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April 8 issue
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2016 WWAMI GME Summit highlights regional innovation, collaboration
Last week, WWAMI faculty, medical and community leaders, and others interested in graduate medical education (GME) convened in Spokane for the 2016 WWAMI GME Summit. This was the fourth WWAMI summit to examine key issues in graduate medical education regionally and nationally.
This year the summit was co-sponsored by the Josiah Macy Jr. Foundation as part of a national series to explore and expand GME innovations. Since 1930, the Macy Foundation has worked to improve the health of the public by advancing the education and training of health professionals.
We were pleased to have George Thibault, president of the Macy Foundation, at the summit. He brought thoughtful reflections on the innovative GME models presented at the meeting—from program design and new training sites, to payment mechanisms and assessment tools—that uncover opportunities to replicate and scale up new approaches to address GME challenges.
Byron Joyner, UW vice dean for graduate medical education and DIO, walked attendees through the history of GME. He noted recurring challenges: mismatch between the healthcare needs of the population and the increase in specialists; persistent maldistribution of physicians; gaps between physicians’ knowledge and competencies needed for current medical practice; and significant differences in the racial and ethnic composition of the physician workforce compared with the patient population.
Bianca Frogner, director for the UW Center for Health Workforce Studies, presented data on the regional physician workforce, including how projections are made regarding numbers of physicians needed, what influences physician productivity, and predictors of where a physician will choose to practice.
Suzanne Allen, UW vice dean for academic, rural and regional affairs, gave an overview of GME in the WWAMI region, and Judith Pauwels, UW associate director for program development and accreditation for the WWAMI Family Medicine Residency Network (FMRN), provided insights into the development of new residency programs and the critical conversations needed in this process. Frederick Chen, director of the WWAMI FMRN, provided an overview of GME funding.
Two lively panel discussions provided the perspectives of outstanding educators involved in GME innovations throughout the WWAMI region and observations by current residents and recent GME graduates.
In his summary remarks, George Thibault described drivers for GME reform, including the vital role of education as a driver for care transformation. GME, he noted, can and should be a catalyst for healthcare reform, addressing social needs, and humanizing medicine.
Significant complexities surround GME that cannot be solved by any one institution, organization, or region. Reforming GME requires a collaborative nationwide effort of sharing best practices that will produce physicians with the skills, specialties and geographic distribution to meet the needs of patients and improve the health of the public.
As George pointed out in his closing remarks, partnerships were in full evidence among attendees and the programs and efforts they represent. Thanks to the wonderful collaboration demonstrated among individuals, programs and states at this summit, the WWAMI region excels in advancing this significant national conversation.
Paul G. Ramsey, M.D.
In a study published in Science, UW researchers presented a new, more complete genome sequence of the Western lowland gorilla. Gorillas are some of our closest relatives, edged out only by chimpanzees and bonobos. This latest genome sequence confirms that just 1.6 percent of their genes diverge from our own.
The research team led by Evan Eichler, UW professor of genome sciences, analyzed DNA in a blood sample of a female Western lowland gorilla from the Lincoln Park Zoo in Chicago. The researchers explained why previous genome assemblies for the gorilla and other mammals have been fragmented, incomplete and potentially misleading.
Because gorillas are so close to us on the evolutionary tree, their genomes are especially valuable to study. “The differences between species may aid researchers in identifying regions of the human genome that are associated with higher cognition, complex language, behavior and neurological diseases,” Christopher Hill, a UW postdoctoral fellow in genome sciences, told Reuters. Coverage also in The Washington Post, Geek Wire and on HSNewsBeat.
Certain heart rhythm medications improve the likelihood of surviving transport to the hospital, a major UW study has confirmed. The study, lead by UW Medicine cardiac electrophysiologist Peter Kudenchuk, medical director of King County Medic One, helps answer a long-standing scientific question about the effectiveness of two widely used antiarrhythmic drugs, amiodarone and lidocaine, given by paramedics to patients when treating sudden cardiac arrest outside a hospital. The results published in the New England Journal of Medicine April 4 were concurrently presented during the annual meeting of the American College of Cardiology in Chicago.
“This trial shows that amiodarone and lidocaine offer hope for bringing patients back to life and into the hospital after cardiac arrest,” said Kudenchuk. For more on the story, including an interview with Kudenchuk, an audio clip of a 911 CPR call and photographs, see the article on HSNewsBeat.
A study published in Cell shows that smoking slows the movement of immune cells and impedes their ability to fight tuberculosis infection. Russell Berg and Steven Levitte, graduate students in the UW Medical Scientist Training Program, were lead authors of the study. The senior author was Lalita Ramakrishnan, formerly of UW Medicine and now in the Department of Medicine at Cambridge University. For more on the study, see the article on HSNewsBeat.
Another study just getting under way at the UW will look at oral swabs to correctly detect TB in adults. Gerard Cangelosi, UW professor of environmental and occupational health sciences and global health, is leading the study and said finding an alternative to sputum testing has been a holy grail in TB testing and diagnostics. The two-year test, involving researchers at UW and the University of Cape Town in South Africa, is being funded from a $1 million grant from The Bill & Melinda Gates Foundation. For more on the study, see the article on HSNewsBeat.
More research stories involving UW Medicine:
Steven Gilbert, UW affiliate professor of environmental and occupational health sciences, has lived with Parkinson’s Disease for 15 years; he underwent deep brain stimuli (DBS) conducted by Andrew Ko, UW assistant professor of neurological surgery, to help stop his tremors. DBS interrupts abnormal neuronal activity in the brain.
DBS doesn’t help patients’ problems with balance, sleeping or speech, nor does it slow the progression of the neurodegenerative disease. But for Gilbert, a competitive cyclist, the results have been life-changing. Three years ago he switched to biking tandem with another rider, and then a year ago, even that became impossible. Walking uphill and rising from a chair were struggles. He couldn’t maneuver through tight or crowded spaces like a mall or airport; independent travel, essential to his career as a lecturer and consultant, stopped. Now, he is back biking, walking and traveling. Read more on HSNewsBeat.
Nurse and competitive skier Nancy Riley-Jones had three arthroscopic knee surgeries, but knee pain was preventing her from masters ski racing. Seth Leopold, UW professor of orthopedics and sports medicine who specializes in hip and knee surgery, did the first knee replacement on Riley in August 2013, and nearly a year later performed the surgery on her other knee. On March 17, 2016, two years after her last knee surgery, Riley competed in a women’s national title for skiing and won the gold medal. For more on her story, see the article on UW Medicine Healthworks.
More than 300,000 patients in the U.S. are on dialysis as a result of renal failure, and the numbers are expected to grow, according to Jonathan Himmelfarb, director of the UW Kidney Research Institute. While doctors hope to find a treatment to prevent people from end-stage renal disease, dialysis is currently the only treatment option. But another option is being studied: A wearable artificial kidney. UW led the first successful trial of seven patients for a 24-hour test. One patient, Chuck Lee, was thrilled with the device. To hear Lee, Himmelfarb and Larry Kessler, UW professor of health services, discuss the advantages and timetable for a wearable artificial kidney, listen to the UW Medicine Pulse podcast (16:30).
More clinical stories involving UW Medicine:
UW Medicine will be hosting its first clinical informatics fellows this year, a new medical specialty at the intersection of technology, business and medicine. This program is hosted by the Department of Family Medicine, and was developed in close collaboration with UW Medicine IT Services, the Department of Biomedical Informatics and Medical Education (BIME), the Graduate Medical Education office and the School of Nursing.
UW is among the first 14 programs in the country with an accredited fellowship program, said Michael Leu, UW associate professor of pediatrics and BIME. In the two-year fellowship, they will work closely with their clinical colleagues to create usable systems that respect the needs of physicians while helping to measurably improve care. In addition, they will practice in their clinical specialty, and will take focused coursework in the Clinical Informatics and Patient Centered Technologies program (including budgeting, organizational change, analyzing and visualizing data and creating clinical decision support).
The 2016 fellows:
Xinran (Leo) Liu
Xinran (Leo) Liu is finishing residency in internal medicine at UW. Prior to residency, he studied chemistry at Cornell University and completed his medical degree at the Geisel School of Medicine at Dartmouth. During medical school, Liu was co-founder and editor-in-chief of UndergroundMed, a student community focused on creating videos to teach clinical topics from the student’s point of view. He was selected as the 2013 Rolf C. Syvertsen Fellow, an award presented to an exceptional single fourth year medical student at Dartmouth who, among many qualities, shared their knowledge of medicine. During residency, he has been involved in using multimedia for patient education of gastroesophageal reflux disease; and has been working with Thomas Payne, Medical Director of UW Medicine IT Services and associate professor of medicine (general internal medicine), on examining the feasibility of using speech recognition to facilitate timely entry of admission notes.
Liu is interested in medical education and also in how to best customize electronic medical records to suit the needs of clinicians.
Craig Monsen is finishing residency in internal medicine at Brigham and Women’s Hospital in Boston. Prior to residency he studied engineering and computer science at Harvard, where he was awarded highest honors. He completed his medical degree at Johns Hopkins, where he was the president of the Medical Student Senate. While in medical school, he founded and served as CEO of Symcat, a venture-backed, award-winning company that builds software leveraging data-driven algorithms and mobile technologies to improve triage of patients with undifferentiated symptoms.
In addition to Symcat, Monsen has worked on a number of clinical informatics initiatives during residency, including developing a patient-risk stratification algorithm that outperforms the industry standard and a text message appointment reminder system that has reduced patient no shows by 20 percent. He writes about and has been an invited speaker on topics of consumer engagement and big data. Monsen will continue to cultivate his strong interest in using technology to support the Institute for Healthcare Improvement’s Triple Aim.
Related education stories:
The Wyoming WWAMI Legislative Day was held this past February in the state capital, Cheyenne. Legislative Day is unique to Wyoming WWAMI and gives the students an opportunity to meet with influential politicians and discuss timely topics related to healthcare. U.S. Senator John Barrasso (R-WY) helped to kick off the day by attending the student lunch. Senator Barrasso, a WWAMI supporter, is known by many as Wyoming’s doctor. During his 24 years as an orthopedic surgeon, Barrasso served as president of the Wyoming Medical Society and was named Wyoming Physician of the Year.
After lunch, the medical students were introduced on the House and Senate floor, and met with Gov. Matt Mead to discuss Medicaid expansion, as well as the future of healthcare in Wyoming.
In other news from Wyoming: Wyoming physicians who have served as clinical preceptors for 10 years or more are being honored this month by Wyoming WWAMI. These preceptors primarily work with students during their third-year required clerkships. This year, the following physicians were recognized for their dedication to medical education in Wyoming:
Peter Allyn, MD – OB/GYN
The Puget Sound Business Journal is doing a series on researchers. Recently, they wrote about Jessica X. Chong, an acting instructor with the UW Center for Mendelian Genomics working on the MyGene2 project.
In seventh grade, Jessica X. Chong was assigned to give a presentation on something interesting in science. She went to the library and found a book on gene therapy. Not only did she learn about the promising technique for her presentation, but she thought it was "the coolest thing ever" and went on to get her PhD in human genetics because of it. "Each gene and disorder is different," she said. "So, it is always a puzzle to figure out how a mutation in some gene would lead to some symptoms you see in someone who has that mutation…."
After focusing a large part of her PhD project on understanding the mutations that caused genetic conditions in the Hutterites, which is a religious group similar to the Amish, Chong came to Seattle. She did her fellowship at the UW because it had recently received funding for the Center for Mendelian Genomics, which studies rare disorders.
While she has been in this field of human genetics for the last eight years, Chong, 31, is still a young researcher. One of the big struggles for young scientists, she said, is figuring out exactly what her research will look like in 20 years. Read more on her story in The Puget Sound Business Journal (subscription required).
A number of staff and faculty members from UW Medicine were among the recipients of the UW 2016 Awards of Excellence. They include:
Distinguished Staff Award: Sabine Aboltina, hospital assistant, Harborview Medical Center, and the International Classification of Diseases, Tenth Edition (ICD-10) team at UW Medicine: Sally Beahan, director, health management; Carol Garsi, coding manager; Sarah Lucas, program director; Rebecca Revand, project manager.
David B. Thorud Leadership Award for Faculty: Norman Beauchamp, UW chair of radiology.
Distinguished Teaching Award: Wendy Thomas, UW associate professor of bioengineering. The Distinguished Teaching Award for Innovation with Technology: David Masuda, UW lecturer in biomedical informatics and medical education. For a complete list, see the article on the UW website.
All four UW Medicine hospitals were recognized as 2016 Leaders in LGBT Healthcare Equality and included in the Healthcare Equality Index 2016, an annual survey that encourages equal care for lesbian, gay, bisexual and transgender (LGBT) Americans by evaluating inclusive policies and practices related to LGBT patients, visitors and employees. The Index is published by the Human Rights Campaign Foundation, the educational arm of the country’s largest LGBT civil rights organization. Only two other Washington state facilities were named to the list, one in Yakima and one in Port Townsend.
“UW Medicine is proud to support and serve LGBT patients and their families, and to serve as an employer for LGBT individuals,” said Cindy Hecker, interim chief health system officer for UW Medicine.
UW Medicine is the first healthcare system in the country to have all of its hospitals achieve Joint Commission Advanced Certification in Palliative Care. “This important accomplishment honors the work of the palliative care providers and staff at all four UW Medicine hospitals,” said J. Randall Curtis, director of the Cambia Palliative Care Center of Excellence at UW. “They have worked toward this certification for several years, and achieving it is key to the mission of ensuring all UW Medicine patients with serious illness—and their families—receive the best possible palliative care.”
Founded in 1951, The Joint Commission evaluates and accredits nearly 21,000 healthcare organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in healthcare.
Rachel Klevit, UW professor of biochemistry, was awarded the The Dorothy Crowfoot Hodgkin Award by The Protein Society. The award, sponsored by Genentech, is granted in recognition of exceptional contributions in protein science which profoundly influence our understanding of biology.
Said The Protein Society: “Klevit’s research has been instrumental in understanding the mechanism of disease of two scourges, breast cancer and Parkinson’s disease. Moreover, she has changed the way research in this area is done. Additionally, she is an exceptional mentor of younger scientists and a wonderful role model for other scientists and educators at all stages of their careers.”
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