December 2016 | Vol. 9 | No. 4

From the Desk of the Associate Dean

I ask you to indulge me as this issue is late. My simple reasons are that I wanted to capture the results of both the pediatrics fall match and the medical specialty match. These two matches affect not only our trainees, but also four of our own fellowships – cardiology and pulmonary/critical care in Las Vegas and geriatrics and hospice/palliative care in Reno. The outcomes for the most part were great and can be found at the end of this newsletter in the In the Spotlight column. What I want to recognize here is the hard work and efforts of both the programs in their recruitment process – specifically the program directors and the fellowship coordinators and that of the graduating residents who went through the process. Regardless of the outcome, your dedication and determination did not go unnoticed; it is truly appreciated and makes us all proud.

As we approach the halfway point of the year, it is terrific to see the progress made at all levels of training. Interns are walking confidently and making decisions – still with supervision – but are fully equal participants on the care teams. Graduating residents and fellows are approaching the time when they will be entering unsupervised practice and are honing their decision making as well as seeking knowledge on things that previously were not of great interest – especially billing and coding. This is a natural transition, part of the cycle of residency life and is nice to see.

A couple of weeks ago, I had the opportunity to attend the ACGME's second symposium on Physician Well-Being. The ACGME in collaboration with other organizations like the Veterans' Administration, the Association of American Medical Colleges, the Association of Hospital Medical Education and others are pushing forward initiatives addressing Well-Being and what we need to prevent burnout especially in residents and fellows. The two day symposium included lots of hard work for the participants with anticipated outcomes. Examples of established programs both at institutions and in professional societies were presented to stimulate the development of new programs. Further, a group of hospital CEOs were present to engage the audience in having conversations about wellness/well-being programs and how to ask for funding. Other sessions focused on positive psychology and the new ACGME common program requirements where well-being will be a required element. At the end of the symposium, each attendee was asked to make a commitment as to what will be implemented at his/her home institution. Stay tuned as to what will be coming to the school of medicine programs.

Speaking about the ACGME's new common program requirements – they are open for review and comment. The ACGME is looking for feedback from all constituents including program directors/associate program directors, coordinators, faculty, DIOs, residents and fellows. The common program requirements can be found by clicking this link and your comments can be written by going to the ACGME webpage. When you go to this page, there is an address and a form to use to submit your comments. As you have heard me say before, apathy is a vote of approval.

Since the last edition of GMEmail, the internal medicine programs had both their regional and statewide American College of Physicians' competition. The results can be found in the In the Spotlight column. In addition, residents from the general surgery program had the opportunity to present at the American College of Surgeons annual meeting – results also at the end of the newsletter. Many pediatrics residents will be heading to Carmel for the Western Society of Pediatrics Research – their acceptances were listed in the last edition. It is really nice to see residents' success in the regional and national venues for presentations of their scholarly activities.

A brief update on the transition – with the accreditation of UNLV both as a medical school (preliminary) and as a sponsoring institution for GME (initial) – a formal letter or set of letters have been written to the ACGME to transfer the Las Vegas programs (17) to UNLV. The ACGME has received the letters both from UNR Med and from UNLV to transfer and to accept respectively the programs. The ducks are in a row and the process will be completed by July 1, 2017. As part of this process, all sites that have agreements, both master with PLAs or just PLAs, will be using new ones. Spearheading that process will be Megan Becerra, the new institutional coordinator for UNLV and UNR – she will start January 1, 2017. The recruitment for a fulltime Reno based coordinator is underway and it is hoped that person will be recruited before Match Day to complete the onboarding of the Reno residents and fellows.

With respect to the coordinators, my long time goal has been for them to achieve Training Administrators of Graduate Medical Education (TAGME) certification. The first coordinator to accomplish that task was Carol Allen, C-TAGME from obstetrics/gynecology prior to her retirement. I am delighted to share that Katina Shehie, C-TAGME from internal medicine – Las Vegas is now the second. To be eligible, coordinators have to have been in their current positions a minimum of two years, study and complete an exam and at recertification, present at a regional or national conference. I hope that the rest of the eligible coordinators will follow this process.

As we move into the new year, recruitment will be winding down. On the horizon are the coordinator retreat March 3, 2017 and the program director retreat on April 4, 2017 featuring Eric Holmboe, MD from the ACGME with a focus on evaluation. These retreats serve to bring together the respective groups statewide for a program designed to meet the current needs of each group. I hope that as the transition occurs, we can continue these retreats as they provide great learning and sharing of information, best practices across disciplines.

With the holiday season rapidly approaching, my wishes for everyone are health and happiness. Regardless which holiday is celebrated, let us join together as a group to be kind to one another, be supportive of differences of opinions and strive for excellence. Happy holidays and a wonderful new year to everyone and your families.


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

The Resident Voice

The Resident Voice is on hiatus this month because Zachary Skaggs is rotating in the ICU. If there are others who are interested in participating in writing for this column, please inform Dr. Bar-on or Zachary.

From the ACGME

What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles

Ingrid Philibert, PhD, MBA
Senior Vice President, ACGME

With the proposed revision of the Common Program Requirements, the ACGME is suggesting that the 16 hour limit on work hours for PGY1 residents be rescinded. This article describes 30 influential articles that help the committee reach their conclusion.

Best Practices

Wellness in Graduate Medical Education: Is It Time to Pull the Andon Cord?

Meghan M. Walsh, MD, MPH
Chief Academic Officer and Designated Institutional Official
Hennepin County Medical Center, Minneapolis, MN

As you read in the associate dean's column, wellness in graduate medical education is of huge concern to all involved – residents, fellows and faculty. The ACGME is proposing to take action in this area by revising the common program requirements with inclusion of a well-being requirement. There is a rate of burnout in medicine that exceeds the national averages by huge numbers and the rate of suicidal ideation is also high. This article makes some suggestions on how to address the issues involved especially in the clinical learning environment.

In the spotlight

In this season of fellowship matches, congratulations to the following residents:

Las Vegas Internal Medicine class of 2017:

  • Muazer Ahmed – nephrology at the University of Texas Health Sciences Center at San Antonio
  • Alhusain Aly – nephrology at the Oregon Health and Science University
  • Simran Matta – critical care medicine at Baylor College of Medicine
  • Subhasree Panchangam – cardiology at Texas Tech University at El Paso
  • Dulip Ratnasoma – sleep medicine at the University of California – Los Angeles
  • Phillip Ribeiro – nephrology at Vanderbilt University
  • Parvine Rustamova – sleep medicine at the University of South Florida Morsani School of Medicine – Tampa

Las Vegas Internal Medicine previous classes:

  • Yousef Ayatollahi (2016 and current chief resident) – cardiology at the University of Nevada, Las Vegas School of Medicine
  • Mily Sheth (2015) – pulmonary critical care at Washington Hospital Center – DC
  • Ahmed Sagaslli (2014 and former chief) – pulmonary critical care at the University of Nevada, Las Vegas School of Medicine
  • Aswathnarayan Mandandhi (2010 and former chief) – cardiology at the University of Connecticut

Reno Internal Medicine class of 2017:

  • Prianka Agarwal – endocrinology at the Medical College of Wisconsin
  • Aashish Khullar – nephrology at the University of Colorado
  • Sandeep Gupta – rheumatology at the University of Tennessee.

Pediatrics class of 2017:

  • Lynsey Zuar (Chief Resident in Pediatrics) – Pediatric Gastroenterology at Cornell University
  • Mallory Cohen (PGY-3 in Pediatrics) – Pediatric Gastroenterology at Washington University, St. Louis
  • Manjiri Tule (Chief Resident in Pediatrics) – PICU at University of Florida, Gainesville
  • Petrina Kaluzhny (PGY-3 in Pediatrics) – Developmental Pediatrics at University of California, Davis
  • Scott Pangonis (PGY-3 in Pediatrics) – Pediatric Infectious Diseases at Cincinnati Children's Hospital
  • Shannon Riley (PGY-3 in Pediatrics) – PICU at University of Tennessee/ St. Jude in Memphis
  • Uche Nwokidu-Aderibigbe (PGY-3 in Pediatrics) – Neonatology at University of New Mexico

Congratulations also to the cardiology and pulmonary critical care fellowships and their staff for filling in the match.

Congratulations to Jessica Arabski PGY 4 from psychiatry – Las Vegas who was accepted into a Forensic Psychiatry Fellowship program at OHSU.

Congratulations to Kelly Conright, hospice and palliative medicine program director and Neila Shumaker, geriatrics program director who were invited presenters at the 3rd annual Clinical Geriatrics Interprofessional Symposium in San Diego, sponsored by GWEP (Geriatric Workforce Enhancement Program), UCSD, VA San Diego.

Congratulations to the rural family medicine program faculty Elissa Palmer, program director, Bradford Granath, Winnemucca site director and faculty Byron Perkinson and Robert Westling who revised the Recommended Curriculum Guidelines for Family Medicine Residents: Medical Genetics. AAFP Reprint No. 258.

Lauren Pellman (PGY-2), Ben Fox (PGY-2), and Omar Ahmed (PGY-2), and Ben Smith (PGY-3) assisted with the Lake Mead EMS Refresher Course Nov. 18 and 19. They engaged in simulated marine rescue operations with Park Rangers at Lake Mead.

Las Vegas EM residents provided care at the most recent Tough Mudder Oct. 29-30 under the direction of clinical faculty member Dr. Christopher Krall. The residents treated the spectrum of heat-related illnesses, orthopedic injuries, and rhabdomyolysis. November 12-13 will see the World's Toughest Mudder Event come to Las Vegas. The event is a 24-hour endurance event featuring 1500 competitors from across the world. Other upcoming Event Medicine events to be staffed by the resourceful residents include the Las Vegas Rock 'n' Roll Marathon on Nov. 13 under the direction of Dr. Christian Young.

Congratulations to Devin Thompson (PGY-1) on receiving the 2016 National Outstanding Medical Student award at ACEP 2016 Scientific Assembly held here in Las Vegas. The award is given to the medical student who demonstrates scholarly achievement, outstanding board scores and grades, and who demonstrates professionalism, humanism, and clinical acumen. He joins the program from St. Louis University School of Medicine, where his achievement earned him this honor.

Welcome to Michelle Fontenele Gilmer who has been appointed as associate program director for the child psychiatry program to help out in Dr. Durette's absence.

Congratulations to general surgery resident Chris McNicoll – PGY3 who was appointed as the Resident Representative to a national workgroup for the American College of Surgeons – Board of Governors Chapter Activities Domestic Workgroup. The appointment lasts for 3 years, and involves participating on conference calls and at in-person meetings to help develop and support local chapters of the ACS.

Congratulations to plastic surgery PGY5 resident Joshua Goldman who received the following awards:

  • AMA Nomination for the Resident Position on the ACGME Institutional Review Board
  • Nevada State Medical Association Health Policy Competition – 2nd Place Poster Presentation
  • 2016 Undersea and Hyperbaric Medicine Annual Meeting President's Award for Best Overall Trainee Poster Presentation

Congratulations to plastic surgery PGY5 resident Joshua Goldman who had the following presentations:

  • Goldman JJ, Wang WZ, Fang XH, Williams SJ, Baynosa RC. "The Negative Effect of Lidocaine on Lipoaspirate Stem Cell Survival". 2016 American Society of Plastic Surgeons Annual Meeting. September 23, 2016.
  • Goldman JJ, Weber RI, et al. "Understanding Trends in Post-Mastectomy Breast Reconstruction Utilization in Nevada". 2016 American Society of Plastic Surgeons Annual Meeting – Senior Resident Conference. September 23, 2016.

Congratulations to obstetrics and gynecology PGY3 resident Lannah Lua who had two papers accepted for publication:

  • Simultaneous Uterine and Bladder Rupture following Successful Vaginal Birth after Cesarean Delivery: Laparoscopic Repair of Defect accepted to The Journal of Minimally Invasive Gynecology
  • Current Practice Patterns for Management of Vulvodynia in the United States accepted to Archives of Gynecology and Obstetrics.

Congratulations to two internal medicine – Las Vegas residents Nitasha Khullar and Ammar Yousif who were recognized by the VA director in her weekly highlights for providing such outstanding care to veterans that they sent in complimentary letters.

Congratulations to PGY3 Las Vegas family medicine resident Harsh Patel who was selected as a recipient of the AAFP Senior Immunization Grant Award, one of seven awards in the country and the first in the state of Nevada. The $11,200 grant focuses on improving influenza and pneumococcal pneumonia vaccination rates in senior citizens at the Family Medicine Practice site. It also provides a $1,200 travel scholarship for one or more of the residents to present the project results at the AAFP 2017 National Conference of Family Medicine Residents and Medicine Students.

Welcome to recently graduated residents David Kuykendall and Kevin Mailland who joined the Department of Family and Community Medicine in Las Vegas as faculty members.

Congratulations to Las Vegas Family Medicine Residency Program Director, Kate Martin, who led a question-and-answer session following a film screening at UNLV on September 21st with Dr. Grace Dammann, a renowned physician featured in the film, States of Grace: A Journey of Loss, Resilience, and Renewal.

Congratulations to the pediatrics residents who had abstracts accepted at the Western Society of Pediatrics Research at Carmel, CA January 26-28, 2017:

  • Two Atypical Cases of Pediatric Lymphohistiocytosis
    Fisher, Emilia Hedin (PGY-2 in Pediatrics); Hogan, Mary Beth (Faculty in Pediatrics)
  • A Skull Depression in a 9-Month Old Girl
    Galvis, Alvaro Eduardo (PGY-2 in Pediatrics); Shoo, Anthony (PGY-3 in Pediatrics); Shedlock, Aaron R (Faculty in Pediatrics)
  • Interrupted Aortic Arch Diagnosed in a 57 Year Old Female with Refractory Hypertension.
    Kaushal Dosani (PGY-2 in Pediatrics), Alvaro Galindo, MD (Faculty in Pediatrics)
  • Bullying – Are Pediatricians Doing Enough?
    Ashley MO (PGY-3 in Pediatrics), Munira Rahman (PGY-3 in Pediatrics), Felicia Lam (PGY-3 in Pediatrics), Samrat U Das (Faculty in Pediatrics)
  • Disseminated Gonococcal Infection Masquerading as Systemic Lupus Erythematous Flare
    Stephanie Lee (PGY-3 in Pediatrics), Dr. Barber (Faculty in Pediatrics).

Congratulations to pediatrics program director Samrat U Das who had his letter to the editor titled "Impact of ACGME Accreditation Process on Quality of Program and Patient Care in the Community" published in the October 2016 edition of Journal of Graduate Medical Education.

Congratulations to HPM fellow, Erin Klinkman who had a case presentation "The "Devil" is in the Details: Dialysis and Religion at the End of Life" accepted for an oral presentation at the annual assembly of AAHPM (American Association of Hospice and Palliative Medicine) scheduled in Feb 2017, Phoenix, AZ.

Congratulations to the Reno and Las Vegas Internal Medicine Residents who participated in the Nevada Chapter of the American College of Physicians resident competition:

  • Northern Nevada Regional Abstract Competition Finalists for Clinical Vignette Category:
    • Htun Latt – The arrhythmogenic right ventricular cardiomyopathy (ARVC): a rare case report
    • Charles Graham – Metastatic Testicular Teratoma: A case report
    • Muhammad Faraz Younus – Rare case of Extramural Adenocarcinoma of Anus
  • Southern Nevada Regional Abstract Competition Resident Finalists for Clinical Vignette Category:
    • Jeffrey Caseja – Lemierre Syndrome with Cavernous Sinus Thrombosis and Orbital Dissemination
  • Southern Nevada Regional Abstract Competition Resident Finalists for Research Category:
    • Yaser Dawod – COPD and The Risk of Aspiration on Fiberoptic endoscopic evaluation of swallowing (FEES)
    • Jibran Rana – B-Type Natriuretic Peptide Levels in Differentiating between Heart Failure with Reduced Ejection Fraction and Preserved Ejection

Jibran Rana with poster

Special congratulations to Jibran Rana (pictured above) who won the research competition.

Christopher McNicoll, Purvi Patel, Paul Chestovich, Deborah Kuhls

Congratulations to Christopher McNicoll, general surgery research resident and Purvi Patel, Acute Surgery Fellow presented at the ACS COT Region IX Resident Paper Competition on December 3, 2016 at USC in Los Angeles. They were accompanied by faculty members Paul Chestovich and Deborah Kuhls. Dr. McNicoll was the first place winner from the Nevada State COT competition and presented "Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma". Dr. Patel was the second place winner from the Nevada State COT competition and presented "Teen seatbelt use: Where you sit matters".

Congratulations to surgical critical care program director Deborah Kuhls who presented American Association for the Surgery of Trauma Grand Rounds titled Firearm injuries: epidemiology, prevention and advocacy on December 8, 2016 in Los Angeles.

Congratulations also go to Deborah Kuhls who won the national safety council surgeons award for her work in injury prevention.

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 © 2016 University of Nevada, Reno School of Medicine.