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GMEmail

March 2017 | Vol. 10 | No. 1

From the Desk of the Associate Dean

This issue is a bit late, but I wanted to capture the results of Match Day. Both the students and programs had a great year. All the programs filled and 42% of the graduating class is joining a training program in Nevada either at UNR Med (9) or UNLV School of Medicine (16). This has to be a record and truly communicates the strength of graduate medical education in the state. Congratulations to all those who had a successful match and many, many kudos to the training program faculty/staff who worked tirelessly in the recruitment process. Strong work by all.

On February 27, the Clark County Medical Society and the Association of Hospital Medical Education (AHME) sponsored a Resident Research Competition at MountainView Hospital in conjunction with the AHME Academy. Over thirty residents competed in Clinical/Basic Science Research, Quality Improvement and Clinical Vignette presentations. The school of medicine residents swept the research category and had took second place in the clinical vignettes category. Winners were:

  • Joshua Goldman – plastic surgery – first place research
  • Harry Ching – otolaryngology – second place research
  • Chris McNicoll – surgery – third place (tie) research
  • Kaushal Dosani – pediatrics – second place clinical vignettes

In addition, the coordinators from all of the Las Vegas programs and the GME office as well as several of the coordinators from Reno attended the Academy. Sessions on new resident orientation, wellness, milestones and use of behavioral interviews provided education for the participants. It was nice for the coordinators to have the opportunity to interact with their counterparts from other institutions regionally and nationally.

The fourth annual coordinator retreat was held on March 3, 2017. Coordinators from both Las Vegas and Reno attended and the event was sponsored by the GME Office. In her first retreat as Institutional Coordinator, Megan Becerra planned a day that focused on the needs of the coordinators and was both fun as well as educational. The morning activities featured team building, ACGME BINGO, and group problem solving. Lunch provided an opportunity for networking across the state and the afternoon session on personal wellness was conducted by Annie Weisman, the director of wellness for UNLV School of Medicine. The balance between education and retreat was achieved.

Resident/Fellow Research Day will be held in Las Vegas on May 12 and in Reno on May 15. The call for submissions was sent and submissions are due March 31, 2017. The categories will again be research (clinical and basic science), quality improvement and clinical vignettes. Judges are being recruited for the competition and prizes are being acquired. This is the 11th time the GME Office is sponsoring this event.

Chief resident retreats will occur in the month of April. In Las Vegas the retreat is April 10 and in Reno April 28. The retreats will be facilitated by Drs. Bar-on and Carlson at their respective locations. This is a good time for the chiefs to get to know each other and begin to work together as a team. Quarterly Chief Councils further this collaborative process and group process to address challenges.

Circling back to the new interns/fellows, the onboarding process has officially started. Incoming residents and fellows have a checklist of items which need to be completed ranging from applications for medical licenses to compliance modules – safety, HIPAA, blood borne pathogens, sleep and fatigue and RATs modules. All of the onboarding activities have to be completed prior to orientation. Intern orientation will be on June 20 in Reno and June 22 in Las Vegas. The Las Vegas orientation will be at the VA.

It is hard to believe that the end of the academic year is rapidly approaching and things will start over again in a new and different way for all of us.

Best,

m

Miriam Bar-on, MD
Associate Dean for Graduate Medical Education and DIO

From the ACGME

As many of you know, the ACGME has been revising the Common Program Requirements (CPR). They started with section VI—the section that focuses on clinical work, transitions of care, duty hours, teamwork and quality/patient safety. The changes were open for comment in the fall and organizations across the country as well as individuals had the opportunity to respond. In February 2017 the ACGME Board of Directors approved them and the final version was unveiled at the ACGME Annual Educational Conference on March 10. There are new sections featuring wellbeing for residents as well as changes in terminology. The new section is called The Learning and Working Environment.

In a press release Thomas J. Nasca, MD, MACP, chief executive officer of the ACGME and vice-chair of the Task Force, in a memo announcing the approved requirements stated "The American public deserves to know that starting on Day One physicians in practice already have the real-world experience they need to ensure high quality patient care. Residents also have the right to develop such experience under appropriate supervision to manage the lifetime of demands and stress that come with the privilege of patient trust."

The revised requirements return first-year residents to the same schedule as other residents and fellows, re-establishing the commitment to team-based care and seamless continuity of care while also ensuring professionalism, empathy, and the commitment of first-year residents to their patients. The cap for first-year residents will return to 24 hours, a cap that has been in place nationwide for all other residents and fellows, plus up to four hours to manage necessary care transitions.

Read the remainder of the revised section VI.

Best Practice

One of the markers for faculty scholarly activities is peer review. It would be great to have more of the faculty serve as peer reviewers. This article from the Journal of Graduate Medical Education proposes a team based approach to facilitate the development of new peer reviewers. Many of the faculty at the school of medicine already participate in peer review. Please let me (mbar-on@med.unr.edu) if you want to participate in team based peer review. Read the Journal of Graduate Medical Education article Team-Based Coaching Approach to Peer Review: Sharing Service and Scholarship.

In the spotlight

The GME office is delighted to welcome Tessa Newman as our administrative support. Please stop by and welcome Tessa. She is located in Suite 590 in the 1701 Building.

Congratulations to Margie Tang, third year gastroenterology fellow who had her paper titled Clostridium difficile infection in inflammatory bowel disease: challenges in diagnosis and treatment accepted for publication in Clinical Journal of Gastroenterology.

Congratulations to Mahendran Jayaraj, second year gastroenterology fellow who had four abstracts accepted for Digestive Diseases Week in Chicago in May 2017 – the last three were co-authored by second year resident Harmeet Mashiana:

  • Performance characteristics of AGA guidelines in the management of pancreatic cysts: Systematic review and meta-analysis
  • The safety and efficacy of combined antegrade and retrograde endoscopic dilation (CARD) for complete esophageal obstruction: Systematic review and meta-analysis
  • Endoscopic retrograde cholangiopancreatography in gallstone pancreatitis without cholangitis: a systematic review and meta-analysis
  • Comparison of outcomes for supine vs. prone position for ERCP: systematic review and meta-analysis

SCCM Surgery Section's Jeopardy competition Southwest Team

Congratulations to UNR Med's Surgical Critical Care fellows who joined with University of Arizona's fellows and competed as the Southwest Team to win the SCCM Surgery Section's Jeopardy competition for the second year in a row. Featured in the attached photo are Nancy Rivera, Allison McNickle, Steve Lorch as well as University of Arizona's fellows Kathy Ho and Ashley McCusker along with both program directors and SCCM Surgery Section leadership.

Jonathan Chiang and Brent Herron

Congratulations to family medicine residents Jonathan Chiang and Brent Herron, for winning best poster at the 1st Annual Nevada Academy of Family Physicians (NAFP) Student/Resident Research Poster Display at the NAFP Winter CME Meeting this weekend in Lake Tahoe. Their poster focused on the feasibility of a student/resident-driven free clinic in Southern Nevada.

Congratulations to pediatrics resident Alvaro Galvis (PGY-2) who has been chosen as a 2017 New Century Scholar (NSC Scholars Program) for Academic Pediatric Association ( APA). The NCScholars Program© was developed to help residents advance their career through leadership development, information about positions in academic medicine, career counseling, and most importantly, mentors and role models in academic pediatrics.

Congratulations to former pediatrics resident Tina Desai (Class of 2015) who has been accepted to a 2 year hematology Oncology survivor fellowship program in Memorial Sloan Kettering Cancer Center, NY.

Congratulations to three of the geriatrics fellows who had posters accepted for the American Geriatrics Society - two were selected for the presidential poster session (Ahlas and Sharma).

  • Andreas Ahlas: CJD: No Laughing Matter
  • Mordechai Lavi: I Want to Go But I Can't: When a Urinary Catheter is a Nursing Home Sentence
  • Umanga Sharma: Valacyclovir - trading rash for confusion?

Congratulations to Mordechai Lavi and Umanga Sharma who will be joining the internal medicine department as full time faculty upon their completion of their fellowships.

Congratulations to Jennifer Hagen, geriatrics fellow, who was invited to present her fellowship QI project at the Sierra Nevada VA research symposium. This project, a collaboration between geriatricians, nursing, dietary services and recreational therapy looked at increasing community living center resident (patient) attendance for meals in the communal dining areas. Literature suggests that communal dining improves functional and quality of life outcomes.

Congratulations to Jessica Arabski, fourth year psychiatry - Las Vegas resident who was accepted to a forensic psychiatry fellowship at Oregon Health Sciences University.

Congratulations to Kevin Tran, obstetrics and gynecology resident who attended the ACOG Section Officer Leadership Development Conference (SOLD) and the ACOG Congressional Leadership Conference (CLC) this past week in Washington DC.

Dodgeball Team

At the EAST meeting in Ft Lauderdale (Eastern Association for the Surgery of Trauma) we put together a dodgeball team (yes, they have a real dodgeball tournament) of current and former residents and fellows of UNR Med. In the picture Andy Shay, Jason Bregg, Patricia Souchon, Purvi Patel, Paul Chestovich. The guy in the red shirt is Andy's boss at his job, the only outlier. We didn't win the tournament but we sure had fun!

Congratulations to Lannah Lua, third year obstetrics and gynecology resident who had a platform presentation titled Comparative analysis of cost and health resource utilization for apical prolapse repair at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Meeting in Scottsville, AZ.

Congratulations to Lannah Lua and her coauthors Pathak P, Dandolu V. who had their paper titled Comparing anticholinergic persistence and adherence profiles in overactive bladder patients based on gender, obesity and major anticholinergic agents accepted for publication in Neurology and Urodynamics.

Las Vegas Emergency Medicine Residents in DC

Las Vegas Emergency Medicine Residents descended on Washington, D.C. for the 2017 ACEP Leadership and Advocacy Conference. Drs. Bailey Zhao (PGY-3), Megan McKay (PGY-3), Tiffany Sigal (PGY-2), and Zachary Skaggs (PGY-2) got to explore the sites and scenes of DC as well as explore the issues with fellow physicians and legislators. Also attending was JD McCourt, current Nevada ACEP President, attending faculty, and Medical Director of the Emergency Department at University Medical Center. Meetings with Sen. Cortez-Mastro (D-NV) and the staff of Sen. Dean Heller (R-NV) allowed for productive discussion regarding the direction of health care reform, EMTALA, and the issues of psychiatric boarding in the ER and balanced billing.

Team "Drop Kick," a spirited crew of residents and faculty from the UMC Emergency Department, went 5-1, coming in second place at the second annual NCCF charity kickball tournament 2/25/17. All proceeds from the tournament went to the Nevada Childhood Cancer Foundation.

Check out the winning entry in the 8th Annual USACS Best In Acute Care Video Challenge: https://www.usacs.com/we-are-vegas. It features an inside look at the Las Vegas EM residency. The video was directed by video editor and PGY-2 Omar Ahmed and features many members of the Las Vegas Emergency Medicine residency class. The winning entry earned the residency $10,000, put toward the residency wellness fund.

Dr. Kelly Morgan, Las Vegas EMR Clinical Faculty, Director of Disaster Preparedness, and Medical Director for all US National Tae Kwon Do events, along with PGY-2 resident Dr. Zachary Skaggs, cared for athletes at the Tae Kwon Do US Open held in Las Vegas Feb. 2, 2017. A broad range of pathology was tended to including gamekeeper's thumbs, ACL injuries, and issues related to "cutting weight" in athletes hailing from Africa to Australia, with backgrounds ranging from amateur to Olympian.

Check out the latest EMRAP "Paper Chase" for a summation of the "Effect of Nebulized Albuterol on Serum Lactate and Potassium Levels." The study shows that the simple administration of 10mg nebulized albuterol can raise serum lactate by, on average, 0.8mmol/L, potentially confounding current core measures that equate elevated lactate levels with sepsis. The study originated out of the Las Vegas EMR program with primary author Tony Zitek, former Chief Resident and current Assistant Research Director, also with David Slattery, Research Director at the program.

Congratulations to Ali Malik third year internal medicine - Las Vegas who had his manuscripts accepted for publication.

  • Malik, AO Abela O, Allenback G, Devabhaktuni S, Lui C, et al. ST segment elevation myocardial infarction systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality. International Journal of Cardiology 2017 Feb 15. pii: S0167-5273(16)32724-3
  • Malik, AO Abela O, Devabhaktuni S, Malik AA, Allenback G, Ahsan CH, Malhotra S, Diep J. Significance of inferior wall ischemia in nondominant right coronary artery anatomy. World Journal of Cardiology (in press, to be published 3/26/2017)

Congratulations to Eyas Chakfeh third year internal medicine - Las Vegas resident who had two abstracts were recently accepted into ATS and will be published in ATS abstract journal May 2017

  • Hypokalemia induced paralysis in the ICU Eyas Chakfeh MD., Ana Bonetti Lugo MD., Amr Chakfeh MD.; Mutsumi Kioka MD.
  • Descending Necrotizing Mediastinitis: A rare but lethal disease Eyas Chakfeh MD., Ana Bonetti Lugo MD., Yaser Dawod MD., Amr Chakfeh MD.; Oliver Romero MD.

Congratulations to third year internal medicine - Las Vegas resident Swetal Patel who had his study accepted to Society for Cardiovascular Angiography and Interventions Scientific Session 2017

  • Namazi A, Patel SD, Diep J, Ahsan C. The need for spasmolytics for radial artery spasm during transradial access- A retrospective study. SCAI. 2017

Congratulations to internal medicine - Las Vegas third year resident Mustafa Al-Shammari who had his abstract accepted to the Digestive Diseases Week Meeting in Chicago in May 2017.

  • Al-Shammari, M., Maklad, M. Yoo, Ji. Makar, R.US national trend analysis of cyclic vomiting incidence with liberalization of cannabis use.

Congratulations to internal medicine - Las Vegas second year resident Harmeet Mashiana who had an abstract accepted to the American College of Physicians national meeting.

  • Should upper endoscopy be used to screen high-risk HIV+ patients for Gastrointestinal Kaposi Sarcoma?

GMEmail is a service of the Office of Communication, University of Nevada, Reno School of Medicine. Miriam Bar-on, M.D., Editor, Office of Graduate Medical Education. Copyright © 2017 University of Nevada, Reno School of Medicine.