is an outstanding medical oncologist with expertise in the genetics of colorectal cancer, let me know!).

Finding the resources to support efforts in all three dimensions is a challenge as well, and we rely on a combination of support generated from patient care, grants obtained by our faculty, and donations from members of the public who share our passion for what we do.
Despite these challenges, engineers know that a three dimensional matrix provides strength and stability that cannot be found in simpler structures. The same is true for our cancer center.

Our goal is to continue to thrive in the matrix, and strengthen the matrix structure so we can increase collaborative interactions between outstanding faculty, staff and students in multiple dimensions which, in this day and age, is vital for top-notch patient care and cutting-edge research.