Winter 2017
The Residents
Report
In This Issue: UCSF Health 1 True North Performance 5 Update from ZSFG 6 GME Diversity 7 10 Questions from RFC 8 Out & About 11 Honors & Recgonition 14 Patient Safety Bulletin 17 Existential Dilemma 18
UCSF Health: Becoming Better Versions of Ourselves Niraj Sehgal, MD, MPH Chief Quality Officer, UCSF Health Professor of Medicine When I was an early medical student, I spent many Tuesday afternoons shadowing a primary care doctor who cared for patients in an urban community clinic. Each week, he would greet me on arrival with the same question: “Niraj, how are you a better version of yourself this week?� With this seemingly innocent question, he began instilling a principle
that was far more important than what I was learning; instead, he was focused on how I was learning and improving. It may not have helped me pass exams at that time but it certainly influenced my early philosophy of continuous improvement. As Chief Quality Officer for UCSF
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Health, most assume that my job is managing dashboards and improving each metric on those dashboards. While those metrics are often important when directly linked to improved patient care, I’m most interested in how our system becomes a better version of itself. The only way this happens is our ability to engage and support all of you to help improve the way we deliver care. UCSF residents and fellows are the envy of academic medical centers nationally and for good reason. I hope this piece provides context for the changes happening within UCSF Health and how you can influence and lead our needed problem-solving and improvement work. What is the vision for UCSF Health?
of you have felt on your busy inpatient services, oversubscribed clinics, and overbooked operating room schedules. Our size and diversity mean it is more important than ever that we focus on the same core mission, vision, values and priorities, especially as we operate in an external health care environment that is increasingly complex. To do that, UCSF Health leadership wanted to develop a simplified way to communicate why we exist, where we are headed, and provide a shared framework to get us there. The pyramid illustration (see Figure 1) is an attempt to achieve that goal. At the top of the pyramid is our mission of Caring, Healing, Teaching and Discovering - why we exist. The body of the pyramid shows how UCSF Health’s vision, values, priorities, management and branding all align to serve our mission.
Over the past couple years, we’ve organized our clinical care into a single health system, pulling together several elements that had been functioning independently. Our health system Our vision - to be the best provider of health also has seen tremendous growth, which many care services, the best place to work and the
Figure 1: UCSF Health Pyramid: An Organizational Compass 2
best environment for teaching and research – is what we aspire to achieve. Our values – Professionalism, Respect, Integrity, Diversity and Excellence - guide our individual behavior that will lead us to our vision. At the foundation of the pyramid is our brand, Redefining Possible – what our patients and their families experience when they access our services, and what every person at UCSF Health and UCSF – whether you are in education, research, or patient care, directly or indirectly – do when you come to work each day. I keep hearing the term True North. What does it mean? Why is it important? Our “True North” pillars represent long-term objectives - how we will achieve our vision - because they will serve as a constant guide for aligning and prioritizing our work. The UCSF Health True North pillars should not surprise you. In fact, we hope the areas of patient experience, quality and safety, our people, financial strength, and strategic growth reflect work you’ve participated in or have observed during your training here. The decision to add a 6th pillar focused on a “Learning Health System” was made to reflect our commitment to truly creating the best learning environment. The True North pillars are also important since they serve as a communication vehicle to link our daily work to that of our organizational priorities. The information in the pillars allow everyone to easily see what is important, the impact of the work that is being done, and the progress that is being made. Improvement work should be owned where the care is delivered, not in a committee meeting or on a dashboard. For example, under the quality and safety pillar, we have two strategic priorities: achieving zero harm and improving clinical outcomes. For a given inpatient unit, their local performance may lead them to focus on reducing their rates of hospital-acquired clostridium difficile infection; or they may focus on improving the care for patients with sepsis, stroke, heart failure, or specific post-operative conditions. Similarly, ambulatory practices might focus on differ-
ent solutions to improving their patient access; or their patient and provider/staff experience. The key is that the problem-solving and innovation is developed by the local teams, since all of you know best your patient populations, local culture, and needs. The goal then becomes sharing why a given area is performing well and allowing others to learn from them. This moves us to an environment of continuous learning and improvement – and embracing the spirit of becoming better versions of ourselves. How can we learn about our performance on True North metrics? We recently developed a UCSF Health True North Scorecard. The purpose of the scorecard is to communicate the priorities of our organization, highlight the key metrics that are guiding whether we’re successful, and encourage every inpatient unit, operating room, and/or ambulatory practice to align their improvement work towards True North. The February True North scorecard is on page five. We will continue to send it monlthy via email. A subset of the True North metrics each year will also serve as our institutional incentive goals. For 2016-17, these include improving the patient experience, reducing patient harm and reducing costs.
What is Lean and why are you hearing more about it? Lean can feel like the flavor of the month for doing improvement work if poorly understood. Many of you have perhaps participated in the “tools” Lean offers to unravel a complex process (e.g., value stream improvement) or problemsolve a big issue (e.g., A3 thinking). Lean in health care is far more than simply tools; it’s an entire operating system that allows us to devel3
op people, continuously improve and eliminate waste. To do so, it relies on engaging providers, staff and trainees at all levels to become expert problem-solvers by identifying local opportunities and solutions. UCSF Health isn’t adopting Lean; it’s adapting Lean principles and tools to provide us a reliable operating system for our organization. Rather than spending our time putting out fires, being confused about our goals, moving from one project to the next, and hiding our problems, we will be successful when we’re in a new system that focuses on planning ahead, working towards clear goals (e.g., True North), aligning and prioritizing our work rather than doing a stream of individual projects, and making our work visible (e.g., True North visibility boards in all units and practices). It’s an exciting time for change and just as all of you are committed about how best to care for patients during your training, we hope you’ll be equally committed in helping our system take better care of patients (and you!). How do I get involved in improvement work to help develop a better version of UCSF Health? There are many ways to learn about the work in your areas. A starting point might include seeking out a medical director of your practice or service, your division or department’s quality leader, or faculty you know are involved in improvement work. Learn about the problems they’re tackling, share problems that you’re seeing in your daily patient care responsibilities, and find ways to get involved. This might range from jumping onto an existing committee, task force, or project team; or helping organize and lead a new quality improvement initiative that is well aligned with the larger improvement opportunities of your clinical area. Over the coming year, we also hope that you’ll participate in the growth of “rounds” and “huddles” that will take place in front of visibility boards in every practice and inpatient unit. There are a number of places already practicing these behaviors to bring teams together for shared problem-solving.
What is the UCSF Health Improvement Poster Symposium? The opportunities to learn from each other, share best practices and innovations, and build a community for improvement work are critically important for our patients and the success of UCSF Health. The UCSF Health Improvement Poster Symposium provides a vehicle to recognize great work and foster our culture for continuous improvement. During our inaugural event in September, the poster session included more than 120 projects that led to tangible, measurable and sustained improvements by teams committed to improving patient care. Just as our metric-driven dashboards tell a certain narrative about our organizational performance, these projects add to that narrative in demonstrating that improvement work truly occurs everywhere. A significant number of the posters presented included trainees. We’ll look forward to encouraging your submissions and participation in the event next September!
Figure 2: 1st Annual UCSF Health Improvement Poster Symposium
In closing, it’s often cliché to state that the greatest asset of any organization is its people. If there is any place that has the people who will transform health care, it is UCSF Health. The stakes are high and the complexity is growing but the opportunities to make a difference have never been greater. All of you are the reasons why we’re confident that the future will be a better place for our patients at UCSF Health.
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True North Performance Scorecard February 2017 All data is UCSF Health West Bay unless noted otherwise
Patient Experience
FY16
Current Period
Would Recommend Hospital
58% (39/67)
60% (41/68)
Physician Communication
59% (41/69)
63% (44/70)
(% of units, practices, services improving)
(% of units, practices, services improving)
Quality & Safety Inpatient Mortality
Clinical Outcomes
(O/E index)
Sepsis Mortality Index (O/E index)
30-day All-Cause Readmissions (per monthly discharges)
0.89 1.12 11.60% 58% (5/9)
Harm Events
101 (monthly) 1,216 (FY16)
(actual # of harm events)
Staff
6.3
Net Income
*UCSF Health West and East Bay
(Adjusted for outpatient activity and acuity)
NA 86
< 11%
44% (4/9)
89% (8/9)
NCQA/HRSA 1st decile
622
*FY17 IAP Goal Threshold: eliminate 40 events Target: eliminate 50 events Outstanding: eliminate 60 events
* Detailed Harm Report on Back Page
FY17 Goals
Benchmark
Jan-17
February 2017 survey 6.9 Performance
($13.8M)
$4.4M Jan-17
$24,153
($13.9M) $24,259
$37.4M
118,547
Ambulatory Visits *Faculty Practices
Jan-17
Ambulatory Access (% of practices meeting unit goal)
NA
Inpatient Discharges
34,039
Length of Stay
1.10
(O/E index)
Average Daily Bed Opportunity (# of days created if LOS = 1.0)
Month
54
45% Jan-17 3,038 Jan-17 1.03 Dec-16 19 Dec-16
0.96 Vizient 1st decile 8.38% Vizient 1st decile
4.13 50th %ile Gallup Healthcare NA External Comparison 7.4 External Comparison
Month ($7.9M)
YTD ($50.2M)
Jan-17
($90.5M)
($26.1M)
($178.1M)
$23,356
*FY17 IAP Goal Threshold: $24,615 Target: $24,492 Outstanding: $24,369 Jan-17
*FY17 IAP Goal Threshold: $24,267 Target: $24,146 Outstanding: $24,024
FY17 Goals
Benchmark
117,386/824,183
9% increase compared to FY16
Performance FY16
Vizient 1st decile
FY17 Goals FY17TD
Jan-17
Strategic Growth
3.95
-12
Month
0.75
11.42%
Dec-15 FY16
Benchmark
1.08
-22
Net Income with actuarial adjustment for retirement benefits
Operating Cost per Case
Nov-16
FY17 Goals
1.10
February 2017 survey
UCSF Place to Work
Financial Strength
10.79%
*Detailed Experience Report on Back Page
0.84
3.82
Dec-15
(Net Promoter Mean Score: 1 to 10)
0.93 Dec-16
Benchmark
0.83
FY17
(Net Promoter Score: -100 to 100)
UCSF Place to Work
0.78 Dec-16
FY16
Gallup Engagement Survey (grand mean)
FY17TD
Performance
Provider
Our People
Month
FY17 Goals *FY17 IAP Goal Threshold: 60-74% Target: 75-79% Outstanding: > 80%
Performance FY16
Ambulatory Quality
(% of metrics meeting benchmark)
Zero Harm
Performance
FY17TD 805,140 52% 20,783
*FYTD17 Goal
80%
*Strategic Access: >75% seen in 14d *All Practices: ď&#x192;Ą 4% from FY16
2,905 / 20,248
6% increase compared to FY16
*FYTD17 Goal
1.07
<1.00
40
0
0.93 Vizient 1st decile -34 Vizient 1st decile
Learning Health System TBD
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Update from ZSFG Roger Mohamed Operations Manager
You may have heard we have a new name, it’s official - Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). Patients moved into this new state-of-the-art acute care and trauma center facility on May 21, 2016. Our new acute care inpatient building can be identified on campus as Building 25. This is a much more secure building where access to clinical work areas is more restricted than our previous inpatient care building. ID badge access will be required to access secured, staff clinical work areas. Only a DPH ID badge will grant you access to Building 25, your UCSF ID badge will not work.
ZSFG named a new CEO: Susan Ehrlich, MD. Dr. Ehrlich was herself a UCSF resident and trained at ZSFG. Prior to her appointment at ZSFG, Dr. Ehrlich served as the Chief Executive Officer, Chief Medical Officer, Vice President of Ambulatory Care Services, founding Medical Director of the Ron Robinson Senior Care Center (an interdisciplinary patient-centered medical home for older adults) and Assistant Health Officer for the San Mateo County Health System. She is a Lean-certified physician executive with extensive expertise leading and transforming public health care organizations serving diverse populations.
To be the best hospital by exceeding patient expectations and advancing community wellness in a patient centered, healing environment.
Building 25 - Hospital New Highlights:
Change in Space Culture
All space in Building 25 is considered shared, interdisciplinary space and not specific to any particular department. Each floor in Building 25 will contain desk space, computers and printers. Separate conference rooms are available for scheduling on each floor. Except for critical services, most call rooms will remain in Building 5 (former inpatient care facility). The Resident Lounge will remain in Building 5.
Virtual desktop access is available via Tap-n-Go system by using your DPH ID badge. • LCR, SALAR, eCW, Xeroviewer and other clinical application are accessible via the virtual desktop.
A New Building AND a New CEO!
Building 25 Vision
-284 Acute Care Beds • 58 critical care • Telemetry capable rooms -90% private patient rooms -58 Emergency Department room • 6 resuscitation rooms • Built in decontamination room • CTs and X-rays imbedded in the Emergency Department -13 Operating Rooms -Roof top garden and labyrinth -115 base-isolators will be able to glide 30 inches in any direction
Accessing computer terminals in Building 25
No More Physical Tokens
DPH has deployed DUO security, a software based twofactor token application that installs on a smart phone/ tablet (preferred) or can be setup to call your cell or landline phone in order to log in remotely to the DPH Web Application Portal. The physical Entrust remote access tokens will continue to work, but will no longer be required when using the new DUO. Requesting DPH remote access will continue to be done via the same process on the UCSF Account Request Form. For additional information and instructions, please visit: DPH Web Connect using DUO/ Soft Token (Windows) DPH Webconnect Using DUO/ Soft Token (Mac)
We look forward to seeing you all at the Zuckerberg San Francisco General Hospital and Trauma Center!
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GME Diversity Update Michelle Guy, M.D. Director of Diversity, Graduate Medical Education
Diversity Advisory Group:
UCSF is committed to creating and fostering a diverse working environment for faculty, trainees and staff. Recruitment and retention of a diverse group of residents is an important part of this mission, particularly recruitment of residents who are underrepresented in medicine (UIM) relative to their numbers in the general population. While UCSF has taken steps toward improving recruitment strategies of UIM residents including funding 4th year elective rotations, and the Diversity Second Look Day, a number of residents note that outside of the recruitment process, they feel a lack of community and support during residency. While some of the larger residency programs like Internal medicine, have been able to create their own diversity support groups within their programs, many other departments lack the number of UIM residents to support programming of their own. Furthermore, many residents wish that they had opportunities to meet and network with residents in other departments. This group will be run by residents with support from the GME. The primary purpose of this group would be to foster community and a supportive working environment for UIM residents through advising, career planning, mentorship, fellowship and community outreach.
GME Second Look Diversity Event: Our annual Second Look Diversity Event for residency program applicants will be held on Friday, January 27th, 2017. In addition to learning more about our training programs, the Second Look program provides applicants with the opportunity to meet campus leaders committed to promoting diversity at UCSF. A panel discussion with housestaff and fellows will be held in the afternoon followed by an evening reception.
Residents at UCSF Diversity Reception
National Meetings: Upcoming annual and regional meetings include: Student National Association Annual Medical Education Conference in Atlanta, Georgia on April 12th-17th, 2017. Latino Medical Student Association National Conference in Hempstead, New York on April 7th-9th, 2017
Interested in being a part of the Diversity Advisory Group? Please contact Michelle Guy, MD at Michelle.Guy@ucsf.edu or Alexis Stanley at Alexis.Stanley@ucsf.edu for further information!
Residents at UCSF Diversity Reception
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10 Questions from the Resident and Fellow Affairs Committee 3) What happens to the money in my retirement account? Is it automatically invested, and if so, how is the investment chosen? You direct how your contributions are invested by setting an investment selection for your contributions. If you don’t select investments, your contributions to your DC Plan account are automatically invested in the UC Pathway Fund closest to the year you turn age 65.
Joe Hager, a Fidelity Director, Retirement Planner, answers resident and fellow questions about the UC Retirement Savings Program, retirement investing and planning. Joe has more than 9 years with the company. He was previously a Sr. Retirement Counselor for Fidelity Retirement Services. A registered securities representative, Joe holds a bachelor’s degree in Economics and Political Science from Boston University.
1) Is money automatically being placed into my UC retirement account each month? Yes, you are automatically enrolled in Safe Harbor, UC’s Defined Contribution Plan (the “DC Plan”). In lieu of contributions to Social Security, residents and fellows contribute 7.5% of each paycheck into the DC Plan on a pretax basis.
2) What is a safe harbor and why is it important? The safe harbor provision is necessary to satisfy state and federal requirements. With safe harbor, certain University of California employees who are not otherwise covered by a retirement system contribute to the University of California Defined Contribution Plan (the DC Plan or the Plan) in lieu of paying Social Security taxes. The DC Plan is qualified under section 401(a) of the Internal Revenue Code (IRC) and is part of the UC Retirement Savings Program, Fidelity Retirement Services provides recordkeeping services. Additional information on the plan is available online www.myUCretirement.com. Select the ‘UC Retirement Benefits’ tab and scroll to ‘Savings’ link.
4) What are my investment options within the UC Retirement Savings Program? The updated fund menu consists of professionally managed funds that are monitored by the Office of the Chief Investment Officer of the Regents (CIO), including: • UC Pathway Funds—each fund has a diversified mix of assets with a target allocation that adjusts over time as each fund approaches its target date; and • An updated menu of 15 additional investment funds representing a comprehensive range of asset classes. If you are comfortable researching and choosing investments and want the widest range of choices, then Fidelity BrokerageLink®, combined with other funds on the fund menu, may be appropriate for you. How does BrokerageLink work? Put simply, BrokerageLink is an account within your UC 403(b), 457(b), or DC Plan that gives you access to thousands of mutual funds available through Fidelity FundsNetwork®. BrokerageLink includes investments beyond those in your plan’s lineup. The plan fiduciary neither evaluates nor monitors the investments available through BrokerageLink. It is your responsibility to ensure that the investments you select are suitable for your situation, including your goals, time horizon, and risk tolerance. See the fact sheet and commission schedule for applicable fees and risks. To learn more about asset allocation and diversifica-
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tion, attend the “Building a Portfolio for any Weather” class, www.myUCretirement.com/classes BrokerageLink includes investments beyond those in your plan’s lineup. The plan fiduciary neither valuates nor monitors the investments available through BrokerageLink. It is your responsibility to ensure that the investments you select are suitable for your situation, including your goals, time horizon, and risk tolerance. See the fact sheet and commission schedule for applicable fees and risks. To learn more about asset allocation and diversification, attend the “Building a Portfolio for any Weather” class, www.myUCretirement.com/classes
5) What if I’m not sure where to invest? The UC Pathway Funds let you make a single fund choice based on the year you expect to begin withdrawing money from the plan. The fund provides automatic reallocation based on the fund’s target date, growing more conservative as they near that retirement target date. Note: The investment risks of each target date Pathway Fund change over time as the Fund’s asset allocation changes. Assets held in the Pathway Funds are subject to the volatility of the financial markets, including equity and fixed income investments in the U.S. and abroad and may be subject to risks associated with investing in high yield, small cap and foreign securities. Principal invested is not guaranteed at any time, including at or after their target dates.
6) What other opportunities do I have to save for retirement? As an employee of the University of California, you can also participate in the other plans in the UC Retirement Savings Program: the Tax-Deferred 403(b) Plan and the 457(b) Deferred Compensation Plan. These plans are not available to trainees who normally work fewer than 20 hours per week. Additional information is available online www.myUCretirement.com
7) What is the difference between the 403(b) and 457(b) plans?
The key difference between the two plans is how you can access your money. It may boil down to when you expect to leave UC and the flexibility you need in access your money. With the 403(b) Plan, you have access to the funds in your account while you are still employed via a loan or a “hardship” withdrawal (if you meet the plan requirements). Also, you can take an “in-service” distribution at or after age 59-1/2. If you separate from employment and take a withdrawal from the 403(b) Plan prior to age 59-1/2, you will generally incur a 10% early withdrawal penalty in addition to being taxed (since this money is pre-tax money), unless you terminate during or after the year in which you reach age 55, or another exception applies. With the 457(b) Plan, once you separate from the University you can access your funds without tax penalties. In-service withdrawals for “unforeseeable emergencies” are available (if you meet the plan requirements), but loans are not. In-service distributions are available in and after the calendar year you reach age 70-1/2. A small ($5,000 or less), one-time, in-service withdrawal is available under certain circumstances. See the 403(b) Plan and 457(b) Plan Summary Plan Descriptions (SPDs) for more information about these plans. The SPDs can be found online at www. myUCretirement.com. To access the SPDs, click on ‘UC Retirement Benefits’ tab and scroll to ‘Savings’.
8) Can I enroll anytime in the retirement plan? Can I make changes anytime in my retirement plan? Eligible participants may enroll in the UC Retirement Savings Plan at any time by calling 1-866-682-7787 or online at www.myUCretirement.com. Changes to investments can also be done over the phone or online. Participants should consider any potential short term trading policy their investment options may have prior to changing investments.
9) What happens to the money in my retirement fund when I leave UCSF? 9
If you leave UC employment, you may: • Keep your money in the Plan if your balance is at least $2,000; • Arrange for a direct rollover of your money to a traditional or Roth IRA or another employer plan that accepts rollovers; • Request a distribution to be paid directly to you. Participants who leave UC employment and have a balance of less than $2,000 in the Plan cannot leave their money in the Plan. Account balances of $1,000 or less will automatically be distributed at the end of the quarter to participants who have not provided distribution directions. Balances greater than $1,000 but less than $2,000 will be rolled over into an IRA in the participant’s name unless the participant provides distribution directions. A participant whose balance is defaulted to an IRA will be notified of the default and the name of the IRA custodian. It is important that you maintain your address records to assure delivery of your distribution.
12) What resources are available to learn more about the UC Retirement Savings Program and financial education in general? UC offers a variety of Financial Education Classes at various UCSF campus locations as well as webinars. You may attend any of the Financial Education Classes offered at UCSF, at no cost to you. To view the class reschedule and register: Online: Go to www.myUCretirement.com/classes. Over the Phone: Employees can call 866-682-7787 between 5am PST and 9pm PST Resources: Fidelity: 866-682-7787, www.myUCretirement.com UC Retirement Savings Program: https://www.myUCretirement.com/UCRetirementBenefits/Savings
Before investing in any investment option, please carefully consider the investment objectives, risks, 10) Can I roll over retirement savings from a pre- charges, and expenses. This document and other information on the UC Retirement Savings Program vious plan? Fund Menu is available, free of charge, online at Yes, rollovers of eligible assets from tax-deferred retire- www.myUCretirement.com or by calling Fidelity® ment plans are allowed into the UC Retirement Savings Retirement Services at 1-866-6UC-RSVP (1-866682-7787). This document and other information on Program. For assistance with potential rollovers, call mutual fund options that are part of the UC Retire800-558-9182. ment Savings Program Fund Menu and other mutual funds outside the UC Retirement Savings Program Be sure to consider all your available options and the Fund Menu can be found in each mutual fund’s applicable fees and features of each before moving prospectus, or, if available, a summary prospectus, your retirement assets. which can be obtained, free of charge, at the same Web site and toll-free phone number. Read the infor11) Is it appropriate to be contributing to retiremation carefully before you invest. ment while I’m still paying off student loans and other debt? How should I balance these obligaInvesting involves risk, including risk of loss. tions? Prioritization of debt versus savings is case specific to the individual. Factors to consider include interest rates, deductibility of interest, tax status and future financial goals.
© 2016 FMR LLC. All rights reserved. Fidelity Brokerage Services LLC, member NYSE, SIPC, 900 Salem Street, Smithfield, RI 02917 599544.2.0
To learn more about prioritizing your debt, attend the “Create a budget, ditch your debt, and start Building for the Future” class. To register for a class, go to www.myUCretirement.com/classes.
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Out & About from the Resident and Fellow Affairs Committee Latin Dancing in the Bay By: Erica Manrriquez, Amaranta Craig, Peter Movilla, Gisela Villagomez, Claudia Diaz San Francisco is a mecca of many things, in this particular case, of Latin music and dance. There are many subcultures and nuances to the Latin music world, but one theme is consistent – there is a magic that is difficult to fully define. It may partly be explained by the frequent lyrical nod to Latin American history, traditional instruments and legendary figures. Or perhaps it’s the appreciation of rhythm as art and the ability of the human body to express joy through movement. Whatever the reason might be, if you are looking to let loose, a boost of energy or even just to feel more alive, let us recommend a few places to indulge in the spicy dance culture that is to be had in the city by the Bay. Most of these venues provide a wide variety of Latin music, so it bears a quick lesson on the more popular genres. For many people, “salsa” is what comes to mind when thinking about Latin music, and indeed, this is a hugely popular style of dance in the US. While there is controversy regarding its country of origin, salsa has evolved greatly over the years under the influence of multiple Latin America countries. Even within the US, there is a different style danced in New York vs California for example. For CA purposes, we tend to dance “On1,” which essentially means a “step, step, pause…step, step, pause” pattern giving you 6 steps per 8 beats. But more on that during your first salsa escapade. Merengue, a faster-paced percussive music originally from the Dominican Republic, is another popular dance style. It can sometimes be difficult to tell the difference between merengue and salsa music, but the important take home is that merengue tends to require less concentration. This is a one step per beat tempo, which may be less intimidating for the new dancer.
Lastly, bachata is another fan favorite. This sensual dance also from the Dominican is strikingly different than either salsa or merengue. It is the ultimate Latin “slow dance” and truly is an art to watch. With that in mind, some of our favorites are below: Cigar Bar A Mediterranean-inspired bar in Jackson Square that hosts a variety of live bands Thursday through Saturday. No cover before 10pm, a great place for beginners and a particularly great spot for merengue. The Ramp A rather unassuming spot on Mission Bay that looks, for all intensive purposes, like a casual seafood restaurant from the outside. But don’t be fooled! Live salsa (and occasionally samba) really change the atmosphere. Also a great place for beginners. Pura Nightclub And lastly, if you’d like to up the ante, Pura Nightclub in SoMa is a prime destination for Latin dancing. This place is not for the faint of heart as it boasts 5 different dance floors in a space >10x the size of your average resident’s apartment. Whether you’re in the mood for a more traditional evening of merengue a la Tono Rosario or salsa a la Celia Cruz, or you’d like to change the pace up with some bachata or reggaeton, Pura has it all. Cover is steep but come alone or with a group. There are excellent dance partners and fun to be had. Enjoy!
Photo 1. Natsai Nyakudarika, Ono Nseyo, Amaranta Craig, Peter Movilla, Jensara Clay (OB/GYN R3s)
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Out & About from the Resident and Fellow Affairs Committee Tech Shop and Hands-on Workshops in the Bay By: Maxim Ritzenberg, MD PGY-4, Emergency Medicine
I’m not a huge TV medical drama buff, though I did start watching The Knick recently and made a disturbing revelation: I may have been born 100 years too late. As I watched the central character, a surgeon, forging steel into a newly-devised surgical tool and then using it on his patient the next morning, I thought to myself, “why can’t I do that on my next shift?” For someone like myself with a background in the arts, the transition to being a physician has been difficult with respect to keeping myself creatively challenged on a daily basis. In order to continue to flex the creative part of my brain, I have gone searching for other hobbies and activities outside of the Emergency Department that allow me a creative outlet. I’ve always been someone with a dozen different projects in the pipeline. As residents, time is a limiting factor when it comes to having interests, projects and pursuits outside of the hospital. However, another limitation for me has been project space. I know, I know, it is hard to believe that in San Francisco, a city famous for being an incredibly affordable city, where a square foot of floor space is basically growing on trees, that space would be an issue, but it is! For years I had been following the growth of TechShop, my new solution to the space issue. As a way to take back the half of our living room that I had usurped for my projects, my wife got me a membership to TechShop. TechShop takes the idea of a gym membership and translates it to the Do-It-Yourself (DIY) world, for those of us more interested in using a Drill Press than a Bench Press. With hundreds of thousands of dollars worth of equipment and plenty of table space for laying out your project, TechShop takes care of two limiting factors in any DIYer’s life: project space and expensive equipment. Founded in 2006 in Menlo Park, the spirit of TechShop is to make project completion and expensive tools accessible to anyone. Through their Safety and Basic Use classes, you are given the opportunity (and are required!) to learn the basics of each of the tools in the shop before using them. This gives you a great starting off point and confidence to work towards mastery of the tool. So far, I’ve been having adventures in the wood shop. Though I’ve done many construction projects in the past, they have always been limited to the tools that my friends or I own. Now, with my TechShop membership, I have access to tools I never imagined owning, nor would have space for. Once you have taken an SBU class, you’re all set to use that tool anytime it’s available. 12
Out & About from the Resident and Fellow Affairs Committee Though being a resident can be detrimental to your social life, our schedule can be advantageous to projects at TechShop, since they are open 24/7 (after a string of night shifts, who doesn’t want to spend their next sleepless night working on carpentry instead of tossing and turning in bed?!?). I find the tools are most often available during the day and late at night. Once you are approved on equipment, you can sign up for times on the tool or sometimes just walk in and start working. So far, I’ve worked my way through the woodshop, perfecting my cuts and learning to measure twice and cut once. I’m starting to take on more ambitious projects as my confidence with the tools has increased. Next stop for me is their metal shop. During college, I did some welding and I look forward to throwing back on my welding helmet and re-learning! After metal, I plan to work my way upstairs and take on some electronics work, laser cutting and AutoCad, all of which is included in TechShop’s array of state-of-the-art equipment and classes. TechShop access is on a monthly basis, with membership costing $150 and classes ranging from $50 - $100 each. http://www.techshop.ws/ 926 Howard Street San Francisco, CA 94103 Phone: (415) 263-9161 Email: info.sf@techshop.com Another workshop space I’ve come across is Workshop SF, closer to the Moffitt and Mt. Zion Campuses. Though they don’t offer access to tools at all hours of the day, their philosophy is to offer classes which make home DIY more accessible. With classes ranging from sewing and screen-printing to cooking classes and cocktail-making, Workshop SF teaches DIY skills for home-based projects. http://www.workshopsf.org/ Address: 1798 McAllister Street @ Baker San Francisco, CA 94115 Email: info@workshopsf.org Phone: (415) 874-9186 My last set of recommendations is to where to get supplies. Though I’m famous for walking into Home Depot, blacking out and then re-emerging 8 hours later with a cart full of supplies, for the DIY crafts-person, Home Depot, Lowes and other large hardware stores are not generally your best bet. For woodworking supplies, I’ve become obsessed with MacBeath Hardwood. With several warehouses full of beautiful rough-cut wood, boxes of wood scraps and knowledgeable staff, it’s become my go-to for wood. And it’s a direct ride on MUNI from SFGH! My other favorite stores to get lost in are Blick and Flax, both on Market Street, and both stacked to the ceiling with craft and art supplies to inspire your creative side. Blick: 979 Market St Phone: (415) 348-8600 Flax: 1699 Market Street Phone: 415-552-2355 13
2015-2016 Honors and Recognition for Housestaff UROLOGY
Best Poster
2016 Exceptional Physician Award
Michael Leapman, MD
Tom Chi, MD
2016 Conquer Cancer Foundation of the Ameri2015 California Urology Foundation Research
can Society of Clinical Oncology, Merit Award
Grant
Michael Leapman, MD
Clarissa Chu, MD
2015 Outstanding Abstract Selected for Oral 2015 Western Section AUA Travel Award
Presentation: UCSF Prostate Cancer Research
Clarissa Chu, MD
Program Michael Leapman, MD
2015 Krevans Award Claire de la Calle, MD
2015 American Urological Association (AUA) Western Section History Essay Contest, First
2015 California Urological Foundation
Place Award
Grant Recipient
Michael Leapman, MD
Matthew Truesdale, MD
2015 Joseph F. McCarthy Physician Essay 2015 Teaching to Choose Wisely Grant Recipi-
Contest, AUA Western Section,
ent
Third Place Award
Matthew Truesdale, MD
Michael Leapman, MD
2015 2nd Place in Clinical Sciences Divisionâ&#x20AC;&#x201C;
NEUROLOGICAL SURGERY
42nd Annual Northern California Research
Charlie Kuntz Scholar Award, AANS/CNS Joint
Seminar
Section on Disorders of the Spine and
Matthew Truesdale, MD
Peripheral Nerves Spine Summit 2016 Andrew Chan, MD
2016 UCSF Pathways to Discovery Travel Grant for the Western Group on Educational Affairs
Charlie Kuntz Scholar Award, AANS/CNS Joint
Matthew Truesdale, MD
Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2016
2015 1st Place in Miley B Wesson Resident Es-
Darryl Lau, MD
say Contest-Western Section AUA 91st Annual Meeting
Depuy Synthes Award for Resident Research on
Matthew Truesdale, MD
Spinal Cord and Spinal Column Injury John Burke, MD
2016 European School of Oncology, 3rd Conference on Active Surveillance,
UCSF Excellence and Innovation Award in 14
2015-2016 Honors and Recognition for Housestaff Graduate Medical Education
2016 Exceptional Physician Award
Corinna Zygourakis, MD
Maria Beylin, MD
UCSF Sustainability Award from Chancellor for
INTERNAL MEDICINE
Project on OR Waste
2016 Exceptional Physician Award
Corinna Zygourakis, MD
Richard Jacobs, MD
UCSF Health “Great Save Award”, Award from
RADIOLOGY
CEO for OR Surgical Cost Reduction Project
2016 Exceptional Physician Award
Corinna Zygourakis, MD
Lorenzo Nardo, MD
UCSF Center for Healthcare Value Fellowship
PEDIATRICS
Corinna Zygourakis, MD
2016 Exceptional Physician Award Biljana Horn, MD
Naffziger Award for Outstanding Clinical Resident, UCSF Neurosurgery Department
2016 Exceptional Physician Award
Corinna Zygourakis, MD
Scott Soifer, MD
UCSF CTSI Catalyst Award, Development of
2016 Exceptional Physician Award
Doctor Mobile App that Decreases Costs
Lan Vu, MD
Corinna Zygourakis, MD
UCSF Medical Center “Great Catch for Patient
NEUROLOGY
Safety Program”
UCSF/SFGH Emergency Medicine Residency
Peter Cooch, MD
Program Medical Consultant of the Year Award Kevin Keenan, MD
OBSTETRICS & GYNECOLOGY Jim Green Award
R25 Research Award
Sigrid Williams, M.D., M.P.H.
Claire Clelland, MD
SFGH Julius R. Krevan’s Award for Clinical R25 Research Award
Excellence
Jonathan Kleen, MD
Zoë Julian, M.D., M.P.H.
ANESTHESIA
SMFM Resident Award for Excellence in
2016 Exceptional Physician Award
Obstetrics
Matt Aldrich, MD
Sarah Isquick, M.D.
EMERGENCY MEDICINE
Special Resident in Minimally Invasive 16
Gynecology
Most Outstanding Fellow Award
Mzimeli Morris, M.D.
Biftu Mengesha, M.D.
UC Criminal Justice & Health Consortium
Best 2nd Year Teaching Resident Award
Andrea Knittel, M.D., Ph.D.
Natsai Nyakudarika, M.D.
UCSF CTSI Spring 2015 Resident Research
American Society for Reproductive Medicine In-
Funding Award
Training Travel Grant
Elissa Serapio, M.D., M.P.H.
Molly Quinn, M.D.
Best Poster Award
Vivere Health Scientific Advisory Board Re-
Elissa Serapio, M.D., M.P.H.
search Grant Molly Quinn, M.D.
Best Oral Presentation - Self-reported racial/ ethnic classification and rates of preterm birth
Outstanding Fellow Award in Medical Student
among women with chronic hypertension in
Teaching
pregnancy
Erin Washburn, M.D.
Ashish Premkumar, M.D.
Pacific Coast Reproductive Society Annual MeetSociety for Academic Specialists in General
ing Scholarship
Obstetrics and Gynecology, Rising Star
Lusine Aghajanova, M.D., Ph.D.
Julia Newman, M.D.
IntegraMed Fertility Research Grant for REI FelFogarty Award for Uganda Research
lows
Megan Swanson, M.D., M.P.H.
Lusine Aghajanova, M.D., Ph.D.
Felix Rutledge Fellow
NAMS/Pfizer Medical Resident, Fellow, & DNP In-
Amaranta Craig, M.D.
Training Reporter Award Eleni Greenwood, M.D.
Best Midwifery Consultant Award Marron Wong, M.D.
Clinical Research Fellowship and Mentor Award in Womenâ&#x20AC;&#x2122;s Health
The Ryan Program Resident Award for
Asima Ahmad, M.D.
Excellence in Family Planning Colleen Denny, M.D.
Pacific Coast Reproductive Society in-Training Scholarship
Best 2nd Year Teaching Resident Award
Asima Ahmad, M.D.
Martha Tesfalul, M.D.
15
FEBRUARY 2017
Safety Bulletin Stories and safety improvement updates for providers at UCSF Medical Center
Inappropriate Prescribing
At UCSF, there have been multiple instances of inappropriate physician prescribing, some resulting in significant consequences for the provider. Providers should be aware that legally, a physician is not permitted to prescribe medications without previously examining the patient and without a medical indication. In addition, the law requires that the physician document the medical indication for the prescription in an official medical record which reflects the existence of a therapeutic provider-patient relationship.
Secure Prescribing at UCSF
Examples of Inappropriate Prescribing at UCSF
Case 1: A provider was found to be self-prescribing a controlled stimulant using UCSF secure prescription pads. A subsequent investigation by law enforcement revealed that the provider was prescribing to fictitious patients with the likely intent to distribute. The provider was terminated from the medical staff and suspended from practice by the California Medical Board. Case 2: A provider is under investigation by law enforcement for suspicious opioid prescribing practices using UCSF secure prescription pads. He was terminated from the medical staff and California Medical Board action is pending.
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At UCSF Health, secure prescriptions must be prescribed electronically using Apex linked to a printer with secure prescription paper
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Secure prescription pads are no longer allowed at UCSF Health
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All unused secure prescription pads must be destroyed according to policy, which includes both documentation on a destruction log and shredding (please contact your clinic administrator for assistance)
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The Administrative Director, or designee, in each ambulatory clinic will be responsible for monitoring the use of secure prescription paper to assure its proper use
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Downtime procedures are in place for times when Apex or Apex printers are not functioning
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Rare exceptions to the elimination of secure prescription pads will need to be directed to Ambulatory Operations
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See email contacts below for questions
Case 3: A provider was prescribing medication for a significant other. The California Medical Board subjected the provider to disciplinary action.
UCSF Prescription Security Policy
UCSF recently adopted a new policy regarding the use of secure prescription forms (secure pads and secure paper used to order Schedule II-V Controlled Substances). The full policy is available at: https://ucsfpolicies.ucsf.edu/Shared%20Documents/MedMgmtPrescriptionS ecurity.pdf The policy is designed to eliminate the use of secure prescription pads after April 1, 2017. Refer to the blue box on the right for the main points contained within this policy. All prescriptions, secure and non-secure, should be entered in to Apex, and either electronically transmitted to the receiving pharmacy via Apex or printed from Apex and handed to the patient.
Resources for Providers
UCSF has numerous resources for providers who may need support for substance use disorders. Providers are advised to contact the Physician Well-Being Committee and the Faculty, Staff Assistance Program: http://academicaffairs.ucsf.edu/impairment.php
From UCSF Medical Center leadership. Editor: Adrienne Green MD (Professor of Medicine, CMO). Please contact Adrienne Green at Adrienne.Green@ucsf.edu, Susan Smith at Susan.Smith2@ucsf.edu, or Shirley Kedrowski at Shirley.Kedrowski@ucsf.edu with questions. Disclaimer: Certain details of cases have been altered to protect provider confidentiality.
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The Physican’s Existential Dilemma Ana Dolatabadi, Psy.D., M.A.
The physician’s encounter with patient suffering and death inevitability tugs at the existential nature of one’s own mortality. This can cause inner conflict which may originate from the intrinsic and inescapable experience of death and the human being’s existence in the world relating to meaning, purpose, and value. Aase, Nordenhaug & Malterud (2008) reported that most physicians could deal with patient death but “mostly keep it at a distance” especially since vulnerability was perceived as “a burden to be handled” (pg. 768). Physicians can have strong emotional reactions to patients’ death. Greif-related job stress can lead to burn-out, which on average affects more than 50% of physicians (Medscape Lifestyle Report, 2013). By confronting one’s own existential anxieties there may be more of a capacity to address patient anxieties and better process and cope with patient death. You may still be asking yourself, why entertain this dark, scary, and unavoidable aspect of life when I don’t even have time to do laundry? The fear of having to investigate overwhelming negative feelings could dissuade you from internal investigation. The conscious exploration of this matter can often be ignored in developing and seasoned physicians alike due to time and space. This may result in a continuous undercurrent of “death” anxiety or perhaps, occasions of unruly eruptions of fear unconsciously manifesting itself in various forms. Death anxiety refers the fear of and anxiety related to the anticipation, and awareness, of dying, death, and nonexistence (Gellman & Turner, 2013). This anxiety can also contribute to symptoms of worry, depression, and stress. Confronting your own mortality and existential anxieties can help to reduce stress and, suffering, and allow you to reenter life in a richer, more meaningful, and compassionate way. Furthermore, it can make you feel more connected to your patients and their family’s experiences of losing a loved one.
For the growing physician, adjustment to medical culture and evolving professional identity- moving from student to expert- is in development. Combining this process with the increased exposure to patient suffering and death can potentially make it even more difficult to address existential anxieties and can result in prioritizing career enhancement over emotional and psychological well-being. Unhealthy coping strategies such as overworking, needing to control, and having a sense of personal omnipotence may arise in efforts to achieve symbolic immortality, defined as a quest to obtain a sense of continuity or imperishable legacy in efforts to stay connected to human life even after death (Lifton & Olson, 1974; Yalom, 1980). Physicians may also absorb the identity of being ‘godlike’ and ‘all-powerful’ when patients place them in that role in efforts to cope with their fears. The more ‘godlike’ one believes themselves to be, the more one views the self as immortal, reinforcing the denial of one’s own death.
So where do we begin? 1) Acknowledgment that it is frightening to take a hard look at our death and existential anxieties. If we can acknowledge our anxieties with courage we have an opportunity to attend to our existential thoughts and behaviors, bringing it out of the shadow of our experience. 2) “Meaning is something to be found, not given. Man cannot invent it but must discover it” 18
(Yalom, 1980). When facing our own mortality and finitude of our human experience we may ask ourselves, why am I here? What gives my life purpose? What do I want from life? Where is the source of meaning for me in life? And in contemplation of these questions we can look at the current forecast of our experience and further ask ourselves, do I like the direction of my life? Am I pleased with who I am? Am I aligned with my values or is it time to let go of values that no longer serve me or are out of alignment with what makes me feel alive? 3) One avenue to meaning is found through interpersonal relationships with family, friends, colleagues, romantic partners, community, and even our patients. We impact those around us and are interconnected to the world and the lives of others. This knowing can remedy our sense of isolation or loneliness. In contemplation of this we may realize this is an area in our life we want to enhance. Finally, seeking counseling services and working collaboratively with a professional can provide a supportive environment to explore existential thoughts, feelings and experiences both personally and professionally. If you are interested in setting up an appointment through the Faculty & Staff Assistance Program, please call 415-476-8279.
Citations:
Aase, M., Nordrehaug, J. E., & Malterud, K. (2008). “If you cannot tolerate that risk, you should never become a physician”: a qualitative study about existential experiences among physicians. Journal of Medical Ethics, 34(11), 767-771. Gellman, M. D., & Turner, J. R. (2013). Encyclopedia of behavioral medicine. New York, NY: Springer. Lifton, R. & Olson, E. (1974). Living and Dying. New York: Praeger. Medscape Lifestyle Report. (2013). Physician lifestyles – linking to burnout: A Medscape survey. Retrieved from http://www.medscape.com/features/ slideshow/lifestyle/2013/public#1 Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books Yalom, I. D. (2008). Staring at the sun. San Francisco, Ca: Jossey-Bass.
Faculty & Staff Assistance Program Finally, seeking counseling services and working collaboratively with a professional can provide a supportive environment to explore existential thoughts, feelings and experiences both personally and professionally. If you are interested in setting up an appointment through the Faculty & Staff Assistance Program, please call 415-476-8279.
As members of the UCSF Campus and Medical Center community, the Faculty and Staff Assistance Program (FSAP) invites all faculty, staff, residents, postdocs, and clinical fellows to use our confidential employee assistance services, which are provided at no cost. They are staffed by licensed psychologists and postdoctoral trainees who provide confidential, brief counseling to individuals and a wide variety of consultation services to the organization. To schedule an appointment, call our main line at (415) 476-8279 and someone will assist you immediately.
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The Residents Report Editorial Staff:
Robert Baron Amy Day Alexis Stanley
UCSF School of Medicine
Graduate Medical Education 500 Parnassus Avenue, MU 250 East San Francisco, CA 94143
GME Contacts Main Line:
(415) 476-4562
Amy Day, MBA Director of GME (415) 514-0146 Robert Baron, MD, MS
Associate Dean, GME baron@medicine.ucsf.edu
GME CIPHER Instructions: Below is an encoded quote from a famous person. Solve the cypher by substituting the letters. Send your answers to Alexis.Stanley@ucsf.edu. Corrent answers will be entered into a drawing to win a $50 gift card! “QDRREKBAA NDK BB XJDKd BvBK EK WQB dDHkBAW JX WEZBA, EX JKB JKEM HBZBZBBHA WJ WDHK JK WQB EEgQW.” REBDA HDZBEBdJHB
GME Confidential Help Line: ((415) 502-9400GME
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