presented by: the office of faculty development august 22, … · · 2017-09-29mario castro, md,...

Department of Medicine New Faculty Orientation

Presented by:

The Office of Faculty Development

August 22, 2017

Department of Medicine Office of Faculty Development

Welcome and Overview The Office of Faculty Development


Office of Faculty Development Department of Internal Medicine

Mission

Provide DOM faculty with guidance & resources that foster professional and personal development to achieve academic and clinical excellence in a supportive environment.


Office of Faculty Development Department of Internal Medicine

Goals

• Provide a new faculty orientation program for DOM faculty

• Develop workshops and seminars to promote career development in clinical care, education, research, mentoring, and leadership

• Support university and department initiatives to recruit, promote and retain a diverse faculty with clinical, teaching and research expertise

• Develop and maintain an OFD website to provide guidance and resources to DOM faculty


OFD - Structure • Report directly to DOM Chair

• Co-directors

Mario Castro, MD, MPH Angela Brown, MD

• Program Coordinator

Jennifer Mosher


OFD – Current Activities

• Faculty Orientation - August 22, 2017 - 4 orientations to date/approximately 190 faculty have attended orientation

• 2017 Leadership Training Course (21 participants) - September 19, October 3, October 17, October 31 - 4 cohorts to date/92 faculty have completed the course

• Clinician Educator Portfolio Workshop - 8 workshops to date/approximately 155 faculty • New Faculty and Family Day at the City Museum - Event for New DOM Faculty and their Families

- November 19, 2017 from 11:00am-4:00pm

- 4 events to date/approximately 300 people (80 faculty plus their families)


OFD – Current Activities • Faculty Satisfaction Survey

- Completed in April 2014. Data analyzed and a summary of key points distributed to DOM Faculty. Follow up survey distributed June 2017. Survey will close on August 25th. Data will be summarized and distributed Fall 2017.

• Mentorship and Career Development Series - Kick off event in April 2016 - Dinner, Dialogue, & Speed Mentoring - Mentee/Mentor needs assessment - Letter of reference workshop - September 27th - Developing a Center of Excellence workshop – February 2017

• OFD Website upgrade and launch in 2017 http://internalmedicine faculty.wustl.edu


Office of Inclusion and Diversity (OID) https://internalmedicinediversity.wustl.edu/

• Established in DOM in July 2016 to expand WUSM’s mission to enhance diversity and inclusion.

• Charged with making structural, process and programming changes to help welcome, support and promote individuals of all backgrounds.

• Office of Inclusion and Diversity staff:

• Joe Pangelinan, PhD, Director

• Kara Sternhell-Blackwell, MD, Director of OUTmed

• Jennifer Mosher, Program Coordinator

• Lisa de las Fuentes, MD, Co-Director of the Forum for Under Represented in Medicine (URM)

• Aubrey Morrison, MD, Co-Director of the Forum for Under Represented in Medicine (URM)

https://internalmedicinediversity.wustl.edu/

https://internalmedicinediversity.wustl.edu/outmed/

https://internalmedicinediversity.wustl.edu/outmed/

https://internalmedicinediversity.wustl.edu/urm/

https://internalmedicinediversity.wustl.edu/urm/



• OID Programming and Initiatives

• Diversity Training

• DOM Task Forces (Faculty, Staff, Managers/Supervisors, Trainees)

• OUTmed

• Forum for Underrepresented in Medicine



How Does the Medical School

and the

Department of Medicine Work?


Victoria J. Fraser, MD Adolphus Busch Professor Of Medicine And Chairman

Department Of Medicine [email protected]

Washington University School Of Medicine

DOM Orientation: WUSM & Faculty Governance

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE ADMINISTRATION

Director of Risk

Management

(D. Pesti)

07.17.17 matteuzzi

Director Occupational Therapy (C. Baum, Ph.D.)

Director Physical Therapy (G. Earhart, Ph.D.)

University Officers

Vice Chancellor for Research J. Lodge, Ph.D.

Vice Chancellor for Human Resources L. Chandler

Assoc. VC for Med. Alumni & Develop. D. Shearrer

Exec. VC & General Counsel M. Allen, Esq.

Assoc. VC/Deputy General Counsel J. Powers, Esq.

Vice Chancellor/Chief Information Officer J. Gohsman

Director for Medical Public Policy R. Blaine

EXECUTIVE VICE CHANCELLOR FOR

MEDICAL AFFAIRS AND DEAN

(D. Perlmutter, M.D.)

Executive

Faculty/Department Heads

(See: Academic Org Chart)

Director Audiology and Communication Sciences

(W. Clark, Ph.D.)

Director Biostatistics (D.C. Rao, Ph.D.)

Assoc Dean & Dir. Office of Diversity

(W. Ross, M.D.)

Assistant Dean Admissions

(L. Stevenson)

Assoc. Dean for Research

(J. Lodge, Ph.D.)

Sr Assoc Dean Human Research Protection

(M. Kass, M.D.)

Exec Director Human Studies

(M. Jones)

Assoc Dean/Chair Human Studies (J. Green, M.D.)

Assoc Dean Faculty Affairs (D. Gray, M.D.)

Asst Dean Special Programs

(G. Wiman)

Dir, Student & Employee Health (K. Winters, M.D.)

Sr. Assoc Dean for Education

(E. Aagaard, M.D.)

Assoc Dean, Med Student Ed. (Interim)

(T. De Fer, M.D.)

Asst Dean for Education

(C. Dufault, Ph.D.)

Asst Dean for Curriculum

(S. Nunez, Ph.D.)

Asst Dean Medical Education (D. Andriole, M.D.)

Assoc Dean Admissions

(V. Ratts, M.D.)

Assoc Dean Student Affairs

(L. Moscoso, M.D., Ph.D.)

Assoc Dean Graduate.Med. Ed. (R. McAlister, M.D.)

Assoc Dean CME

(A. Zazulia, M.D.)

Assoc VC /Assoc. Dean Med. Public Affairs

(J. Westerhouse)

Ex. Dir., Siteman Marketing, Comm & Phys. Srvcs.,

(A. Warren)

Director, Web Technical Strategy

(B. Marston)

Exec. Dir., Integrated Marketing & Branding

(V. Tipton)

Exec. Director, Research Comm.

(C. Arbanas)

BJH

SLCH

Asst Dean Strategic Planning/ Executive

DirectorJOSP (L. Reimann)

HIPAA Privacy Officer

(C. Schorb)

Asst Dean Clinical Trials

(Y. Zhang)

Senior Director, Clinical Operations

(K. Mullen)

Dir. Billing Compliance

(J. Ditch)

Assoc. VC/Assoc. Dean Admin & Finance

(R. Stanton)

Associate VC Clinical Affairs and CEO, FPP

(P. Scheel, M.D.)

Asst VC Facilities (M. Hopkins)

Exec. Dir., Phys.Practice Develop. & Analysis

(J. St. Aubin)

Asst Dean/ Exec. Dir. Human Resources

(L. Chandler)

Senior Director, Communications

(Kay Franks)

Assoc Dean/ Dir Medical Library

(P. Schoening)

Chief – Director of Emergency Medicine

(B.E. Ruoff, M.D.)

Asst VC/Asst. Dean Finance

(M. Corcoran)

Exec. Dir., Managed Care Cont & Phys. Billing

(J. Albertina)

Chief Medical Officer, FPP

(S. Bhayani, M.D.)


Executive Vice Chancellor for

Medical Affairs and Dean

David H. Perlmutter, MD

Washington University School of Medicine Administration

Provost and Executive Vice

Chancellor for Academic Affairs

Holden Thorp, PhD

Chancellor

Mark S. Wrighton, PhD



Associate VC Clinical Affairs and CEO, FPP

Paul Scheel, MD

Assoc Dean for Research Jenny Lodge, PhD

Associate VC/Dean Admin & Finance

Richard Stanton

Sr. Assoc Dean for Education

Eva Aagaard, MD

Assoc Dean & Dir. Office of Diversity

Will Ross, MD

Assoc VC/Dean Admissions

Valerie Ratts, MD

Assoc Dean, CME Allyson Zazulia, MD

Assoc Dean/Faculty Affairs Diana Gray, MD

Assoc VC Medical Public Affairs Joni Westerhouse



Asst Dean/ Ex. Director Human Resources Legail Chandler

Executive Director, Physician Practice Develop. & Analysis

Jeannette St. Aubin

Director of Risk Management Dawn Pesti

Assoc Dean/Chair Human Studies

Jonathan Green, MD

Asst Dean Clinical Trials

Yi Zhang, JD, RN

Exec Director Human Studies Martha Jones

Sr Assoc Dean Human Research Protection

Michael Kass, MD

Senior Director, Communications

Kay Franks


Washington University School of Medicine Academic Organization

David H. Perlmutter, M.D. Executive Vice Chancellor for Medical Affairs and Dean

Pre-Clinical Departments

Anatomy & Neurobiology Azad Bonni, MD, PhD

Biochem. & Molec. Biophysics John Cooper, MD, PhD

Cell Biology & Physiology David Piston, PhD

Genetics Jeffrey Milbrandt, MD, PhD

Molecular Microbiology Stephen Beverley, PhD

Developmental Biology Lilianna Solnica-Krezel, PhD

Programs Clinical Departments

Anesthesiology, Alex Evers, MD

Internal Medicine, Victoria Fraser, MD

Neurology, David Holtzman, MD

OB/GYN, George Macones, MD

Ophthalmology, Todd Margolis, MD, PhD

Otolaryngology, Richard Chole, MD

Orthopedic Surgery, Regis O’Keefe, MD, PhD

Pathology & Immunology, Herbert Virgin, MD

Pediatrics, Gary Silverman, MD, PhD

Psychiatry, Charles Zorumski, MD

Radiology, Richard Wahl, MD, PhD

Radiation Oncology, Dennis Hallahan, MD

Surgery/Siteman Cancer Center Timothy Eberlein, MD

Neurological Surgery, Ralph Dacey, MD

EF Sub-Committees

Executive Faculty

Academic Affairs

Administration and Finance

Faculty Practice Plan

Governance and

Strategic Planning

Research Affairs

Audiology and Communication

Sciences William Clark, PhD

Biostatistics D.C. Rao, PhD

Occupational Therapy M. Carolyn Baum, PhD

Physical Therapy Gammon Earhart, PT, PhD



Pre-Clinical Departments

Anatomy & Neurobiology Azad Bonni, MD, PhD

Biochem. & Molec. Biophysics John Cooper, MD, PhD

Cell Biology & Physiology David Piston, PhD

Genetics Jeffrey Milbrandt, MD, PhD

Molecular Microbiology Stephen Beverley, PhD

Developmental Biology Lilianna Solnica-Krezel, PhD



Clinical Departments

Anesthesiology Alex S. Evers, MD

Neurology David M. Holtzman, MD

OB/GYN George A. Macones, MD

Ophthalmology Todd Margolis, MD, PhD

Orthopedic Surgery Regis O’Keefe, MD, PhD

Neurological Surgery Ralph G. Dacey, MD

Internal Medicine Victoria J. Fraser, MD

Otolaryngology Craig A. Buckman, MD



Clinical Departments

Pathology & Immunology Herbert W. Virgin, MD

Pediatrics Gary A. Silverman, MD, PhD

Psychiatry Charles F. Zorumski, MD

Radiology Richard Wahl, MD, PhD

Radiation Oncology Dennis E. Hallahan, MD

Surgery/Siteman Cancer Center Timothy J. Eberlein, MD


Executive Faculty

• Made up of all department chairs, elected members, ex officio members – Attended by OGC, all deans, BJH & SLCH presidents, PR, interns, Programs

• Monthly meetings

• Subcommittees: Finance, Academic Affairs, Governance, Research, FPP

• Shared decision making for institutional strategic planning and change

• Decentralized


Other Key Organizational Efforts • Faculty Senate

• Executive Committee of Faculty Senate

• Ombuds: Karen O’Malley, PhD & Jim Fehr, MD

• FPP Membership: Clinical Chiefs & elected representatives

• AWN

• Office of Faculty Development (OFD)

• Institute for Public Health (IPH)

• Diversity & Inclusion (Adrienne Davis, JD; Rochelle Smith, MS; Diana Gray, MD; Will Ross, MD; Daniel Blash, PhD; Cherilynn Shadding, PhD, Joe Pangelinan, PhD)


Washington University School of Medicine Programs/Institutes

Physical Therapy Gammon Earhart, PT, PhD

Occupational Therapy M. Carolyn Baum, PhD

Biostatistics D.C. Rao, PhD

Audiology and Communication Sciences

William Clark, PhD

Institute for Informatics (I2) Philip Payne, PhD

McDonnell Genome Institute Susan Dutcher, PhD

(Acting Director)


Many Other Interdisciplinary & Interdepartmental Programs

http://dbbs.wustl.edu http://cadr.wustl.edu/

http://icts.wustl.edu/

http://www.siteman.wustl.edu/

http://genome.wustl.edu/

https://gtac.wustl.edu/

http://gps.wustl.edu/

http://cmhsr.wustl.edu/PractitionersResearchers/DIRC/Pages/DIRC.aspx

Dissemination & Implementation Research Core

(DIRC)

http://dbbs.wustl.edu/

http://cadr.wustl.edu/



http://www.siteman.wustl.edu/



https://gtac.wustl.edu/

http://gps.wustl.edu/




Interdisciplinary Research Centers

http://cwidr.wustl.edu/

Center for Women’s Infectious Disease Research

http://biomed21.wustl.edu/ircs/cgssb

http://csi.wustl.edu/

http://www.rheumatology.wustl.edu/

Center for Rheumatology, Arthritis &

Autoimmune Diseases

http://dcdc.wustl.edu/

http://dhbr.dom.wustl.edu/shared-resources/diabetes-research-and-training-center-core.html

Diabetes Research & Training Center

(DRTC)

http://cardiology.wustl.edu/ccr-home.html

http://cwidr.wustl.edu/

http://biomed21.wustl.edu/ircs/cgssb

http://csi.wustl.edu/

http://www.rheumatology.wustl.edu/

http://dcdc.wustl.edu/


















Interdisciplinary Research Centers

http://pharmacogenomics.dom.wustl.edu/

Center for Pharmacogenomics

Nutrition & Obesity Research Center

(NORC)

http://chn.dom.wustl.edu/norc/about-norc.html

http://www.musculoskeletalcore.wustl.edu/

Consortium for Translational Research in Advanced Imaging and Nanomedicine

http://ctrain.wustl.edu/

https://hopecenter.wustl.edu/

http://actu.im.wustl.edu/

http://ddrcc.wustl.edu/

Digestive Diseases Research Core

Center (DDRCC) http://cimed.wustl.edu/

http://pharmacogenomics.dom.wustl.edu/




http://www.musculoskeletalcore.wustl.edu/

http://ctrain.wustl.edu/

https://hopecenter.wustl.edu/

http://actu.im.wustl.edu/

http://ddrcc.wustl.edu/

http://cimed.wustl.edu/


Department of Medicine Stats – FY17

• Employees – 591 Faculty – 124 Postdocs – 2078 Staff

• Clinical Activity – $466 M Clinical revenues – 349,331 Out patient visits – 245,306 In patient visits

• Research – 521 Grants - $132 M – 741 Clin trials - $31 M

• Education – 166 Medical residents – ~70 Clinical fellows/trainees – ~30 Research trainees – ~150 Graduate students


Department of Medicine Patient Services Locations Center for Advanced Medicine (CAM) CAM South County WU Complete Care

Barnes-Jewish West County Hospital Barnes-Jewish St. Peters Hospital Infectious Diseases Clinic Siteman Cancer Center Medicine Multispecialty Center Siteman South County Christian Northeast


Department of Medicine Division Chiefs

Allergy & Immunology H. James Wedner, MD

Bioorganic Chemistry & Molecular Pharmacology

Richard Gross, MD, PhD

Cardiovascular Diseases Douglas Mann, MD

Dermatology Lynn Cornelius, MD

Endocrinology, Metabolism & Lipid Research

Clay Semenkovich, MD

Bone & Mineral Diseases Roberto Civitelli, MD

Gastroenterology Nicholas Davidson, MC

Hematology J. Evan Sadler, MD, PhD

Geriatrics & Nutritional Sciences Samuel Klein, MD

General Medical Sciences Bradley Evanoff, MD, MPH


Department of Medicine Division Chiefs

Pulmonary & Critical Care Medicine

Michael Holtzman, MD

Renal Diseases Benjamin Humphries

Rheumatology John Atkinson, MD

Oncology John DiPersio, MD, PhD

Veterans Administration Daniel Goodenberger, MD

Medical Education Melvin Blanchard, MD

Hospitalist Medicine Mark Thoelke, MD

Infectious Diseases (Basic Science)

Daniel Goldberg, MD, PhD

Infectious Diseases (Clinical)

William Powderly, MD


Department of Medicine Chairman’s Office

Patient Safety Officer Andrew Odden, MD

Exec Dir, Finance & Admin Steven Reynolds

Assoc Chair for Clin Programs Jeffrey Crippin, MD

Co-Director, Office of Faculty Development Mario Castro, MD

Co-Director, Office of Faculty Development Angela Brown, MD

Assistant to the Chair Alison Ebers

Special Project Admin. Betsy Presson

Secretary Robin Wolfsberger


Department of Medicine Office of Inclusion and Diversity

Director, Cultural Awareness and Diversity

Joseph Pangelinan, PhD

Forum for Underrepresented in Medicine (URM)

Forum for Women in Medicine

OUTmed

Gabriel Mbalaviele, PhD Kara Sternhell-Blackwell, MD

Lisa de las Fuentes, MD Aubrey Morrison, MD

Rakhee Bhayani, MD


Medical Alumni & Development • Part of WU’s Alumni and

Development Programs

• Represent more than 22,000 alumni from WUSM

• Medical Corporate and Foundation Relations Program

• Patient Giving working with physicians, patients and friends who have an interest in philanthropy

Erica Lebo Director, Clinical Programs

Medical Alumni & Development (314) 935-2875 office

[email protected]

Rachel Hartmann Senior Director of Development Medical Alumni & Development

(314) 935-9715 office [email protected]

Courtney Weeks Executive Director of Development

Siteman Cancer Center (314) 935-5425 office

[email protected]


MSTP Director Wayne Yokoyama, MD

MSTP Associate Director and Assoc Dean for Grad Educ,

Div of DBBS (effective 1/1/18) Robyn Klein, MD, PhD

PSTP Co-Director Stuart Kornfeld, MD

PSTP Co-Director Deborah Lenschow, MD, PhD

Assoc Dean for Grad Educ, Div of DBBS (to 12/31/17)

John Russell, PhD

Medical Scientist Training Program, Physician Scientist Training Program, and Division of Biology and Biomedical Sciences (DBBS)

MSTP Associate Director Daniel Ory, MD


Department of Medicine Medical Student Educational Efforts

Cardiovascular Diseases Dana Abendschein, PhD

Endocrinology & Metabolism William Clutter, MD

Medicine Clerkship Thomas De Fer, MD

Hematology & Oncology Scot Hickman, MD

The Practice of Medicine II Megan Wren, MD

Dermatology David Sheinbein, MD

The Practice of Medicine III Timothy Yau, MD

Asst Dean for Curriculum and the Basic Sciences

Sabrina Nunez, PhD


Department of Medicine Medical Student Educational Efforts

Infectious Diseases Nigar Kirmani, MD

Pulmonary Diseases Adrian Shifren, MD

Family Medicine Clerkship Amy Loden, MD

Renal & Genitourinary Steven Cheng, MD

Rheumatology Richard Brasington, MD

Gastroenterology Deborah Rubin, MD

Primary Care Med Student Education

Kirsten Dunn, MD


Educational Recognition

• Clinical Department of the Year

• Goldstein Educational Leadership Awards

• Distinguished Service Teaching Awards

• Coursemaster Awards

• Lecturer Awards

• Small Group Leader Awards

• Loeb Fellowships

• Washington University Manuals


Firm A Joshua Saef, MD

North Campus Niall Prendergast, MD

Ambulatory Catherine McCarthy, MD

Firm C/VA Amit Bery, MD

Firm C/VA Jackie Chen, MD

Firm B Bamvi Fohtung, MD

Department of Medicine 2017-2018 Chief Residents


House Staff Program

• 53 Categorical Interns + 15 Prelims and Neurology

• From 27 different states and 5 different countries

SingleMarried

Kids

Interns

Single

Married

Married w/Kids

Single

Married

Kids

End of Residency

Single

Married

Married w/Kids


17 -T32, T35, TL1, R25 Training Programs • Bone & Mineral Metabolism (T32: Civitelli)

• Cardiology (T32: Mann)

• Endocrinology (T32: Semenkovich)

• Gastroenterology (T32: Davidson, T35: Rubin)

• General Medical Sciences (R25 PI: Garbutt)

• Hematology (T32 & K12 PI: Sadler)

• Infectious Disease (T32: Goldberg; TL1: Piccirillo, KL2 Fraser, Garbutt Evanoff)

• Nutritional Science (T32: Bradley)

• Oncology (T32: Ratner, R25 & K12: Govindan)

• Pulmonary (T32: Holtzman, R25: Castro)

• Renal (T32: Humphreys)

• Rheumatology (PI: Lenschow, Yokoyama; PI: Atkinson)


Sam Bhayani, M.D., M.S. CMO, WUSM Physicians

Holekamp Professor of Surgery [email protected]

Washington University School of Medicine

EPIC

mailto:[email protected]


Epic Project In General

• Academic + Community Project

• Will first hit the non-academic BJC hospitals

• Boone (Columbia MO), BJCMG: Live

• Pod 1: 4 STL community hospitals: December 2017

• Pod 2: 3 more STL community hospitals: February 2018

• Academic: BJH, BJWCH, SLCH: June 2 2018

• It is the same system at all the hospitals!


Unification of multiple EHR systems

• Clin desk (mostly BJC information, inpatient, hospital data, radiology, path)

• Allscripts (outpatient notes, outside records sent to the office)

• Compass (inpatient orders, notes)

• + 60 other systems

• Epic will unite these fragmented systems


• Epic will make us more efficient and unified, but there is a learning curve

• Challenges:

• Changes in workflows (many existing workarounds)

• Dissemination of Epic personalization tools (dot phrases, macros, etc.)

• Potential evolution from dictation to voice recognition or Epic tools for note writing

• Sharing of several aspects of the build with the community MDs

• Large size of academic “go live” will require significant resources from BJC and WUSM Departments

Epic will disrupt several workflows


Questions?

• If you have experience with Epic, your knowledge will be fantastic at go-live.

• Please look for our biweekly Vlogs.

• Epic is NOT a one-time install – customizations will develop over time.


Melvin Blanchard, MD Professor of Medicine

Chief, Division Of Medical Education Director, Internal Medicine Residency Program

[email protected] Washington University School Of Medicine

Medical Education & Teaching



Medical Education and Teaching PH: 314-362-8065

• Division of Medical Education • Chief: Melvin Blanchard

• Education • Residency Program

• Clinical • Inpatient, COH, Affinia, Washington University Complete Care, VA

• Research • MiM (Victor Davila), CSTAR (Brian Gage), Global Health (Rupa Patel) • QI/Patient Safety (Emily Fondahn/Thomas Ciesielski)

• Medical students • Tom DeFer, Megan Wren, Kirsten Brandt • POM 1, POM 2, Clerkship, Junior Internship, Capstone

• The Washington Manual series

• Primary care services • Washington University Complete Care

How Do I Plan My Career Development


Career Development Plans

Nicholas Davidson, MD, DSc John E. and Adaline Simon Professor of Medicine and Developmental Biology

Chief, Division of Gastroenterology [email protected]




Dr. Davidson’s presentation is available upon request by contacting

the DOM Office of Faculty Development.

PH: 314-454-8960

EM: [email protected]

What Does One Need to Succeed in Academics?


Victoria J. Fraser MD Adolphus Busch Professor Of Medicine And Chairman

Department Of Medicine [email protected]


Promotion Guidance & Timelines


Staying Out of Trouble • Conflict of Interest reporting (research and clinical)

• Professionalism, Learning Climate (be nice )

• Email strategies: no “Howlers,” front page sniff test

• Complaints: Listen, apologize, address

(Stephanie Weisenborn, 314-362-1061, [email protected] )

• Lawyers and lawsuits: call WU Office of General Counsel ASAP (314-362-3966), notify Division Chief (DO NOT deal with alone)

• Cultural humility (gender, generation, race/ethnicity)

• Talk to Division Chief, ask for help, SOONER not later


Academic Career Pace?


Career Building Blocks • Getting and using mentors/advisors

• Choosing research areas/projects

• Formal coursework/training

• Hands-on mentored research experiences

• Research infrastructure

• Writing: abstracts, manuscripts, reviews

• Other skills: teamwork, teaching, budgets, management (time & people), organization, conflict resolution

• Writing and obtaining grants

• Individual Development Plan: Competencies, Career goals and plan (work & life)


Scientific Career Advancement

• Requires an in-depth understanding of many complex organizational structures of academic institutions, industry, laboratories, public & private sector, diverse cultures and teams

• Competencies to be identified, attained and measured


National Postdoctoral Association 6 Core Competencies

• Discipline specific conceptual knowledge

• Research skill development

• Communication skills

• Professionalism

• Leadership and management skills

• Responsible conduct of research


Keep Track of Your Activities

• NIH Biosketch • Curriculum Vitae (CV) • Clinician Educator Portfolio (CEP) • Other Support • Trainee Tables • Pertinent records of effort: lectures, teaching, clinical time, service,

administrative, • Community activities, • Research projects, abstracts and papers, • Honors and awards, • This your “portfolio”


Interact With Mentors & Bosses

• Update them regularly

• Show them data, progress,

goals & objectives, productivity

• Don’t be shy, come with agenda and questions, lists

• Foster regular performance goals and appraisals

• Solicit feedback

• Do self appraisals and ask for feedback

• Make sure your goals and theirs align

• Assess your top priorities vs how you actually spend time


Appointments & Promotions Guidelines & Requirements (APGAR)

• 3 tracks (Investigator/tenure, Clinician/educator & Research)

• Departmental differences

• Criteria for promotion on each track

• Changing tracks

• Periodic reviews & faculty evaluations

• Tenure Timeline, delay of tenure clock – Midpoint review 3-4 years

• CV & Clinician educator portfolio

• Individual (Career) Development Plan


OFD Website http://internalmedicinefaculty.wustl.edu

• Appointments & Promotions

• Information about appointments and promotions including the APGAR

• CV and CEP

• Templates, guidelines, and examples of each document

• CEP workshop information and audio of previous workshops

http://internalmedicinefaculty.wustl.edu/


• Mock Study Section

• Grants Library

• Research and Grants Resources

Office of Training Grants (OTG) https://crtc.wustl.edu/otg/

ICTS Scientific Editing Service http://www.icts.wustl.edu/icts-researchers/icts-cores/scientific-editing-service

Betsy Keath, PhD - Director Sara Steenrod, PhD - Scientific Editor Laura Zonia, PhD - Scientific Editor

Comprehensive editing services to meet the specific needs of your grant application

Betsy Abente, MPH OTG Administrator

http://www.icts.wustl.edu/icts-researchers/icts-cores/scientific-editing-service










EPIC Electronic medical record implementation

GO LIVE Implementation JUNE 3, 2018


Curriculum Vitae

• All faculty members must have a CV in the Wash U format

• https://internalmedicinefaculty.wustl.edu/appointments-promotions/

https://internalmedicinefaculty.wustl.edu/appointments-promotions/




Clinician Educator Portfolio • Required for all faculty members on the clinician track

• Supplement to CV that is a detailed compilation of clinical, educational, and community service activities

• Showcases the quality and extent of clinical expertise, educational scholarship, and other areas not covered in the traditional CV

• Should not duplicate the CV, but content should be consistent

• “Real time” document

• Can be used as a tool for strategic career planning and development

• https://internalmedicinefaculty.wustl.edu/appointments-promotions/clinician-educator-portfolio/

https://internalmedicinefaculty.wustl.edu/appointments-promotions/clinician-educator-portfolio/









DOM CEP Workshop

• October 6, 2017 from 11:30am-1:00pm Location: 213 FLTC

• All faculty on clinician track

• Bring a completed CEP for review

• Small group format – max of 40

• For information, visit the OFD Website: https://internalmedicinefaculty.wustl.edu/appointments-promotions/clinician-educator-portfolio/ or contact Jennifer Mosher at

PH: 314-454-8960 or EM: [email protected]










Promotions Process • Division Chief & Department Chair review all faculty annually

• Portfolio: CV, CEP, letters, manuscripts

• Pillars of Excellence: research, clinical, education

• APGAR document criteria w/ Departmental view

• Internal departmental review committee

• Ad Hoc Committee (no DOM members, 5 Dept Chairs, 2 senior faculty)

• Executive Faculty Review

• WU Board Review


Robert Jones, PhD

2012 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2022

Today

End Year 10 6/30/2021

Promotion 7/1/2021

End Year 8

6/30/2020

End Year 7

6/30/2019

Hire Date

10/1/2012

Start of Tenure Clock

7/1/2012

Promotion paperwork to Chair's Office 2/1/2020 - 3/1/2020

Board of Trustees Meeting 3/1/2021 - 3/31/2021

Terminal Letter (if necessary) 3/1/2021 - 3/31/2021


Thank You

• Questions?

• [email protected]

• 314-362-8061



Persistence Is Really Important


Mentoring, Networking, Professional Societies, And Time Management

Benjamin D. Humphreys, MD, PhD

Chief, Division of Nephrology

Friedman Chair and Associate Professor

of Medicine

[email protected] Washington University School of Medicine


Disclosures • I was in the audience for this talk two years

ago • I am not entirely sure how I ended up being

successful in academics • I have support at home • I work hard

• I have made a lot of mistakes (but I have learned from them)

• I have learned a lot from my colleagues and trainees

• These are my personal observations

http://www.google.com/url?sa=i&rct=j&q=stream+of+consciousness&source=images&cd=&cad=rja&docid=3Q1SEFhZZ5ex0M&tbnid=eNk4Wf2JJRaZHM:&ved=0CAUQjRw&url=http://brewsandbooks.com/index.php/2012/08/bookrageous-episode-42-stream-of-consciousness/&ei=tEvxUeaEFsz-rAGynIHQDw&bvm=bv.49784469,d.aWc&psig=AFQjCNEIt1m9mvUBo9aLlWTQffnNnA8LdA&ust=1374854411974901


What are the best practices of successful academicians?


The Big Stuff


Work Life Balance

http://www.people.com/article/philippe-petit-9-11-world-trade-center-wire-the-walk

Family Friends

Self

WORK


Work Life Balance

• Prioritize and protect time with family and friends

• Exercise

• If you have a significant other or children:

– Do not underestimate the work-life balance challenge

• Make sure your spouse is supportive (and vice versa)

• Find reliable child care


Dedication and Commitment

“I'm a great believer in luck, and I find the harder I work the more I have of it”

Thomas Jefferson

http://www.google.com/url?sa=i&rct=j&q=thomas+jefferson&source=images&cd=&cad=rja&docid=iczpPRyuD-RyuM&tbnid=dcQqs-kqgik1dM:&ved=0CAUQjRw&url=http://www.biography.com/people/thomas-jefferson-9353715&ei=gi_xUZKbIs6YqAGc5oHoAQ&bvm=bv.49784469,d.aWc&psig=AFQjCNEvBm5a1pqE8_4fFOuarNLd0cmpAQ&ust=1374847215391601


Mentoring


Faculty and Trainees who identify Mentors…

• Are more likely to be promoted

• Are more productive and publish more frequently

• Are more likely to obtain funding

• Have higher retention rates

• Report higher career satisfaction

Cho, Ramanan and Feldman, Am J Med, 2011


Mentor as Teacher

Educate about research methods

Clinical/teaching skills

Professional values and behaviors

Organizational culture

How to succeed

M. Feldman, MD, MPhil


Characteristics of Outstanding Mentors

1. Enthusiasm, compassion, altruism

2. Act as a career guide for mentee

3. Adequate time commitment to mentoring

4. Support personal/professional balance

5. Leave a legacy of how to be a good mentor

Cho, Ramanan and Feldman, Am J Med, 2011


Practical Issues

• Establish expectations early

– What does mentee expect? Mentor?

• Successful mentoring relationships involve some degree of reciprosity

• Personal connection/shared values important

• Regular meetings are key even if brief

• Perceived or real competition/COI will doom relationship

Strauss, Johnson, Marquez and Feldman, Acad Med, 2013


Time versus Money

Understand the financial implications of your career goals and the time required to achieve them

http://www.google.com/url?sa=i&rct=j&q=money%20versus%20time&source=images&cd=&cad=rja&docid=IEqZjdneLPtN4M&tbnid=J8OOuBiZrJkceM:&ved=0CAUQjRw&url=http://www.mint.com/blog/consumer-iq/the-time-value-of-money-vs-the-money-value-of-time-012012/&ei=Qj7xUZ76LIP7qAGJhoCYAg&bvm=bv.49784469,d.aWc&psig=AFQjCNFVTwxwBpcC_H6JCuoSehSYYj2wDw&ust=1374850995420747


Networking


Networking = Connecting with People

Your success at Wash U will be determined by your own skills, as well as your colleagues and your environment. -Find people with shared interests, treat them with honesty and respect.


Are You a Giver, Matcher or Taker?

• Givers: Support and help others, no strings attached

• Matchers: What goes around comes around

• Takers: Get as much as possible from others

Adam Grant, PhD https://www.ted.com/talks/adam_grant_are_you_a_giver_or_a_taker


Social Capital

• The reliance and interdependency that builds trust

• This is built only with time together, leading to openness and candor

• Creates a safe environment for conflict

• Conflict and disagreement turns good ideas into great ones because no idea is born fully formed

Margaret Heffernan https://www.ted.com/talks/margaret_heffernan_why_it_s_time_to_forget_the_pecking_order_at_work/up-next


Networking Specifics

• Take responsibility for your relationship with your chief/chair. Learn what is important to them.

• Expand your network so you have a diverse community both in and outside of your field.

• Professional societies are an enjoyable, efficient and rewarding way to connect with colleagues.

• Ask to get involved and contribute.


Gain Multidisciplinary Experience

• A mix of skills is increasingly important for success in academic medicine.

• Simply recognizing this will give you an advantage.


My chance at becoming a CEO…

https://www.nytimes.com/2016/09/11/upshot/how-to-become-a-ceo-the-quickest-path-is-a-winding-one.html?_r=0


Time Management


Have a system


Prioritize your tasks

Stephanie J. Lee JCO 2013;31:811-813

Email-free worktime in the morning


When to Say Yes • Opportunity to learn new skills or meet new

people, within your interests

• Chance to work with accomplished colleagues outside of your field

• NIH is asking

• Offer is uninteresting

• Little opportunity for learning or meeting new people

• If it infringes on personal/family time

When to Say No

It is a myth that junior faculty should follow a blanket policy of saying ‘No’ when asked to serve on committees, teach or participate in activities not directly related to their principal tasks.


Be a Finisher !

“Perfect is the enemy of the good” -Voltaire

“Done is better than perfect” -Facebook

“Inspiration is for amateurs; the rest of us just show up and get to work.” -Chuck Close

“Show up, show up, show up, and after a while the muse shows up, too. You have to finish things.” -Isabel Allende


Other Useful Stuff


Leave your Div/Dept/World a Better Place


“Learn the Ropes” Early On Understand the rules for tenure and promotion at Wash U

Make sure you understand your responsibilities and that your supervisor and/or Division chief knows what you are doing, and is happy with that. Prepare for your annual review.

Get your CV (and CEP) in the proper format now and keep it updated. “If it is not on your CV, it didn’t happen”

http://www.google.com/url?sa=i&rct=j&q=learn+the+ropes&source=images&cd=&cad=rja&docid=KcgWotm-STSu4M&tbnid=QGOPhryPv0HNKM:&ved=0CAUQjRw&url=http://www.istockphoto.com/stock-photo-4309688-learning-the-ropes.php&ei=mEjxUcfuEIG9rgG2g4GACw&bvm=bv.49784469,d.aWc&psig=AFQjCNEbR5gmZDflikFYPpUhsJnMZeHS9w&ust=1374853409863772


• At some point in your career, do what really scares you.

• In order to reach your true potential, risk taking is a requirement.

Take some risks


Take Homes

• Relationships matter

• Finish things

• Stay balanced


Your academic career is a marathon and not a sprint. Learn to “lean in” every day. It is as much about the journey as the destination.

Going the Distance

http://www.google.com/url?sa=i&rct=j&q=Life+is+a+marathon+and+not+a+sprint&source=images&cd=&cad=rja&docid=mUvve_e5DZyNFM&tbnid=z6gbYCK8DP_7iM:&ved=0CAUQjRw&url=http://nycteachingfellows.tumblr.com/page/5&ei=rDzxUdbDG4LAqwGZ-4HoDw&bvm=bv.49784469,d.aWc&psig=AFQjCNEdozvc5-jyDfsnJsSfS8toa1FYcA&ust=1374850560407871

What if I am interested in research


What If I Am Interested In Research?

Mario Castro, MD, MPH

Alan A. and Edith L. Wolff Professor of

Pulmonary and Critical Care Medicine,

Department of Medicine

Director, Asthma and Airway Translational

Research Unit

[email protected]



Research Training and Resources

• Office of the Vice Chancellor for Research

• Institute of Clinical and Translational Sciences

• Clinical Research Training Center

• Institute for Public Health

• Siteman Cancer Center

• Division of Biological and Biomedical Sciences


Visit the OVCR Website

http://research.wustl.edu/Pages/default.aspx




Research Gateway

• One stop for all research

resources

• Common Sign-on (WUSTL Key)

https://research.wustl.edu/Pages/ResearchGateway.aspx



Compliance https://research.wustl.edu/ComplianceAreas/Pages/default.aspx



Learn at Work https://learnatwork.wustl.edu/


What is the ICTS?

ICTS - Institute of Clinical & Translational Sciences http://icts.wustl.edu The ICTS creates a “home” for clinical & translational research/education at WUSTL and its partner institutions CTSA - Clinical & Translational Science Award http://ctsaweb.org/ •National network of 63 institutions •Disease-agnostic •Improve health of nation and communities by building research capacity & providing training and career paths for clinical/translational investigators •Enhance scientific/clinical/translational collaboration


http://ctsaweb.org/


Phase 1 clinical trials: Proof of

Concept

Moving laboratory findings to clinical solutions in humans

Phase 2 & 3 clinical trials

Testing hypotheses into effective care in early –stage and multi-center human trials

Phase 4 clinical and outcomes research

Delivery of timely and recommended care into practice

Population level outcomes research

Translation of new data into clinical and health decision making


BECOME A

MEMBER!

EXPLORE CORE

SERVICES

APPLY FOR

FUNDING

ACCESS e- OR

PERSONAL

GUIDES TO

RECOURCES


Institute of Clinical and Translational Sciences Services at Every Phase of Clinical & Translational Research


Visit ICTS website: http://icts.wustl.edu • Become a member – it takes 5 minutes! • Explore the ICTS Honeycomb to find Core services for every phase of your clinical and

translational research project

Contact ICTS Scientific Program Officer

• Dr. Betsy Keath with resource questions: [email protected]

Scientific Editing Service (SES):

• Works with ICTS members to strengthen and clarify extramural grant applications • Sara Steenrod, PhD - [email protected] • Laura Zonia, PhD - [email protected]






Clinical Research Training Center Career Development Awards • Postdoctoral Program • Predoctoral Program l ASPIRE

Clinical Research Training Center (CRTC) http://crtc.wustl.edu

314-454-8224

Rachel Sorensen CRTC Manager

Email: [email protected] Telephone: 314-362-8719

http://crtc.wustl.edu/



Clinical Research Training Center

• Institutional K awards • Scholars receive salary support, tuition funds and $25-30k for research related

expenses

• KL2 Multidisciplinary Career Development Awards • Dr. Victoria Fraser, Director; Dr. Jane Garbutt, Co-Director • Multidisciplinary, mentored clinical and translational research • 17 current scholars • Applications for a July 1st start are open until September 15th

CRTC Career Development Programs

Career Development Awards • Postdoctoral Program • Predoctoral Program l ASPIRE



• Other institutional K awards (K12)

• Paul Calabresi Program for Clinical Oncology

• Building Interdisciplinary Careers in Women’s Health

• Psychiatry Program in Drug Abuse and Addiction (NEW)

• Mentored Training in Implementation Science (MTIS): A Career Development Program for Heart, Lung, Blood and Sleep Researchers (NEW)

• Clinical Hematology

• Others: Inflammatory Airway Disease, Reproductive Health, etc.

CRTC Career Development Programs




• Dr. Patty Cavazos-Rehg, Director

• Mentored clinical and translational research, didactic coursework, multidisciplinary peer interactions

• Senior Fellows and Junior Faculty in medicine and allied health professions

• Requires 60% protected time, provides partial remission for coursework

• 27 current scholars

• Applications for January 1st start date are open from September 15th through November 1st.

Mentored Training Program in Clinical Investigation (MTPCI)



Clinical Research Training Center Career Development Awards • Postdoctoral Program • Predoctoral Program l ASPIRE

Didactic Training in Clinical Investigation

• Monthly Career Development Seminar • Master of Science in Clinical Investigation (MSCI) Degree

• Dr. David Warren, Director • 33-credit masters degree in one of three concentrations:

• Clinical Investigation Concentration • Translational Medicine Concentration • Genetics/Genomics Concentration

• Master of Science in Applied Health Behavior Research (AHBR) Degree • Dr. Amy McQueen, Director • 33-credit masters degree in one of two concentrations:

• Health Education, Program Planning, and Evaluation • Health Behavior Research


Office of Training Grants crtc.wustl.edu/otg

NIH Mock Study Section November 14, 2017

12:00-4:00 PM

Location: CAM, Room 1

Letters of Intent: Due August 18th.

Visit crtc.wustl.edu/otg for LOI guidelines.

NIH clinical and translational R, K, and F series grant applications will be discussed during this internal review.

NIH Mock Study Sections Leaders

Dr. Mario Castro

Professor of Medicine

Director, Office for Faculty Development and Office of Training Grants

Dr. Jay Piccirillo

Professor of Otolaryngology H&N Surgery

Director, Predoctoral Clinical Research Training Program


Office of Training Grants crtc.wustl.edu/otg

GRANTS LIBRARY The Office of Training Grants (OTG) has developed a Grants Library to serve as a centralized resource for investigators at different career stages. This SharePoint site contains:

•Awarded training, career, and research grant applications

•General stock language and proposal templates and tools

To Access: http://wustl.box.com/wustlgrantslibrary

Accessible to all with a current WUSTL Key

•Want to share your awarded Grant?

•Contact: [email protected]

http://wustl.box.com/wustlgrantslibrary


The Institute for Public Health harnesses the

strengths of Washington University in St. Louis to

address the complex health issues and health

disparities facing the St. Louis region and the world.

Upcoming Event:

Wednesday, September 27

10th Annual Conference focusing on “Why

Science Matters: The Case for Evidence-

Based Public Health.”

Learn more & subscribe to eNews at: publichealth.wustl.edu

Institute for Public Health

Connector

Convener

Catalyst


Representing a diverse range of

disciplines, what our over 200 faculty

scholars have in common is a desire

to work together to improve public

health.


Master of Population Health Sciences Degree Program • Population-based research training for clinicians and clinical doctorates

• Advanced skills to design, implement, and evaluate clinical and disease outcomes research and health services research

• Quantitative curriculum provides a strong foundation for clinical effectiveness and outcomes research

Program Contacts

Director

Graham Colditz, MD, DrPH

[email protected]

(314) 454-7940

Deputy Directors

Adetunji Toriola, MD, PhD

[email protected]

(314) 286-2668

Yikyung Park, ScD

[email protected]

(314) 362-9651

Coordinator

Joyce Linn

[email protected]

(314) 362-5501






SCC Benefits All faculty who have a cancer-focus in clinical practice and/or research

www.siteman.wustl.edu/research/membership

All members receive:

•Eligibility for SCC funding opportunities

•Accessibility to undergraduate and graduate/postgraduate trainees

•Association with specific disease-site, specialty, and/or program affiliation listed on SCC Website;

•Educational opportunities (speakers, program retreats, seminars/lectures)

•Any Member serving a membership role on an SCC committee will be eligible to apply for the Siteman Shared Resources RFA.

CCSG Members receive:

• Priority access to and subsidized rates for SCC shared resources

http://www.siteman.wustl.edu/research/membership


Division of Biology & Biomedical Sciences

• Umbrella for > 420 Faculty Mentors across University (SOM, A&S, Engineering)

• > 620 Ph.D. and M.D./Ph.D. (MSTP) Students

• 11 Interdepartmental Ph.D. Programs

• 40+ Years of experience in the administration of interdisciplinary programs.

• “Dual citizenship” of faculty

• Apply for DBBS Faculty Affiliation http://dbbs.wustl.edu/faculty/

http://dbbs.wustl.edu/faculty/


Division of Biology & Biomedical SciencesOffice of Postdoctoral Affairs

• Established in 2002 within DBBS

• Supports the School of Medicine

• Provides support and resources for postdoctoral researchers, as well as faculty and administration, and advocates for postdoctoral issues.

• http://dbbs.wustl.edu/Postdocs/Pages/Postdocs.aspx

http://dbbs.wustl.edu/Postdocs/Pages/Postdocs.aspx


In Summary…… • Many, many resources available for investigators • Training • Pilot funds • Consultation • Hardware

• Ask around • Join relevant cross-departmental groups • Take advantage of institutes, centers • Mario Castro – [email protected]

OFD Website and Resources


Angela L. Brown, M.D. Associate Professor of Medicine

Co-director, Office Of Faculty Development [email protected]

& Mario Castro, MD, MPH Professor of Medicine

Co-director, Office Of Faculty Development [email protected]


OFD Website & Resources




Computer Support Services

http://imcss.wustl.edu


Department of Medicine Computer Support Services Basics

http://imcss.wustl.edu

Hours of Operation: Monday through Friday 7:30 am – 5:00 pm Phone – 362-2165 (2-2165) E-Mail - [email protected]

After-Hours Support An on-call technician is available to assist users between 5:00 p.m. and 7:30 a.m. weekdays and from 5:00 p.m.

Friday until 7:30 a.m. Monday. Users may call the Help Desk number (362-2165) to receive an automated voice mail regarding the on-call number, or may call the on-call number directly ONLY during non business hours.

After Hour Phone: (314) 807-8690

Details regarding response time standards and services offered can be found on the DOMCSS Help Desk Website.

http://imcss.wustl.edu/

http://imcss.wustl.edu/



BJC/CAM IT • For Questions, Concerns, or Help call 362-4700

• Compass

• Geoffrey Cislo – [email protected]

• Rachel Schmitt – [email protected]

• Clindesk 2

• Geoffrey Cislo – [email protected]

• Touchworks/Allscripts

• Michael Kriemelman – [email protected]






Links to internal resources and key department-related information

Internal Medicine Website http://internalmedicine.wustl.edu

http://internalmed.dom.wustl.edu/


HIPAA Privacy Liaison– Arinda Nenninger (314-286-1003)

HIPAA Security Liaison – Jill Mantia (747-1149)

• Washington University’s Information Security Office and HIPAA Privacy Office work together to protect patient health information and the data of the WUSTL Community.

• https://informationsecurity.wustl.edu/

Department of Medicine – HIPAA Contacts

https://informationsecurity.wustl.edu/


Becker Medical Library http://becker.wustl.edu

http://becker.wustl.edu/


Resources and Helpful Links • Office for the Vice Chancellor of Research


• University and Medical School consulting policies https://facultyinformationhandbook.wustl.edu/faculty-policies/

• Environmental Health and Safety http://ehs.wustl.edu

• HIPAA https://imcss.wustl.edu/hipaa/

• Research Ethics and Compliance Office, 362-2709 http://research.wustl.edu/Offices_Committees/Pages/RECO.aspx

• Risk Management, 362-6956 https://collaboration.wustl.edu/depts/risk/Pages/Default.aspx

• Office of the Ombuds, 314-660-2089 http://ombuds.med.wustl.edu



https://facultyinformationhandbook.wustl.edu/faculty-policies/





http://ehs.wustl.edu/

https://imcss.wustl.edu/hipaa/

http://research.wustl.edu/Offices_Committees/Pages/RECO.aspx



https://collaboration.wustl.edu/depts/risk/Pages/Default.aspx



http://ombuds.med.wustl.edu/


Work-Life Balance https://internalmedicinefaculty.wustl.edu/work-life/

• Use the Work-Life balance section of the OFD site to find information/resources on those key areas that affect your Work-Life.

• Health & Wellness

• Childcare

• Housing

• Cultural activities & Local Attractions

• Other faculty resources

• Discounts and perks

https://internalmedicinefaculty.wustl.edu/work-life/




OFD Website https://internalmedicinefaculty.wustl.edu/

https://internalmedicinefaculty.wustl.edu/


OFD Website https://internalmedicinefaculty.wustl.edu/

• Can’t find what you are looking for?

• Is there a topic, link, resource that should be added to the OFD website?

• Let us know!

• Jen Mosher, [email protected]

https://internalmedicinefaculty.wustl.edu/



Thank You! Please take a few minutes to fill out your orientation

evaluation.

The Office of Faculty Development

Department of Medicine Washington University School of Medicine

660 South Euclid, Campus Box 8051 Office: 314-454-8960

Fax: 314-454-8279 WEB: http://internalmedicinefaculty.wustl.edu

presented by: the office of faculty development august 22, … · · 2017-09-29mario castro, md,...

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