February 2015, Issue 2 DOM GME Snapshot

With almost 19,000 active members from over 100 countries, the American College of

Chest Physicians (CHEST) is a global leader in medical education and clinical research. Over 5,000 attended the

CHEST 2014 international scientific meeting in Austin, TX. Several Walter Reed/Uniformed Services University Depart-ment of Medicine physicians significantly contributed to the success of that meeting by presenting their research and expertise in multiple sessions during the week, including: Fellows (Right, Clockwise) CPT Michal Sobieszczyk, LT Nikunj Bhatt, MAJ David Hostler, MAJ Tim Hauser, LCDR Joe Zeman. (not pictured: MAJ Brian Cohee, CPT Patrick Smith)

Residents (Bottom, Clockwise) - LT Ian Grasso, CPT Brian Foster, CPT Camellia Hernandez, LT Donovan Mabe, CPT Blair Glasgo, MAJ Ted Bridges.

Faculty (not pictured) - LTC John Sherner, CDR Anthony Na-tions, LCDR Scott Parrish, LCDR Andrew Philip, LTC Eric Os-born, MAJ Jordanna Hostler, LTC Aaron Holley, Dr. Andrei Khramtsov, Dr. Teotimo Andrada, Ms. Karen Sheikh, CDR

Saira Aslam, CAPT (ret) Angeline Lazarus, COL William Kelly (USU) and COL Lisa Moores (USU).

CHEST (ACCP) MEETING AWARDS: Representing Walter Reed NCC IM Resi-

dency, CPT Blair Glasgo, won 1st Place in the Resident Clinical Poster category.

Representing NCC Pulmonary/Critical

Care Fellowship, CPT Patrick Smith won

1st place in the Fellow Poster category.

COL William F. Kelly, MC, USA, FCCP, received the Distinguished Service Award for leading significant achievements and for donating time, leadership, and service to CHEST.

Photographer of the Year:

LCDR Andy Philip (Pulm/CC staff)

HIGHLIGHTS

American College of Chest Physicians (ACCP OCT 2014)

WALTER REED DOM GME Snapshot

Recap

A MONTHLY AND EVOLVING

SNAPSHOT OF GME NEWS & HIGHLIGHTS

February 2015, Issue 2 DOM GME Snapshot

Check It Out!

We are now able to use Google's analytics to display real-time analysis of resident/faculty research activities!!

Please visit: <http://tinyurl.com/residentresearchfacts>

You can see the raw data:

<http://tinyurl.com/IMResearchRecord>

Residents, at press-time

we have over

50 entries in

the database.

Please highlight

successes at:

http://tinyurl.com/ResidencyResearchRegistry

For CCC's, the best way

to use this data during

reviews is downloading as excel

spreadsheet from: http://tinyurl.com/IMResearchRecord

and then organizing is based on

your class etc. Hope this is helpful

to your mission.

THANKS to CPT Rohul Amin!!

RESEARCH & ACADEMIC SUCCESS

LT James Fisher (PGY2 IM Resident) and mentors MAJ Dustin Little (Nephrology Staff) and CPT Sarah Gordon (Nephrology Fellow) were selected to

present their abstract, "Recurrent Renal Infarction in an Otherwise Healthy Active Duty Male" at the National Kidney Foundation meeting March 25-29 in Texas.

Attention CCC chairs and PD's!! A new guidebook (Wahoo!!) has been developed to aid Clinical Competency

Committees (CCCs). The guidebook provides information regarding the purpose and structure of the CCC, how to prepare for and run a CCC meeting, and post-CCC meeting actions, as well as legal and other considerations. Also included is an annotated bibliography. The ACGME Clinical Competency Committees: A Guidebook for Programs can be found in the Milestones section of the website.

Of note, one of the authors, Dr. Eric Holmboe, is a retired Navy Internist and former

GIM Clinic Chief here, as well as a contributing instructor at the NCC Program Director Course held here every January. Dr. Padmore from MEDSTAR also helps teach the NCC course and is a frequent partner of the NCC. Its available on the web at the link below: <http://www.acgme.org/acgmeweb/tabid/430/ProgramandInstitutionalAccreditatio n/NextAccreditationSystem/Milestones.aspx>

MD ACP 2015 Please be sure to congratulate the Walter Reed Navy ‘Doctor's Dilemma’ (Medical Jeopardy) team - (side: left to right) coach

MAJ Joshua Mitchell, competitors LTs Benjamin Vipler, James Fisher, Benjamin Kurth, and Chris-ta Eickhoff - who came in 1st place at this year's competition at the Maryland ACP meeting.

The Navy team beat the best of Baltimore, with a 12-team field including Johns Hopkins and

Maryland, and the Army team - (bottom left: left to right) CPTs Sarah Ordway, Ryan Jones,

Adam Barelski, and Jennifer Masel - also played well, losing a tight first round to the eventual 2nd and 3rd place finishers. http://www.acponline.org/about_acp/chapters/md/dd_2015.htm

Adam, Mike and Allison, I extend my thanks for representing our specialty so well by coordinating the Resident/Student-focused "Iron Med" competition at the Maryland ACP. The interest and participation in the event was tremendous, and offered a nice complement to the outstanding Maryland ACP Chapter content... and hope that we can continue this excellent collaboration among our Chapters in seeking to promote our great specialty and inspire our 'replacements' in the future. Thanks to Maryellen Woodward, Dr. Steve Sisson and the MD Governor's Council for making this possible in the meeting as well. (William Shimeall, PD NCC - Internal Medicine)

(bottom right photo) Iron Med

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February 2015, Issue 2 DOM GME Snapshot

FOR YOUR EYES ONLY

Sakai

Have you presented a poster? Given a podium? Published in a peer-reviewed journal? Presenting at an upcoming meeting? Then share your outstanding work for all to see on the Residency Sakai

Research Page. Just click on the "Research" link on the Residency Sakai main page and fill in the details under the "Celebrate Successful Projects" link. This helps your peers see what you've done and promotes collaboration among peers and faculty alike.

If CPR doesn’t work, try biting — heartwarming video of a

monkey saving the life of a friend who had fallen unconscious after being electro-cuted at Kanpur train station in India: https://www.youtube.com/watch?v=YKpsQVgz0vM

WATCH AND LEARN

IM Meeting 2015

Congratulations to CPT Cynthia Philip (IM Intern) and ENS Chris Shank (USU Student and future IM Intern) (and thanks Nephro for mentors CPT Sarah Gordon and staff Dr. Dustin Little, and Dr. C. Yuan) for having been selected by the American College of Physicians Abstract Review judges for presentation as a poster finalist. Their poster, "A CASE OF SUPPLEMENT-ASSOCIATED ACIDEMIA AND ACUTE KIDNEY INJURY IN AN ACTIVE DUTY SOLDIER", will be judged on-site at the Internal Medicine Meeting 2015 in Boston.

Hats off to Dr. Gordon (with CPT Philip and ENS Shank as co-authors) submitted to the National Kidney Foundation national meeting a larger case series of similar patients we've seen (Renal failure soldiers taking NO Xplode), which was also accepted for presentation in March.

MORE ON SUPPLEMENTS

The use of per-formance-enhancing sup-plements in the US military in-

troduces real clinical risk to our servicemen and women and a le-gitimate threat to force health pro-tection. Many of these supplements are

marketed as performance-enhancing with-out a clinical benefit, therefore there is no direct Food and Drug Administration (FDA) oversight for this multi-billion dollar indus-try. Performance-enhancing supplements include over-the-counter multivitamins, single ingredient supplements including creatine and protein powders, pre-workout vasoactive substances as well as thermo-genic/fat-burners and anabolic agents.

Within the Department of Defense (DoD), clinicians and scientists are working togeth-er to tackle this growing problem. At the Uniformed Services University for Health

Sciences, Dr. Patricia Deuster is the director for the Center for Human and Military Performance (CHAMP), the DoD Center of Excellence

for integration, translation, & education of all topics related to human performance optimization & total force fitness.

CHAMP has developed the Human Performance Resource Center (HPRC, http://hprc-online.org) to provide

military service members and healthcare providers important information to best address the risks of supplement use.

To learn more about performance-enhancing supplement use, check

out the HPRC supplement pages, http://hprc-online.org/dietary-supplements/opss."

To report adverse effects and also querying their enormous database of reported effects from other sup-plements when you have concerns:

http://tinyurl.com/hprc-supplement-adverse-effect - The adverse event re-porting tab is on the right side.

Questions? Feel free to email her direct-

ly patricia.deuster@usuhs.edu, or ,Charles Magee, MD, MPH, FACP, General Internist, and Assistant Professor of Medicine, at charles.magee@usuhs.edu or 301-295-0123 (office).

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February 2015, Issue 2 DOM GME Snapshot

QUALITY IMPROVEMENT / PATIENT SAFTEY

COMING

SOON

3rd Annual

Walter Reed

IM Residency

Quality

Improvement/

Patient Safety

Poster Fair

WHAT: Resident

teams will present

their year-long QI

projects

WHEN: May

2015—TBD

Attend to learn

about what our

residents have been

working on with

faculty mentors,

give feedback, and

improve your un-

derstanding of the

QI process.

2013—2014 Projects Team Alpha

Members: Andrew Biggs, Karen Zeman,

Christie Joya, Tyrone Robinson, Donovan Ma-

be, Lee Jamison, Emily Brown, Krystle Salazar

Title: “Pre-Appointment Questionnaires: Improving

Outpatient Patient and Physician Satisfaction”

Team Bravo

Members: Joe Roswarski, Marsha Johnson, Adam

Barelski, Akira Shishido, Ryan Jones, Laura Gilbert,

Serennah Harding, Daniel Hodge

Title: “Improving diabetes care in Bravo clinic

through implementation of ACC/AHA lipid guideline”

Team Charlie

Members: Nelani Pathirana, Dustin Albert, Jack Hut-

ter, Michael Dore, Monsur Ali, Oliver Chiong, Nicho-

las Fiacco

Title: “Implementation of mock codes into Internal

Medicine residency curriculum”

Team Delta

Members: Edward Bridges, Geoffrey Loh, Dorian

Anderson, Hector Medina, Matthew Biscotti, Allison

Bush, Diana Dougherty, Kayleen Elsbree

Title: “Improving Screening Rates for Hepatitis C

Virus:A Process-Improvement Exercise in an Internal

Medicine Home Team”

Team Echo

Members: Jackie Kircher, Kia Gallagher, Derek For-

sthoefel, Amy Puderbaugh, Shannon Wood, Richard

Plasse, Nicholas Pytel, Brett Sadowski, Robert Wauters

Title: “Vancomycin Adminstration and Serum Concen-

tration Monitoring: The Sequel”

Team Hotel Members: Anumeha Singh, Jennifer Masel, Brian Park,

Stacy Comer, Mark Pence, David Cook, Scott Snyder,

Andrew Spiro

Title: “Optimizing documentation of code status on the

inpatient medicine service”

Team Juliet

Members: Rohul Amin, James Nguyen, Stephen

Koplin, Michal Sobieszczyk, Blair Glasgo, Jeffrey

Eickhoff, Ryan Haley, Maryann Sullivan

Title: “Burnout Elimination Therapy To Enhance Re-

siliency (BETTER) Study”

Team Kilo Members: Chris Drinkwater, Camellia Hernandez,

Brian Foster, Gilda Bobele, Mark Hubbard, Matthew

Middendorf, Kenneth Motoyama

Title: “Implementation of a CCU Procedure Resident”

Team Lima

Members: Nicole Harrison, Julia Cheringal, Richele

Corrado, Benjamin Vipler, Christa Eickhoff, Melanie

Acevedo, Michael McMahon

Title: "Rethinking the Radiology Protocol: An Institu-

tion-Based Quality Improvement Project to Improve the

Ordering Process for Inpatient Radiology Studies"

im strong

im strong

im strong

im strong

DOM GME QI Review Conferences — Every 3rd Thursday of the Month

The Department of Internal Medicine held an outstanding Quality Improvement Review Conference (formerly known as Mor-bidity and Mortality Conference). The focus of this discussion was determining the potential cognitive and systems-based

errors made in our care. For this month’s case, we welcomed guests from Interventional Radiology and Pulmo-nary/Critical Care to comment on an insightful presentation by LT Donovan Mabe. The goals of the meeting was educa-

tional with generation of recommendations for improvement across the clinical spectrum. These recommendations will be sent to the Quality Management Committee and should generate action toward improvement in the suggested areas.

Than k you for Joining Us!!Than k you for Joining Us!!Than k you for Joining Us!!

Recap

P AGE 4

February 2015, Issue 2 DOM GME Snapshot

← Using the hint to the left, can you guess the Plenary speaker?

1st Annual Walter Reed

IM Research Symposium

We are excited to host a Symposium on March 12th at 11:30PM in the America Bldg, 2nd floor, room 2525 B/C. This provides a forum for IM residents to share active research projects and focus on the process of conducting research during residency. This year's guest speakers include:

COL Peter Weina, Chief, Dept. of Research Programs at WRNMMC

Panel Q & A session with success-ful resident research mentors in clinical and basic science areas

Subspecialty education coordina-tors to bring active and upcoming research projects where mentor-ship might be available for inter-ested residents.

The goal is to continue to foster world-class research at Walter Reed as a dis-tinguishing characteristic of this resi-dency program. We encourage all to come support resident research by attending this year's event. For any questions, the POC for this event is MAJ Charlie Magee (charles.magee@usuhs.edu). In April we are rolling out a new,

monthly resident research meeting, to be co-led by the residency research coordinators for each class and facilitat-ed by MAJ Charlie Magee. We invite all research-minded faculty to attend and support our resident researchers over the academic year by attending when possible. If you are a research-minded

faculty member and interested in providing short lectures or leading discussions on research topics, please email MAJ Charlie Magee (charles.magee@usuhs.edu). Name and specific dates and times TBD.

DOM

Annual

Retreat

Is being held Fri-day 13 March, 0800-1700 at USO NSA

Bethesda, Bldg 83. Open to all interested faculty, fellows and staff who work with IM Residents. Please clear with your Service if attending. Details to follow.

And we would like to thank Marla Redmond and her outstanding team of administrators for all of their behind-the-scenes work coordinating the logistics.

SNEAK PEAKS & NEW BEGINNINGS

THIS IS A HINT

CALLING ALL CARS, CALLING ALL CARS!!! Invitation to 1st Annual WR IM Resident Research Symposium (below)— Please extend this welcome to any Faculty (and Fel-lows) in your Services who are interested in providing mentorship or want to encourage research opportunities for residents. There will be an opportunity for your Service to showcase available research opportunities to our trainees. And please ensure that our Subspecialty Education Coordinators for the IM subs are up to date and that a backup has been identified.

Hail to the New Chief, Walter Reed Department of Medicine We are proud and excited to have Dr. Nations as our new Chief of Medicine. Anthony has been a

great leader, patient and staff advocate, clinician, and educator, and he will certainly put these

skills he has shown in the hospital, region, and national pulmonary communities to good use in

his new position. Some Quick Facts:

CDR Joel (Anthony) Nations, MD, MBA, FCCP

Born in Jackson, Mississippi and prior enlisted Navy

MD from University of Mississippi

Internship and Residency at NMC Portsmouth (separated by 3 year GMO tour)

Chief Resident at NMC Portsmouth

Fellowship in Pulmonary/Critical Care Medicine NCC/NNMC

Additional recent degrees: MA (Naval War College) and MBA (George Mason University)

Most recently served as Chief, Pulmonary Medicine, WRNMMC

Has won multiple teaching awards throughout residency, fellowship, and as faculty

Has over 8 peer-reviewed publications and multiple invited lectures and other presentations

Really looking forward to the Annual DOM Faculty Residency Retreat in March

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February 2015, Issue 2 DOM GME Snapshot

DOM GME SNAPSHOT P AGE 6

WELL-DESERVED RECOGNITION

ity I cannot recall such enthusiasm and genuine interest on the part of our students in completing this activity. Because of the outstanding volunteer participation of your resi-dents we were able to provide one faculty member for each group of four students giving them a high quality learning opportunity. The students cherished this opportunity to learn from and connect with their "near peers". The dedicated USU physiology faculty that stead-fastly help me teach this laboratory year in and year out were vocal in their admiration and appreciation of your residents support. To an individual they were superb. Thank you for allowing them to partici-pate in this event. I hope we can continue to work together in this regard in the future.

Respectfully, Brian E. Neubauer, MD, FACP Major, USAF, MC Assistant Professor of Medicine / Cardi-opulmonary-renal Module Director F. Edward Hebert School of Medicine - Uniformed Services University of the Health Sciences

OCEAN’S ELEVEN CAST: CPT Jed Mangal CPT Jennifer Masel CPT Stephen Savioli CPT Ryan Haley LT John Mattingly LT Meredith Lutz CPT Zachary Junga CPT Sarah Ordway LT Benjamin Vipler CPT Adam Barelski CPT Jack Hutter FAN MAIL NOT ACCEPTED AT THIS TIME.

Dr. Shimeall and Colleagues, I am writing to express my sincere appreciation and gratitude for the

expert teaching pro-

vided by 11 of your

residents… in the USUHS pre-clerkship cardio-vascular-pulmonary-renal module. For five solid hours...these residents helped our faculty provide the high-est quality instruction to 180 pre-clerkship medical students in work-ing through a practical experience exploring the electrocardiogram and phonocardiogram. And by helped I mean they were the stars of the show. In the two previous years that I have been responsible for this activ-

meaningful and substantive contribu-tions to our PI project. I hope to update you on our progress and look forward to continuing to work with your enthusiastic house-staff. Thank you! Very Respectfully, Taylor Taylor Banks, MD LCDR MC USN Allergy/Immunology Staff Physician, Walter Reed National Military Medical

“Allergy Antibiotic” Consult or-

der is now live in Essentris!!

If your patients are eligible for this PI project, please include the PCN/beta-lactam of interest in the "Comments"

CONGRATULATIONS!! CPT Rita Richardson (PGY2 in

the IM/Psych Resi-dency Program) has been “Nominated as a Star of Virginia

Hospital Center". She was nom-inated for "compassion, being straight forward and made dealing with father's death much easier" while serving as the resident in the VHC ICU over the holidays.

CAPT Shimeall, I wanted to recognize four of your house-staff for their willingness to vol-unteer as peer representatives to help their colleagues navigate our new Pen-icillin/Beta-Lactam PI Project.

CPT Jamison, CPT Bobele, and LT Salazar have already begun re-

viewing the project with the ward teams and have my thanks for their efforts. I would also like to specifically recog-

nize CPT Hyun (Robert) Park, who

is not only serving as a peer repre-sentative, but has been actively en-gaged in the development of the pro-

ject, collaborating with Drs. Ress-ner, Kim, Gada, and myself. He has been an active participant and made

February 2015, Issue 2 DOM GME Snapshot

DOM GME SNAPSHOT P AGE 7

Also here are the WINNERS: The "Tom Sellick" Best Mustache Award: Dr. Jace Mattingly The "John Waters" Creepiest Mustache Award: Dr. John Greenwald The "Joe Flacco" "I need a mustache so bad" Award: Dr. Michael Dore The "Miley Cyrus" Best Fake Mustache Award: Caelis and Sidera Mattingly (Jace's daughters, who had - as the award states - awesome fake mustaches!) Thanks to all who participated. Dr. Alexander Dew will be a shoe-in for

next January's new award: The "Mike Ditka" "Da Mustache" Award! Stay tuned...

In our first issue, we asked the DOM GME Community if they could

identify these four worthy contestants of the noble SCHNURRBART com-petition IM Residents and Faculty have proudly upheld for these many years.

Clockwise from the top left:

Dr. Ichee Frankenscratchme himself, the founding father of the long

and noble tradition, the discerning Dr. Blair Glasgo, the venerable Dr. Jack Hutter, and the esteemed Dr. Ben Vipler. The GME Community is

proud of your effervescent partaking in this tradition.

How Did It All Begin You Ask?

In the first issue, we also challenged our creative readers to finish the IM

folktale in 97 words or less. Here it is:

GUESS WHO

As the celebrated, medical legend goes, Long, long ago, before Blue Cross & Blue Shield, deep in

the bowels of the Middle Ages, Dr. Frankenscratchme was sitting on the latrine, and thought to

himself…”I think I’ll grow a mustache,” and there, the noble tradition began. Yes, hard to

believe, I know.

Discussing the Undiscussable With the Powerful: Why and How Faculty Must Learn to Counteract Organizational Silence Mary E. Dankoski, PhD, Janet Bickel, MA, and Maryellen E. Gusic, MD Abstract Dialogue is essential for transforming institutions into learning organizations, yet many well-known characteristics of academic health centers (AHCs) interfere with open discussion. Rigid hierarchies, intense competition for resources, and the power of peer review in advancement processes all hamper difficult conversations, thereby contributing to organizational silence, and at great cost to the insti-tution. Information necessary for critical decisions is not shared, individuals and the organization do not learn from mistakes, and di-verse perspectives from those with less power are not entertained, or worse, are suppressed. When leaders become more skilled at inviting multiple perspectives and faculty more adept at broaching difficult conversations with those in power, differences are more effectively addressed and conflicts resolved. In this article, the authors frame why this skill is an essential competency for faculty and leaders alike and provide the follow-ing recommendations to institutions for increasing capacity in this area: (1) develop leaders to counteract organizational silence, (2) develop faculty members’ skills in raising difficult issues with those in positions of power, and (3) train mentors to coach others in rais-ing difficult conversations. The vitality of AHCs requires that faculty and institutional leaders develop relational communication skills and partner in learning through challenging conversations.

http://journals.lww.com/academicmedicine/Abstract/2014/12000/Discussing_the_Undiscussable_With_the_Powerful__.17.aspx

SOMETHING TO CONSIDER

February 2015, Issue 2 DOM GME Snapshot

DOM GME SNAPSHOT P AGE 8

Your Fellows and House

Staff Read Snapshot

Post upcoming events, accomplish-ments, or projects here!! E-mail Sean.M.Lynch36.ctr@mail.mil

SNIPPETS. Please share any successes or

highlights we may have missed, or that you would

like included in the next issue. Help us by providing all of the key details or as you would like it to appear.

WE WANT YOU!!

Contact Us If You Must

Sean M. Lynch

Self-Declared Supreme Editor-in-Chief

Please use Subject Line: Snapshot

Sean.M.Lynch36.CTR@mail.mil

(301) 319-4399

And please share your ideas on how we

can improve the value of the newsletter

and the engagement of our readers.

We are also looking for

cartoonists, artists, po-

ets and writers (even if

you are only self-declared) Let us

know who you are.

Did someone say book CLUB?

BREAKING NEWS: THE HIGHEST U.S. FOOD

PANEL NOW SAYS IT IS

ok TO EAT EGGS!!

“I never know

how much of

what I say is

true”

Bette Midler

All are invited to join us for Board Review

Every Monday at 1600, and Friday at 0700 in Building 19, Shore Conference Room 1118

Much Gratitude to LT Donovan Mabe and the Chief Residents

for your hard work organizing the 46 hours of new video based board prep series!!

Link to the schedule: http://tinyurl.com/Video-Based-Board-Prep-Series

Leadership Book Club is successfully underway!

Thanks LT Cheringal for getting us started on JAN 27th,

discussing Part 1 of the book “Turn the Ship Around”, by

CAPT (ret) L. David Marquet. The next port of call will be

10 MARCH at noon in America rm 2525. We may be

hearing more for CAPT Marquet soon...

We need your help to share “...the many great things that our students, interns, residents, fellows

and faculty are doing within and outside the Command. The picture that emerges as you read through this issue is clear demonstration of excellence in clinical care, research, education and community service. It in part repre-sents the great things we can accomplish together. To build Departmental cohesion, we hope to see the many unreported accomplishments of all DOM GME training programs highlighted. This forum is FOR YOU! I will ask all Service Chief, fellowship Program Directors and all faculty to use future issue of this newsletter as the big board to spotlight your accomplishments as we bond together to achieve the Quadruple Aim of readiness, better care, better health and lower cost in our enterprise.”

V/R Sam O. Wanko, MD, FACP, CAPT(s) MC, USN, Hem/Onc Specialty Leader