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GMEmail

June 2016 | Vol. 9 | No. 2

From the Desk of the Associate Dean

It is hard not to be a bit emotional at this time of year. With preparations for the incoming interns and fellows in high gear and excitement running high, there is still the aspect of saying "good-bye and good luck" to those who are moving on to new chapters in their lives. In the next few weeks, there will be celebrations recognizing completion of training programs, relocating to pursue further training and starting new positions as attending physicians. To everyone moving on to the next phase of your careers, congratulations on your accomplishments and best wishes for an awesome future. Know we are proud of you and hope you will stay in touch. As you go forward, remember the school of medicine, your faculty, your program directors, your coordinators and everyone who has been there to make sure you were successful in this part of your journey.

Since the last issue of GMEmail, many things have transpired. Program coordinator and director retreats were held. After building marshmallow and spaghetti bridges and an update from the ACGME Annual Educational Conference, the coordinators focused on problem solving, communication and organization.

marshmallow Challange

marshmallow Challange

The program directors participated in the marshmallow challenge followed by a workshop conducted by Ingrid Philibert, Senior Vice President of the ACGME. She focused on the self-study visits which are being conducted by the ACGME as part of the Next Accreditation System (NAS). A major aspect of the workshop was to have program directors think about their programs and develop AIMS that clearly articulate the uniqueness of their program. At the joint GMEC meeting in July, programs will present their AIMS for their peers to receive feedback. The afternoon focused on using the knowledge of the group to solve common problems.

Since the marshmallow and spaghetti bridge building activity was so successful with the coordinators, we implemented it for the incoming chief residents as part of their retreats—one in Las Vegas and one in Reno. These retreats focused primarily on leadership skills, communication and planning for the upcoming year. Incoming chiefs were asked to determine what they were going to do to influence their programs and implement change. It is going to be an especially challenging year for the Las Vegas chiefs as they work to transition their programs to UNLV which will occur in July 2017.

Goodman award winners

On April 21, 2016 representatives from the Reno residency programs participated in the 5th Annual Philip H. Goodman Resident Competition in Critical Appraisal. Residents representing their programs were: Travis Walker – Family Medicine, Sandeepkumar Gupta – Internal Medicine and Faraz Merchant – Psychiatry. Each presenter critically reviewed a journal article in their discipline; all were outstanding. The judges including Dean Thomas Schwenk, Senior Associate Dean for Research James Kenyon and former UNSOM student and resident Reka Danko had a tough decision to make, but the recipient of the prize was Faraz Merchant. Dr. Merchant will receive funding to a professional meeting of his choice to further his career. As always, Nancy Brick-Goodman and her family were present to demonstrate their support for the competition. We are grateful for the support of the Goodman Family in providing this educational experience for the Reno residents as well as opportunity to honor Dr. Goodman.

Late spring also signals Resident/Fellow Research Days – one in Las Vegas and one in Reno. The events were held within a week of each other. Dr. Schwenk served as a judge for both competitions along with Carl Reiber, PhD, Warren Evins, MD and Robert Langer, MD in Las Vegas and Elizabeth Hill, RN, PhD and James Kenyon, PhD in Reno. In Las Vegas, the quality team from UMC of Kurt Houser and Mary Brann, DNP also joined as guest judges. There were 30 submissions for the Las Vegas event with 24 presenters and 7 submissions with 6 presenters in Reno. Traditional presentations of clinical/basic science research and case vignettes were accompanied for the first time by presentations of quality improvement projects in both locations. Awards were presented in both venues to the following individuals:

Las Vegas:

Research:

  • First place: Joshua Goldman – Plastic Surgery
  • Second place: James Bailey – Emergency Medicine
  • Third place: Chris McNicoll – Surgery

Quality Improvement:

  • First place: Ali Malik – Internal Medicine
  • Second place: Munira Rahman – Pediatrics

Clinical Vignettes:

  • First place: Lindsay Wenger – Surgery
  • Second place: Mallory Cohen – Pediatrics
  • Third place: Sehyr Imran – Pediatrics

Reno:

Research/Quality Improvement:

  • Chia-Yang Hsu – Internal Medicine
  • Jennifer Hagen – Geriatrics

Clinical Vignettes:

  • Helena Russell – Geriatrics
  • Amani Altamimi – Geriatrics

This was the 10th Research Day in Las Vegas and the 9th in Reno. I want to thank all who participated – presenters and judges as well as those who attended the event. My goal is to have representation from all of the training programs and if necessary have a separate day for presentations from the fellows. This year's event was highly successful.

As many of you know, at the 2015 Legislative Session, a line item in the budget was allocated to GME expansion. Ten million dollars was budgeted to be distributed in two aliquots of five million each. A taskforce was assembled comprised of hospital leaders and the deans of the four medical schools in the state. A request for applications or RFA was created with the focus on mental health and primary care. There were eight proposals/applications submitted – six from the school of medicine. At a meeting on May 10, 2016 the proposals were presented to the taskforce who had the opportunity to ask questions. In the end, UNSOM faired quite well receiving 4.4 million of the 5 million dollar total. Interestingly the funding was split with 2.2 million to Las Vegas and 2.2 million to Reno. The recipients of the funding were:

Las Vegas:

  • Psychiatry – Alison Netski, project director – $900,000
  • OB/GYN – Vani Dandolu, project director – $1,300,000

Reno:

  • Psychiatry – Dave Carlson, project director – $500,000
  • Internal Medicine – Nagesh Gullapalli, project director – $1,700,000

When all of these projects are fully implemented there will be a total expansion of GME in Nevada by 51 positions. This is quite an accomplishment for us and for Nevada. The next RFA should be forthcoming in the upcoming weeks. It is our hope that the request will be expanded to give other specialties opportunities to be developed and created. Expansion is terrific, but now it is imperative to expand the GME portfolio in Nevada to provide opportunities for our graduating students who want diversification in the specialties available in state.

As evidenced by the length of my column, lots of things have been occurring in GME over the past three months. Again, I want to wish best of luck to our graduates and to our prelim residents – all who ae about to embark on the next phase of their careers. To everyone else, have a wonderful and safe summer.

Best,

m

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

Residents’ Voice

How to Get Involved in Health Policy

By Zachary David Skaggs (PGY-1 EM)

Currently running for the soon-to-be-vacated Nevada Senate seat left behind by outgoing Senate Minority Leader Harry Reid is none other than Dr. Joe Heck. Dr. Heck, an Emergency Medicine Physician, promises to bring to Washington, D.C. a voice that can speak for physicians nationwide on matters ranging from the funding of ACGME residency programs to the ongoing rollout and nationwide implementation of the Affordable Care Act.

But Dr. Joe Heck is the exception, rather than the rule, when it comes physicians serving in the highest corridors of power. Namely, they are a rarity. And they are vastly outnumbered by lawyers, who represent fully 44% of the current 113th Congress. And even outside Washington, D.C., whether in the pages of newspapers or in the ranks of local advocacy organizations, physicians are grossly underrepresented among other professions.

This is unfortunate because there are far-reaching changes that are occurring in healthcare at this very moment. If we do not participate in the shaping of this legislation, we risk being served laws and regulations that do not necessarily serve ourselves as a specialty, and, more importantly, the patients that we more than any other group know how best to serve.

This article describes how you, as resident physicians, can make your voice heard in the political process.

Join an organization. Probably the easiest first step for many residents to take is to join their specialty organization's advocacy organization. All residents are permitted to join AMA, representing medicine broadly, and you can also join your own specialty's specific group. Discounted memberships for residents are available, and representing these groups is a great way to network within your field, and to learn about the key legislative and regulatory issues facing your specific specialty.

I personally participated in a recent delegation to Washington, D.C. with co-residents Drs. Iggie Tanone (PGY-2) and Tiffany Sigal (PGY-1) on behalf of the American College of Emergency Physicians (ACEP). We had the opportunity to meet with Nevada Senators, Congressmen, their staff, and many of the nationwide leaders in our medical specialty's community. We discussed current legislation relating to prescription opioid analgesics, EMTALA, tort reform, EMS, mental health, and affordable healthcare. While there, we ended up bumping into members of the American Society of Anesthesiologists (ASA), who were in town advocating for issues of importance to their specialty.

Develop a personal relationship. As physicians, we have a unique opportunity to personally build relationships with the figures that represent us in politics. They value our feedback, and they—perhaps uniquely among professionals—see us community leaders worth courting. These relationships can be initiated at local campaign events and nurtured in many other ways, which brings us to…

Call your local representatives. Did you know that you can call the office of your local Congressman? Your concerns regarding local issues will be logged and presented to him or her at a weekly meeting by his staff. Try it out and see. Reno residents can call the office of Congressman Mark Amodei (R-NV-2) at (775) 686-5760. Las Vegas-based residents should try the aforementioned Joe Heck (R-NV-3 currently in Congress but running for a Senate Seat) at (702) 387-4941. You can also place a formal request that your legislator visit the hospital you work at in order to familiarize his or herself firsthand with the issues you are facing.

Contribute. Articles, letters to the editor, blog posts, twitter posts. While you should be careful that your message is professionally presented, these all represent an opportunity to advocate for your issues.

Comment. Did you know that all regulatory bodies allow comments from the public? This applies to CMS, HHS, NIH, and FDA proposed rules and regulations. Because regulatory matters are ones that typically are not voted on, a comment is one way to make sure that your voice is heard. Check out HHS.Gov Comment on Open Rules to see a list of regulations that you can comment on today.

While fully acknowledging how busy each and every resident is, and that political engagement isn't necessarily for everyone, if you want to become involved in politics, some of these represent a good way to start. If you'd like any other resources on this matter, feel free to contact me.

From the ACGME

Resident and Faculty Perceptions of Program Strengths and Opportunities for Improvement:
Comparison of Site Visit Reports and ACGME Resident Survey Data in 5 Surgical Specialties

Donna A. Caniano, MD, Kenji Yamazaki, PhD, Nicholas Yaghmour, MPP, Ingrid Philibert, PhD, MBA, Stanley J. Hamstra, PhD

In this article from the May 2016 issue of the Journal of Graduate Medical Education, the ACGME looked at surgical disciplines' programs' strengths and opportunities for improvement from site visits compared to the residents/faculty surveys. It appeared that faculty and residents were for the most part aligned in their perspectives of these two areas, but only two questions on the resident survey focused specifically on opportunities for improvement. Read the Resident and Faculty Perceptions of Program Strengths and Opportunities for Improvement: Comparison of Site Visit Reports and ACGME Resident Survey Data in 5 Surgical Specialties article.

Best Practice

Entrustment as Assessment: Recognizing the Ability, the Right, and the Duty to Act

Olle ten Cate, Ph.D.

In the Ripout article in the May issue of the Journal of Graduate Medical Education, the father of the EPA or entrustable professional activity, Olle ten Cate discusses using entrustment as assessment. The piece discusses when to allow residents/fellows the opportunity to practice independently or at least unsupervised. The concept of EPA connects competencies with practice and allows faculty the opportunity to determine when they are comfortable in letting residents/fellows do things independently without supervision based on performance. This essentially separates the complex competency based or milestones based descriptors from actual practice. View the Entrustment as Assessment: Recognizing the Ability, the Right, and the Duty to Act rip out.

In the spotlight

Welcome to Daniel Lucas, the new Geriatrics and Hospice and Palliative Medicine program coordinator. He is a welcome addition to both programs.

Congratulations to Stephanie Reinhardt, PGY3 and chief resident in the Reno Family Medicine residency program and to David Kuykendall, PGY3 in the Las Vegas Family Medicine residency program for receiving the Outstanding Resident Reno and Las Vegas respectively from the Class of 2016.

Congratulations to Acute Care Surgery program director John Fildes for receiving the Outstanding Full-Time Professor, Las Vegas from the Class of 2016.

Lightning strikes Las Vegas! UNSOM Emergency Medicine Residency Program Director Ross Berkeley, along with recently graduated EM residents Kellen Galster and Ryan Hodnick published a case report in Wilderness & Environmental Medicine "Lightning Strike in Pregnancy" describing a case in which a pregnant female struck by lightning resulted in fetal ischemic brain injury and long-term morbidity. The case represents one of only 20 cases of lightning strikes in pregnancy described within the medical literature and popular press combined.

Ross Berkeley along with our own UNSOM Associate Dean of Graduate Medical Education Miriam Bar-on, have described the process of "Early Engagement of Residents in Root Cause Analysis Process" in the Journal of Graduate Medical Education, slated for July publication.

Josh Pascoe (Emergency Medicine PGY-3)continues to discuss the ins and outs of critical care medicine on the Las Vegas Emergency Medicine FOAM Blog. Check out his latest posts on "Crash Ventilator Management" and "Anatomic Insertion of Central Venous Catheters" to apprise yourself of some key information on the management of the sickest patients in the hospital.

Tony Zitek

Former UNSOM EM resident and current UNSOM faculty Tony Zitek was awarded Best Research in the Plenary Session in the Western Regional Society for Academic Emergency Medicine (SAEM) conference for his work on the effects of nebulized albuterol on lactate levels. With the recent upsurge in attention toward sepsis, and with many patients receiving albuterol prior to labs being drawn in the ED, "The Effect of Nebulized Albuterol on Serum Lactate and Potassium in Healthy Subjects" was considered a timely and important original research project. Dr. Zitek found that 70 minutes after receiving an albuterol treatment, every single test subject saw an elevation of his or her lactate level, with a mean increase of 0.77 mmol/L.

Tanone, Sigal, and Skaggs at the White House

Iggie Tanone (Emergency Medicine PGY-2), Tiffany Sigal (Emergency Medicine PGY-1),and Zachary Skaggs (Emergency Medicine PGY-1)were delighted to represent Nevada's American College of Emergency Physicians (NV ACEP) for the organization's annual Leadership and Advocacy Conference in Washington, D.C. 5/15-5/18. Among many Capitol Hill offices visited, these residents had the opportunity to meet with Congressman Dr. Joe Heck (R-NV-3), who represents Southern Nevada and is running for the Senate seat of retiring Senate Minority Leader Harry Reid (D-NV). They also met with Harry Reid's staff. They would like to thank ACEP as well as EMP/USACS for funding their trip.

Congratulations to Pulmonary Critical Care program director Hide Shigemitsu, Child and Adolescent Psychiatry program director Lisa Durette and Otolaryngology program director Robert Wang who were named in the 2016 Top Doctors issue of VegasInc Magazine.

Congratulations to VegasSeven's Top Doctors edition awardees - Internal Medicine program director Sandhya Wahi-Gururaj, Colorectal program director Ovunc Bardakcioglu, OB/GYN program director Vani Dandolu, Otolaryngology program director Robert Wang, Otolaryngology associate program director Matthew Ng, Plastic Surgery Hand fellowship director Kayvan Khiabani, Plastic Surgery associate program director John Menezes, Pulmonary Critical Care program director Hide Shigemitsu and Surgical Critical Care program director Deborah Kuhls.

Congratulations to Alessandra (Lexi) Guiner (PGY-3 Pediatrics) had her book chapter titled " Approach to the Adolescent Psychiatric and Behavioural Health Emergency" published in textbook of Adolescent Medicine textbook from the American Academy of Pediatrics. Adolesc Med 026 (2015) 552-569

Congratulation to Senthil Bhoopalan (PGY-1 Pediatrics) had his manuscript titled "Worsening snoring in a 7-year old male" accepted in the journal of Pediatrics in Review. Samrat Das (Program Director) is a co-author.

Congratulations to fourth year Surgery residents Danielle Herder who matched at William Beaumont in Detroit and Maggie De Guzman who matched at East Carolina University both for Vascular Surgery Fellowships.

Congratulations to Las Vegas Sports Medicine program director Will Rosenberg who was appointed to the Nevada Interscholastic Activities Association (NIAA) Sports Medicine Advisory Committee. The NIAA is the governing body for high school athletics in Nevada.

Congratulations to Elissa J Palmer Rural Residency Program Director had 3 peer reviewed presentations accepted to the June 2016 WONCA Europe Congress in Denmark: (1)Leadership: competency assessment with a focus on advancement of women in medicine (2) Systematic inventive thinking "inside the box": practical approach to creativity, innovation and problem solving to advance educational and professional goals and (3) Implementing evidence-based tools to improve patient safety: creating a plan for your primary care office. WONCA is an acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. WONCA's short name is the World Organization of Family Doctors.

Congratulations to Surgical Critical Care associate program director Paul Chestovich who had an abstract accepted with student Joshua Catapano titled PRE-INJURY POLYPHARMACY PREDICTS MORTALITY IN ISOLATED SEVERE TRAUMATIC BRAIN INJURY PATIENTS as a Quick Shot Presentation at the 68th Annual Meeting of The Southwestern Surgical Congress held April 3-6, 2016 at the Hotel del Coronado, Coronado, CA.

Chestovich, Fraser, Chapman, Souchon

Surgical Critical Care and Acute Care Surgery associate program directors and fellows Paul Chestovich, Doug Fraser, Alistair Chapman and Patricia Souchon attended a rib fixation course in Miami, Florida to learn the latest techniques for rib fracture repair. April 22, 2016.

Congratulations to Acute Care Surgery associate program director Doug Fraser and medical student Joshua Catapano who had their abstract titled PRE-INJURY POLYPHARMACY PREDICTS MORTALITY IN ISOLATED SEVERE TRAUMATIC BRAIN INJURY PATIENTS selected for a Quick Shot Presentation at the 68th Annual Meeting of The Southwestern Surgical Congress held April 3-6, 2016 at the Hotel del Coronado, Coronado, CA.

Congratulations to Hasan Khashwji (PGY3 Surgery), one of 30 general surgery recipients in USA to receive the "Looking to the Future Scholarship" from the Society of Thoracic Surgeons. This process included writing an essay stating his interest in CT surgery, letters of recommendation, and publications. Through this scholarship he was able to participate in the STS conference in Phoenix, AZ, connected with the leaders of the field, and networked for future endeavors.

Congratulations to Hasan Khashwji (PGY3 Surgery) who had his paper titled Challenges of Complex Open Abdominal Wound Management in Trauma: A novel use of chitosan and hyaluronic acid as a three dimensional scaffold to overcome resilient open abdomen with high bio-burden accepted in Journal of the American College of Clinical Wound Specialists. He co-author was surgery faculty Jay Coates.

Congratulations to Reno Child and Adolescent Psychiatry program director John Pruett who won the election of Secretary-Treasurer for the American Association of Directors of Child and Adolescent Psychiatry.

Congratulations to Htun Latt (PGY2 Internal Medicine - Reno) who had his abstract titled Compartmentalized cAMP response to prostaglandin EP2 receptor activation in human airway smooth muscle cells accepted for presentation in "Annual Meeting at Experimental Biology 2016" in San Diego. Htun works with/in the lab of department of pharmacology professor Robert Harvey.

Congratulations to Muhammad Faraz Younus (Internal Medicine - Reno) who had his case report titled Gastric and Duodenal Pseudomelanosis: An Extended Unusual Finding in a Patient with End Stage Kidney Disease, published in Case Reports in Gastrointestinal Medicine, vol. 2016, Article ID 2861086, 3 pages, 2016. doi:10.1155/2016/2861086.

Chris McNicoll

Congratulations to Chris McNicoll (PGY3 Surgery) who had two posters presented at SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) 2016. Both posters included current and past residents from the training program and faculty.

  • "Intraoperative Management of Mirizzi Syndrome with Cholecystohepaticodochal fistula: A Case Report." Christopher McNicoll, Raffi Kotoyan, Lindsay Wenger, Cory Richardson, Matthew Johnson, Charles St. Hill, Nathan Ozobia.
  • "Management of Choledocholithiasis with Laparoscopic Surgery and Endoscopic Retrograde Cholangiopancreatography in Pregnancy: A Case Series" Christopher McNicoll, Lindsay Wenger, Cory Richardson, Matthew Johnson, Charles St. Hill, Nathan Ozobia.

Congratulations to Chris McNicoll (PGY3 Surgery) and his co-investigator Charles St. Hill who had their mini-grant application to the Mountain West Clinical Translational Research Infrastructure Network accepted and funded for $12,500. The title of the grant is In vitro electroporation with microRNA in human HepG2 and Panc-1 cancer cells. Surgery program director, Jennifer Baynosa is one of the co-investigators on this project.

Chris McNicoll (PGY3 Surgery) had the opportunity to attend the American College of Surgeons Leadership and Advocacy Summit 2016 in Washington DC. One picture is with Senator Dean Heller and the other is with Rep. Cresent Hardy (4th district). He was the only surgeon from Nevada to meet with them, and the staff of Sen. Harry Reid in his Capitol office, regarding current legislation affecting the patients of Nevada. Chris also received a $500 resident scholarship from the American College of Surgeons to attend the summit.

Chris McNicoll Rep. Hardy

Chris McNicoll and Senator Heller


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.