The rapidly growing research enterprise at the Geisel School of Medicine and Dartmouth-Hitchcock (D-H) is poised to take the next step toward national prominence with the hiring of Steven L. Bernstein, MD, a few months ago.
Before joining Dartmouth, Bernstein, a highly respected physician-researcher and public health advocate, served as professor and vice chair of research in the Department of Emergency Medicine at the Yale School of Medicine and professor of public health in the Yale School of Public Health, where he was also the founding director of the Yale Center for Implementation Science.
Bernstein recently sat down with Dartmouth Medicine to talk about his multiple leadership roles across Dartmouth—which include overseeing all aspects of research for D-H as its inaugural chief research officer, as well as serving as associate dean for clinical research at Geisel and director of the C. Everett Koop Institute at Dartmouth.
Q: Could you tell us a little bit about your background—where you grew up and what got you interested in medicine?
Bernstein: I’m from New York City by birth. I spent a good part of my childhood there, but we moved around a bit. I lived in Stamford, CT for a few years, and then in the suburbs of Philadelphia for a while. I went back to New York to finish high school, so I consider myself primarily a New Yorker.
There were a couple of very formative experiences that served as the genesis for my interest in medicine. One was that both my parents smoked when I was a kid, and I had some asthma. I remember wondering why people smoked and that there had to be a way to help them stop or maybe get them not to start. Later, when my dad suffered some medical consequences from it, I thought more intently about what I might be able to do to help people like him. Thankfully, both my parents stopped smoking eventually.
Another defining moment came for me in college, when I volunteered to work at a refugee camp in Thailand one summer, where thousands of people had fled from Cambodia to escape the Khmer Rouge regime. One of my duties was to drive an ambulance, basically a pickup truck, between medical tents. I got to see the doctors and the nurses there and what they did, working for various NGOs like the Red Cross and Doctors Without Borders. I really admired them, and I thought, “These are the coolest people I’ve ever met; I want to be like them; I want to do what they do.” Also, the events in Cambodia in the mid-to-late 70s under that brutal regime were in effect a genocide. I’m a descendent of Holocaust survivors (on my mom’s side), so the experience resonated in a very powerful way for me.
Q: What drew you to Dartmouth?
Bernstein: It was serendipity, really. My wife and I had stopped in Hanover a few times in recent years on our way to Quebec where we like to vacation. There are a number of former Yale colleagues of mine, close friends, who work here in emergency medicine. We’d stop to visit and have lunch with them and continue our trip. One of them told me about this position opening up. I was very happy at Yale, but after reading the job posting I thought, “This is exactly what I’d like to do with the next step of my career.”
Importantly, some of Dartmouth’s areas of strength align closely with my particular areas of interest—in healthcare delivery science, implementation science, and in tobacco control.
One of the things that really appealed to me about this job was the opportunity to serve in a founding role; I like to build programs and I’ve enjoyed doing that throughout my career. I also specifically liked that this was a bridge position—spanning the healthcare delivery system, the medical school, and college. To have the opportunity to work with colleagues across our institutions in a unified effort to optimize the clinical research enterprise, was very important to me.
Q: As the inaugural chief research officer (CRO), leading D-H’s Office of Research Operations, what is your overall vision for the organization’s growing research portfolio?
Bernstein: The biggest part of my vision is to create a seamless biomedical research enterprise that spans Dartmouth-Hitchcock, Geisel, other components of Dartmouth, such as the Thayer School of Engineering and the Tuck School of Business, and some of our community partners, as well. As a result, patients will be able to benefit from the care, the know-how, and the passion of investigators in all areas as they work together.
I think we have great opportunities to catalyze and grow certain programs that are already strong—in areas such as healthcare delivery science, translational bioengineering, care for the elderly, neurologic care, heart and vascular, and cancer—as well as new programs that either don’t yet exist or that are in nascent form. This includes continuing to recruit, retain, and train the next generation of investigators who will make important contributions to advancing health and healthcare in the future.
A related aim is to encourage the growth of clinical research programs that support the mission of D-H and help to enhance the strengths of the clinical service lines. Part of that will include expansion of the clinical research enterprise in the southern part of the state, and working to further develop health information technology, to make it easier for investigators to access clinical data for use in research studies.
Q: In your role as associate dean of clinical research, what stands out as a major priority in the coming year?
Bernstein: The biggest project coming down the pike, that will involve my roles as associate dean and CRO, will be creating an application for a clinical translational science institute (CTSI) here at Dartmouth. This will be a successor to SYNERGY, the clinical and translational science institute that was established here before, under the direction of Dr. Alan Green.
Securing funding to support another CTSI will be a massive undertaking that will take at least a year for our organization to put together. But it is critically important—to maintain a competitive advantage with our peer institutions, to recruit talent, to be resourced adequately to grow the research enterprise at Geisel and D-H, and to allow us to continue to focus on equity, diversity, and inclusion in hiring and in scholarship. With a CTSA, you don’t only get that 5-year grant, it opens the door to other kinds of funding opportunities as well.
Q: Could you describe the focus of your research, and some of your most recent findings?
Bernstein: The thrust of my career has been using implementation science methods—which are based on figuring out how to push evidence-based practice out into real world clinical settings—to find ways to improve the treatment of people who smoke. I’ve done that in a variety of places including emergency departments, inpatient units, and the community.
The longest continuous thread in my research has been a series of clinical trials that I’ve done in the emergency departments (EDs) of the different places I’ve worked to identify effective components of tobacco treatment. The last trial I did at Yale before coming here, which we’re still reporting on, used a study design known as the Multiphase Optimization Strategy.
What we found was that if you have a smoker in the ED and give him or her a counseling intervention called a motivational interview—that works. If you give them six weeks of nicotine patches and gum (in their hands, not a prescription) with the first dose starting in the ED—that works. Conversely, if you connect them with a free state-sponsored smokers’ quitline—that doesn’t work. Neither does signing them up for a free smartphone app offered by the National Cancer Institute.
So, for the first time, we were able to not only design a multi-component package of effective treatments in the ED but identify which of those were individually effective. My next study, which I hope to do at Dartmouth, will be a continuation of that kind of work testing tobacco-control interventions in an emergency department environment.
Q: Given the focus of your research, it seems especially fitting that you are also assuming the directorship of the C. Everett Koop Institute at Dartmouth—Dr. Koop D’37 is perhaps best known for his efforts to educate the public about the dangers of smoking and its causal links to many diseases.
Bernstein: It’s the deepest honor for me to have been asked to lead this institute. I’m very grateful to Jim Sargent for his leadership, mentorship, and guidance as we’ve transferred “the reigns” of the Koop from Jim to me, and I want to thank Sue Tanski for all of her help as well.
I met Dr. Koop, by the way, at a conference, a tobacco meeting, about 16 or 17 years ago. It was towards the end of his life, and he was there to get an award. I got to shake his hand and thank him for his many important contributions to public health and for being such an inspiration to those of us who work in the field. Everybody was flocked around him, like the rock star that he was—it was very touching to see.
So, it’s deeply meaningful to me to be able to do this. I view the Koop Institute as a leading voice in healthcare policy, education, and research—in working to mitigate threats posed by the unhealthy promotion and use of not only tobacco, but products such as alcohol, junk foods, and prescription drugs. I’m excited to be working with my colleagues there on key initiatives, like our annual conference, which will take place this fall.
Q: It’s been about 6 months since you joined the Dartmouth community; how are you and your family adjusting to life in the Upper Valley?
Bernstein: You know, it’s funny. I’m a New York native as I said, and when my wife and I moved to New Haven we wondered if it would be a little provincial, a little too “small townish,” running into our colleagues at the grocery store or at our kids’ soccer games. That did happen, and we wound up enjoying it very much.
We’re finding that the Hanover/Lebanon area is a similar kind of environment, one that we feel quite comfortable in. Everyone has been very warm and welcoming and gracious—it’s been a fantastic move for both of us. I should mention that my wife, Carol Barsky, also recently joined Dartmouth-Hitchcock. She is the new chief quality and value officer, succeeding George Blike, who has stepped down.
Now that many of the restrictions associated with COVID-19 are easing, we’re eager to get back to doing some of the things that we love to do, such as going out with friends to restaurants, to the theatre, and to live music shows. We’ve also become big fans of the outdoors, and really enjoy activities like hiking. We’re looking forward to experiencing the many things the area has to offer.