Transformative Integration: Navigating Opportunities and Challenges in a Medical School's Evolution Into Integrated Service Units.

Medical schools must evolve with the changing healthcare landscape and financial pressures. Academic Health Centers have responded to these changes with a novel organizational model known as an integrated service line. Traditional medical school departments often create silos, lack of alignment, and financial burdens. To our knowledge, we were the first medical school to implement an integrated structure combining the tripartite missions of academics, research, and clinical services.  The University of Texas Rio Grande Valley School of Medicine accepted its charter class of 55 medical students in 2016 with a traditional medical school department model. By 2023, it had 154 full-time faculty, 14 departments, a growing clinical practice with 25 ambulatory sites, and no university teaching hospital. Facing changes in the local healthcare landscape, medical school leadership implemented a restructuring of the medical school and its outpatient health system into Integrated Service Units (ISUs) in 2023.  This study aims to (1) describe the institutional steps taken to implement an ISU model across academic, research, and clinical domains of a medical school; and (2) evaluate initial outcome observations in the first one-year post-implementation. Over six months in 2023, the institution successfully implemented its vision of reorganizing the medical school across the academic, research, and clinical care areas. The new structure had seven ISUs: Primary and Community Care, Medicine and Oncology, Surgery Specialty and Musculoskeletal, Neuro and Behavioral Health, Surgery, Medical Education, and Clinical Support Services. This paper delves into the challenges, opportunities, and key lessons learned. Embarking on the ISU transformation led us out of our comfort zones and beyond conventional paradigms.  Preliminary findings across academics, research, and clinical services are presented and support that within the first year, the ISU model has accelerated the ability to accomplish our vision of transforming the health of the Rio Grande Valley. Next steps involve examining the long-term impact of the ISUs on the medical school, residencies, patients, and the health system. Areas of focus include financial success, faculty recruitment and retention, and research impact.