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May 16, 2014

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Message from Paul Ramsey

UW School of Medicine recognized for training family physicians

Dear Colleagues:

I am very pleased to announce that the American Academy of Family Physicians (AAFP) has named the UW School of Medicine to its annual Top 10 list among the nation’s 126 allopathic medical schools for contributing to the pipeline of family physicians. The 10 named were those medical schools that, during a consecutive three-year period, graduated the greatest percentage of students who chose first-year family medicine residency positions.

This is the fourth year in a row that the UW School of Medicine has been awarded this honor.

The UW School of Medicine has for many years taken very seriously the need to develop a primary care workforce to meet health shortages, and has acted on that need, targeting rural and underserved areas in particular. The WWAMI program, established 42 years ago, is a direct reflection of that commitment.

map of the state of Washington from our WWAMI Center for Health Workforce Studies indicates both our success and the work ahead. Many counties in the state of Washington are above the national average for per capita family physicians—the specialty that provides the bulk of medical care for rural and underserved communities. Without the WWAMI program, there would be far fewer counties with these vital health professionals to serve them.

We can and must, however, do more. With the increased number of insured patients through the Affordable Care Act, the need for family physicians and other physicians is increasing rapidly; rural and other underserved communities will have the greatest need. The UW School of Medicine is addressing that need with a combined approach of training more medical students in eastern Washington through our WWAMI program, providing programs that encourage students and residents to practice in rural and underserved locations, and working to expand graduate medical education (GME).

These strategies must go hand in hand. Without additional GME slots, even our students who are most motivated to serve in rural and underserved communities will receive their advanced training elsewhere. Where one completes residency training is the best predictor of practice location—expanding the entire training pipeline is essential.

Therefore, we have been working for more than one year on a proposal for a demonstration project to expand GME throughout the region. Earlier this week, I was in Washington, D.C. to talk with our senators and representatives about this proposal. We also intend to approach the State of Washington legislature to increase the number of medical students training at the Spokane WWAMI Medical Campus—our goal is to be teaching an additional 40 students in the Spokane WWAMI classrooms by 2017.

There is much work to do. Indications of progress, however, like the AAFP Top Ten Award, demonstrate good progress, and the programs, commitment and established capacity to do more. Thank you to the Department of Family Medicine and the many individuals throughout the WWAMI region involved in building an outstanding program to train the next generation of family physicians to serve the region.

Read more at the AAFP site.

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

Advances in stem cell therapy for damaged hearts

Chuck Murry
Charles Murry

In a major development, UW researchers have successfully restored damaged heart muscle of monkeys using heart cells created from human embryonic stem cells. The results of the experiment appear in the April 30 advance online edition of the journal Nature in a paper titled, “Human Embryonic-stem Cell Derived Cardiomyocytes Regenerate Non-human Primate Hearts.”

“Before this study, it was not known if it is possible to produce sufficient numbers of these cells and successfully use them to remuscularize damaged hearts in a large animal whose heart size and physiology is similar to that of the human heart,” said Charles (Chuck) Murry, UW professor of pathology, bioengineering and medicine (Division of Cardiology), who led the research team that conducted the experiment.

Murry said he expects the approach will be ready for clinical trials in humans within four years.

Read more and watch a video describing the research in UW Medicine/Health Sciences NewsBeat.

UW researchers awarded grant for work on cell lineage

Jay Shendure
Shendure

Two UW researchers have been recognized by the Paul G. Allen Family Foundation for their work on cell lineage. Jay Shendure, UW assistant professor of genome sciences, and Marshall Horwitz, UW professor of pathology and adjunct professor of genome sciences, have been awarded an Allen Distinguished Investigators (ADI) grant with funding of $1.2 million over three years.

Marshall Horwitz
Marshall Horwitz

Cell lineage traces the story of how humans grow from a single cell to 100 trillion cells as cells divide, die and renew to work together in the complex system that is the human body. This field of study looks to understand the process of cell division, renewal and death, as well as how cells in a developing embryo diversify into many distinct cell types.

Shendure, Horwitz and colleagues are pursing a new approach for mapping cell fate — how a cell becomes one type or another. Rather than trying to decode the history of each cell among the trillions in the human body, they are relying on mutations in the genome that occur during cell division and using this inverse information to enable a 4D visualization of the entire cell map of an individual human being.

Read more at the Paul G. Allen Family Foundation site.

Maternal deaths on the rise in the United States

The Institute for Health Metrics and Evaluation (IHME) published two studies in The Lancet on May 2, “Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013” and “Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.”

This first installment in IHME’s new updates to the Global Burden of Disease (GBD) study showed that the United States is among just eight countries in the world to experience an increase in maternal mortality since 2003 — joining Afghanistan and countries in Africa and Central America, and falling to number 60 in the list of 180 countries on maternal deaths.

Read more on the IHME site.

 


 

Clinical Care

Airlift Northwest transports five patients from the Oso mudslide

Airlift Northwest
Airlift NW

Michael Durkin, a flight nurse and safety coordinator for Airlift Northwest, didn’t know what to expect when his flight crew received the call to respond to the Oso mudslide, but he quickly realized the scale of the disaster when the crew made visual contact with the ground. His team transported five patients from the disaster site to Harborview Medical Center.

With its highly trained medical staff and well-stocked aircraft, Airlift Northwest makes about 3,200 transports per year in its territory, which includes Washington, Alaska, Idaho and Montana. The teams are ready for almost any type of triage care.

“We’re really a flying intensive care unit,” said Chris Martin, executive director of Airlift Northwest.

Read more and see a slideshow of Airlift Northwest photos in the Puget Sound Business Journal.

Nurse’s art conveys the humanity of homeless patients

For more than a decade, Mary Larson has immortalized the faces of patients of UW Medicine's Pioneer Square Clinic. The nurse paints portraits of people who are often overlooked by others because they live on the street.

"I feel like it is such a privilege to come be a part of their lives," Larson said.

Read more at UW Medicine/Health Sciences NewsBeat.

What price for a cure? The economics of drug pricing.

Sean Sullivan
Sean Sullivan

The decision by the drugmaker Gilead Science, Inc. to charge $84,000 for a 12-week course of its new hepatitis C drug Sovaldi (sofosbuvir) has churned up protest.

In an interview in UW Medicine/Health Sciences NewsBeat, Sean Sullivan from the UW School of Pharmacy talked about why he thinks the uproar surrounding Gilead’s decision may mark a turning point in the economics of drug pricing in the United States.

Read more in NewsBeat.

 

Harborview Injury Prevention and Research Center names new director

Monica Vavilala
Vavilala

Monica Vavilala, UW professor of anesthesiology and pediatrics, and an adjunct professor in neurological surgery and radiology, has been named director of the Harborview Injury Prevention and Research Center (HIPRC), a worldwide leader in injury research, education, outreach, and training. Vavilala succeeds Beth Ebel — UW associate professor of pediatrics and adjunct associate professor of epidemiology and health services — who served as director of the HIPRC from 2008 through 2013.

Vavilala is an expert in the care of injured patients, has authored over 150 peer-reviewed publications related to injury, and is internationally known for her work in traumatic brain injury. As a 20-year faculty member in the UW School of Medicine, she has mentored over 27 fellows across UW, has current research support from the National Institute of Neurological Disease and Stroke, and is co-director of the National Institute of Child Health and Human Developmentsponsored UW Pediatric Injury Training Program. Vavilala is also the first anesthesiologist in the nation to lead an injury research center — and the only anesthesiologist on the Brain Trauma Foundation Guidelines working group pertaining to the acute care management of patients with severe traumatic brain injury.

“Dr. Vavilala brings to the Center the energy and commitment to move it ahead and keep it at the forefront of injury research and prevention,” said Frederick P. Rivara, UW professor of Pediatrics and founder of the HIPRC.

Read more about the Center and its groundbreaking work at the HIPRC site.

 

 


Education and Training

Spokane and UW faculty work together to change the way teaching happens

Marcella Pasqualy
Pascualy

University of Washington WWAMI medical students in Spokane are accustomed by now to being the “first” at many things. During this first year of a pilot that placed 19 second-year students at WWAMI Spokane, each course has been taught in a small-group setting, with anywhere from 2 to 19 students. The emphasis has been on using “flipped classroom” techniques and small-group dynamics with peer teaching to facilitate rapid and effective learning.

To make existing materials work in this new setting, many of the courses required significant adaptation by the four faculty “Guides,” four generalist physicians from Spokane hired to work with WSU and UW faculty in guiding the Spokane-based students through their second-year education. The four Guides are Bruce Abbott, Alisa Hideg, Bill Sayres and Cicily White. The use of generalist Guides during the pre-clerkship phase is a significant innovation in the UWSOM curriculum.

Students watched prerecorded lectures from Seattle — some shorter and prepared just for them and others longer and recorded during the regular lecture at UW. Students read and prepared for class with many resources — some assigned and others they chose for the purpose of preparing for the USMLE Board examinations completed by all UW medical students at the end of their second year.

Alisa Hideg
Hideg

One course, Mind, Brain & Behavior, took an even greater leap. This course was completely redeveloped for both Seattle and Spokane at the same time under the guidance of Marcella Pascualy, UW associate professor of psychiatry and behavioral sciences, and Alisa Hideg, a family physician and faculty Guide for the second-year UW program in Spokane on the WSU Health Sciences Campus. Neurology and psychiatry topics were chosen based on what is expected knowledge for Board exams and for students’ third-year clinical rotations.

Essentials of each topic and applicable pharmacology were distilled into handouts and tables that the students supplemented with assigned readings from texts and the “First-Aid” book for Psychiatry Boards. Jeannie Padowski, pharmacology faculty member and WSU clinical assistant professor, developed tables and reviewed handouts for the students to use. A few lectures were prerecorded and available as well.

Student preparation for each day’s topic in the “flipped classroom” format was done prior to the day of class. In all the Spokane courses, cases have helped students learn to think creatively and more intuitively along with the facts they actively digest. Daily quizzes on each day’s topic helped reinforce the material and encouraged the students to come prepared. Seattle is working toward this small-group, active-learning format with its curriculum renewal and in some existing classes. The active-learning approach in the Spokane pilot provides an excellent foundation and prototype, with much to be learned and adopted from the pilot experience.

As we move forward into the future of medical education, there will be many more “firsts.” Through Spokane WWAMI, UW and WSU faculty have been able to work together in moving toward active learning, small groups and addressing new challenges.

Drs. Hideg and Pascualy are already making plans to revise the Mind, Brain and Behavior course further. Mara Rendi, UW assistant professor of pathology, plans to incorporate applicable pathology material into the course for next year. Quiz questions and cases will be revised and handouts with other assignments improved. Students in Spokane and Seattle made suggestions during the course.

This school year will always be remembered as a year of firsts in Spokane: first group of second-year WWAMI medical students, first course to be completely revised in preparation for 2015 curriculum renewal, first time that Mind, Brain & Behavior was graded entirely by quizzes, and first course to be redeveloped across multiple departments and multiple WWAMI locations (Spokane and Seattle) in a cooperative and creative way.

New medical school curriculum moving forward to content development

Curriculum Graphic

In April, the UW School of Medicine Curriculum Renewal Steering Committee presented the proposed new medical school curriculum structure for a second time to UW Medicine leaders at the annual UW Medicine Senior Leadership Retreat. The proposal for the newly incorporated changes resulted from feedback from hundreds of faculty, staff and students WWAMI-wide over recent months. The revised plan was received with enthusiasm and, following the retreat, the UWSOM is moving forward with the new curriculum, which will start in August 2015.

The curriculum will be an innovative, competency-based model with three integrated phases: Scientific Foundations, Patient Care, and Explore and Focus. A special feature of the new curriculum will be intersessions structured using a lifelong learning model where students can pursue opportunities in remediation, enrichment, or wellness. The curriculum will also include a new governance structure, with an overarching curriculum committee and four additional committees representing the curriculum’s three phases and key cross-cutting themes. Completion of a scholarship project will be incorporated into the curriculum.

In the new curriculum, the current basic sciences instruction will become the Foundations Phase, an 18-month program consisting of interdisciplinary block courses that incorporate the basic sciences, clinical medicine, and social sciences. This new phase will have fewer classroom contact hours than students now have and will emphasize active learning and a “flipped” classroom approach. Students will complete this phase of the curriculum in December, and will then have a block with time for study for and completion of Step 1 of the National Board of Medical Examiners (NBME) exam, and consolidation of scholarship work. Students will enter their core Patient Care Phase in late March, several months earlier than in the current curriculum.

In the Patient Care Phase, students will be expected to achieve specific competencies in core clinical disciplines. They will continue to have the opportunity to complete clinical rotations in a variety of locations — urban and rural, in Seattle, and throughout the WWAMI region.

Students will complete core clinical rotations several months earlier than in the past and will then have an extended Explore and Focus Phase that provides greater flexibility in pursuing students’ goals, including opportunities for in-depth scholarship. This phase will also include a “transition to residency” experience in line with students’ residency plans.

Now that the structure of the curriculum has been established, the next phase of the curriculum renewal process will consist of the creation of governance committees and development of course content, as well as content development of additional new components like an initial clinical immersion for each new medical student. The curriculum renewal team is moving forward to identify leaders for the curriculum committees, as well as leaders for the components of the Foundations Phase.

For the Foundations Phase, faculty with relevant interest and expertise will be selected to lead the various blocks, as well as the content threads (e.g., anatomy and pharmacology), and the course themes (e.g., diversity, lifelong learning, etc.). Once formed, the block, thread, and themes committees will develop course objectives and create content, as well as develop core competencies across the curriculum.

Please contact Sarah Shirley, curriculum renewal project manager, at sarahs23@uw.edu with questions or comments about curriculum renewal or if you would like to become involved.

Office of Graduate Medical Education hosts research day

The Office of Graduate Medical Education (UW GME) hosted the 2nd Annual UW Medicine GME Research Day, on Saturday, May 3, 2014. The half-day session, hosted by Samuel Browd, MD, PhD, associate professor of neurological surgery, was designed to provide residents and fellows an opportunity and venue to showcase their research, receive expert feedback from faculty judges, network with colleagues from other specialties, and learn more about the path to a successful research career while practicing medicine.

The keynote speaker,Thomas Gallagher, UW professor in the Department of Medicine and the Department of Bioethics and Humanities, presented “Confessions of a Reluctant Researcher,” sharing his journey to a successful research career. It was perfectly suited for the audience of residents and fellows interested in pursuing their own journeys as clinician-researchers.

Trainees from multiple clinical departments submitted over 60 outstanding abstracts. The UW GME Research Review Committee identified the top 10 abstracts for oral presentations. The remaining abstracts were identified for poster presentations. Judges for both the oral presentations and the poster presentations were faculty, representing multiple clinical specialties across the UW School of Medicine.

Awards were presented to the following individuals:

Oral Presentations

  • First Place: Jonathan Sham, MD, Surgery. Novel Antibody-Targeted Zirconium-89 Pet Imaging of Hepatocellular Carcinoma.
  • Second Place: Fred Baik, MD, Otolaryngology. Fluorescence Detection of Oral Squamous Cell Carcinoma with Indocyanine Green-labeled Chlorotoxin in an Orthotopic Xenograft Model.
  • Third Place: Franklin Lee, MD, Urology. Novel Automated Stone Detection System to Measure Renal Calculi with Ultrasound.

Poster Presentations:

  • Judges’ Choice: Erik Carlson, MD. Psychiatry, Genetic Dissection of Cerebellar Circuitry in Cognitive, Social, and Affective Behavior.
  • People’s Choice: Meera Kotagal, MD and Morgan Richards, MD, Surgery. CT or Ultrasound? Diagnostic Imaging in Pediatric Appendicitis.

Honorable Mention:

  • Wendy Gao, MD, Radiation Oncology. Do Emergent Treatments Result in More Severe Errors? Analysis of a Large Institutional Near-Miss Incident Reporting Database.
  • Mark Kilgore, MD, Breast & Gynecologic Pathology. Using Immunohistochemical Proliferative Markers to Predict Local Recurrence/Progression of Ductal Carcinoma In-Situ: A Search for a More Cost-Effective Solution.

The Office of GME salutes all of the day’s participants and their mentors whose dedication to research will contribute to the field of medicine and, ultimately, to the health and well-being of patients.

 


 

WWAMI Regional News

Alaska WWAMI holds 9th Premed Summit

190 attend the Alaska Premed Summit
Premed Summit

The Alaska WWAMI program is increasingly focusing on building and improving pipeline programs to medical school. One of the more visible pipeline events is the Alaska Premed Summit, which this year was held on Saturday, March 22, 2014 to provide information for potential students on the process of applying successfully to medical school. More than 190 participants traveled to University of Alaska, Anchorage (UAA) from Chevak, Fairbanks, Galena, Healy, and Juneau. An equal number of high school and undergraduate students attended, in addition to graduate and non-traditional students, parents, teachers, school counselors, and others.

The summit provided information on the WWAMI Alaska medical school program, the UW School of Medicine admissions process, best practices for medical school interviews, job shadowing and volunteering, and required preparation at different educational levels to successfully be admitted to medical school.

The keynote speakers, Alaska WWAMI Native physicians, Melissa Shein and Nora Nagaruk, spoke about their personal journeys into medicine and what their career choice has meant to them.

Attendees were able to obtain experience suturing a banana, practice on the WWAMI's virtual anatomy table, view simulations at UAA, and participate in a mock admissions interview.

Thomas Steck receives Jon B. Syren Award

ICM director Tanya Leinicke and Thomas Steck
Steck

This year’s recipient of the Jon B. Syren Award is Thomas Steck. The Jon B. Syren Award recognizes a first-year medical student in the University of Alaska, Anchorage WWAMI Program who has demonstrated personal qualities of character, integrity, and compassion, combined with a commitment to and promise of community service in medicine.

It is named for Jon Syren, an Alaska WWAMI medical student who expected to graduate from the University of Washington School of Medicine in the Class of 1993. During his third year of clinical rotations in Seattle, he developed cancer and died in August 1992. He left behind a wife and two children.

The family established this award in his honor. First-year Alaska WWAMI students nominate potential candidates who demonstrate the same ideals as Syren. The honoree is selected by the ICM faculty and WWAMI Director.

 


Awards

  • Harborview Medical Center has been awarded a 2014 Qualis Award of Excellence in Healthcare Quality for its Fast Track on Burn Care program, and University of Washington Medical Center has garnered a 2014 Qualis Award of Excellence for its Advanced Heart Failure Care Service. Since 2002, Qualis Health has presented the Award of Excellence in Healthcare Quality to outstanding organizations in Idaho and Washington that have “demonstrated leadership innovation in improving healthcare practices, reflecting the very best in healthcare quality improvement.” The awards will be presented at the 2014 Northwest Patient Safety Conference on May 28, 2014, at the Lynnwood Convention Center.

  • UW medical student Siobhan Thomas-Smith has been awarded a 2014 Carolyn L. Kuckein Student Research Fellowship for her study of electronic health assessments for adolescents. Thomas-Smith will receive a $5,000 award, with $1,000 available for travel to a national meeting to present the results of her research. Read more.

  • George Kraft has been named the recipient of the Kessler Foundation DeLisa Award for Excellence in Research and Education in the Field of Physical Medicine & Rehabilitation. Kraft, UW Alvord Professor of MS Research and emeritus professor of rehabilitation medicine and neurology, was honored at Kessler Foundation’s Board of Trustees dinner on May 8th. Read more on the Kessler Foundation site.


Upcoming Events

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

Annual Science in Medicine Lecture, May 28

Mitchell Lazar, Sylvan H. Eisman professor of medicine and genetics, the chief of the division of endocrinology, diabetes, and metabolism, and the director of the Institute for Diabetes, Obesity, and Metabolism at the University of Pennsylvania, will present the annual Science in Medicine Lecture on Wednesday, May 28 from 12­-1 p.m. at Turner Auditorium in the Magnuson Health Sciences Center. The lecture is open to all faculty, staff and students. No registration is required. Visit the Science in Medicine site for further information. For questions, please e-mail School of Medicine events at somevent@uw.edu.

Summer Institute in Global Health, June 23

The Global Health Summer Institute will be offering condensed courses that are open to both students and the public via either UW tuition (for credit) or a fee-per-course (non-credit) basis. Classes start June 23. For a list of courses.

Summer Institute in Statistics for Clinical Research, June 23-27 and July 7-23

The UW Department of Biostatistics will host the Summer Institute in Statistics for Clinical Research (SISCR 2014), June 23 - 27. The Institute consists of a series of half-day, one-day and one-and-a-half day workshops that introduce participants to modern issues in the design and conduct of clinical trials and the statistical analysis of clinical trial data. Topics, presented by experts in the field, include enrichment, design and missing data in randomized clinical trials, personalized medicine, and comparative effectiveness, among others. Online registration for SISCR 2014 is now open. Visit the Summer Institute in Statistics for Clinical Research (SISCR 2014) website to learn more. Contact Monica I. Feliu-Mojer at monicai@uw.edu or 206.543.5912 for more information.

The Department of Biostatistics will also host the 19th Summer Institute in Statistical Genetics (SISG), July 7 - 25, 2014 and the 6th Summer Institute in Statistics and Modeling of Infectious Diseases (SISMID), July 7 - 23, 2014.

Continuing Medical Education 

Visit Continuing Medical Education for information on upcoming classes.

 


 

In the News 

  • ECG better at detecting student athletes’ heart risk, U.S. News & World Report, May 8, 2014. Including an ECG in a screening for high-school athletes increases the odds of detecting problems that can lead to sudden cardiac arrest and death, according to a study led by Jordan Prutkin, UW assistant professor at the UW School of Medicine Center for Sports Cardiology.
  • New care approach eases depression among women, Obstetrics & Gynecology, May 7, 2014. Women who received collaborative care for depression at two UW Medicine obstetrics and gynecology clinics showed fewer symptoms after treatment than women receiving usual depression care in the same setting.
  • From UW startups come medical innovations, KING5 HealthLink, May 6, 2014. UW entrepreneurs and students display new ways to reboot damaged hearts, save lives in the E.R. and prevent severe reactions to gluten.

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