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January 24, 2014
Table of contents
UW School of Medicine leads the way in graduate medical education
UW Medicine is fortunate to have outstanding graduate medical education (GME) programs and I write to provide an update on progress in the past year. UW Medicine currently has 96 programs accredited by the Accreditation Council on Graduate Medical Education (ACGME), including 26 residencies and 68 subspecialty fellowships, as well as two fellowships approved by the American Board of Obstetrics and Gynecology. The UW is sixth in the nation in the number of GME training programs and eighth in the number of trainees.
The GME Office, led by Larry Robinson, vice dean for GME and clinical affairs; Byron Joyner, associate dean for GME; and Amity Neumeister, assistant dean for GME, has focused over the last year on implementation of the Next Accreditation System (NAS) and milestones, quality and safety initiatives, advancing a comprehensive wellness program and expanding regional GME.
The implementation of NAS represents a major change in accreditation monitoring and oversight. NAS was designed by the ACGME to reduce the administrative burden of accreditation and increase the focus on public accountability. Outcomes will be evaluated through the implementation of milestones, which provide a standardized system to assess resident performance within the six domains of clinical competence, and key performance indicators to assess program quality and effectiveness. Seven specialties began implementing the milestones in July 2013 and the remaining programs will implement them in July 2014.
Monitoring of GME programs is moving to annual Residency Review Committee (RRC) review of key performance indicators and institutional monitoring of annual program evaluations. RRC site visits are replaced by 10-year self-study visits and clinical learning environment (CLER) site reviews every 24 months. Key performance indicators that will be collected and reviewed annually include program attrition and characteristics; Board pass rate; logs of clinical experiences; ACGME surveys of residents, fellows and faculty; and milestones. This new system involves considerably more observation of trainees and active monitoring of their performance through Clinical Competency Committees (CCCs) in each program.
It is vitally important to involve residents and fellows in quality and safety — trainees are on the front line of clinical care and are well positioned to effect change. The GME Office has developed an excellent resident program of quality and safety over the last several years, including a Housestaff Quality and Safety Council. This group plays a major role in focusing on areas of particular relevance to trainees, including assessment of and training in use of problem lists in the medical record, reducing central line infections and improving processes and outcomes for transitions of patient care. We are fortunate to have many excellent residents and fellows involved in this key activity.
The GME Office has been expanding wellness services and activities with the vision of creating a culture of wellness. In addition to regular wellness emails and events, mindfulness training is routinely offered for residents and their families, and free, confidential counseling services are made available on site. A recent resident worklife survey indicates that in several areas, including sense of community and perception of fairness and value, our residents are now more satisfied with their work environment than the general population.
While we have many excellent residency and fellowship training programs in Seattle and throughout the WWAMI region, the numbers of GME programs and positions are insufficient to meet the health needs of the region. Expanding GME in the region, especially in specialties that will best serve rural populations, is a key need. We are exploring ways to expand regional GME through a number of mechanisms, including a federal proposal for new GME funding.
I would like to thank Larry Robinson, Byron Joyner, Amity Neumeister, the GME staff, our excellent residency and fellowship programs directors, and the hundreds of outstanding faculty and staff who make the UW School of Medicine GME program an example for the nation.
Paul G. Ramsey, M.D.
A new industry-sponsored study, led by UW researchers, has found that a new drug, called pritelivir, may offer a new treatment option for patients with genital herpes.
The study appears in the Jan. 16 issue of The New England Journal of Medicine. The lead author is Anna Wald, UW professor of medicine, epidemiology, and laboratory medicine, and medical director at the Virology Research Clinic at the University of Washington. Other UW coauthors include Amalia Magaret, Christine Johnston, Lawrence Corey, Meei-Li Huang and Stacy Selke.
“These data suggest this drug may be a potent treatment for HSV-2,” said Wald. “That’s exciting because we have not had a new drug for herpes for three decades. In addition, our approach of using viral shedding as an endpoint clearly defined the dose that should be used in future studies.”
Most recurrent genital herpes are caused by with herpes simplex virus 2 (HSV-2). The infection, which is usually transmitted through sexual contact, can cause pain and sores in the genital area, anal region and lips. However, in most cases symptoms can be mild or altogether absent. As a result, most people who have been infected with HSV-2 are unaware they are infected, though they can still transmit the virus to others.
Currently, there are treatments that shorten outbreaks, prevent recurrences and reduce transmission to sex partners, but there is no cure. Treatments include the prescription drugs Acyclovir (Zovirax), Valacyclovir (Valtrex) and Famciclovir (Famvir), which all inhibit viral replication by inhibiting a viral enzyme called HSV DNA polymerase.
The new drug, pritelivir, is the first in a new class of drugs that inhibit HSV by targeting a different part of the virus’s replication machinery, the helicase-primase enzyme complex.
In the new study, 156 patients with genital HSV-2 infection were randomized to receive either placebo or four different dosage regimens of the new drug for 28 days.
The four dosing regimens for pritelivir were a loading dose of 20 mg followed by a daily dose of 5 mg; a loading dose of 100 mg followed by a daily dose of 25 mg; a loading dose of 300 mg followed by a daily dose of 75 mg; and a weekly dose of 400 mg.
All the patients kept a diary recording any signs and symptoms of the infection and swabbed their genital areas daily. The swabs were then tested to detect and quantify any shedding of the virus.
The 75 mg a day dosing schedule proved to be the most effective, the study found. That dose was associated with an 87 percent reduction in days of viral shedding, from 16.6 percent among those taking the placebo to 2.1 percent among those taking 75 mg of the drug a day. What’s more, substantially less virus was present during breakthrough shedding in persons receiving pritelivir, another indication of the drug’s efficacy.
Results from a national, decade-long study suggest that particular types of cognitive training can have lasting benefits for older adults. The study showed the training can help maintain certain thinking and reasoning skills, but at 10-year follow-up the memory training and control group had no differences in memory performance.
The latest findings from the Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE study, are reported in the January 2014 issue of the Journal of the American Geriatrics Society.
Sherry L. Willis, UW professor of psychiatry & behavioral sciences, was one of seven investigators on the trial. The National Institute on Aging and the National Institute of Nursing, both part of the National Institutes of Health, funded the project.
The researchers had published previous papers on the results of the training at earlier points in the study.
This is the first large-scale, randomized control trial of cognitive training in healthy older adults. Most previous clinical trials of this nature were with adults with mild cognitive impairments, dementia, a functional limitation, or another disorder. ACTIVE was a scientific evaluation of the effects of three theory-based training programs.
ACTIVE volunteers, average age 74 at the start of the study, were divided into three training groups memory, reasoning, and speed of processing, or performing a mental task quickly. There was also a control group who did not receive training.
The researchers checked to see whether the training had an effect on the participants’ ability to carry out some of the routine and complex tasks of daily living. They used standard measures to assess time and efficiency in performing everyday tasks, and also asked the volunteers to describe their ability to prepare meals, use the telephone, manage their finances, shop and travel, and whether they needed assistance in dressing and other personal care.
By the end of the study, all of the groups, now 10 years older, showed decline in their reasoning, memory, and speed of processing, compared to their tests at earlier points in the study. Nevertheless, those who had received training in reasoning and speed of processing showed less decline than the memory-training or control group.
The efforts of five UW Medicine researchers who are seeking to advance promising translational health research got a recent boost when the Institute of Translational Health Sciences (ITHS) awarded each a $10,000 pilot grant.
The ITHS translational health pilot grants are intended to provide the researchers with jump-start funding to develop preliminary findings and test “proof of concept” to support future full-scale, competitive grant applications.
The research supported by these grants focused on improving health outcomes for individuals with autism spectrum disorder, chronic kidney disease, Type 1 diabetes, surgical site infections and Parkinson’s disease.
The UW Medicine researchers receiving awards and their projects during this application cycle are:
Visit the ITHS website to learn more.
Sleep apnea is a common sleep disorder that occurs twice as frequently in men than women. “It can leave you feeling tired during the day and, over the long term, can cause serious health consequences, including increasing your risk of high blood pressure and heart disease,” says Nathaniel F. Watson, a neurologist and co-director of the UW Medicine Sleep Center at Harborview.
The most common form of sleep apnea is called obstructive sleep apnea, which occurs when a person’s airway becomes blocked during sleep. “When you sleep, the muscles around your throat relax. As a result, the airways tend to collapse or narrow. This can impede the flow of air or block it altogether. When this happens, the person temporarily stops breathing, causing blood oxygen levels to drop and increasing the person’s effort to take the next breath,” Watson says. “The brain, sensing this increased effort rouses the person from sleep enough so they take a breath. This cycle repeats again and again throughout the night so that the person’s sleep is constantly being disrupted and they never get a good night’s rest.”
Warning signs of sleep apnea include restless sleep; loud snoring, irregular breathing, gasping and choking at night; excessive daytime sleepiness; and irritability, inability to concentrate and depression.
Because their sleep is disturbed, people with sleep apnea tend to feel drowsy throughout the day.
“Sleep apnea has a big effect on the quality of their lives,” Watson says. “But they don’t know they have apnea because it’s happening while they are asleep. Often, it is a bed partner who notices that they are snoring loudly or breathing irregularly in the night.”
Learn more about sleep apnea:
Sleep Apnea Seminar: 7 p.m., Tuesday, Feb. 25, Hogness Auditorium, Warren G. Magnuson Health Sciences Center. Dr. Nate Watson will speak at a sleep disorders class as part of the UW Medicine 2014 Mini-Medical School.
The School of Medicine has announced the appointments of new holders of endowed faculty positions. They are:
Howard Chansky, UW professor, Department of Orthopaedics and Sports Medicine,
Jonathan M. Chen, UW professor, Department of Surgery, Division of Cardiothoracic Surgery
Michele Curatolo, UW professor, Department of Anesthesiology and Pain Medicine
Annette Estes, UW professor, Department of Speech and Hearing Sciences; director, UW Autism Center
Stanley A. Herring, UW clinical professor, Departments of Rehabilitation Medicine, Neurological Surgery, and Orthopaedics and Sports Medicine; medical director of UW Medicine Sports, Spine and Orthopedic Health
Eric C. Holland, UW professor, Department of Neurological Surgery; director, Nancy and Buster Alvord Brain Tumor Center; senior vice president and director, Human Biology Division, Fred Hutchinson Cancer Research Center (FHCRC); and director, Solid Tumor Translational Research, UW Medicine and FHCRC.
Shaun W. Jackson, UW acting assistant professor, Department of Pediatrics
Michael J. Lee, UW associate professor, Department of Orthopaedics and Sports Medicine
Michael Regnier, UW professor and vice chair, Department of Bioengineering
Kathleen Sie, UW professor, Department of Otolaryngology - Head & Neck Surgery
Nona Sotoodehnia, UW associate professor, Department of Medicine, Division of Cardiology
Matthew J. Thompson, UW professor and vice chair for research, Department of Family Medicine
Christopher M. Traudt, UW acting assistant professor, Department of Pediatrics
William T. C. Yuh, UW professor and vice chair, Department of Radiology
For more information about these appointments, please contact UW Medicine Advancement at 206.543.5686.
The response to the Request for Proposals from the Foundations Phase Committee for the UW School of Medicine Curriculum Renewal has been outstanding. The Foundations Phase of the new medical student curriculum will focus on providing medical students with a scientific foundation prior to intensive clinical training. The scientific Foundations Phase is expected to begin in fall 2015 and will feature blocked courses. Proposals were requested to address the structure of the Foundations Phase.
Sixteen full proposals were submitted for structuring the entire Foundations Phase of the medical student curriculum, and an additional 12 proposals were submitted for individual courses or themes to be woven into foundational courses. Proposals came from basic science and clinical departments and from the WWAMI region. Individuals and groups of faculty, staff, medical students, and residents submitted proposals.
The Foundations Phase Committee, chaired by Tom Montine and co-chaired by Robert Steiner, is requesting community-wide participation in evaluating the proposed curricula and themes through two approaches:
1) All proposals have been posted to a Catalyst web site available to anyone with a UW NetID.
The committee asks all interested individuals and/or groups to review the proposals and complete the survey at the top of the Catalyst site. The survey asks for comments on each proposal and whether or not the proposal should be considered further. Survey entries will be tabulated and will provide input for committee members in selecting proposals for further consideration. The deadline for submitting surveys is noon on Tuesday, January 28.
2) The committee will host a session for public presentation of the proposals on Friday, January 31, from 2:00 to 5:00 p.m. in D-209 (Turner Auditorium, Health Sciences Center) and requests that all interested community members attend. The proposers each will have 10 minutes to summarize and discuss their proposal and then respond to questions.
On the following day, Saturday, February 1, the committee will hold a retreat for committee members to review and select a proposal or multiple proposals to advance as recommendations for implementation.
The Foundations Phase Committee will submit its recommendations to the Curriculum Renewal Steering Committee in mid-February. The steering committee will consider the recommendations and, if approved, submit them to Ellen Cosgrove, vice dean for academic affairs. Further discussion of the recommendations will occur with UW School of Medicine leadership over the subsequent month. In addition, public comments on the recommendations will be elicited broadly through open forums.
Once a structure is decided upon for the Foundations Phase, development of course content will begin. More information is available about curriculum renewal in the November 15 issue of Online News. Please contact Michael Ryan, associate dean for curriculum, at firstname.lastname@example.org with any questions.
The sixth largest city in Wyoming, Sheridan is located in the northeastern part of the state at the foot of the Big Horn Mountains. Sheridan has been a top destination for Wyoming WWAMI graduates returning to the state. Currently, there are eight WWAMI graduates practicing in Sheridan, a city of 17,500. In 2013, nine Wyoming WWAMI graduates returned to the state to practice — and four of them chose to practice in Sheridan.
In 2013, Hannah Hall, Jason Ackerman and Juli Ackerman joined Ian Hunter, a 2003 Wyoming WWAMI graduate, to practice internal medicine at Big Horn Mountain Medicine in Sheridan. Hannah Hall and Jason Ackerman are Wyoming WWAMI graduates, while Juli Ackerman is a Washington WWAMI graduate. In addition, Wyoming WWAMI graduates, Luke Goddard and David Nickerson joined the Sheridan Memorial Hospital Emergency Department in 2013 with Jacob Lieb, also a Wyoming WWAMI graduate. Amber Robbins, a dermatologist and Wyoming WWAMI graduate, has been practicing in Sheridan since 2008.
Mike McCafferty, CEO of Sheridan Memorial Hospital, attributes the high number of WWAMI graduates returning to Sheridan to several factors: the desire to be close to home and family, Sheridan Memorial’s very collegial environment, the hospital’s supportive medical staff, and its modern, state-of-the-art facilities.
Sheridan is just one example of the success of the WWAMI program in returning graduates to practice in Wyoming, as there are currently 49 graduates practicing throughout the state.
The following events may be of interest to the UW Medicine community:
20th Annual Helen & John Schilling Lecture, Jan. 31, 2014
Of Men and Mice: An Iterative Strategy to Dissect the Immune Response to Trauma, 4 p.m., Friday, Jan. 31, Hogness Auditorium, Health Sciences Bldg., Room A-420. Timothy R. Billiar, the George Vance Foster Professor and chair of the Department of Surgery, University of Pittsburgh, will discuss recent findings about mechanisms regulating immune dysfunction following trauma in both human and experimental models. The talk will also provide a framework around which to pursue a complex human disease through an iterative strategy between clinical data and mouse models. A reception will follow the lecture. Contact Kate Rimmer at email@example.com or 206.616.2752 for more information.
Mini-Medical School begins Feb. 4
Hypnosis and Meditation: Similarities and Differences Between Two Successful Therapeutic Approaches, 7 p.m., Tuesday, Feb. 4, Hogness Auditorium, Warren G. Magnuson Health Sciences Center. The lecture will be given by Sarah Bowen, UW acting assistant professor of psychiatry & behavioral sciences, and Shelley Ann Wiechman, UW associate professor of rehabilitation medicine. This is the first of UW Medicine’s 2014 Mini-Medical School, a series of free lectures and demonstrations designed to teach the general public about medical science, patient care and leading-edge research at the UW. All lectures take place at 7 p.m. on consecutive Tuesdays through March 11. Learn more about the 2014 Mini-Medical School online. For more information on Mini-Medical School, call 206.685.9420 or e-mail Julie Collier, UW Medicine Strategic Marketing and Communications, at firstname.lastname@example.org.
Paul Ramsey’s Annual Address, Feb. 6, 2014
Paul Ramsey, CEO, UW Medicine, executive vice president for medical affairs and dean of the School of Medicine, University of Washington, will review progress at UW Medicine over the past year and cover challenges and opportunities for the upcoming year. The address will be held from 4 to 5 p.m., Thursday, Feb. 6 in Hogness Auditorium, Health Sciences Bldg., and simulcast to Harborview Medical Center, South Lake Union, Northwest Hospital & Medical Center, and Valley Medical Center. Receptions in each setting will follow the address. The recorded talk will be available later on the UW Medicine website. For more information, contact Julie Monteith at email@example.com or 206.543.7718.
UW School of Medicine alumni awards nominations open until Feb. 21
UW School of Medicine alumni, faculty, staff and other professional colleagues are invited to nominate alumni for a series of awards, including the Distinguished Alumnus Award, to be presented at the Reunion Weekend, June 6-7. Anyone who has received an M.D. from or completed a residency program or fellowship at the UW School of Medicine is eligible. Nominations are due by Feb. 21, 2014. Nominations can be submitted online or by email at firstname.lastname@example.org. For more information, please call 206.685.1875.
Microsoft-UW Workshop on Technology Enriched Instruction offered Feb. 25
Learn to Use Technology in Teaching: A Microsoft-UW Workshop on Technology Enriched Instruction, 8 a.m. to 5 p.m., Tuesday, Feb. 25, in the Husky Union Building (HUB), Room 250, UW Seattle campus. The session incorporates participatory and inquiry-based learning, allowing faculty to actively experience a range of technology tools and resources and research-based approaches to use in teaching. This activity has been approved for AMA PRA Category 1 Credit™. Sign up for the workshop online. Contact Stephanie Habben at email@example.com for information.
Continuing Medical Education
Visit Continuing Medical Education for information on upcoming classes.
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