residents report - summer 2013
DESCRIPTION
UCSF Office of GME - Residents Report Summer 2013TRANSCRIPT
The Residents Report
Diversity at UCSF
Page 18
Out & About ....Destination Spa Therapy Page 10
10 Questions ....Incident Reporting
Page 6
in this issue
Summer 2013
1 Continued on page 2
The Patient and Family Experience at UCSF: Achieving Excellence in CommunicationBy Diane Sliwka, MDAssociate ProfessorDepartment of Medicine, UCSF
The Institute of Medicine defines quality medical care as “patient centered” in addition to safe, equitable, timely, effective and efficient. Improved healthcare provider communication with patients has been shown to improve many facets of care including: patient safety, compliance with plan of care, patient anxiety, readmissions to the hospital, malpractice claims, and clinical outcomes. In improving the value hospitals provide to patients, the Centers for Medicare and Medicaid Services now use patient feedback data to determine reimbursement to hospitals as part of a greater “value based purchasing”
program, further compelling improvement in this area. As healthcare providers, we play an integral role in the patient and family experience.
What are patients asked? Patients give feedback about physician care by a survey that is mailed following any medical encounter. Currently, inpatient physician care is rated based on what percent of patients answer “always” to the following questions: How often did doctors 1) treat you with courtesy and respect? 2) listen carefully to you? 3) explain things in a way you could understand? Improvement depends largely on moving the answer from “usually to always.”
in this issue
Excellence in Communication 1Incentive Update 4
10 Questions 6Incident Reporting SFGH 8Incident Reporting SFVA 9
Out and About 10Lean Launchpad 11
CTSI Update 13Mindfulness Exercises 14
Radiology Tips 16Patient Safety Bulletin 17
Diversity at UCSF 18GME Diversity Update 19
Housestaff Awards 20GME Cypher 24
Sustainability Box 24
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What works?Improvement is dependent on consistently using the fundamentals of communication with all patients and guests. The AIDET SMiLe framework captures fundamentals which are highly effective when used in every patient interaction. Organizationally, UCSF Medical Center staff, physicians and nurses are all being trained in communication through an initiative called Living Pride.
AcknowledgeIntroduceDurationExplanationThankSit DownManage UpListen
Acknowledge the patient and family: use the patient’s name (preferred name or formal name if preferred is unknown). Acknowledge family by introducing them and their relationship to the patient.
Examples: “Hi Mrs. Smith, My name is ….. Is there a name you prefer to go by?” “I see you have some family/ friends here. (Turning to family) How are you related?”
Introduce yourself (by first and last name) and your role on the healthcare team. Write your name on white board. Use a business card or face card to reinforce your name and role. Patients meet many providers in a teaching hospital. In the literature, only 10% of patients could correctly name one physician involved in their inpatient care. This leads to confusion about who is responsible for what part of care, how people are communicating with each other, and whether anyone is responsible.
Example: “My name is John Smith, I’m one of the residents on the surgical team. I work with Dr. Jones who is the supervising doctor on the team. We are the primary team taking care of you while you’re in the hospital, though you may also see some other specialists. I’m putting our names here on the white board.”
Sit down. Standing over the patient can contribute
to the hierarchical dynamic. Get down to the patient’s level if possible. Sitting down is known to increase the patient’s perception of time spent with a physician..
Listen. Start by asking open ended questions. Elicit the patient’s concerns first, before moving on to your own. Avoid interrupting for the first couple minutes.
Examples: “I’d like to review your medical history with you today, but first, is there anything you or your family would like to make sure we talk about today?” “We’re going to spend some time talking about what we’ve found so far, but first I want to make sure I understand what your main concerns are.”
Duration. Address how long things will take. Patients spend a lot of time waiting in the hospital, and often they are unsure about what happens next. Explain the work that is happening behind the scenes and approximately when they can expect to see you again, have an answer, or be discharged.
Example: “You are scheduled to go to the operating room to have your gall bladder removed later this afternoon. The surgery should take a couple hours and you’ll come back to this room this evening. Most people can go home the day following surgery, and we expect you will be able to go home tomorrow. I will speak with your family when the surgery is completed.”
Explain. Simplify medical language and avoid acronyms. Consider using analogies or drawings to help explain medical conditions. For patients with a non-English primary language, ask what the patient’s preferred language is and if they would prefer to have an interpreter. At Moffit-Long, interpreter phones are now available at every patient’s bedside for this purpose. Recap the assessment and plan into a lay-person two line summary at the end of your visit so that the patient is left with a clear understanding of what is happening.
Example: “I want to recap what we talked about to be sure I’ve been clear about what the plan is. You were admitted with bleeding from your stomachthat we think was caused by an ulcer. In you, we
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think the ibuprofen you were taking contributed to the ulcer forming. The treatment for this is to avoid ibuprofen and to start a new pill which blocks acid in your stomach and allows the ulcer to heal. The new pill is called lansoprazole, and you take it once daily.”
Ask what questions the patient and family have at the end.
Example: “It’s my job to make sure we’ve explained everything well. What questions do you have?”
Manage Yourself and Others Up. When introducing yourself, it is helpful to share any information about yourself that instills confidence and reduces anxiety. Share your expertise and experience when appropriate. As housestaff, emphasize that you work within a team of experienced physicians. Remember that we are a healthcare team, working together to provide the best patient care. It is our collective responsibility to deliver excellence, and conflict within the team deteriorates the patient’s trust. Speak well of other healthcare team members when appropriate, and avoid speaking negatively of others. Address conflict with healthcare team members outside of the patient and family’s presence.
Examples: “I’m working with Dr. Smith to take care of you. He’s a national expert in the type of tumor you have.” “I know you’ve heard some different opinions from some of our specialists. Often there are multiple correct approaches to your medical problem, and we have a lot of really smart people thinking about what’s best for you specifically. Let me communicate with the team and hopefully we can present you with a clearer picture of the options and get your thoughts on what you think you’d like to do next.”
Thank the patient and family on closing the interview.
Example: “Thank you.”“Thank you for your time.”“Thanks for letting us take care of you.”To family, “Thank you for helping me understand your mom’s medical history. It’s been very helpful to understanding what’s going on.”
Lastly, remember that the patients and families that come through our doors are experiencing illness, often some of the most trying experiences of their lives. As physicians, we are in a unique position to impact those experiences. Slight changes in how we communicate with patients, incorporating the techniques above, can go a long way to reassure, decrease anxiety and build trust between the patient/family and healthcare team. Neglecting these can have the opposite effect. Engagement from each member of the healthcare team is critical to our vision of providing the best care. Maya Angelou said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
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UCSF Smile AIDET Card 2013 Front.pdf 1 5/10/13 1:02 PM
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Glenn Rosenbluth, MDDirector, Quality and Safety Programs, GME
The Resident and Fellow Quality Improvement Incentive Program for 2012-13 is almost complete. As you know, we have three goals which apply to all residents and fellows who spend at least 12 weeks at UCSF Medical Center. Each of these goals is worth $400 per eligible resident.
Goal 1: Patient Satisfaction: Maintain an annual average mean score of 91.6 on the likelihood of recommending question.
For this goal, we are currently at 91.0, so this goal will not be achieved for 2012-13. However, it will remain a goal for 2013-14, so there is still benefit to improving! This score is based on the degree to which our patients would recommend UCSF Medical Center to others. It is a team effort, including physicians, nurses, environmental services, nutrition, etc. We are all doing our part!
Quick tips: • Avoid jargon – most patients don’t
know what it means to take a “po med,” be transferred “to the floor,” or even whether “intern” means that you’re a doctor. Pretend you’re talking to your grandmother!
• Sit down – patients like it and you get to rest your feet.
• Introduce yourself when you enter and say “thank you” when you leave – in the hustle-and-bustle of hospital work, it can be easy to forget these simple things.
For more tips, take a look at the cover article by Diane Sliwka in this issue of The Residents Report
Goal 2: Hand Hygiene: Achieve 85% compliance by physicians, for at least six of 12 months.
This effort has been amazing! The physicians have met this goal for EVERY month this year! This is an incredible accomplishment and speaks highly of your commitment to patient safety. Our patients thank you!
Housestaff Incentive UpdateGoal 3: Discharge Process: Complete 20% of all inpatient discharges before 12 PM, for at least six out of 12 months.
Overall we are at about 19%, so we are MUCH closer to the goal. We won’t make it for 2012-13, but this will continue to be a goal for the Medical Center, so keep up the great work.
Services that are above 20% for the most recent period include: Adult General Surgery, OMFS, Ophthalmology, Otolaryngology, Pediatric Surgery, Plastic Surgery, Urology, and Vascular Surgery!
What can you do to expedite the discharge process?
About 20% of our patients are discharged between 12 and 2pm. Focus on those patients. They are often the ones who you know are going home right after lunch. Is there a reason they can’t go home before lunch? If an additional two out of every 100 patients go home before lunch, we will achieve our goal!
Unfortunately, the time measured is when the patient leaves, not when the order is written. This makes it a team effort. If you want to get a patient out early, be sure the whole team knows it!
Quick tips:
• Start early. Long before discharge, start the discussion about needs for home tube feeds, PT/OT, other medical equipment, etc.
• Think 24-hours in advance. If we identify patients who may be ready in the next 24 hours, there is time to ensure that all of the discharge planning is complete. Make this a part of daily rounds!
• Alert nursing and pharmacy staff early in the morning. Even if the order is written at 11:00am, if no one was expecting the order it can be a challenge to get patients out the door by 12:00pm.
• Tell the patient! Don’t forget that many patients need time to arrange transportation home.
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Jennifer Kaplan, MD presents General Surgery’s housestaff
improvement Project.
JP Yu, MD discusses the Radiology quality
improvement project.
Amanda Whitaker, MD answers questions regarding Orthopaedic
Surgery’s poster.
The UCSF Resident and Clinical Fellow Quality Improvement Incentive Program Poster Symposium was held on May 30th. At this end-of-year celebration, resident and fellow champions from 18 program-specific projects displayed posters and presented their incentive project findings.
Housestaff Incentive Update
Heather Leicester - Patient Safety and Quality Services Metrics Collected - 6/6/2013
Immediate Attention (>5% below target) Warning (≤5% below target) On Target (meets or exceeds target)
CLINICAL HOUSESTAFF INCENTIVE GOALS SCORECARD: FY2012-2013 June
:PATIENT SATISFACTION
For the period of July 2012-June 2013, on the patient satisfaction survey likelihood of recommending question, maintain an annual average mean score of 91.6. Percentile rankings shown are national benchmarks. Due to change from received date to date of discharge information will be lagging by 3 months.
40 36 40 40 39 40 39 39 39 38 40 42
91.3 91.3 91.3 91.4 91.4 91.4 91.3 91.0 91.0 91.0 91.0 91.0
20
40
60
80
100
Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13
Axis Title
Likelihood of Recommending by Date of Discharge
Monthly percentile Monthly mean score Running average percentileRunning average mean score Linear (Running average percentile)
:PATIENT SAFETY AND QUALITY
For the period of July 2012-June 2013,achieve 85% hand hygiene compliance by physicians for at least six of twelve months.
Utilization/Discharge Resource:Process
Complete 20% of all inpatient discharges before 12 PM, for at least six out of twelve months. This will include completion of all elements of the discharge process.
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13
Perc
ent C
ompl
eted
Inpatient Discharges Completed before 12 PM
Actual Target
60%
80%
100%
Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13
Com
plia
nce
Rate
Overall Hand Hygiene Summary Rolling 12 Month Period
MD/NP/IPA (Provider) IAP-Goal
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1. What is an Incident Report?
Incident reports are an important tool used by the Medical Center to identify adverse events and near misses, so that we can improve systems to support patient safety.
2. How do I file an Incident Report and what should be included?
The incident reporting system can be accessed from the “CareLinks” page, the link is in the second column labeled “UCSF Pages.” You will need to complete some basic demographic information, answer some questions about the event, and then describe the event in free text. It is most helpful to be brief, but include enough detail to facilitate the next steps in the investigation of the event. It is important to be objective. The IR system is not a good place to speculate, assign blame, or vent about an event. Event details should include: what happened, who was involved, and the outcome of the patient if that is known.
3. What type of thing should I be reporting? What are the goals of an Incident Report system?
We encourage reporting of both serious events or errors and near misses. Reporting of serious or sentinel events, such as a retained sponge or death from a medication error, allows for rapid review with a root cause analysis and timely reporting to the state. Reporting of near misses allows us to perform a review and implement system improvements, so that we can avoid errors in the future. An example of a near miss is a medication error that is caught before reaching the patient.
4. What happens when I send in an incident Report?
Incident reports are categorized into 32 categories. Each category has a category manager. When an IR is filed it is automatically routed to the category manager, the nurse manager or supervisor of the area where the event took place, and to the service chief and/or quality improvement representative for the involved service. For example, if a medicine
patient on 14L falls, the IR will be routed to the 14L nurse manager, the medicine service chief and the category manager for “falls.” They would investigate and review the circumstances of the fall as well as the patient outcome. If needed, improvement activities and follow-up plans would be initiated. This would be documented in the IR system before “closing” the IR. Serious incidents, a fall with injury for example, are quickly escalated through the IR system to Medical Center and medical staff leadership for review and consideration of a root cause analysis.
5. How many Incident Reports are submitted at UCSF?
10,000 incident reports are filed each year. The four categories with the most IRs are medication related events, skin issues (for hospital acquired pressure ulcers), IVs tubes and drains (largely for IV infiltrates), and falls.
6. Is my name used if I file an incident report? What happens if someone files an incident report about me?
Yes, when you complete an incident report you will be asked to include your name. This is helpful for further investigation of the
Adrienne Green, MD, Professor of Medicine and Associate Chief Medical Officer at UCSF Medical Center answers resident and clinical fellow questions about Incident Reporting at
UCSF Medical Center
10 Questions from the Resident and Fellow Affairs Committee
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event beyond what is written in the IR. Some institutions have anonymous reporting of IRs, but UCSF does not.
The most frequent IRs about residents and fellows involve unprofessional behavior, poor communication, slow response time to pages, and slow response to requests for orders. If an IR is filed about you, it will be sent to your program director and/or service chief for review. He or she will contact you to hear about the event from your perspective.
7. Is an Incident Report charted in the patient’s medical record? Does it go in anyone’s personnel file?
The incident reporting system is independent of the electronic health record. It is always best to consult Risk Management before documenting possible errors in a patient’s record.
Incident reports may not be copied and placed in an employee’s personnel file. In fact, they may not be copied for any purpose. An IR is a confidential and privileged communication and must be appropriately handled to protect that privilege.
8. What is a Root Cause Analysis, how is it organized, and who does this?
A root cause analysis is a multidisciplinary, structured, retrospective review of an event. At UCSF we perform RCAs on serious, sentinel events as well as near misses. The UCSF Patient Safety Committee has oversight over the RCA itself and is accountable for assuring that improvement actions identified at the RCA are implemented, sustained, and disseminated. Some examples of recent RCAs and the changes that were put in place, have been nicely described in the GME Patient Safety Bulletins that have recently been distributed.
9. Will I hear what happened to the situation about which I submitted an Incident Report?
One of the pitfalls of our current system is that we do not do a great job of closing the loop with each person who has filed an IR. In general, the more serious the error, the more
likely it is that you will be a part of the review process and thus hear about the outcomes. If you have filed an IR but haven’t received feedback, it would be appropriate to ask your service chief for follow up.
10. How can I learn about what comes out of the UCSF Incident Report and Root Cause Analysis system?
The Patient Safety Committee and the Office of GME are partnering to develop Patient Safety Bulletins highlighting key events, what we have learned about the root causes, and what we have done to improve our systems. We also conduct a Patient Safety Grand Rounds each year in March. An upcoming GME Grand Rounds will focus on the IR system and root cause analysis.
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Submitting an Incident Report at San Francisco General Hospital & Trauma Center
Incident reports at SFGH are called Unusual Occurrence Reports or UOs and the UO system is web based and housed on the secure DPH/SFGH intranet.
There are two ways to submit a UO depending on whether it is patient related or non-patient related:
1. Patient Related: SFGH Electronic Medical Record [Invision/LCR (Lifetime Clinical Record)]
• If the UO is related to a specific patient, access the patient in Invision/LCR. On the menu bar on the left side of the first screen, click on “UO/Suggestion Box” link.
• The first time you access the UO system, you will be asked to enter your active directory account. This is the same log on that you use to access the Citrix portal for Invision/LCR.
• The UO category screen will then appear. Click on the appropriate category of UO, then hit “Next”.
• The UO template will appear and will automatically be populated with the patient’s identifying information. You then type a description of the incident in the text box and click ”Next”.
• If you are unable to finish, click on the “Save as Draft and Quit” and you can return later to complete it.
• UOs are triaged by Risk Management and sent to the appropriate category manager for investigation. The category manager enters her or his investigate report into the system.
2. Non-Patient Related: CHN intranet site: http//insidechnsf.chnsf.org
• On the SF Department of Public Health’s CHN intranet website, click on the UO Icon
• The first screen provides an explanation for how to proceed. • On this screen the second line has a “click here” link for a
non-patient related UO that will take you to the system.• The first time you access the UO system, you will be asked to
enter your active directory account. This is the same log-on that you use to access the Citrix portal for Invision/LCR.
• After entering your active directory account, you will be asked to enter the correct risk management office which for SFGH is “SFGH-COPC”; you will then be directed to the screen where you select the UO category, proceed as above.
• You may also enter a patient related UO by this approach, but the patient data will not automatically be populated on the form.
If you need assistance in submitting a UO, please call Risk Management at 206-6600.
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Adverse Event, Close Call, and Risk-Prone Condition Reporting at SFVA Medical Center
Reporting to the Quality Management Office is crucial for the patient safety program. Through analysis of incident reports and a focus on system errors rather than on the actions of individuals the patient safety process can lead to the development of measures to prevent future patient harm. Although reporting is voluntary, it is strongly encouraged, and is confidential.
Events that should be reported: · Adverse Event: Unplanned, unexpected, and
undesired outcomes that result from medical care rather than from the natural course of the disease.
· Close Call: An event or situation that might have resulted in an accident, injury, or illness but didn’t either by chance or through timely intervention.
· Risk-Prone Condition: Any circumstance (exclusive of the disease or condition in which the patient is being treated), which significantly increases the likelihood of a serious adverse outcome.
How to report an Adverse Event, Close Call, or Risk-Prone Condition:
If you have CPRS access:
A. Select Patient in CPRSB. Select ‘Tools’ from the toolbarC. Scroll down to ‘More’, hover with the mouse:
select ’QI Reporting’ from the menu and clickD. Type in your Access and Verify codes againE. The ‘On-line QI Reporting” screen will appear:
1. You will be entering information in the left hand box ‘Find Patient’. Please skip the Find Employee box and the Visitor box.
2. To the left of the “find Patient” radio button: type in the patient’s full social security
number or full patient name. Click once on ‘find Patient’.
3. Click TWICE on the applicable patient’s name/number from the white box.
4. Click on the radio button that applies to the type of incident (falls, medication error, missing person, parasuicide or other).
5. Click on the calendar icon, select date and time that the incident occurred, and click ‘okay’.
6. Hit ‘next’.Pop-up box(es): These will vary depending on the type of incident that you selected, use the ‘next’ button after entries to move through the screens.
1. Complete the location of the incident and related information, as applicable
2. Briefly describe the incident (please be as objective and factual, as possible), and click on radio buttons with further description, as applicable
Completing the report:1. If you want to report anonymously, click on
“Anonymous”. (Otherwise, your CPRS log-on automatically assigns your name to the report. The Patient Safety Managers will use your name ONLY for purposes of contacting you if they have questions).
2. Click on “Save to QI database”; a dialogue box will appear confirming that the QI report has been filed.
If you do not have electronic (CPRS) access, or if you have questions, you may report via telephone to the SFVA Patient Safety Managers: 415-221-4810, extension 4756 or extension 2018.
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OUT & ABOUT from the Resident and Fellow Affairs Committee
My favorite indulgence on a rare day off is a trip to the spa! As surgeons, we work hard - really hard - and I have learned during residency that it is also important to rest and restore yourself. Getting a massage, facial, or body wrap in a completely removed and serene setting is my way of “getting away from it all.” Sometimes, I will just treat myself to a quick morning massage, but if I can, I will usually make a little trip out of it. As luck would have it, there are a bounty of spa and massage destinations in the bay area from which to choose.
VISTA BLUE SPA @ THE MONTEREY PLAZA HOTELThis is my number one spa. I used to live in Monterey and would always pass by the incredibly beautiful oceanfront terraces of the Plaza Hotel. It wasn’t until my intern year that I found out there was a spa, too! Take the scenic drive from San Francisco down Highway 1 and valet park at the Plaza Hotel (it’s covered by the spa). The spa itself is located on the roof top deck where you will find a bird’s eye view of the deep blue water of the Monterey Bay, the courtyard with a lovely dolphin fountain, and a small secluded beach below. This is an open-air space with hot tubs overlooking the ocean, deck chairs for lounging or sunbathing, a steam room with fresh towels and
strawberry water, and a fireplace for chilly days. They will even bring you lunch a la carte. The deck is shielded from wind, and on sunny days it is just pure bliss. Make a day of it. At night, you have a view of the stars. There is also a boutique, which offers an array of lotions and fragrances, as well as stylish spa shoes. And if you join as a spa member (free), they offer all sorts of discounts. There is an extensive spa brochure with signature treatments such as foot and scalp massage, facials, wraps, scrubs, skin care, nail care, and even a “for men” section. For couples, there is a special bubble bath room with an ocean view. It’s a wonderful place to visit alone, with a partner, or a group of friends. Just go, you won’t regret it.
WATERCOURSE WAY in PALO ALTOAn old favorite of mine, this spa is completely unique with private tub rooms combined with steam or sauna and cold plunge wells. It has a tasteful zen vibe and asian-inspired decor. Every time I go, it is like entering a different world of utter relaxation; I have yet to find another place like it. You can book a one hour tub room and combine it with a massage -- deep tissue is my favorite. The therapists are excellent at working with you on problem areas (good for those knots after long surgeries!). You can easily add aromatherapy and hot stones to your massage. They also have holiday treatments, monthly specials and couples massages. Definitely splurge on the rooms that offer steam or sauna options -- my top picks are “Six Dragonflies” which has a lovely wooden tub and warm natural light, and “Nine Bats” which is modern with sleek glassy decor and a tiled hot tub under a “dome of starlight.” I can’t think of a better way to unwind. Nearby Stanford, my alma mater, is a place I love to roam afterward. I like to do a morning treatment, then go shopping next door at Anthropologie, walk through the Stanford Quad, and end with lunch at the Cantor Art Museum Cafe. A perfect day.
ESALEN INSTITUTE in BIG SURThe most dramatic setting of all combined with the best massage of my life was at Esalen. It is a
DESTINATION SPA THERAPY
Ginger Xu, MD, Fifth Year Resident in Plastic Surgery
Where members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF
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retreat in a world of its own, with sweeping vistas of the big sur coastline and steep cliffs dropping into the ocean. What’s special here are the hot springs which reside on the grounds of Esalen, and are open only to 1) guests participating in a workshop, 2) renegades who show up during the 1am-3am time slot for “public access”, and 3) those who have booked a massage. I recommend the 3rd option. Of note, the baths are clothing optional, so come at your own comfort level! The grounds are large, and you will enter a common changing area with an eco-modern design. There is a large open air shower room with a glass wall looking out at the Pacific Ocean. You really feel one with nature. This leads to a perch with a number of individual claw foot tubs, and a scattered pools on different levels, all filled with the water from the hot springs. This is a place of complete serenity, quietude, and spirituality. You will marvel at an unforgettable view of the immense ocean. You might be brought into an indoor or outdoor space for a massage. With eyes closed you will hear the waves and feel enveloped by and connected with the sea. It is an amazing experience. My masseuse was incredibly in tune and used special “Esalen-style” massage
techniques that left me feeling totally rejuvenated. If you are looking for the ultimate massage, Esalen is not to be missed. Afterward, check in to the nearby Ventana Inn for a luxurious escape -- it’s worth the splurge. This is another haven in Big Sur with hundreds of acres of woodlands and its own on-site Spa and Japanese hot baths. Some rooms will have a deck with a private hot tub and distant ocean views -- a mini spa experience in your own room. I celebrated my last two birthdays at the Ventana; you’ll know where to find me next year!
The Entrepreneurship Center at UCSF is offering a unique course for entrepreneurs starting this Fall. Lean Launchpad for Life Science/Healthcare is an exciting new UCSF course taught by acclaimed entrepreneur/educator Steve Blank and a life sciences teaching team for people who have an interest and passion in discovering how an idea can become a real company. This is a team-based, experiential, hands-on opportunity to learn how to build companies in the real world. Class starts on October 1 for 10 weeks and meets in the evening.
This class is not about writing a business plan or doing library research. You will be talking to actual customers and partners for your idea and learning the chaos and uncertainty of how a startup actually works. You’ll learn how to use a business model to brainstorm each part of a company and customer development to get out of the classroom and talk to real prospects to see if anyone other than you would want or use your product. Each week will be a new adventure as you test another part of your business model and share this knowledge with the rest of the
class. The experience of working with your team will help you learn how to build, manage or interact with others in a venture. You will be assigned a mentor to support and inform you who will interact weekly.
Class is organized around a lecture on one of the nine building blocks of a business model, student presentations on “lessons learned” from the week’s interviews and the team’s progression as captured through an online blog/journal/wiki.
The Entrepreneurship Center will be holding an information session and mixer on July 17 to tell you more. If you don’t have a team or are looking for an idea, come to the mixer and find others with whom you can collaborate. Information is also available on our website: cbe.ucsf.edu, and on the links below:
http://www.businessmodelgeneration.com/canvas
For more on the Lean Launchpad, go to www.steveblank.com. Steve’s lectures for his tech-oriented class can be found on www.udacity.com.
Contact Stephanie Marrus ([email protected]) or Kyra Davis at the Entrepreneurship Center for more information.
Lean Launchpad Launches for Life Science/Healthcare Entrepreneurs at UCSF
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San Francisco is a classical music lover’s dream. There is something for every taste, with prices ranging from free to fancy. I grew up playing classical piano and singing, so this list is a bit biased, but can hopefully be a good start. SF Gate and KDFC (the classical music station) both have listings for current concerts. Happy listening!
OPERASF Opera is a wonderful way to enjoy great music and theater at the same time. They feature world-class artists each season as well as divas-in-training who sing some of the minor roles in the operas. Each season features some well-known, popular operas as well as music by modern composers. Check out their schedule athttp://sfopera.com/Home.aspx.
They have many options for half-season tickets that can save you about 15-30%. If you are new to opera, the best way to get a taste for it is the free simulcast in AT&T Park, where you can enjoy your garlic fries with great music. Bring a blanket! Also, many movie theaters such as Kabuki in Japantown and West Portal now also do simulcasts of operas either sung in SF or at the Met in New York- see http://www.metoperafamily.org/metopera/liveinhd/
OUT & ABOUT from the Resident and Fellow Affairs CommitteeWhere members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF
Tippi C. MacKenzie, MD
Associate Professor in Residence, Surgery
Pediatric and Fetal Surgeon in the Division of Pediatric Surgery
LiveinHD.aspx or the theater schedules. In the summer, they also put on Opera in the Park, which is always a fun afternoon of picnicking and listening. This year it is on September 8th. http://sfopera.com/Season-Tickets/Opera-in-the-Park.aspx
If your taste runs more modern, check out Opera Parallele at Yerba Buena Center: They are superb musicians not afraid to try new works and multidisciplinary art. http://operaparallele.org/
SF Symphony: Something for everyone! In addition to standard symphony fare, they also have kid-friendly family concerts and a youth orchestra. You can find the schedule at http://www.sfsymphony.org/. They also have great discounts such as same-day rush tickets that are detailed here: http://www.sfsymphony.org/Buy-Tickets/Discount-Tickets
Stern Grove Music Festival: This is an incredible opportunity to hear a range of music options, all free. Sundays in the summer, June 16 - August 18. Say hello to SF summer fog and remember to wear layers! http://www.sterngrove.org/home/2013-season/
CHORAL MUSICThere is a lot of excellent choral music in the area. The SF Bach Choir is an excellent option. http://www.sfbach.org/ In early December, multiple groups hold Messiah sing-alongs to help get you in the holiday spirit. For those of you with children, the SF Girls chorus is a wonderful opportunity to introduce kids ages seven and up to classical music (they sing a Holiday concert at Davies symphony hall each year).
OTHER VENUES
There are several churches that have their own concert series. Check out:
Old First Church: they usually have a lineup of talented musicians in a beautiful, intimate setting.http://www.oldfirstconcerts.org/
Grace Cathedral is an incredible place to hear classical music, especially organ.http://www.gracecathedral.org/visit/concerts-and-events/
BAY AREA CLASSICAL MUSIC
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On May 8, 2013 the Resident Research Training Program (RRTP) of UCSF’s Clinical and Translational Science Institute held its annual Resident Clinical & Translational Research Symposium in Millberry Union. The symposium provides an opportunity for residents to present their work and to develop cross-departmental collaborations.
The event began with an overview of RRTP by Co-Director Emily von Scheven, MD and all the opportunities it offers. Sam Hawgood, MD, Dean, School of Medicine then shared some opening remarks about the scope and innovation of the work being presented.
Five oral presentations were selected from among the resident abstracts submitted for consideration. Jennifer Jarvie, MD, presented “Prospective Association of Physical Activity and Markers of Inflammation and Insulin Resistance in Outpatients with Coronary Heart Disease: Data from the Heart and Soul Study;” Rushi Parikh, MD, presented “HIV Elite Controllers Have Lower Asymmetric Dimethylarginine and Improved Endothelial Function as Compared to Individuals with Treated and Suppressed HIV;” David Solomon, MD, PhD, presented “Frequent Truncating Mutations of the STAG2 Gene in Bladder Cancer;” Julian Villar, MD, MPH, presented “The Diagnostic Accuracy of Emergency Ultrasound for Acute Cholecystitis Using a Simplified Definition of a Positive Test;” and Matt Zinter, MD, presented “Impact of Cancer Type on Complications and Outcomes in the Pediatric ICU.”
In addition, there was a poster viewing and a reception. In all, 24 resident posters were presented from many programs across campus from Anatomic Pathology to Radiology.
The event was informative and entertaining. Many residents had the opportunity to present for the first time. Residents were exposed to the experience of presenting, the chance to learn, and the exchange of ideas with peers and mentors.
If you are interested in learning more either about the Symposium or the other opportunities of the Resident Research Training Program, please go to http://accelerate.ucsf.edu/training/resident.
2013 UCSF Resident Clinical & Translational Research Symposium
Connecting to Interpreting Services is as easy as 1, 2, 3!When communicating clinical information with a patient who does not speak English fluently, UCSF policy requires you use a professional interpreter to bridge the language barrier.
UCSF policy recommends using an in-person professional interpreter for complex communication with substantial psychosocial or educational content and for patients with impaired hearing or using American Sign Language.
Call 353-2690 to schedule an in-person interpreter; choose Option 1 to access an interpreter over the telephone 24/7.
In the hospital, look for the dual-handset telephones and follow the instructions on the label for rapid telephone interpreter access.
Locate your patient’s preferred language for healthcare in the APeX header.
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Manuel Manotas, Psy.D. UCSF Faculty & Staff Assistance Program
Imagine you are about to make an important case presentation to your medical team. All the residents, fellows, your attending, and other senior faculty members are present. The room is across the hall from a very noisy nursing station and the audio/visual systems are not working; you won’t be able to use your Powerpoint presentation and you will virtually have to yell to be heard in the back of the room. Suddenly, you feel your chest tighten, your palms begin to sweat, your heart is racing, and your breath shallow. You begin thinking about how your colleagues will judge you during the conference. You feel light-headed and fear kicks in--you know you are not well enough prepared! This thought pumps up your worry and you remember an old idea that you are a bad presenter. You begin to recall how terribly you have presented in the past and in your mind, you screw up this presentation too. You will do a terrible job and end up humiliated and criticized by your supervisors and colleagues. You are now frozen in fear. In this mind/body state, it will be nearly impossible for you to deliver the presentation you have so well prepared. This is an example of how easily our mind and its future-tripping habits can control us in the present. Fortunately, we can learn to observe our thoughts and feelings in the present moment without getting caught up by them. This is called mindfulness.
In 1979, at the University of Massachusetts, Jon Kabat-Zinn Ph.D., began to teach mindfulness meditation to chronic pain patients who had exhausted all other medical and surgical alternatives. He brought this 2500-year-old practice into the medical setting without the religious component of its origins and developed a curriculum, Mindfulness Based Stress Reduction (MBSR), which is now taught and researched in over 400 universities and medical centers across the United States. Research studies have demonstrated MBSR training reduces symptoms of depression, anxiety, and perceived stress; it has been shown to help patients with GI distress, high blood pressure, cardio-vascular disease, sleep problems and chronic pain. Recent neuroimaging
studies show gray matter increases in the areas of the brain associated with memory, empathy and emotional self-regulation following mindfulness training. In addition to the long term benefits of mindfulness training, there are immediate benefits including relaxation, reduced stress, and improved emotional regulation. At UCSF, the Osher Center for Integrative Medicine, teaches the full eight-week MBSR class and has an active research program investigating applications of MBSR to a wide variety of health conditions (http://www.osher.ucsf.edu/classes-and-lectures/meditation-and-mindfulness/). Participating in an MBSR class can be a life changing experience. During Residency, however, it may be impossible to take a full class due to its significant time commitment (8-weekly 2-hour classes, 45-minutes of daily practice and a full day retreat). Fortunately, there are many ways you can begin to develop mindfulness. When the time is limited, short practices throughout the day have beneficial effects.
Kabat-Zinn defines mindfulness as a way of “paying attention in a particular way: on purpose, in the present moment, and non judgmentally.” When truly in the immediate moment our perception is more accurate, and we respond simply and appropriately to the issue at hand by recognizing our feelings, thoughts or emotions and without identifying with them. This is very different from how we usually get caught up in our mental and emotional reactions, which are based on a story we tell ourselves based on past experience. With mindfulness training, we learn to recognize our stories and begin to free ourselves from their push and pull on our mind.
Re-imagine the presentation situation at the beginning of this article. This time, when you notice your body tightening and heart racing, you are able to acknowledge these feelings and the thought: “Here I go again – always screwing up presentations.” Instead of believing this thought as true, you take a deep breath, feel your feet on the ground and notice how your body relaxes and your thoughts slow down. Simply observe the thoughts, sensations and feelings that arise without fighting them, acting them out, or even judging them. This frees you from old ideas and bodily tensions and allows your energy and attention to re-focus
Brief Mindfulness Exercises for the Busy Physician
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on your current presentation. The sooner you recognize old patterns and refocus, the easier it will be to disengage from unhelpful thoughts and reactions. When you are pressed for time, there are many simple practices that are helpful. Below are a few you might want to give a try:
One minute meditation:
• Stop what you are doing/thinking• Close your eyes • Feel your body sensations as they are (do
not think about your body, but actually feel its sensations)
• Focus your attention on your breath, notice how it feels in your nostrils when the air flows across them—cool on the in-breath, warm on the out-breath.
• Choose an area of bodily sensation and focus your breath there. For example, you might focus your breath on the tension in your abdomen and notice how it expands and contracts with each inhalation/exhalation. o Expect your mind to wander and get
distracted. This is what minds do. o Every time you notice your mind wandering,
simply bring it back to your breath, without judgment.
o Letting go of judgment and self-criticism is an important part of this practice.
o Practice frequently, and extend your practice time (5-10 minutes) as your schedule permits.
Daily Mindful Activity:
It can be very helpful to develop this habit. Choose an activity that you do on a daily basis (e.g., teeth brushing) that is simple and repetitive and does not require much thinking. Commit to bringing your full attention to this activity. For example, while brushing your teeth, feel how you hold the brush, how your hand moves, the sensation of the brush in your mouth, the flavor of the toothpaste, etc. Be prepared for your mind to wander and get distracted into thinking about something else (Did you order those patient labs?!). As soon as you notice that you have drifted, bring your attention back to the sensations of your body as you do your activity. Remember that the mind’s tendency is to drift and this will happen repeatedly--don’t use this as an excuse to beat yourself up. Beginning
this practice can be very challenging and you may get lost in distraction the whole time. As you practice bringing your attention back again and again, your mind will begin to habituate to being in the present moment.
Mindful Movement:
You don’t have to take a yoga class to get the benefits of mindful movement. Throughout the day, you can introduce very brief times (as little as one to two minutes) when you simply stretch while being aware of your body sensations. This simple exercise connects and grounds you. Our body is how we operate in the world, it is not separate from our mind and it is a powerful tool that is always available to bring our attention back to the present moment.
Mindful Deep Breathing:
Deep, purposeful breaths have a very powerful calming effect. It is easy to undervalue the power of this simple practice. When tensions are high and anxiety rampant, we tend to take very shallow breaths or hold the breath. Counter this by taking a few deep, regular breaths to activate the parasympathetic nervous system and the relaxation response.
Although mindfulness and other coping mechanisms can be effective strategies in coping with everyday stress, at times work or personal problems can interfere with your functioning and you could benefit from some extra support. The Faculty and Staff Assistance Program can help you by providing you with counseling services as well as referrals for therapists in the community. FSAP services are free and confidential and available for both personal and work-related issues.
Faculty and Staff Assistance Program
(415) 476-8279For more information,
please visit our website:http://www.ucsfhr.ucsf.edu/assist
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Vignesh Arasu & Hriday Shah, Second Year Residents in Radiology
Interacting with radiologists is like requesting a consult – it’s all about knowing how to think about your diagnostic question and how to communicate it. The following suggestions will help you (and the radiologist) figure out the right study for your patient, and receive the most relevant interpretation.
1. Providing a “radiology” clinical history: Location, location, locationRadiologists analyze studies by finding abnormal anatomy and making an interpretation on the clinical context provided. Thus, if possible, think about your diagnosis in terms of likely anatomic location to help radiologists improve detection of subtle findings and give a more narrow interpretation. In addition to giving the chief complaint or relevant signs/symptoms, consider the following:
a. What is your preliminary differential diagnosis? It helps to know a ddx instead of only one diagnosis to exclude.
b. How specific can you anatomically pinpoint the pathology? For example, right lower quadrant? organ? C7 spinal level? 5th right DIP?
c. Is there any existing abnormal anatomy the radiologist should know about? For example, history of surgery, cancer, trauma, XRT, etc.
2. Requesting the appropriate studyOnce you know the diagnostic question you want to answer, choosing the right radiologic study for your patient can be difficult. Here are ways to start:
a. Do-It-Yourself: Go to acsearch.acr.org or google “ACR appropriateness criteria,” to find guidelines published by the American College of Radiology.
b. Call a radiologist: Call the reading room for a radiologist to help choose the best study. As always, have the patient’s history, clinical question, and MRN ready.
c. GFR: Know your patient’s GFR (not just creatinine) and google “UCSF radiology contrast” to find UCSF’s official policies if a contrast-enhanced study is safe
d. Priors: Perhaps a study has been done previously, that may already have answered your question. Which is a perfect segue to…
Tips for Effectively Working with Radiology3. PRIORS! PRIORS! PRIORS!It cannot be emphasized enough, but comparing current studies to priors are one of the most important tools for radiologists. It is the best way to strengthen an interpretation of findings. Always try to obtain prior studies done on a patient.a. Outside hospital studies: If you have the CD,
bring it to the film library at the hospital you are working at: at Moffitt: M381 (x31640) at SFGH: 1x42 (x68033)
b. Push studies: If the study was done at one of the UCSF sites, call the reading room at the original study site to “push” it to the site you are at.
c. Formal dictations: Sometimes, there may be a need for a formal dictation in the medical record of an outside study. If so, please provide the original outside report to the radiologist. Also, bear in mind that these “over-read” reports will be billed to the patient.
4. Consulting radiology about results of a studyWhen seeking a radiologist consultation in person or over the phone, keep the following in mind:a. Know your clinical history: See tip #1 to optimize
communicationb. Call/visit us: Once a study is completed, it may
be necessary to expedite interpretation for urgent cases. Please call or visit the reading room and a radiologist will do their best to interpret in a timely fashion.
c. Patience: Please also be patient if a radiologist cannot respond immediately. Radiologists handle many urgent/emergent studies simultaneously, and the on-call resident takes more than 100 phone calls overnight. If the study is non-urgent, consider waiting for the final read during the daytime.
d. Read the full report: Radiologists try to mention the most important findings in the impression, but still make many other observations in the findings.
Radiologists truly enjoy reviewing cases with the clinical teams. This year, the Department of Radiology will be distributing a pocketcard at GME orientation listing the phone numbers for the different radiology reading rooms, so that it is easier for clinical teams to open discussions with radiologists. These conversations are essential to interdisciplinary teamwork and ensure that miscommunication is reduced. Carrying out these conversations in an effective manner can help all of us improve patient care.
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Vaccination RESULTING IN vision loss
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CASE DETAILS: A 19 year old male with a severe underlying immunodeficiency was given varicella vaccine as a part of health maintenance visit. Due to his immunocompromised state, he developed severe varicella retinitis, retinal necrosis, and loss of vision in one eye. MEDICAL OUTCOME: A prolonged hospital stay and surgical interventions were required. The patient has permanent vision loss in one eye and requires ongoing VZV suppressive therapy. CASE REVIEW: Record review noted unclear information regarding which vaccinations to administer. An immunology note and email did note contraindication to live vaccines, however, these communications were not prominent in the chart such that the ordering provider was aware. The patient noted that was never told of a contraindication to live vaccinations.
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RCA Process: To better understand this incident and to prevent similar events in the future, a root cause analysis (RCA) was performed. The following improvement actions have been implemented:
¥ A departmental M&M was performed, highlighting the issue and bringing attention to populations at risk from live vaccine administration. ¥ It was noted that no visit-independent place existed in the paper medical record to prominently display vaccine contraindications. APeX was configured to document live vaccines so that a pop up reminder of these contraindications appear to providers trying to order live vaccines. ¥ A drug-disease interaction alert for live vaccines and their contraindicated use in patients with an immune-compromising diagnosis was developed and is now fully functional in APeX.
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From the UCSF Patient Safety Committee and Office of GME Editors: Herman S. Bagga, MD (Resident, Urology) and Mary H. McGrath, MD (Surgery and Office of GME) Questions? David Buchholz, MD (Pediatrics; Executive Medical Director, UCSF
Primary Care) [email protected]
PATIENT safety bulletin Patient stories and quality of care improvement updates for residents and fellows at UCSF
MAY, 2013
Incident reports (IRs):
¥ Important, even if the situation is resolved! We want to learn from “near misses!”
¥ Allow review of adverse events and unsafe conditions to optimize processes – do not serve to punish individuals
¥ Safe, blame-free, confidential
¥ IR system may be accessed from the CareLinks Page: http://carelinks/
Root cause analyses (RCAs):
¥ In-depth, multidisciplinary review of an event
¥ Focus on systems and process improvements to prevent future events
¥ Safe, blame-free, confidential
Residents/Fellows:
¥ Play a large role in quality of care improvement at UCSF
¥ Often the first to identify patient events
¥ Can improve quality of care by filing incident reports
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“Diversity – a defining feature of California’s past, present, and future – refers to the variety of personal experiences, values, and worldviews that arise from differences of culture and
circumstance. Such differences include race, ethnicity, gender, age, religion, language, abilities/disabilities, sexual orientation, socioeconomic status, and geographic region, and more.”
As Vice Chancellor, Diversity and Outreach, I would like to welcome new and returning trainees to our campus community. The Office of Diversity and Outreach established in December 2010, strives to ensure that the University of California, San Francisco embraces and nurtures our commitment to a diverse and just campus community. We recognize that our strength as an institution lies in the full participation and contribution from individuals of different backgrounds and that your participation is an essential component of maintaining our excellence in education, research, patient care and service.
We are committed to providing an environment that is a supportive place to work, learn, discover, teach, and care for patients; and we strive to serve local and global communities to eliminate health disparities. To nurture this environment, several principles of community have been established to guide campus life at UCSF. Adherence to these principles is essential to ensuring the integrity of the University and achieving our campus goal of a diverse, open and inclusive community. A copy of these principles can be found on our website: http://diversity.ucsf.edu/POC/. We ask that you read them and abide by these principles during your time at UCSF.
Our office offers ongoing cultural competency training, support for first generation, underrepresented minorities, GLBT, women, disabled and others within our community. We host an Annual Leadership Forum on Diversity, the Inside UCSF campus-wide outreach event,
Diversity at UCSFJ. Renee Navarro, MD, Pharm DVice Chancellor, Diversity and Outreach
GME Diversity Calendar of Events 2013-14
JulyAssociation of American Indian Physicians (AAIP) Annual Meeting and National Health ConferenceJuly 29-August 4, 2013 - Santa Clara, CA AugustUCSF GME Diversity Advisory Group Meeting-Welcome Mixer for New TraineesAugust 28, 2013 6-8PMLocation TDB
For more information or to learn how you can get involved, please contact Dr. René Salazar, GME Director of Diversity via email ([email protected]) or phone (415) 514-8642
Diversity Month Celebrations each October, a joint diversity celebration with Graduate Medical Education in December, and provide ongoing enhancements to our curriculum.
We encourage you to get involved with diversity initiatives within your department or training program. Rene Salazar, MD, Director of Diversity, GME is an excellent resource and provides guidance and support through annual diversity outreach events including involvement in annual medical conferences and activities for top-tier URM undergrads interested in training programs at UCSF.
Please visit the Diversity and Outreach website for information on campus resources, events, and demographics, diversity.ucsf.edu/. You may also subscribe to the Diversity Listerv by going to sending me an email to [email protected].
We invite you to engage in a dialogue directly with us. When there is a concern or something exciting to report, we want to hear about it. Please don’t hesitate to contact our office ([email protected]). Follow us on Facebook (facebook.com/UcsfDiversity) and twitter (@UCSFODO) for information on events, workshops and research opportunities.
I hope your time here at UCSF is both fruitful and rewarding.
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Drs. Rene Salazar and Renee Navarro attend the SNMA Conference in Louisville, Kentucky
Meeting Update:
Drs. Fernando Maldonado (PGY2, Family and Community Medicine) and Cynthia Maldonado (PGY2, Emergency Medicine) attended the Latino Medical Student Association Annual Meeting held on March 15 and 16, 2013 in Miami, FL. Over 300 Latino medical students from across the county attended. The UCSF Office of Graduate Medical Education participated in the residency fair, and provided attendees with information on UCSF residency training programs and scholarship opportunities for visiting students.
Drs. Rene Salazar (Director of Diversity, GME) and Renee Navarro (Vice Chancellor of Diversity and Outreach, UCSF) attended the Student National Medical Association Annual Medical Education Conference held on March 27-31, 2013 in Louisville, KY. In addition to providing information to attendees on training opportunities at UCSF, Dr. Salazar participated in two workshops (“How to Provide Culturally Sensitive Care to Diverse Patient Populations” and “How to Successfully Navigate the Residency Program Application Process”) sponsored by the Physicians Medical Forum (PMF) of Oakland. Dr. Navarro participated in a workshop on “Women in Medicine.”
GME Diversity UpdateRene Salazar, MDAssociate Professor of Clinical Medicine GME Director of Diversity
Diversity Advisory Group:
The newly created GME Resident and Fellow Diversity Advisory Group (DAG) met on April 9, 2013 in the Multicultural Resource Center to discuss plans for 2013-14. Some plans for next year include:
• Establishment of a medical student organization liaison program for interested housestaff and fellows to serve as liaisons to UCSF student groups including LMSA, SNMA, LGBTQSA, APAMSA, and NAHA
• New resident and fellow welcome event with diverse faculty and campus leaders on August 28, 2013
• Creation of “Diversity Profiles,” which profile current diverse resident and fellows on the Diversity Section of the GME website
Anyone interested in joining the DAG should contact Dr. Salazar for more info.
Visiting Scholarship Opportunities:
The Departments of Anesthesia, Emergency Medicine and Internal Medicine have partnered with the UCSF Clinical and Translational Science Institute (CTSI) to provide scholarships of up to $1500 for visiting students interested in completing a fourth year visiting elective at UCSF. Additional funds are available for students interested in other rotations through the Physicians Medical Forum (PMF). Current trainees (housestaff and fellows) are encouraged to share these opportunities with anyone who may be interested in completing a visiting elective at UCSF.
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ANATOMIC AND CLINICAL PATHOLOGY2012 CTSI Resident Research Funding AwardTami Rowen, MS, MD2013 Society for Pediatric Pathology’s Young Investigator Research GrantGabrielle Rizzuto, MD2013 Stowell-Orbison AwardDavid Solomon, MD, PhDKrevans AwardJonathan Esensten, MD, PhDDavid Solomon, MD, PhDPathologist-in-Training Award, Society of HematopathologyBenjamin Buelow, MD
ANESTHESIOLOGY2013 CTSI Resident Research Travel AwardJina Sinskey, MD
EMERGENCY MEDICINE2012 CTSI Resident Research Funding AwardHangyul Chung-Esaki, MDDaniel Kievlan, MD2013 CTSI Resident Research Travel AwardJulian Villar, MD, MPH2012-13 Department of Emergency Medicine Intern of the YearKalie Dove-Maguire, MD2012-13 Department of Emergency Medicine Graduating Resident of the YearAaron Kornblith, MD2012-13 Department of Emergency Medicine Medical Student Teaching AwardKendall Allred, MD2013 Krevan’s Award for Clinical ExcellenceJuan Carlos Montoy, MDAAEM Resident-Student Association At-Large Board Sean Kivlehan, MD
SAEM Emergency Medicine Student Interest Group Grant Julian Villar, MD
FAMILY AND COMMUNITY MEDICINEAAFP Bristol-Squibb Myers AwardHeather Bennett, MDHearts Grant RecipientBrigitte Watkins, MD
INTERNAL MEDICINE2012 CTSI Resident Research Funding AwardJonathan Budzik, MS, MD, PhDRushi Parikh, MDVictoria Parikh, MDSahael Stapleton, MDTyson Turner, MD, PhD2012 CTSI Resident Research Travel AwardSara Kalkhoran, MDCharles Langelier, MD, PhD2013 CTSI Resident Research Travel AwardJonas Hines, MDJennifer Jarvie, MDCFAR Mentored-Scientist AwardCarina Marquez, MDClinical Fellow AwardCarina Marquez, MDCommunity Service AwardsMohammed Bailony, MD, M.Sc. Mai-Khanh Bui-Duy, MD Floyd Rector Basic Science Research AwardRushi V. Parikh, M.D.Floyd Rector Clinical Science Research AwardSara M. Kalkhoran, M.D.Jeffrey Weingarten Award (R3 award)Ari B. Hoffman, MDKeith Johnson Award (R2 award)Christina Cho, MDProfessionalism AwardLeticia Rolon, MD Reza Gandjei Humanism Award
2012-2013 Honors and Recognition for Housestaff
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2012-2013 Honors and Recognition for Housestaff
Daniel E. Westerdahl, MD Teaching Excellence Awards for Cherished Housestaff (T.E.A.C.H.)Charlotte M. Carlson, MD Robert Y. Lee, MD Thomas Evans Teaching AwardSophia Monica Soni, MD
MEDICAL GENETICSTed Adams Award (Pacific Coast Obstetrical and Gynecological Society)Ben Li, MD Dr. Koch Memorial Scholarship (National PKU Alliance)Chung Lee, MD NEUROLOGY2012 CTSI Resident Research Funding AwardLara Zimmermann, MD2012 CTSI Resident Research Travel AwardSunil Sheth, MD
NEUROLOGICAL SURGERY2013 Boldrey Award for research project in neuroscience, San Francisco Neurological Society, CARajiv Saigal , MD2013 The Congress of Neurological Surgeons (CNS) Socioeconomic FellowshipJohn Rolston, MD2013 Harold Rosegay Young Investigator Award, San Francisco Neurological Society, CAAaron Clark, MD2013 John Hanbery Award for Best Clinical Neurosurgery Paper, San Francisco Neurological Society, CADario Englot, MD2013 Krevan’s Award for Outstanding Surgical Intern of the Year, UCSF/SFGH Department of Surgery Faculty Selected Joe Osorio, MDNeurosurgery Research and Education
Foundation (NREF) -Section on Brain Tumors AwardMichael Ivan, MDResident Award, Approaches for Brain Tumor and Vascular Neurosurgery Surgical Course Joe Osorio, MDSteinhart Scholarship Award, UCSF School of MedicineJoe Osorio, MD
OBSTETRICS AND GYNECOLOGY2012 CTSI Resident Research Funding AwardAdam Lewkowitz, MDMolly Quinn, MD2012 Infection Diseases Society for Obstetricians and Gynecologists ScholarshipMichelle Khan, MD, MPHAward of Excellence in Female Pelvic Medicine and Reconstructive SurgeryVictor Long, MDBest PGY1 Teaching AwardWael Salem, MDBest PGY2 Teaching AwardMelinda Lorenson, MDBest PGY2 Teaching AwardChristopher Jones, MDBest PGY3 Teaching AwardCraig Mayr, MDBest PGY4 Teaching AwardWayne Lin, MDJames Green Memorial AwardRasha Khoury, MDKrevans Award, SFGHSiri Gardner, MDNorth American Menopause Society, Resident ScholarMeera Shah, MDPfizer President’s Presenter Award, 60th Annual Meeting of the Society for Gynecologic InvestigationHakan Cakmak, MD
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2012-2013 Honors and Recognition for Housestaff
SMFM, Best Poster AwardStephanie Valderramos, MDSpecial Resident in Minimally Invasive GynecologyJessica Chan, MDWayne Lin, MDTeaching Excellence Award for Cherished HousestaffTushani Illangasekare, MDTed Adams Award (Pacific Coast Obstetrical and Gynecological Society)Ben Li, MDUCSF Selected Research Presenter at San Francisco Gynecology SocietyJessica Chan, MD
OPHTHALMOLOGY2013 CTSI Resident Research Travel AwardNoelle Layer, MD
OTOLARYNGOLOGY2012 BARRS Award for Best Basic Science PresentationKevin Burke, MD2012 CTSI Resident Research Funding AwardMegan Durr, MDDaniel Faden, MDAmerican Head and Neck Society Alando J. Ballantyne Resident Research Pilot Grant – 2012Jonathan George, MDKrevans Award for Excellence in Patient Care 2013Jonathan Overdevest, MDUCSF OHNS Resident Research Symposium – Third PlaceMegan Durr, MD
PEDIATRICS2013 ATS Fellows Track Symposium, Selected AttendeeAaron Spicer, MD2012 CTSI Resident Research Funding Award
Kendell German, MDEmily Levy, MDMatt Zinter, MDAGA 2013 Emmet B. Keeffe Award in Translational or Clinical Research in Liver DiseaseEmily Perito, MDAhmad Ghanea Bassiri, MD Pediatric Intern AwardEnrique Escalante, MDAST Fellows Symposium Travel AwardAudrey Lau, MDBrown-Coulter AwardKaitlyn Bailey, MDCompassionate Physician AwardWilliam DeGoff, M.D.Dr. Koch Memorial Scholarship Chung Lee, MD Faculty Teaching AwardIlse Larson, M.D.Grossman AwardAdam Schickedanz, MDInvestigator Travel Award, CTSA Consortium Child Health Oversight CommitteeMonique Radman, MDKrevans AwardCheryl Cohler, M.DLucy S. Crain, MD AwardMichelle Kaplinski, MDMentored Clinical Scientist Development Program GrantEfrat Lelkes, MDNIAID/IDSA Career Development Conference Eileen Foy, MDNIH FIC GloCal Health FellowshipHilary Wolf, MDPostdoctoral Fellow Teaching AwardJacob O. Robson, MDResident Teaching AwardSabrina R. Santiago, MDDavid Young, MD, PhDMatthew Zinter, MD
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2012-2013 Honors and Recognition for Housestaff
Roy Rodriguez AIDS Fellowship Research FundHilary Wolf, MDRudolph AwardTrevor Williams, MDStanford University Institute for Immunity, Transplantation and Infection Young Investigator AwardAudrey Lau, MDTed Adams Award (Pacific Coast Obstetrical and Gynecological Society)Ben Li, MD UCSF CTSI-SOS-CRS Early Career Investigators Pilot AwardEmily Perito, MDVolunteer Faculty Teaching AwardNeelesh Kenia, M.D.Young Investigators’ Travel Award, Pediatric Academic Society, Washington DCMonique Radman, MD
PSYCHIATRY2012 CTSI Resident Research Funding AwardKaren Mu, MPH, PhD2012-2013 CTSI Resident Research ScholarMichael Hoefer, MD
RADIATION ONCOLOGY2012 CTSI Resident Research Funding AwardChristopher Tinkle, MD, PhD2012 CTSI Resident Research Travel AwardMoshiur Anwar, MD, PhDCharles Hsu, MD, PhDChristopher Tinkle, MD, PhD
RADIOLOGY2013 CTSI Resident Research Travel AwardDavid Tran, MDAmerican Roentgen Ray Society (ARRS) Residents in Radiology Executive Council AwardRonnie Sebro, MD
American Society for Human Genetics (ASHG) semifinalist Epstein AwardRonnie Sebro, MDAssociation for University Radiologists (AUR) Residents in Research AwardRonnie Sebro, MDKrevans AwardMelinda Yeh, MDSociety for Computed Body Tomography and Magnetic Resonance Imaging Poster Finalist AwardRonnie Sebro, MD
SURGERY, PLASTIC SURGERY & EAST BAY SURGERY2012 CTSI Resident Research Travel AwardJessica Beard, MD, MPHNatalie Lui, MD2013 CTSI Resident Research Travel AwardLucy Kornblith, MDAnne Peled, MDVictoria Trinh, MD
UROLOGY2012 CTSI Resident Research Travel AwardSarah Blaschko, MD
Confidential GME Help Line
415-502-9400Confidential Line for housestaff, faculty,
and program administrators to voice their questions, comments, or concerns 24 hours
a day. The Office of Graduate Medical Education will respond to all messages.
UCSF School of MedicineGraduate Medical Education500 Parnassus Avenue, MU 250 EastSan Francisco CA, 94143
tel (415) 476-4562fax (415) 502-4166www.medschool.ucsf.edu/gme
Many thanks to the following contributors:
Vignesh ArasuHerman BaggaPaul DayAdrienne GreenChristian LeivaTippi MacKenzieManuel ManotasMary McGrathRenee NavarroGlenn RosenbluthRene SalazarHriday ShahDiane SliwkaSandrijn van SchaikGinger Xu
Summer 2013
The Residents Report
Editorial Staff:Robert BaronAndrea CunninghamAmy Day
Cover Photo:Dr. Tina DasguptaRadiation Oncology
Cover photo by:Elisabeth Fall
Instructions: The above is an encoded quote from a famous person. Solve the cypher by substituting letters. Send your answers to [email protected]. Correct answers will be entered into a drawing to win a $50 gift certificate!
The Winter/Spring 2013 Cypher Answer was:
Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.
Theodor Seuss Geisel, The Lorax
Congratulations Steve Braunstein MD, PhDRadiation Oncology Resident
GME CYPHER“DKC XDJQF UJI DIQG HA CAJUMAO ZMCDKXM J PAMTUQA DY J LQJI, TI VMTUM VA WKFZ YACPAIZQG HAQTAPA, JIO KLDI VMTUM VA WKFZ PTXDCDKFQG JUZ. ZMACA TF ID DZMAC CDKZA ZD FKUUAFF.”
--LJHQD LTUJFFD
GME Contacts
GME ConfidentialHelp Line:(415) 502-9400
Amy Day, MBADirector of GME(415) [email protected]
Robert Baron, MD, MSAssociate Dean, GME(415) [email protected]
What does water have to do with sustainability? Everything! Clean, fresh water has become a scarce resource: less than 1% of the earth’s
water is suitable for consump>on yet in the US we use gallons of water everyday.
Water & sustainability
Keep our water clean. Everything you flush down the toilet or pour down the drain ends up in one of the waste
water treatment facili>es of San Francisco, where solids are
separated out and the water is disinfected before it ends up in
the Pacific Ccean or the bay.
Conserve water. Don’t let faucets run, shorten your showers,
report or fix leaky faucets and pipes. A leaky faucet that drops one drop per second can waste more than 3,000 gallons of
water, per year!
Comments or ques,ons? Email Sandrijn
van Schaik at [email protected]
Drink it…. but not from a bottle. San Francisco’s tap water comes from the Hetch Hetchy reservoir and is considered amongst the cleanest water available, cleaner than most boNled water! And did you know that boNled water produces up to 1.5 million tons of plas>c waste per year? Even though these boNles can be recycled, over 80% are thrown away, and it costs an es>mated 47 million gallons of oil per year to produce
those boNles.