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March 30, 2012

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Message from Paul Ramsey

Paul G. Ramsey

UW School of Medicine and WSU to pilot second-year medical training program

Dear Colleagues:

I am very pleased to announce an agreement between the UW School of Medicine (UWSOM) and Washington State University (WSU) to initiate a pilot WWAMI second-year medical school training program at the Spokane Riverpoint campus. The agreement was announced on Friday, March 23 after two years of discussions related to curriculum renewal and workforce needs. The announcement coincided with both a celebration in Spokane of WWAMI’s 40th anniversary and the second Graduate Medical Education Summit attended by more than 100 educators, legislative representatives and administrators from the region and nation.

The proposed start date for the second-year pilot program is fall 2013. The pilot will place up to 20 second-year UWSOM medical students in Spokane for each of two consecutive years. Continuation of the program beyond the two pilot years is dependent on approval from the Liaison Committee on Medical Education (LCME) and funding from the Washington State Legislature.

As discussed in the recent press release and Q & A, the second-year pilot is made possible by strong collaboration between the UWSOM, WSU, the Spokane business community and others.

I would like to thank in particular several individuals and associations for their strong support and dedication to making the pilot a reality. Warwick Bayly, WSU provost and executive vice president; Brian Pitcher, chancellor of WSU Spokane; and Gary Pollack, vice provost for WSU health sciences, have been outstanding collaborators in developing a shared vision and approach. Rich Hadley, CEO of Greater Spokane Incorporated (GSI) and the entire GSI organization have done a superb job of making the case for a second year in Spokane and providing major fundraising for the pilot. The Empire Health Foundation and the Health Sciences and Services Authority of Spokane County (HSSA) have been important collaborators and funders of the pilot.

Key WSU faculty involved in planning the pilot include Ken Roberts, director of WWAMI Spokane, George Novan, associate director of WWAMI Spokane, and Chris Coppin, curriculum development leader. These three individuals are the primary WSU planners of the proposed curriculum and will have major roles in its implementation. At the UW School of Medicine, Suzanne Allen, vice dean for regional affairs, Ellen Cosgrove, vice dean for academic affairs, Michael Ryan, associate dean for curriculum, Mary Fran Joseph, associate dean for administration and finance, Dave Green, director of finance and operations, and others have done an outstanding job of working with individuals and curriculum committees to plan the pilot, its curriculum and funding.

There is still much to do. The WWAMI Spokane curriculum planning committee is proposing a more active, case-based approach to the second-year curriculum, with frequent one-on-one and small-group meetings of students with clinician and scientist mentors. The WWAMI Spokane second-year pilot is a wonderful opportunity to model some of the curricular changes recommended in the recent pre-curriculum renewal process. Representatives from the LCME will carefully track the proposed curriculum and visit the Spokane site in November 2012 to meet with curriculum planners and educators and evaluate our progress.

Please join me in thanking the organizations, groups and individuals who have worked to make this pilot possible—at WSU and the UWSOM, in the Spokane community and from throughout the entire WWAMI region—over the past several years. Your hard work is having an important impact that will advance our WWAMI curriculum, increase our health workforce, and further our mission of improving health.

Sincerely,

PGRamsey Signature2

 

Paul G. Ramsey, M.D.
CEO, UW Medicine
Executive Vice President for Medical Affairs and
Dean of the School of Medicine,
University of Washington

  


 

Research

Embryonic stem cells shift metabolism in a cancer-like way upon implanting in uterus 

Ruohola-BakerShortly after a mouse embryo starts to form, some of its stem cells undergo a dramatic metabolic shift to enter the next stage of development, Seattle researchers reported last week. These stem cells start using and producing energy like cancer cells.

This discovery was published March 23 in EMBO, the European Molecular Biology Organization journal.

“These findings not only have implications for stem cell research and the study of how embryos grow and take shape, but also for cancer therapy,” said the senior author of the study, Hannele Ruohola-Baker, UW professor of biochemistry. The study was collaborative among several research labs in Seattle.

The metabolic transition the researchers discovered occurs very early as the mouse embryo, barely more than a speck of dividing cells, implants in the mother’s uterus. The change is driven by low oxygen conditions, Ruohola-Baker explained.

The researchers also saw a specific type of biochemical slowdown in the stem cells’ mitochondria – the cells’ powerhouses. The phenomenon previously was associated with aging and disease. This was the first example of the same downshift controlling normal early embryonic development.

“This downshift coincides with the time when the germ line, the keeper of the genome for the next generation, is set aside,” Ruohola-Baker said. “Hence reduction of mitochondrial reactive oxygen species may be nature’s way to protect the future.”

Read more in UW Today.  

Pediatricians' pain-medication judgments affected by unconscious racial bias, says UW study

Janice SabinPediatricians who show an unconscious preference for European Americans tend to prescribe better pain-management for white patients than they do for African-American patients, new University of Washington research shows.

In the research, pediatricians responded to case scenarios involving medical treatments for white and African-American patients for four common pediatric conditions.

"We're talking about subtle, unconscious attitudes that are pervasive in society. Because these are unconscious attitudes, doctors aren't aware that their racial attitudes may affect their treatment decisions," said Janice Sabin, a UW research assistant professor of biomedical informatics and medical education.

Sabin lead author of the study, The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma, published online March 15 in the American Journal of Public Health.

Sabin's study reveals that unconscious beliefs and attitudes can influence doctors' treatment decisions.

"Coupled with known racial and ethnic disparities in healthcare, our findings suggest that well-meaning physicians may unconsciously treat people differently in some areas of care," said Sabin.

Among the 86 pediatricians who participated in the study, 65 percent were female, 82 percent were white and 59 percent were medical residents or fellows. Participants completed three Implicit Association Tests to measure unconscious attitudes and beliefs. The test was developed in 1998 by Anthony Greenwald, a co-author and a UW psychology professor.

Sabin chose four conditions commonly treated by pediatricians. Case scenarios were created for each condition for both an African-American and a white patient.

For the asthma, ADHD and urinary tract infection case scenarios, doctors did not show an association between unconscious attitudes about race and treatment decisions for the two patients. However, recommendations for optimal pain treatment decreased for the African-American patient as doctors' pro-white bias increased.

Because physicians are likely unaware of unconscious attitudes and beliefs and the unintended disparities that may result, Sabin suggested incorporating awareness of personal bias and methods to avoid the influence of bias on decision-making into medical education, continuing medical education and training of health professionals is necessary for health sciences education.

Read more in UW Today

UW anesthesiology professor calls for more international collaboration in traumatic brain injury research

Monica VavilalaGlobally, traumatic brain injury is a major public health problem and the numbers of patients with traumatic brain injury are rising in the developing world.

Monica S. Vavilala, UW professor of anesthesiology, has called for a new translational model to bridge the gap between discovery and public health, especially in the area of traumatic brain injury in developing countries.

Vavilala gave the keynote address, Translational Research in Pediatric Traumatic Brain Injury, at the Indian Society of Neuroanesthesia and Critical Care Conference in Bhopal, India, in February. She stressed the importance of injury prevention efforts and injury research to patient outcomes.

“We need interdisciplinary teams to work together to solve problems of common interest and for resource-limited nations to collaborate in research,” she said.

In media interviews with local Hindi newspapers and television, Vavilala gave suggestions to parents on symptom recognition and also cited the need for rehabilitation services after discharge from the hospital.

Vavilala noted that “head injuries that occur in children while playing at home should not be neglected, as these injuries can cause long-term disability as they get older.”

Vavilala is the lead principal investigator for the CHIRAG (Improving Indo-U.S. Traumatic Brain Injury Outcomes – Collaborative Head Injury and Adherence to Guidelines) Study, funded by the U.S. State Department, the Department of Biotechnology in India and the National Institutes of Health. ). CHIRAG is a collaboration between UW Medicine’s Harborview Injury Prevention and Research Center and the All India Institute of Medical Sciences’ Jay Prakash Narayan Apex Trauma Center in New Delhi, India.

Other UW investigators on the project are Charles Mock (Surgery), Frederick Rivara (Pediatrics), Deepak Sharma (Anesthesiology), Jay Hecker (Anesthesiology) and Kalpana Kanal (Radiology).

 


 

Clinical Care

UW Medical Center is first in Pacific Northwest to discharge a Total Artificial Heart patient

Artifical Heart PatientUW Medical Center has become the first hospital in the Pacific Northwest to discharge a patient implanted with the world’s only approved Total Artificial Heart. The device, manufactured by SynCardia Systems, is approved for use as a bridge to heart transplant in the United States, Canada and Europe. The UW Medicine Regional Heart Center is the first Western Washington heart-care service to offer this technology.

The patient, Christopher Marshall, of Wasilla, Alaska, was discharged from the hospital March 21. He was implanted with the Total Artificial Heart during a six-hour procedure on Feb. 6. The surgeon was Nahush A. Mokadam, the hospital’s co-director of heart transplantation and director of mechanical circulatory support. He was assisted by Dr. Awori J. Hayanga, chief resident in cardiothoracic surgery. Mokadam is the LeRoss Endowed Professor in Cardiovascular Surgery, UW Department of Surgery.

“Mr. Marshall has done remarkably well on the device. I’m very pleased with its performance and his recovery. We continue to support him as we await his heart transplant,” Mokadam said. Marshall, 51, was admitted to UW Medical Center in January with a heart performing barely well enough to keep him alive, Mokadam said. Marshall had been diagnosed in 1999 with idiopathic cardiomyopathy, a deterioration of heart function with an unknown cause, and ventricular tachycardia, an irregular, fast heartbeat. The conditions progressively reduced his heart muscle’s pumping capacity.

Originally designed as a permanent replacement heart, the SynCardia device is approved by the Food and Drug Administration (FDA) as a temporary solution until a donor heart becomes available. The device is available to patients at risk of imminent death from biventricular failure. This is an irreversible state affecting both chambers that pump blood away from the heart.

Currently, the only FDA-approved driver for powering the Total Artificial Heart weighs 418 pounds and confines patients to the hospital while they wait for a matching donor heart. SynCardia’s portable driver, which weighs only 13.5 pounds, is undergoing an FDA-sanctioned clinical study to determine whether it can safely be used at home. This driver is battery-powered, rechargeable, and can be carried in a backpack, shoulder bag or rolling caddy.

The manufacturer has certified UW Medical Center to implant the device, and the hospital is a study site for the portable driver. Marshall met study criteria to be switched to the portable driver and was discharged—although to Bothell, Wash., instead of Wasilla so that he is close by when a donor heart becomes available.

Read more in UW Today.  

Alex Cahana testifies before Senate panel on prescription-painkiller abuse epidemic

(The following is an adaptation of the article 'Senate panel struggles to get pain treatment right' by John Reichard, CQ HealthBeat editor, that appeared in CQ.com, March 23, 2012.)

Alex CahanaAlex Cahana, UW professor of anesthesiology and pain medicine, was among the witnesses who testified at a Senate hearing Thursday addressing the national epidemic of prescription-painkiller abuse.

Lawmakers said the testimony would help guide Medicare and Medicaid officials in developing new measures to help curb the abuse of pain treatments, such as hydrocodone and oxycodone, as well as anti-psychotic medications.

Sens. John D. Rockefeller IV, D-W.Va., and Charles E. Grassley, R-Iowa, said that abuse of the drugs harms patients and their families and drains Medicare and Medicaid financially by making the programs the target of fraud. Rockefeller has introduced legislation (S 507) to better educate patients about prescription drug abuse and better train doctors about prescribing controlled substances.

Cahana, chief of the Division of Pain Medicine, said doctors need to move away from simply prescribing painkillers.

“Take care of the disease, and the pain goes away,” he said. “However, when pain becomes the disease, when there is nothing broken to fix, [no] infection to cure or tumor to operate upon, treating pain as a symptom doesn’t work. It actually makes things worse,” he said. “This is why we are seeing so much harm with prescription pain drugs.”

“There is virtually no evidence,” Cahana said, “that high-dose opioids relieve pain or improve function in chronic noncancer pain,” and “there is growing evidence that shows that opioid treatment over 90 days is usually a commitment for life.”

Since November 2008 the UW Medicine Pain Center has used a patient assessment and screening tool during every clinical encounter, he said. The tool allows patients to describe how pain affects key aspects of their lives, including the way it interferes with essential activities. It also assesses the status of the patient’s physical functioning and his sense of emotional well-being.

Read the entire article at CQ.com (subscription required) or watch the hearing.

 


  

Education and Training

GME Summit explores funding challenges of graduate medical education 

The UW School of Medicine convened medical and community leaders from throughout the WWAMI region to explore key issues and best practices of financing graduate medical education (GME) in an era of increased need for physicians and reductions in federal and state funding for medical training.

The Second GME Summit was held Friday, March 23, at the Spokane Riverpoint campus. The event was hosted by Paul Ramsey, CEO of UW Medicine and dean of the School of Medicine.

Summit participants discussed ways to cost-effectively extend the School of Medicine’s WWAMI model to more residencies in communities throughout the region. WWAMI, one of the most cost-effective and highest quality medical education programs in the country, trains medical students from and for the five-state region of Washington, Wyoming, Alaska, Montana and Idaho. The program works to ensure adequate numbers and distribution of physicians, provide trainees with needed skills sets, and provide a workforce of sufficient size and specialty mix in areas that are underserved in those states.

Topics discussed included accreditation requirements, graduate medical education expansion and various funding methods, such as all-payer systems, consortium models and public/private partnerships.

On the evening prior to the summit, participants celebrated WWAMI’s 40th anniversary at a reception at the Davenport Hotel in Spokane.

Medical school celebrates students' residency placements at Match Day 2012

Match Day 2012Take-out boxes lined the tables of the Hogness Auditorium lobby outside the UW medical school main offices the morning of March 16. Each box was decoratively labeled with the name of a graduating medical student. Inside each box were festive crinkled paper, a fortune cookie, a gift from the alumni office, and a letter announcing where the medical student was accepted for residency training.

Soon-to-be UW M.D. graduates began gathering early in the lobby, along with their families, friends and faculty mentors. Many glanced hopefully at the boxes, which stood in alphabetical groupings.

Every year in March, on Residency Program Matching Day, graduating students at medical schools across the country learn their residency placements at the same time, noon Eastern Daylight Savings Time. After medical school, newly minted M.D.s go on to complete three to seven years or more of graduate medical education, the formal term for residency training, in a selected primary care or specialty field. They will be intensely involved in caring for patients and in learning and honing clinical skills, under the supervision of attending physicians.

This year, 211 UW School of Medicine graduates participated in the National Residency Matching Program. The program takes students choices of residency programs, and residency programs choices of students, and compares the lists to try to make a match.

UW 2012 seniors matched to residencies in 35 states. Forty-three percent of the UW seniors matched into residency programs in a WWAMI state, up from 36 percent in 2011. Fifty-four percent of seniors matched into a primary care specialty of family medicine, pediatrics, internal medicine, or internal medicine/pediatrics. This percentage has increased steadily each year.

Read more in UW Today

(Photo: UW graduating medical students Tiffany Irwin (left) and Madeline Turner show their official residency match letters and give "thumbs up" to their placements. Photo by Clare McLean)

Students unlock 'hidden topics' for April 27-29 global health conference

UW students from across disciplines have come together to create a conference about issues they feel are critical but largely ignored in global health. The organizers hope to bring a new direction to the global health agenda.

The 9th Annual Western Regional International Health Conference, At a Crossroads: Choosing Hidden Paths in Global Health, will take place at the UW April 27-29.

Mental health needs in developing nations is one of the little-explored topics the conference will cover.

“We are trying to identify topics in global health that get marginalized and elevate them at our event,” said Colleen Fulp, the graduate student lead organizer of the event.

The keynote speaker is acclaimed human rights advocate and thought leader Kavita Ramdas, the executive director of a newly launched program on social entrepreneurship at Stanford University. Her talk is titled, Nothing Less than a Revolution: Why I'm Preoccupied with Inequality, Social Justice and Health.

Ramdas is widely recognized as a pioneer in the field of global development, gender justice, and philanthropy. She is working to advance the rights of marginalized and excluded communities worldwide. As president and CEO of the Global Fund for Women from 1996 to 2010, Ramdas led the world's largest public grant-making organization supporting women's human rights in more than 170countries.

The conference, co-sponsored by more than two dozen universities and colleges along the West Coast and Canada, is organized around six tracks—global mental health, marginalized populations, organizing and funding of global health, clinical issues in global health, communications and technology in global health, and the environment and global health. Within these tracks are 18 breakout sessions with some of the top leaders in global health in this region.

Register for the conference online. For more details about the conference, visit the conference website or contact Colleen Fulp, graduate student WRIHC coordinator at cfulp@uw.edu.

Read more in UW Today.

 


 

WWAMI Regional News

Francis Spain receives Idaho WWAMI Alumni Award

Dr. Francis SpainFrancis Spain is the 2012 recipient of the Idaho WWAMI Alumni Award for Excellence in Mentoring, Teaching, Leadership and Patient Care. Spain received the award at the WWAMI 40th celebration in Boise on February 27, 2012.

Spain is a member of the first Idaho WWAMI entering class of 1972 and has been involved in teaching and mentoring WWAMI students in the first year program since his return to Moscow as a family physician. Spain is a fifth generation Idahoan, with strong roots in north-central Idaho. He is a long-time advocate for WWAMI medical education in Idaho. At the 40th WWAMI celebration, Spain was presented with a framed award with a picture of his 1972 Idaho medical class and a more recent photo of his work with a current WWAMI student.

Other 40th anniversary events scheduled for the WWAMI regional medical education program include: Moscow/Pullman, April 20; Billings, May 10; Missoula, May 18; and Seattle, June 3. The Alaska program marked its 40th year in September; Boise and Cheyenne held celebrations in February; and Spokane held a celebration on March 22. For more information, please contact Kellie Engle at 543-2249 or kaengle@uw.edu.

Idaho WWAMI works on 2012 legislation to ban teen use of tanning devices

Melanoma is the leading cause of cancer in young adults ages 25-29 and the second leading cause in ages 15-29. The incidence has tripled over the past 30 years. Yet many people remain poorly informed. Idaho consistently ranks at the top in melanoma death rates and incidence. Additionally, teen girls in Idaho tan at rates up to 2.6 times the national average. Since the World Health Organization placed UV radiation and UV tanning devices into the same cancer-causing category as cigarettes, countless organizations are advising that children under age 18 should not use tanning devices.

Blake Sampson, a fourth-year Idaho WWAMI medical student, partnered with Rep. John Rusche and local dermatologist Steve Mings to bring forth legislation that would ban tanning in kids under the age of 18. The bill was drafted and proposed to the House Health and Welfare Committee, where it was officially printed as House Bill 486. The first committee hearing was a powerful testament to the impact of melanoma. Many people, including melanoma survivors and dermatologists from across the state testified on behalf of the bill, all contributing to its initial success. Since then the bill has had a circuitous route through the House of Representatives, being amended, sent back to committee, and re-amended.

“Cancer is a word no young person deserves to hear, but that’s exactly what happened five years ago to my then 22-year-old wife,” says Sampson. “Thankfully, the doctor caught the premalignant moles early, but what should have been a standard visit to the dermatologist ended up as a serious discussion of her need for a lifetime of cancer surveillance. My wife’s story is one that is all too common in our state and unfortunately is a problem that continues to grow rapidly.”

Sampson gained experience in health policy advocacy, preventive medicine and politics by authoring this bill. “It has added a unique aspect to my WWAMI education. It provides the opportunity to have a broad-reaching impact even before becoming a physician and to make a difference in the lives of people I will never even meet.”

For more information, contact Blake Sampson at blakektl@uw.edu or 208.705.5557.

 


 

Upcoming Events

The following events may be of interest to the UW Medicine community:  

Bioethics Grand Rounds, April 3

People Matter: Innovative Approaches to Engage Participants in Research by Kelly Edwards, 4 p.m., Health Sciences Building, T-625. Reception to follow. Edwards is UW associate professor of bioethics and humanities and a core faculty of the Institute for Public Health Genetics. She will discuss biobanks and other clinical data repositories, patient consent, and strategies for keeping research participants engaged. She will also consider common challenges and new media solutions to advance biobanking research. This presentation is co-sponsored by the Department of Bioethics & Humanities and the Ethics Advisory Committee at UW Medical Center. Contact bhinfo@u.washington.edu or 206.543.5145 for more information.

Rodger C. Haggitt Lecture, April 4

New Roles for Pathologists in the Era of Personalized Cancer Care by Stanley Hamilton, 4:30 p.m., Wednesday, April 4, Health Sciences Center, Room K-069. Hamilton is professor and head of the Division of Pathology & Laboratory Medicine at University of Texas MD Anderson Cancer Center. The lecture is in memory of Rodger C. Haggitt, UW professor and chief of the Division of Anatomic Pathology from 1984 to 2000. For more information, visit the UW Medicine Pathology website or contact Steve Berard at 206.685.0564 or sberard@uw.edu.

Pediatric Urology Lecture, April 14

Pediatric Neurogenic Bladder: The Challenge of Transitioning Care from Childhood to Adulthood by Andrew E. MacNeily, 8 a.m., Saturday, April 14, Wright Auditorium, Seattle Children’s, 4800 Sand Point Way N.E. MacNeily is professor and head of the Division of Pediatric Urology at the University of British Columbia. This lecture is presented by Seattle Children’s Division of Pediatric Urology and UW Medicine Department of Urology. Please RSVP to doram@uw.edu.

Faculty Development Workshop, April 24

Audience Response Systems, 8:30 a.m. to 10:15 a.m., will demonstrate basic audience response functions, with an emphasis on determining appropriate use of basic and advanced ARS tools to poll audiences on content questions or controversial topics. Digital Professionalism, 10:15 a.m. to noon, will explore how social media is used in the classroom, clinic and beyond and will illustrate cases where social media led to unprofessional behavior.  Presenters include Michael Campion, UW School of Medicine director of academic and learning technologies; Margaret Isaac, UW assistant professor of medicine; and medical students Michael Duyzend, Jay Conahim, Gabriel Wallace, and Alex Farnand. All workshops are free to all UW School of Medicine faculty and health sciences faculty. Registration is required. For more information, contact Rachael Hogan at rhogan@u.washington.edu  or 206.616.9875.

9th Western Regional International Health Conference, April 27-29

At A Crossroads: Choosing Hidden Paths in Global Health, April 27-29, UW Seattle campus. This student-led conference seeks to engage the global health community in prioritizing global health programs based on need and to challenge existing paradigms in global health. The conference will explore the politics of the global health agenda, training for healthcare professionals, and realities in the field. Kavita Ramdas, executive director of Ripples to Waves: Program on Social Entrepreneurship and Development at Stanford University’s Center on Democracy, Development, and the Rule of Law will be the keynote speaker. Students, faculty, and professionals from all disciplines are invited to attend. Early bird registration until March 15. Register online. For more details about the conference, visit conference website or contact Colleen Fulp, graduate student WRIHC coordinator at cfulp@uw.edu.

Genome Sciences Department to celebrate 10th anniversary May 7

The Future of Genome Sciences, a panel discussion, 7 p.m., Monday, May 7, Kane Hall, Room 210. Speakers are Bruce Alberts, editor of Science magazine, author of The Cell, and former President of the National Academy of Sciences; Natalie Angier, a Pulitzer Prize-winning science writer for The New York Times and the Andrew D. White Professor-at-Large at Cornell University; James Evans, the Bryson Distinguished Professor of Genetics and Medicine at University of North Carolina and director of the Clinical Cancer Genetics Services at UNC; and Keith Yamamoto, University of California, San Francisco vice chancellor for research, executive vice dean of the School of Medicine, and professor of cellular and molecular pharmacology. The public panel discussion will be moderated by Maynard Olson, UW professor of genome sciences and medicine, and one of the founders of the Human Genome Project. A reception will follow. Contact Carlene Cross at 206.221.5374 or crossc2@uw.edu  for more information.

Continuing Medical Education

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