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June 8, 2012 Table of contents
School of Medicine celebrates 63rd medical student graduation Dear Colleagues: The 63rd annual School of Medicine graduation took place on Saturday morning, June 2. The graduation ceremony was preceded by two celebrations associated with key educational programs: the UW School of Medicine All-Pathways Graduation Luncheon, held on May 31, and the Multicultural Graduation Celebration and Reception, held on June 1. (See related article in the Education & Training section below.) In the June 2 graduation ceremony, 212 medical students received diplomas. George Novan, associate director of WWAMI Spokane and UW clinical professor of medicine (photo below), was selected by the graduating students to address the class. This choice was fitting for many reasons, including its timing with the graduation of the first WWAMI-Spokane class. The WWAMI-Spokane graduates stood in unison as Dr. Novan completed his remarks, giving him a standing ovation. Prior to the Physician’s Oath that marks formal entry into the career of medicine, the students presented awards voted by their class to faculty, staff and students. Each award was preceded by remarks from a graduating student about the awardee; these remarks reflected highly on the recipients but also on the values and commitment of the students presenting the awards.
Among awards to graduating students, Kevin Fiori received the Ellen Griep Award that honors a graduate who has inspired his classmates, staff and faculty by successfully managing both the academic demands of medical education and continued excellence in other endeavors. Fellow student Robin Chand described Kevin’s remarkable work in co-founding Hope through Health (HTH) with his wife prior to starting medical school. This not-for-profit organization provides technical and financial support to community-based health initiatives in poverty settings. Kevin continued his service commitments throughout medical school and is field director for the HTH Community-Directed HIV Initiative. Graduating student Amy Cheney presented the Roger Rosenblatt Community Service Award to Justin Kopa, describing his outstanding work with the underserved and calling him “a wonderful human being and humanitarian.” These awards presented at graduation are a reminder of the exceptional accomplishments of our faculty and students. Many vital activities occur throughout UW Medicine in diverse areas, and it is a pleasure to recognize a sample of the teaching excellence of our faculty and the service orientation of our students. I ask each member of our community to always honor and uphold the paramount importance of teachers and learners in each of our settings and the value of community service. Thank you to all of our graduates and to all teachers for your outstanding work and your dedication to service through medicine. Sincerely,
Paul G. Ramsey, M.D.
Baby's genome deciphered prenatally from parents' lab tests
Maternal blood sampled at about 18 weeks into the pregnancy and a paternal saliva specimen contained enough information for the scientists to map the fetus' DNA. This method was later repeated for another expectant couple closer to the start of their pregnancy. The researchers checked the accuracy of their genetic predictions using umbilical cord blood collected at birth. Jacob Kitzman and Matthew Snyder, under the supervision of Jay Shendure (photo, right), UW associate professor of genome sciences, led the study. Kitzman is a National Science Foundation Graduate Research Fellow. Snyder, a graduate student in Genome Sciences, holds degrees in biostatistics and economics. Based on this phenomenon, other research labs are designing maternal blood tests for major aberrations in the fetus's genetic makeup. The tests are considered a safer substitute for the more invasive sampling of fluid from the uterus, a common procedure in obstetrical practice. These new tests search for just a few genetic disorders or specific congenital abnormalities. Kitzman explained that what distinguishes his team's latest methods is the ability to assess many and more subtle variations in the fetus' genome, down to a minute, one-letter change in the DNA code. With technical advances as well as statistical modeling, the research group overcame several obstacles that had stymied previous efforts to determine fetal genomes. With a preponderance of maternal rather than fetal DNA in plasma samples, a major problem was figuring out which genetic variants had passed from mother to child. The scientists applied a recently developed technique to resolve the mother's haplotypes, which are groups of genetic variations residing on the same chromosome. From these groupings, the researchers could pick out the parts of the baby's genetic material inherited from each parent with over 98 percent accuracy. Read more in The New York Times and UW Today. Read the journal article in Science Translational Medicine. Study seeks to better understand experiences of LGBT partners in U.S. healthcare systems Ruth Engelberg, UW research associate professor of medicine and co-director of the End-of-Life Care Research Program, is the principal investigator of a study funded by the National Palliative Care Research Center. LGBT people across the country will be surveyed about their experiences when a partner is hospitalized. The goal of the study is to learn more about people’s experiences when making care decisions for their partner. “Anecdotally, we are hearing that hospitals and care facilities are not always recognizing the rights of LGBT couples when they are trying to identify legal next of kin,” said Engelberg. “This failure to recognize LGBT partners as appropriate decision makers adds another element of stress, in an already stressful situation, when that partner is either denied access or questioned inappropriately.” Engelberg is seeking to recruit 100 LGBT people across the country who have had the experience of advocating for a partner who was ill or injured over the past five years and received care in a hospital or other healthcare facility. To determine eligibility, people are asked to contact the study to answer several questions. The study hopes to capture both good and bad experiences. Engelberg says she is especially interested in hearing from LGBT people who identify with groups that may be underrepresented in research, such as people of color and older people. “There are many LGBT couples who have been in same-sex relationships for years and years,” she said. “Then one of them falls seriously ill and the partner feels that she/he must stand back in the shadows because she/he isn’t ‘legally’ the next of kin — even though they have been in a loving relationship for years.” For more information about the study, visit the Caring for Partners LGBT Study website, call 1.877.749.3970 toll free, or send an e-mail to info@caringforpartners.org. New Financial Conflicts of Interest training available online Ruth Ballweg receives American Academy of Physician Assistants' highest honor, the Eugene Stead Award Named for the founder of the physician assistant (PA) profession, the Stead Award recognizes Ballweg’s lifelong commitment to advancing the PA profession and her dedication to creating paths to the profession for military servicemen and women. In 1985, Ballweg became director of the MEDEX program, founded by Richard Smith in 1968. She is a longtime champion of rural access to care and has secured millions in funding to expand access in Washington, Oregon, Alaska, Montana, Wyoming, Idaho and Nevada. She is a prolific writer, speaker and advocate for the PA profession. “It is wonderful to be acknowledged for the many dimensions of my PA career. Early on, Dr. Richard Smith taught me that one of the benefits of being an educator—and also a policy maker—is the opportunity to “multiply our hands” as we impact the lives of our students and mentees,” said Ballweg. “I feel privileged to have had that opportunity, and I challenge all of us continue to promote the PA profession as a strategy for social change.” As the MEDEX director, Ballweg is involved in healthcare workforce issues in Washington, Montana, Idaho, Oregon and Nevada and has been increasingly involved in the formulation of federal policy on the expansion of the primary care workforce. Her commitment to the value of veterans has allowed those with experience as military healthcare specialists, who do not have an extensive academic background, to use their knowledge to become physician assistants and have the opportunity to obtain a bachelor’s degree from the University of Washington. Watch a video montage of Ballweg throughout her career on YouTube. Hall Health honored for innovation that reduces over-prescription of opioids “Previously, our medical providers were not given specific guidance, and our electronic health record tool set the prescription default to 28 pills per encounter. After reviewing our prescription data, Hall Health set the default to 10 pills per encounter,” said David C. Dugdale, Hall Health director. “We developed what is a best practice for prescribed amounts of medication.” After evaluating the patients seen at Hall Health, the Best Practice Committee concluded that the prescription of 28 opioid pills per encounter “was just too much for the types of medical conditions we most often treat,” said Dugdale, who explained that Hall Health orders 100 to 130 opioid prescriptions a month, with the great majority of them for acutely injured or ill patients. About two-thirds of Hall Health’s patients are UW students. The project began in 2009 when providers asked for more guidance around opioid prescriptions for chronic pain, but after reviewing their data, the Hall Health staff realized that prescribing for acute pain was much more common. “When it was first recommended that we change the default settings, there were some concerns about whether the new default ordered amounts would be enough,” said Dugdale. “The answer is, it appears to be,” Dugdale said. “We didn’t see an uptick in patients coming back for more prescriptions of Vicodin, oxycodone or codeine.” Dugdale noted that the new default setting does not preclude a physician from ordering 28 pills or more when needed. “We just made it easier for the provider to make the decision that is right for the large majority of our patients; it reduces the chances of left-over pills; and it’s cheaper for the patient as well.” In addition to being honored by Qualis Health, the findings of Hall Health’s study were presented at the annual meeting of the American College Health Association in Chicago. UW Medicine mourns the death of Alvin J. Thompson, emeritus clinical professor and mentor Dr. Thompson’s record of service is prodigious: He was a former governor of the American College of Physicians (ACP) of Washington State and Alaska and a past president of the Washington State Medical Association, the Providence Medical Center Medicine Staff, the Washington State Society of Internal Medicine, the Seattle Academy of Internal Medicine, and the King County Medical Society. Thompson was founding president of the Washington State Association for Biomedical Research and co-founder and president of the Washington State Association of Black Professionals in Health Care. Thompson initiated the African American Mentor Program at the UW School of Medicine and was a longtime mentor for the UW Minority Medical Education program, as well as a community liaison for minority medical students. He and his wife established a fund to support the recruitment and retention of African American students in the UW School of Medicine. He served on numerous UW and community committees. The UW Medicine/Health Sciences Martin Luther King Jr. Tribute Committee honored Thompson with its Distinguished Service Award in 2003. David C. Dale, professor of medicine, former dean of the UW School of Medicine, and former ACP president, said of Dr. Thompson, “He was an exceptional leader and an important liaison between the School of Medicine and the Seattle physician community. The ACP’s Claypoole Award reflected his very distinguished contributions to medicine and medical organizations.” UW medical student Eriberto Michel receives AMA Foundation 2012 Minority Scholars Award Michel comes from a rural farming community in Eastern Washington. From an early age, he and his family were challenged by many barriers. His parents were first-generation Mexican immigrants who did not have extensive formal education. English was their second language. His father, a farm laborer, suffered from a chronic heart condition and Michel helped his parents navigate the complexities of the U.S. healthcare system. Michel’s passion for helping underserved communities evolved from these early experiences. As a medical student, Michel has served as clinical director of a student-run free clinic that offers services to immigrant day laborers in greater Seattle. He was also the service director of the Latino Medical Student Association, for which he designed a plan to engage medical students in service learning projects. Michel's research was recognized when he received the national Society for Pediatric Student Research Award for his project titled, “The Impact of Limited English Proficiency on Improvements in Pediatric Quality of Life after Hospitalization.” He is in the Hispanic Health Pathway program, and also served as a teaching assistant for the School of Medicine’s first year Histology course and the Spanish for Medical Professionals course. The Minority Scholars Award, given in partnership with the AMA Minority Affairs Section, with support from Pfizer Inc., promotes diversity in the medical profession and helps with the rapidly rising cost of medical education. The awards recognize scholastic achievement, financial need and commitment to improving minority health among first- or second-year medical students in groups defined as historically underrepresented in the medical profession. Less than seven percent of U.S. physicians fall within these groups, which include African American/Black, American Indian, Native Hawaiian, Alaska Native and Hispanic/Latino. “The AMA Foundation takes enormous pride in its association with these exceptional medical students,” said Owen Garrick, AMA Foundation president. “Their outstanding academic achievements as well as numerous activities illustrating leadership and service in their communities speak to their commitment to make a difference in the health of minority populations and the medical profession.” Visit the AMA Foundation website to learn more. Medical students in underserved and multicultural programs celebrate their achievements Pathway Certificates were presented to 60 students in the Indian, Hispanic, Global Health and Underserved Pathways. The certificates recognize the students’ special preparation and skill in working with vulnerable populations in the United States and internationally. Speakers included Sharon Dobie, UW professor of family medicine, and Ellen Cosgrove, School of Medicine vice dean for academic affairs. Each Pathway allows students to organize their courses, clinical rotations, and volunteer opportunities around a particular community, population, or aspect of underserved medicine. The Pathways also allow students to explore career interests with mentorship from faculty, staff, and community providers and partners who share those interests. View the All-Pathways Celebration program and see a listing of this year’s Pathway Certificate recipients. The School of Medicine’s Office of Multicultural Affairs (OMCA) honored 25 graduates at the OMCA Multicultural Graduation Celebration and Reception June 1 in the Cascade Room of Haggett Hall. The Honorable Cecile Hansen, chair of the Duwamish Tribe, welcomed the graduates and their guests. David Acosta, UW School of Medicine chief diversity officer, made opening remarks, and Paul Ramsey, dean of the School of Medicine, delivered a short message to the graduates. Seattle Indian Health Board Traditional Health Liaison Annette Squetimkin-Anquoe, Glen Pinkham (Yakama Elder), and Victoria Gardner, director of the Office of Multicultural Affairs, were emcees for the event. Graduating students were honored with drumming and dance by Adefua Dance and Drum Group. Graduates also received a Pendleton blanket, kente or serape sash, as well as a Certificate of Appreciation to give to a family member or friend who has served as a major support for the graduate. View a listing of the OMCA Class of 2012. (Photo: David Acosta, UW School of Medicine chief diversity officer, celebrates with 2012 graduates Alexandra Hunt, Karen Quaynor and Avram Hecht.) WWAMI Spokane advances medical student research training “The idea behind students doing original research is a good one,” said WWAMI Spokane first-year director Ken Roberts. “We’ve encouraged students here to take a look around at the faculty who are teaching them — almost all of them have research programs —and as they build relationships with them, learn about what they do and potentially do a summer project with them.” Three students are teaming with an interprofessional group of faculty collaborators led by WSU nursing assistant professor Kenn Daratha. Other students are working on projects related to kidney disease and studying how serious mental illness affects pregnant women. Daratha, Roberts and local nephrologist Kathy Tuttle are each mentoring a student. “These are projects initiated by the students. They decide the topics; they’re the ones who write the proposals,” said Daratha. He says they work together through the process of obtaining support from institutional review boards. These students will review databases that include unidentified hospital patient information to find and analyze relevant data. Daratha says the students will combine that knowledge with evidence from other sources of medical information and assemble the data into papers they prepare for publication. Two students are working with sleep and addictions researchers at Washington State University. One is comparing the physiological effects of e-cigarettes and regular cigarettes in people who use them. The other is examining the sleep patterns of people who are dependent on opioids. Students will present their research at the poster presentation session in Seattle in November. Roberts says some of the students will be invited to present their research papers at the Western Student Medical Research Forum next January in Carmel, Calif. in 2013. For more information contact, Michelle Fleming at flemingm@u.washington.edu or 206.543.5560. Adapted from an article by Doug Nadvornick for the WSU Spokane Campus Bulletin that will be published June 13, 2012.
The following events may be of interest to the UW Medicine community: South Lake Union Science Trek, June 8 UW Medicine South Lake Union is participating in the South Lake Union Science Trek, from 10 a.m. to 4 p.m., Friday, June 8. UW Medicine is joining other science, technology, engineering and applied math organizations in the SLU neighborhood to host a series of interactive experiences for K-12 students, teachers and parents who will be visiting the area as part of the Seattle Science Festival. For more information, contact Matthew Curry at 206.685.8769 or mcurry@uw.edu or Steve Berard at 206. 206.684.-0564 or sberard@uw.edu. UW Urology Hirschler Professor Lecture, June 9 Cancer Biomarkers: From Discovery to Application in Personalizing Treatment of Bladder and Prostate Cancer, 8:00 to 11:30 a.m., Orin Smith Auditorium, Brotman Building, South Lake Union. The 4th Annual Hirschler Professor Lecture will be presented by Visiting Professor Yves Fradet, professor of surgery and urology and Uro-Oncology Program head, at Universite Laval in Quebec, Canada. Fradet studies tumor immunology; molecular biology of bladder and prostate cancer, and its applications to new diagnostics and treatments; epidemiological studies in bladder and prostate cancers; and clinical trials in prostate cancer, and other genitourinary cancers. The lecture is sponsored by the UW Department of Urology. For more information, contact Ken Forssen at 206.685.4504 or kforssen@uw.edu for more information. 2012 - 2013 Teaching Scholars Program applications due June 30 The 2012-2013 Teaching Scholars Program is a ten-month professional development program for health sciences professionals who want to improve their teaching and academic leadership skills. The program runs from Sept. 18, 2012 to June 18, 2013 and includes a one-day teambuilding session on Sept. 25. Applications are due by June 30, 2012. For application requirements, visit the Teaching Scholars Program website and press the "Register Now" button. Contact Teaching Scholars Program Co-directors Lynne Robins at lynner@u.washington.edu or Jan Carline at carlinej@washington.edu for more information. Survival Skills for the Research Years, July 9 - 10 Everything You Need to Know to Thrive in Academics! The annual UW Department of Medicine Workshop on Survival Skills for the Research Years, July 9 – 10, UW Medicine South Lake Union, 850 Republican St., Seattle. The two-day workshop covers skills necessary for academic success, such as grant writing, scientific writing, oral presentation and job negotiations. The course will be led by Lynn Schnapp (Pulmonary and Critical Care Medicine) and Dr. Thomas Hawn (Allergy & Infectious Disease). This free workshop is designed for research fellows and is open to fellows and junior faculty from all departments. Please visit the workshop website to register and to see a detailed course agenda. Continuing Medical Education Visit Continuing Medical Education for more information on upcoming classes.
In the News UW faculty publish editorial on sleep apnea in JAMA Vishesh Kapur, UW associate professor of medicine in the Division of Pulmonary and Critical Care Medicine, and Edward Weaver, UW associate professor in the Department of Otolaryngology—Head and Neck Surgery, co-authored an editorial published in the May 23/30 JAMA: Filling in the Pieces of the Sleep Apnea–Hypertension Puzzle. Kapur is founder and medical director of the UW Medicine Sleep Center and program director of the UW sleep medicine fellowship. Weaver is chief of sleep surgery and the surgical program director of the Sleep Center.The Pieces of the Sleep Apnea–Hypertension Puzzle
UW Medicine magazine
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Graduating seniors presented the Distinguished Teacher Awards, selected by the Graduating Class of 2012, to five individuals. Gabe Wallace described clinician-educator Andy Luks’ unparalleled dedication, calling him a role model and mentor. Gabe said, “I have the urge to write down everything Dr. Luks says because it’s pure gold.” Matthew Swanson thanked WWAMI preceptor Suzanne Swietnicki of Havre, Mont., for crucial guidance, calling her a teacher and a friend. Graduating student Amanda Messinger observed that WWAMI preceptor Margaret Dow, also of Havre, Mont., taught her how to connect with each patient and described the way Dr. Dow consistently advocates for and facilitates student learning. Julie Cella talked about basic scientist Frank Vincenzi’s unwavering commitment to students and his “uncanny ability to inspire students with his passion for pharmacology.” Ben Lucas-Roberts called clinician-educator Heidi Coombs one of the finest teachers and clinicians with whom he expects ever to work. 
UW scientists have successfully sequenced the genome of a baby in the womb without tapping its protective fluid sac. This non-invasive approach to obtaining the fetal genome is reported in the June 6 issue of Science Translational Medicine, a journal of the American Association for the Advancement of Science.
Scientists have long known that a pregnant woman's blood plasma contains cell-free DNA from her developing fetus. Fetal DNA appears in the mother's plasma a few weeks after conception. It rises during gestation and normally vanishes after the baby arrives. While the concentration varies among individuals, about 10 percent of the cell-free DNA in a pregnant woman's blood plasma comes from her fetus. 
Researchers at the University of Washington are working to understand the current experiences of lesbian, gay, bi-sexual and transgender (LGBT) couples when one partner is seriously ill. They are hoping their results will inform public policies, ensuring that LGBT couples have access to their partners and can participate in critical decision-making.
Ruth Ballweg, director of MEDEX Northwest, has received the American Academy of Physician Assistants (AAPA) highest honor, the Eugene A. Stead Jr. Award. The academy presented the award to Ballweg at its annual conference May 27 in Toronto, Canada.
Hall Health Primary Care Center has improved the quality of opioid prescribing by changing the number of pills prescribed at any given encounter, from 28 pills to 10 pills, through the use of electronic health record tools. Last month, Qualis Health honored the project associated with this innovation, Modifying opioid prescribing patterns by use of Electronic Health Record tools, with its Award of Excellence in Healthcare Quality Innovation.
Alvin J. Thompson, UW emeritus clinical professor of medicine, died May 21. He practiced internal medicine and gastroenterology in Seattle for 40 years and was a passionate mentor to many health professionals who trained at the UW. 
Eriberto Michel, a second-year UW medical student at the UW, is one of 13 medical students to receive the American Medical Association (AMA) Foundation’s 2012 Minority Scholars Award. The $10,000 scholarship recognizes academic achievement and commitment to eliminating healthcare disparities. 
The UW School of Medicine All-Pathways Graduation Luncheon Celebration May 31 in the Health Sciences Lobby marked the achievements of students who have prepared to work with diverse and vulnerable populations. 
The 10-week Medical Student Research Training Program (MSRTP)—which allows students to participate in a research project during the summer between their first and second year of medical school—is becoming a popular option for WWAMI Spokane students. Four of the 20 students in the most recent Spokane class are paired with Washington State University (WSU) faculty members for summer projects. A fifth student—from WWAMI Spokane’s E2010 class—is returning to Spokane to continue a research collaboration he started last summer.
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