Spring 2016
10 Questions .... Emotional Intelligence
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Out & About... Open Water Swimming
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Out & About .... Theatre in the Bay Area
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The Residents in this issue Tips from the UCSF Library 1 Sepsis Screening 3 GME Diversity Update 5 10 Questions from RFA 6 Lexicomp Access 9 Out & About 10 Update from ZSFG 14 UCSF GME Awards 15 Self-Compassion 16 QI Incentive Update 18 Housestaff Awards 20 Patient Safety Bulletin 23 GME Cypher 24 Sustainability Box 24
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Report
Top Tips from the UCSF Library Kemi Amin, Julia Kochi, and Evans Whitaker, UCSF LIbrary The Library asked our Education & Information Librarian for Medicine, Evans “Whit” Whitaker if he had any tips for residents at UCSF. The following is Whit’s list of need-to-know tips to help make life as a resident a little smoother, and just maybe a little more…fun:
to get to full text. Find it here tiny.ucsf.edu/ ezproxy click and drag the bookmarklet to your browser tool bar. If you run into a pay wall when trying to read an article, click the bookmarklet and you will be prompted to sign into MyAccess. While we’re at it, bookmark library.ucsf.edu, pubmed. ucsf.edu, uptodate.ucsf.edu for one click access to UCSF Library’s versions of these resources.
Remote Access
Mobile Library
Add the “Reload via EZproxy” bookmarklet to cut down on the number of clicks needed
Looking to go mobile with your databases? UpToDate has an app that works well on Continued on page 2
mobile devices. Visit our Mobile Library guide (guides.ucsf.edu/mobile) for a list of the Library’s mobile-friendly resources.
the Mission Hall building has booth seating, walkstations, and a white board wall to spark social relaxation and collaboration.
New Video Journal Check out JOMI, a video journal of surgical procedures. It is new with a limited amount of content for now, but it is extremely well done and growing fast. For all you procedural people it is worth a look. We are subscribing now but sustaining our subscription depends on usage. If you like it vote with your clicks on the JOMI site and spread the word! Quiet Study and Sleepy Busy schedules and high demands call for a little peace and quiet. The Library has quiet study areas at Parnassus and comfy armchairs that look out over Golden Gate Park if you need a quick nap. At Mission Bay use The Hideout in the Mission Hall building. Social Studies
The Mission Bay Hub and Hideout are located within the Mission Hall Learning Commons and are accessable 24/7 with your UCSF ID
Where to Get Help That’s what we are here for, so, go ahead, ask us! We can meet with your residency group and we can also meet with any of you one-on-one. Can’t find the information you seek? The Library can help you with finding full-text, provide advice about subjects like PubMed or EndNote and much more. Evans Whitaker is your Library liaison and you may contact him directly at evans.whitaker@ucsf.edu. You can visit the UCSF’s library Medical Education Guide at http://guides.ucsf.edu/meded.
Caffe Central is now open in the Parnassus Library from 8am - 6pm (Mon- Fri)
The Living Room area of the Parnassus Library is open library business hours for your coffee and food (Caffe Central), lounging and popular (nonmedical) reading needs. It’s a great for meet-ups, conversation, casual gatherings or a place to relax away from the hospital. Need social space at Mission Bay? We got you covered. The Hub in
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UCSF Library at the Parnassus Campus
Sepsis Screening at UCSF: Utilizing Technology to Improve Outcomes Mary Cook Sullivan RN, MS, CNS Sepsis Project Manager In 2012, UCSF Medical Center launched a sepsis process improvement initiative with the goal of decreasing sepsis-related mortality. It was started in the Emergency Room and four inpatient units (9 ICU, 13 ICU, 14 Long, and 14 Moffitt) on the Parnassus campus. Prior to initiation, an interdisciplinary team was assembled and given the task of determining a process to identify patients who were exhibiting signs of sepsis in its earliest stages. A paper-based screening tool was developed, tested, optimized, and re-evaluated to ensure validity, reliability, and alignment with clinical workflows. In addition, a Code Sepsis response team was created to meet early goal-directed therapy for those patients with severe sepsis/septic shock. This process of “calling a Code Sepsis� included an emergent page initiated from the bedside nurse utilizing Pagerbox in order to bring a team of experts to the bedside to assist in patient assessment and timely implementation of the UCSF sepsis bundle elements. The Code Sepsis team experts include an ICU nurse practitioner, the Rapid Response Team, and a pharmacist. During the time inpatient processes and the workflow were being developed, the Parnassus emergency department (ED) launched an electronic screening tool for sepsis using a sepsis Best Practice Alert (BPA) in APeX. After a few iterations and learned lessons, the ED incorporated the alerts into everyday practice and has had great success with the early detection of sepsis and early implementation of the UCSF sepsis bundle care elements. In June of 2013, the interdisciplinary team reconvened and worked on adapting the paper screening tool into a sepsis BPA within APeX. The inpatient electronic alerts were based on the successful ED model. Currently, clinical data (vital signs, laboratory values, and nursing documentation)
is continuously scanned within APeX for the early signs and symptoms of severe sepsis/septic shock. Once a threshold is met, a Sepsis BPA is triggered to warn clinicians of the possibility that a patient may have severe sepsis/septic shock. The provider then performs a quick evaluation of the patient and, if appropriate, initiates the UCSF severe sepsis resuscitation bundle. Much work and analysis has been done to combat alert fatigue and prevent false firings of the alert. Contingencies or exclusions were built into the alerts in an attempt to decrease firings for chronic conditions, such as end stage liver disease and end stage renal disease. Specific alerts for two patient populations were also created in an attempt to increase the alerts’ specificity. For example, the oncology unit has a sepsis BPA that does not incorporate either the white blood cell count or platelet count in its triggers. In addition, the cardiovascular step down unit and cardiac intensive care unit require three or more signs of SIRS, not two, in an attempt to make the alert more specific. Exclusions were also included on these cardiac units for patients with intra-aortic balloon pumps, ventricular assist devices, or extracorporeal membrane oxygenation. Also built into the alerts are opportunities to silence the alert for those clinical syndromes that mimic sepsis physiology. By interacting with the sepsis alert and using the sepsis navigator/narrator, the alert can be silenced from 24 hours or more by selecting the appropriate syndrome. Patients who may have transitioned to comfort care can also have the alerts turned off for the remainder of their inpatient stay. Work still continues to improve the sensitivity and specificity of the sepsis alerts and remains a priority for the sepsis project leadership. Since the beginnings of the sepsis program, the Code Sepsis team has identified multiple cases where having Sepsis BPA in place greatly impacted a patients trajectory of care. Case studies where patients were quickly recognized and transported to an intensive care unit keep clinicians motivated and these positive results helped recognize the
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importance of the program. The following case studies show how Code Sepsis has impacted the patients at UCSF Medical Center.
code status with his family, Mr. H. was intubated at bedside and transferred safely to 9ICU with the sepsis bundle already implemented.
Mr. H., a 77 year old gentleman with secondary CNS lymphoma, was admitted to the oncology unit for chemotherapy treatment. It was noted that he had an aspiration event during a swallow evaluation around 10:00 am. Vitals remained stable, until around 10:00 pm when the patient triggered the severe sepsis alert due to a heart rate of 119 beats per minute, a respiratory rate of 24 breaths per minute, and oxygen saturation of 90%. The patient also had an elevated temperature of 38.1 C at this time. Mr. H’s nurse quickly responded by ordering and collecting a lactate per nursing protocol and activating a Code Sepsis. The lactate result was 2.5 mg/dL. Blood cultures were collected immediately and antibiotics were started. Mr. H was initially protecting his airway but then his hypoxia worsened, requiring a non-rebreather mask. The ICU triage fellow was called and it was determined, in conjunction with the oncology on-call physician, that intubation was required for airway protection. After confirming full
Severe sepsis/septic shock bundle of care for adult patients:
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1. Obtain blood lactate level to identify possible tissue hypoperfusion related to severe sepsis 2. Obtain blood cultures before administering antibiotics 3. Administer broad-spectrum antibiotics within 1-hour of severe sepsis or septic shock recognition 4. Administer IV fluids totaling 30 mL/kg if patient has hypotension or a lactate level of ≥ 4 mmol/L 5. Start a vasopressor infusion if hypotension persists after initial IV fluid challenge
GME Diversity Update Rene Salazar, MD GME, Director of Diversity
• Opportunities to volunteer in the community o UCSF student-run homeless clinic o Clinica Martin Baro-student-run clinic
Diversity Advisory Group
GME Diversity Second Look
The GME Diversity Advisory Group (DAG) was established to promote and support diversity among UCSF residents and fellows. All UCSF residents and fellows are invited to join the DAG including those from racial and ethnic groups traditionally underrepresented in medicine (UIM), LGBT trainees and trainees with disabilities. DAG activities include: • Quarterly meetings with residents and fellows to develop recruitment and retention programs for diverse trainees
Our 9th annual Second Look Diversity Event for residency program applicants will be on Friday January 29, 2016. In addition to learning more about our training programs, the program provides applicants with the opportunity to meet campus leaders committed to promoting diversity at UCSF. A panel discussion with housestaff and fellows was held in the afternoon followed by an evening reception.
• Networking/Social Opportunities: o Annual Dean’s Diversity Reception o GME Diversity Holiday Reception • Participation in the School of Medicine’s
Underrepresented in Medicine (UIM) Dinner Program for UCSF medical students • Participation in outreach programs o Visiting Elective Scholarship Program-
supports medical students interested in working with diverse populations
o Support for residents and fellows to attend and
represent UCSF GME at national meetings including: Student National Medical Association Annual Medical Education Conference Latino Medical Student Association Gay and Lesbian Medical Association
• UIM Trainee Recruitment o GME Second Look Diversity Event for
residency program applicants
Applicants at the Second Look housestaff panel.
Volunteer Opportunities UCSF sponsors several student-run clinics in the city. Volunteer preceptor opportunities for housestaff and fellows are available year-round at the following clinics: Homeless Clinic (provides care to the homeless), Hepatitis B Clinic (focuses on hepatitis B screening in Asian communities) and Clinica Martin Baro (provides free primary care services for Latino day laborers in the Mission). In addition to providing free screening and health care to underserved populations, the clinics also provide a chance to work with first and second year UCSF medical students and undergraduate students from UC-Berkeley and San Francisco State University.
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10 Questions from the Resident and Fellow Affairs Committee 2. Can emotional intelligence be learned, or is it inborn?
Loma K. Flowers, MD, Clinical Professor in the UCSF Department of Psychiatry and Ruth ThomasSquance, PhD, Executive Director, Equilibrium Dynamics 501(c)3, answer resident and clinical fellow questions about emotional intelligence and discuss the emotional competence curriculum developed by LKF. 1. What is emotional intelligence (EI)? Emotional Intelligence (EI) is an umbrella term used to encompass a broad spectrum of both intrapersonal [internal, personal] and interpersonal [social, relationship] emotional intelligence skills, all related to feeling management. Around 1984 Gardner identified seven intelligences: musical, kinesthetic, special, mathematical, intellectual--the familiar IQ--and the two EIs. Goleman dubbed emotional intelligence as EQ around 1994--in parallel to IQ--Intelligence Quotient-but it is commonly referred to in medicine as EI. Emotional intelligence is fundamentally about feeling management skills that positively direct behavior and increase your chances of success at work, everyday life and relationships.
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Anyone can improve their EI skill set with good teaching and practice just like you can learn to play a musical instrument. Innate talent always helps, but as with most education, the motivation and interest you bring as a learner are key ingredients for success. At some point, beginner level skills become intermediate and eventually turn into competence. That top level of EI skills is known as emotional competence [EC]. The teacher’s job is to provide clear, accurate, learnerfriendly instruction and support. Any educational set up like this is an example of EC in action. We run a nonprofit, Equilibrium Dynamics (EQD) www. eqdynamics.org whose mission is to teach emotional competence skills, especially to low income and disadvantaged groups and those who work with them. Participants (n>1,000 now) report very favorably on the impact of EQD workshops and trainings with about 91 % finding that they learned something that they can use to meet their responsibilities. The website has a number of free downloads available, e.g. a feeling management protocol, judgment and goodbye checklist, and a grief and loss process description to promote dissemination and application of these skills. 3. Why is personal competence a primary competency of EI and social competence the secondary competency of EI? Emotional competence is really about highly skilled coordination of your emotions with everything else you do, including relate to other people. The first step in this process is to identify what you feel. Then, rather than ignore those feelings, override them or let them run wild, you integrate them with your thinking and judgment before you take any action. This is personal competency, which then forms the springboard for social or interpersonal competence. As a result, social
competency is secondary--not in importance--but in sequencing.
individuals and relationships of the effort and hours required to get there.
Relating to people is so complicated--whether professional colleagues, patients, family or lovers-because it involves three components: each person’s personal competency, their social competency, and thirdly, whatever happens between them. For example, every single interaction or transaction between people has a motivation and an impact. All too often these are mismatched and can trigger misunderstandings, which need to be fixed. “Oh sorry, I didn’t mean it that way!” is a quick and familiar attempt to fix a common unintended impact.
In addition, success is a very personal matter. As you complete your training, you will need EI skills to repeatedly redefine success for yourself, independent of academic or family views of what you should be doing. EI gives you the opportunity to acknowledge your feelings. When you also recognize your emotions as the fundamental driving force of your actions and harness them equally with thinking (IQ) and judgment you have the basics of emotional intelligence. In this context, thinking involves clarifying your goals: what is your end result desired? What is your best plan for now and later to get there? Judgment is essentially a quick risk assessment for any plans and choices going forward.
4. IQ or EQ: which is more important to success? At your levels of accomplishment as residents and fellows, I recommend you employ both IQ and EQ/ EI. Frankly, since you are already here at UCSF, your IQ has been vetted and is continually engaged. I also suggest that you will be happier if you keep your EI at the same level of competence as your IQ. EI can help you to both generate less stress and avoid stress more skillfully, which enables you to pursue your profession further at less emotional cost and greater efficiency. Traditionally medicine neglected EI, except for the doctor patient relationship, giving pride of place to intellect and short shrift to feeling management. However, with the late 20th century change in society’s expectations, mercifully the old routes of “blowing off steam” to manage feelings are closed. Surgeons no longer have tantrums in the OR, sexist jokes are forbidden in lectures, smoking is prohibited in hospitals and sexual harassment is also taboo. As a result, today’s physicians have to adopt appropriate ways of managing their feelings while practicing 21st century medicine where heavy drinking and substance use are now recognized as dangerous and healthier tends are promoted. EI encompasses the skills to manage the deluge of feelings generated by high academic achievement and the impact on
5. Does EQ correlate with leadership potential? Yes. Stoller comments in Academic Medicine, 2013 “Perhaps the most important differentiating feature of the effective health care leader is emotional intelligence (EI).” Businesses were the first to do a lot of work on this because it affects the bottom line independently of expertise in any particular field. Medicine now recognizes EI as an essential skill because it has evolved from a hierarchical field to one of interprofessional collaboration, with team and consensus building. The medical bottom line is also getting more attention. 6. Are there gender differences in EI? McKinley et al 2014 looked at differences in pathology, pediatrics and surgery residents. Although the overall scores on the validated Trait Emotional Intelligence Questionnaire (TEIQue) were similar in both genders, women scored higher in impulse control and relationships. Men scored higher in stress management and emotion management.
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In Western society, women have been long assigned the role of dealing with feelings, often for themselves, their children and the men in their lives. This constant usage usually enhanced some skills, e.g. “other awareness,” as I call one of the relationship skills. This skill is often taught in medicine as empathy, but in practice we are not always ‘empathetic’ even if we are emotionally astute about others. Individually, EI skills scatter over an enormous range, just like cooking skills--also traditionally assigned to women. How emotionally competent any particular man or woman is in any specific EI domain will be related to the attention they have paid to learning these skills, self-help reading they have done and training they received informally from family or other role models and formally. I expect the “new man” society of the 21st century where men discuss their own feelings openly and take a significant role in parenting will affect our historical trends. 7. How is personality different from EI? This issue is very complicated. Practically, I [LKF] have always thought of personality as a combination of genetic predispositions and individual responses to life experiences, reinforced by habit. In my experience [LKF], this makes personality very difficult—but not impossible--to adapt, requiring someone to work hard at it for years in psychotherapy. By comparison, EI skills are in large part behavioral steps and behavior is much easier to change. Equilibrium Dynamics teaches EI in three functional dimensions: instant, considered, and developmental responses. In each dimension, there are different steps required to achieve mature responses to all kinds of events, and to keep impulsive, reckless, shortsighted, or self-destructive responses to a minimum. In the developmental response we believe there can sometimes be an overlap of EI skills with personality. This is because personal growth both initiates and follows the development response which occurs
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when you realize that it is time to change your ways on a permanent basis--not just because somebody is watching or to achieve one finite goal. This change requires you to relinquish and grieve “the old you” [personality or personality traits like narcissism] and adopt “the new you” with the associated behavioral changes. Patients including physicians in recovery can be eloquent about this process. 8. How do physicians score with EI testing? In 2008, Jensen et al noted that the 74 general surgery residents tested using the BarOn Emotional Quotient Inventory (EQ-i) had scores higher than national norms. In addition individuals varied substantially on EQ-i subscale scores. There’s more on this in Emotional intelligence in medicine: A systematic review through the context of the ACGME competencies. Med Educ 44:749–764. One small training that we did at EQD included a few physicians with a pilot pre- and post- testing for objective comparison with self-evaluations. We used the same Barr-0n test as the surgical group I mentioned above. We also asked participants to selfrate their overall EC skills before and after. Although the n was too small for statistical significance, we found comparable positive evaluations of the training’s impact, an objective improvement and-quite unexpectedly—a subjective drop in their selfassessments of their overall emotional competence. This suggested that although their skills improved with training, the participants realized after training that they had previously overestimated their skills. Exposure to the big picture of EI led to a realistic downward adjustment of their self-evaluations. 9. Do physicians with higher EI scores have higher patient satisfaction scores? In Medical Education 2011 Weng reports a significantly positive correlation between doctor EI and patient trust for all patients (p < 0.01). In addition, Health
Care Climate –which refers to a key component in communication and reflects the extent to which patients perceive their health care providers as supporting patient autonomy rather than controlling the provision of treatment--was positively associated with patient trust for internists but not for surgeons. Arora et al. (2010) note that higher EI contributed to enhanced physician- patient relationships, as well as enhanced teamwork and communication skills, better stress management, and enhanced organizational commitment and leadership. These all can contribute to patient satisfaction. 10. Is there any EI training at UCSF? I periodically see emails advertising courses on EI skills at UCSF. In addition, Naomi Rachel Ramen, has a course with an introspective view of the process of becoming a physician. In Psych Emergency Jo Ellen Brainin-Rodriguez, MD sponsored a recent training
on “Trauma Informed Care” that highlighted how our patients’ traumatic experiences affect their response to our ED “culture,” as well as how physicians’ life events and training often evoke unskillful responses that act at cross purpose with both the patient’s “best result for now or later” and our own. EQD has been invited to provide trainings and consultation on various UCSF programs incorporating cognitive behavioral components to enhance success, e.g. PROF-PATH a research program for medical students from a disparities background or interested in health care disparities research, an innovative Nurse practitioner residency, the UIM and Interprofessional UIM mentoring dinner series for professional students, faculty, residents and graduate students, and the GME Bridge program.
Did you know you can download Lexicomp onto your smartphone? Michelle Deng, PharmD Lexicomp is an online database that provides drug information, including dosing, administration, warnings and precautions, as well as clinical content, such as clinical practice guidelines, and other tools. Mobile app access to Lexicomp is available for UCSF Medical Center staff and physicians. The authorization code can be found online on the Lexicomp e-formulary page (www.crlonline.com/lco/action/home/switch) located on the main UCareLinks page (carelinks.ucsfmedicalcenter.org) On the right-hand side, click on “Mobile App Access” and this will provide the user with an authorization code and installation steps based on platform (i.e. iPhone, Android) for new and existing customers.
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OUT & ABOUT from the Resident and Fellow Affairs Committee
Where members of the UCSF Community recommend their favorite scenes outside UCSF
Open Water Swimming in San Francisco Bay
year, but is generally about 55-60F. The warmest temperatures are in late summer (Aug and Sept), when it is around 61-63F. The coldest temperatures are in the winter months (Jan and Feb) when it is around 52-53F.
Tom Shimotake, MD Associate Professor of Pediatrics Director, Neonatal-Perinatal Medicine Fellowship Program Many people say the best way to approach a new experience is to let go of your inhibitions and dive right in. This is literally true for open water swimming in San Francisco Bay. Though you may get some funny looks from the uninitiated, those who have experienced it will tell you that swimming in San Francisco Bay is an exhilarating and unforgettable experience. You will see the Golden Gate Bridge and Alcatraz Island from a perspective that few tourists will ever have. There is a certain mystique about swimming in San Francisco Bay that adds an extra level of excitement. In June of 1962 three inmates made the only “successful escape” from Alcatraz Federal Penitentiary. The FBI concluded the three most likely drowned “in the frigid waters” of San Francisco Bay. But generations of San Francisco Bay swimmers would probably have a different opinion about their chances. There has actually been a well-established community of open water swimmers in San Francisco for over a century. But there are a few things you might want to consider before jumping into the Bay for your first swim.
Wetsuits: Though many people swim in the Bay regularly year round without a wetsuit, you may want to wear an extra layer of insulation until you are accustomed to it. Wetsuits can be rented from local sporting good stores, like Sports Basement (http://www. sportsbasement.com/) on a weekly or monthly basis. If you choose to continue swimming on a regular basis, you can usually find good deals on triathlon wetsuits for between $100-200. Just be sure to get the right type of wetsuit for swimming, as opposed to surfing or diving. Swimmers in the Bay may choose to wear either a Farmer John style wetsuit (sleeveless style), or a full triathlon wetsuit. These differ from surfer or diver’s wetsuits in some key ways. A wetsuit for swimming tends to be made of thinner neoprene
Water temperatures: The waters of San Francisco Bay can be chilly. The water temperature varies depending on the time of
NOAA table of the average water temperatures for San Francisco Bay: JAN
FEB
MAR
APR 1-15
APR 16-30
MAY 1-15
MAY 16-31
JUN 1-15
JUN 16-30
JUL 1-15
JUL 16-30
AUG 1-15
AUG 16-30
SEP 1-15
SEP 16-30
OCT 1-15
OCT 16-30
NOV
DEC
52
53
54
54
55
55
56
57
57
58
60
61
61
61
60
60
58
57
53
Note: water temperatures have been about 2-3 degrees warmer in the summertime for the last few years
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(3mm) as opposed to a surfer wetsuit (4-5mm). Surfers spend a lot of time just sitting on their boards in the cold water, waiting for just the right wave but losing body heat. An open water swimmer, on the other hand, is constantly moving and generating body heat. This allows them to get away with using a thinner wetsuit. Swimmers are also are reaching their arms above their heads with every stroke, which means triathlon wetsuits need to be more flexible around the shoulders. They are often made of thinner material around the shoulders, or specially cut to allow movement of the arms.
event. It is always a good idea to swim with a buddy. But this is especially true in San Francisco Bay, where the currents/counter currents can be quite significant depending on the direction of the tides. You can easily find yourself swimming in the same place for 30 minutes before you realize you are caught in a counter current. If that ever happens, start swimming perpendicular to the current towards shore. You can seek more advice about navigating the currents within the Bay from experienced swimmers.
Other accessories:
Several organizations exist to support open water swimmers in San Francisco and those interested in trying open water swimming for the first time.
People may choose to add insulation or other accessories for their open water swim, such as the following items:
Who can help get me started?
• Goggles - regular swim goggles will do, though you may want to treat them with a drop of anti-fogging solution before entering the water.
• Water World Swim (https://waterworldswim. com/) was started by Pedro Ordenes, an accomplished International open water swimmer, who wanted to help other swimmers make the transition from the pool to the open water. Water World Swim offers open water swimming clinics and events on an almost weekly basis throughout the year.
• Ear plugs – available in the swimming section of your local sports store. These are made from malleable wax and can retain a good amount of heat.
Two historic athletic clubs have existed for over a century to support rowers and swimmers in San Francisco:
• Swim Cap - may be of thicker latex or even neoprene
• Glide or Vasoline - applied to your neck and/ or joint regions, this can prevent chaffing against your wetsuit. • Booties or gloves – used more by surfers than swimmers in the Bay • Fins, pull-paddles – Just make sure they float or you may lose them. Getting out there: If you’ve never done an open water swim before, especially in San Francisco Bay, you should join another experienced swimmer or an organized club
• The South End Club (http://serc.com/) was established in 1873 and has a club and boathouse near Hyde Street Pier. The club house has a private beach entrance to the water, and hot showers and sauna for after your swim. • The Dolphin Club (http://www.dolphinclub. org/) was established in 1877 and is quite literally right next door to the South End Club. They have also have a club and boathouse, with hot showers and sauna available to his members and to guests for a daily fee.
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Events: There are many different open water swimming events in San Francisco Bay hosted by different organizations throughout the year, though most occur during the summer months when temperatures are the warmest. Several different groups host “Escape from Alcatraz” swims from Alcatraz island to the beach at Aquatic Park. There is also a Tiburon Swim, from Tiburon to Angel Island, and a swim from one end of the Golden Gate Bridge to the other.
Where to swim: The most popular swimming area in San Francisco Bay is Aquatic Park, which is a picturesque protected cove in front of Ghiradelli Square, adjacent to the historic tall ships at Hyde Street Pier (http://www.nps. gov/safr/learn/historyculture/historic-vessels.htm). This is also where both the South End Club and The Dolphin Clubs are located. Anyone is free to swim the within the protected Aquatic Park area. You can enter the water anywhere along the beach. A line of permanent bouys run parallel to the shore and mark a quarter mile course. People may also choose to swim the perimeter of the harbor just inside the piers. There is nice shallow sandy access, and public showers are at either end of the beach (note: showers have been turned off recently due to the drought). Other areas people may choose to swim in the Bay include Crissy Field, and the waters near Tiburon in Marin County. Just be sure to check the tide charts to avoid getting caught in unpredictable currents.
The event that is near and dear to us here at UCSF is the Annual San Francisco Bay Swim (http://www. swimacrossamerica.org/site/PageServer?pagename=SF_ Home), sponsored by Swim Across America: Making Waves to Fight Cancer. This is a 1.5 mile swim that starts beneath the mid-span of the Golden Gate Bridge and goes to the beach area in front of the St. Francisco Yacht Club next to Crissy Field. The event is a fund raiser for Pediatric Cancer research at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco. The event caps at about 300 swimmers, but in 2014 was still able to raise about $500,000 for Pediatric Cancer Research at UCSF. If you are interested in signing up for the event, you can contact me with questions or simply sign up online and join one of our teams (eg, UCSF Team Newborn or Team UCSF Survives). We host regular group training swims in preparation for the event, which is an exhilarating and moving experience you will never forget.
Confidential GME Help Line
415-502-9400 Confidential line for housestaff, faculty, and program administration to voice their questions, comments, or concerns 24 hours a day. The Office of Graduate Medical Education will respond to all messages. 12
Theatre in the Bay Area Erin Morrow MD, PGY-2, Psychiatry Before I was ever a resident at UCSF (first in obgyn, then in psychiatry), or the mother of two young boys (Luca, 3 years, and Leo, 15 months) I traveled the country performing in musicals. I first came to San Francisco many years ago with the national tour of CATS, and have fond (and strange) memories of walking through the Tenderloin on my way to work at the historic Golden Gate Theater. San Francisco, of course, has a thriving performing arts scene, from national touring companies of the latest Broadway shows, to exceptional semi-professional and professional regional theatre companies. If only there were more hours in the day, there are so many options for so much great theatre. The best way to one-stop-shop for performing arts options in San Francisco, is www.theatrebayarea. org. Some highlights of the professional theatre scene that are especially unique to San Francisco include ACT (American Conservatory Theatre) and the Berkley Repertory Theatre. These theatre companies are Broadway caliber and offer plays and musicals alike. If you actually want to see Broadway shows, there are, of course, national touring companies that roll through San Francisco each month. Go to shnsf.com, which brings in the latest Broadway touring companies to the Curran, Orpheum, and Golden Gate Theaters. These days I prefer to go a little bit off the grid, and a little bit less expensive, for the rare night out so I prefer the smaller, more local scene for shows and concerts. The New Conservatory Theatre Center, on Van Ness, just a few blocks south of City Hall, is a non-profit theatre company that produces high quality youth, and queer and allied theatre. I had the incredible experience of performing in their main stage production of “The Marvelous Wonderettes,” a former off-Broadway bubble-gum montage of 50s and 60s hits. It was during the run of this super fun
show that I learned about Feinstein’s at The Nikko, which is a fairly new 140 seat nightclub in the lobby of The Nikko Hotel, in Union Square, that brings in the best cabaret performers, including my personal favorite Tony Award winner, Sutton Foster. If I didn’t at least mention Martuni’s, San Francisco’s legendary after show piano bar, I would be doing you all a disservice. After you have seen a performance at one of the aforementioned venues, and have been sufficiently inspired to perform your own Broadway classic, you must mosey over to Martuni’s on the corner of Market and Valencia and sing for a room full of rowdy theatre junkies, with live piano accompaniment. You may even get lucky and see some impromptu performances by cast members of local shows. My “Wonderettes” cast often sang at Martuni’s during the run of our show, and I have seen some pretty impressive local talent, as well as members of Broadway national touring companies stop by and belt out some tunes. Be careful of Martuni’s martinis, however, I have been told they are quite strong.
Erin Morrow (center) and her cast members in “The Marvelous Wonderettes,” at the New Conservatory Theatre Center in San Francisco
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As a resident with two small children, I have to admit that my wild theatre ways are mostly in the past now, but I am looking forward to taking my boys to local theatre when they are just a little bit older. Bay Area Children’s Theatre is a non-profit that comes highly recommended that performs in SF at the Children’s Creativity Museum on 4th Street. My family frequents
the Bay Area Discovery Museum, in Sausalito, just past the GG Bridge, which is an indoor/outdoor space that my kids love. We go there several times a month to dig in the dirt, do art projects, and see live music. If you have kids, and have an afternoon to spare, you will probably see us there.
Update from ZSFG
image, and nutrition. They held focus groups with middle school students in the club to determine workshop conceptual content. They then worked with students to collaboratively design engaging, relevant, and culturally appropriate workshops for the club members. Workshops included an online game about cyberbullying and interactive stations about the impact of media on body image. The curriculum was compiled for the Boys’ and Girls’ Club organization, so that they could continue using and updating it in the future.
Roger Mohamed Operations Manager, UCSF SOM Dean’s Office, Zuckerberg San Francisco General There are specific resident programs unique to the ZSFG campus. Over the next few reports we will present the ZSFG Distinctive Trainee Series, highlighting some of those programs and their unique and innovate projects. We begin the series with the Family and Community Medicine Residency Program (FCMRP). Under the leadership of the residency program director, Dr. Diana Coffa, this residency program is based at SFGH and is dedicated to training family physicians to partner with and care for urban underserved patients and their communities. Their curriculum is focused not only on teaching excellent clinical care, but also on teaching residents to partner with and empower communities, serve as effective policy advocates, and become teachers and leaders in primary care. They train 48 residents a year: 15 R1s, R2, and R3s, and three fourth year chief residents. This year FCMRP was ranked the 6th best family medicine residency program in the country by US News and World Report. There are several community-based programs within the Department of Family and Community Medicine (FCM), which not only provide a fulfilling training experience to our residents but also provide specialized programs to our patient population. This year, FCM residents partnered with the Mission Boys and Girls Club to create and run interactive workshops on cyberbullying, substance use, body
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The MINT (Mothers and Infants Nurturing Together) program allows pregnant women who are incarcerated to spend the end of their pregnancy and their post-partum period in an environment that supports maternal-infant bonding. The program also provides an opportunity for residents to provide prenatal, intrapartum and postpartum care for incarcerated women. Through their community engagement curriculum, the residents involved with the MINT program have been deepening their involvement with the program outside of the clinic and hospital by visiting with women at the MINT halfway house and Dublin Prison, providing educational and group support sessions for program participants, and advocating to ensure that incarcerated women and their children receive the services that they need to succeed after release. FCMRP will soon be launching the SUHLA (Student Health Leadership Academy). The program has been developed in partnership with John O’Connell High School in the Mission neighborhood, FACES for the Future, UCSF medical students in the PRIME program, and UCSF nurse practitioner students. SUHLA is designed to encourage youth from underrepresented backgrounds to advance academically and consider careers in healthcare. FCMRP will host a three-week
fellowship for high school students focused on social determinants of health, health disparities, advocacy skills, college application skills, and shadowing a variety of healthcare providers in our system. The fellowship will end with a capstone project, in which
students will lead a health and reading fair in their own community. FCMRP’s hope is to build capacity in the local community and help develop a pipeline of students from underrepresented backgrounds entering medicine and other health careers.
UCSF Excellence and Innovation in Graduate Medical Education Awards At our GME Celebration we announced the winners of the 2015 UCSF Excellence and Innovation in Graduate Medical Education Awards. These awards recognize program adminstrators, faculty, and residents and fellows who show exemplary efforts in improving graduate medical education at UCSF. These individuals have demonstrated a commitment to advancing GME through educational and clinical quality improvement, service excellence, and innovation.
The GME Celebration honnored the GME Award winners as well as the 2014-2015 QI Champions
The program administator awards went to Winnie Chan, Eve Dinh, and Virginia Schuler. Winnie is the assistant residency program coordinator for the Ophthalmology department. She was applauded for being an exceptional administrator and a true advocate for her trainees. Eve is the medical educational programs administrator for the Department of Emergency Medicine. She was acknowledged for her willingingness to go above and beyond to support her trainees and the educational mission of the program. Virginia Schuler is the program administrator for the infectious diseases fellowship program. She was recognized for her extraordinary ethusiasm and the dedication she brings to her program.
Eric Widera, MD accepting his award from Associate Dean Bobby Baron, MD
The faculty award winners were Robert Harrison, MD and Eric Widera, MD. Dr. Harrison serves as the associate program director of the occupational and enviornmental medicine residency program and was acknowledged for his work organizing their resident orientation and for serving as an excellent mentor to the OEM residents. Dr. Widera is the program director of the geriatrics fellowship program. He was recognized for his teaching exellence and for the significant innovations he has brought to the fellowship program.
Resident and Fellow Award Winner Seunggu Han, MD (right) with his QI Poster
Jacob Robson, MD accepting his award from Associate Dean Bobby Baron, MD
The resident and fellow awards went to Bryn Boslett, MD, Seunggu Han, MD, and Jacob Robson, MD. Dr. Boslett is a fellow in the division of infectious diseases. She was prasised for her excellent teaching skills and her involvement in several programmatic improvements to the infecious disease fellowship program. Dr. Han is a resident in the neurological surgery program. He is an active leader in the department’s quality and safety improvement efforts and has been published numerous times. Dr. Robson is pediatric gastroenterology fellow. He was commended for his work developing and evaluating the department’s EPAs.
Winnie Chan (left) and Virginia Schuler (right) accepting their awards.
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Developing Self-Compassion During Residency Joseph Zamaria, PsyD UCSF Faculty and Staff Assistance Program The time that you spend in residency is likely one of the most challenging periods of your career as a physician, and these challenges can seemingly come from all directions. A high workload, learning on the fly, and constantly being evaluated are all par for the course. These difficulties may arise during the early stages of training, while transitioning from medical school to internship – and coincide with the stresses of potentially having to relocate, and of coping with the change in role from student to physician. Some challenges arrive at later stages, such as job searching or preparing to apply for fellowship. The fact remains, however, that the expectations placed upon you during residency are particularly demanding. High expectations may certainly come from external sources – from supervisors and attending physicians, and from the reality of having to deliver optimal patient care and safety. On the other hand, another source of these expectations may be from within. High achievers naturally have high expectations for themselves, accompanied by an inner critic that preaches the importance of success. This can be useful – you would not have gotten where you are today if not for your drive and your ability to achieve. However, if those high expectations turn into excessive self-criticism, demanding success to the point of perfection, they may be adding more to the problem than to the solution. Enter self-compassion. This construct, new to the field of social research, was coined by Dr. Kristen Neff, Associate Professor of Human Development and Culture at the University of Texas at Austin. Neff states that feeling compassion for the self is very similar to the feeling of having compassion for others (not an uncommon experience for physicians). That is, self-compassion comes
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from validating your own experience (e.g. “this is indeed so stressful right now – most anyone would be having a hard time!”) and with addressing it in a kind manner (e.g. “what can I do to take care of myself at this time?”). According to Lars-Eric Petersen from the University of Halle-Wittenberg’s Department of Psychology, “self-compassion is a self-regulation strategy for countering negative self-directed feelings and emotions.” He goes on to state that “highly selfcompassionate people treat themselves with kindness, care, and concern when facing negative life experience.” In other words, those who exhibit the highest degree of self-compassion are those who can most adaptively cope with external life stressors through the use of kindness. So, how does one operationalize this concept? How to put rubber to road? There are a variety of techniques that can be used to cultivate selfcompassion. Neff has techniques and exercises, as well as more resources, available for free on her website, selfcompassion.org. Most of the exercises, such as “Changing your critical self-talk,” can be completed in just a few minutes, with little more than a sheet of paper. She also provides seven downloadable guided meditations, each approximately 10 to 20 minutes in length, that can help to recognize critical emotions and thoughts and to develop a more self-compassionate mindset. As with the development of any new coping strategies, it may take consistent practice over the course of a week or two to begin to feel the benefits of the selfcompassion exercises. One exercise to try is the “Self-compassion break.” For this exercise, follow these steps:
• Sit down, and think of a situation in your life that is causing you anxiety or stress. Really try to bring this situation to mind, and see if you can feel the discomfort of this in your body.
• Acknowledge the stress (e.g., “Yuck.” “I can’t stand this.” “This sucks!”).
• Acknowledge that stress and suffering is a common part of human experience (e.g., “I’m not alone in feeling this way,” “I’ve struggled before in my life.”)
• Express kindness to yourself, in the face of the challenging or stressful situation (e.g., “I’m doing the best I can with this,” “I accept myself as I am,” “I commit to giving myself the compassion that I need to get through this.”) Another exercise to cultivate self-compassion is “How would you treat a friend?” In this exercise, follow these steps:
• Consider a time when a close friend or family member was struggling with something, and is “beating himself/herself up about it.” Imagine how you’d respond in this situation, what you’d do or what you’d say to your friend, and write it down.
• Next think about times in which you have struggled or have “beaten yourself up.” Think about what you do, or what you say to yourself in these situations, and write it down, including the tone you use to speak to yourself.
• Note any differences between what you’d say to your friend and what you’d say to yourself. Try to think about why there is a discrepancy, if there is one.
• Finally, write down how you think you would respond if you treated/spoke to yourself the same way you would to a friend. With both of these exercises, practice and consistency are important. Try doing one of them 2-3 times per week, for a couple of weeks, before making any judgments about whether it is helpful. It usually takes about that long for the effects to
sink in. If you would like to hear more from Dr. Neff, she also has brief and full-length lectures available online, including a full-length TED talk. Most are available on YouTube. High achievers, prone to negative self-talk, may also be reticent to ask for support, especially professional help. Concerns may abound, such as worry that peers or supervisors will find out that they are struggling. Sometimes, all it takes is a brief conversation with a co-worker, friend, or family member to feel just a little relief from the stress of overly high expectations. However, it may take more. One resource available to all faculty and staff, including residents, fellows, and postdocs, is the Faculty and Staff Assistance Program (FSAP). Staffed by clinical psychologists and clinical psychology postdoctoral fellows, FSAP provides no-cost and confidential counseling. We provide counseling for personal and work-related issues. If you are feeling stressed out, please call us at 476-8279 to make an appointment to see one of our counselors. References Kristen Neff (www.selfcompassion.org) Neff, K.D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-102 Peterson, L. (2013). Self-compassion and selfprotection strategies: The impact of self-compassion on the use of self-handicapping and sandbagging. Personality and Individual Differences, 56, 133138.
Faculty and Staff Assistance Program (415) - 476-8279 For more information, please visit: http://www.ucsfhr.ucsf.edu/assist
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UCSF Resident and Clinical Fellow Quality Improvement Incentive Program Update Glenn Rosenbluth, MD Director, Quality and Safety Programs, GME We are excited to share the latest results for the UCSF Medical Center Resident and Clinical Fellow QI Incentive Program, as well as details of our progress.
Goal # 2: Patient Quality and Safety
Reduce hospital onset clostridium difficile by 15% to 11.1/10,000 patient days. Results: C.Diff rates went sky-high in January! Now is a great time to revisit the myths and tips. Please take a few minutes to review the link below and do your part to protect our patients: http://infectioncontrol. ucsfmedicalcenter.org/ucsf-clostridium-difficileinfection-prevention.
2015-2016 Housestaff-Wide Goals Goals are determined by UCSF Medical Center and School of Medicine leadership based on clinical quality and operational priorities. They are focused on specific areas where physicians have the most impact, while at the same time being aligned with UCSF Medical Center organizational goals.
Goal #1: Patient Satisfaction
For the composite of survey questions MD/Provider Communication Quality, achieve 4 of the following for percentage of patients rating “always” (top box) or mean goals for FY 2016:
• Inpatient adult (HCAHPS top box): 83.2% • Outpatient (CGCAHPS top box): 90.7% • Pediatric (Press Ganey mean): 92 • ED (Press Ganey mean): 88.6 • Ambulatory Surgery (Press Ganey mean): 93.3% Results: We continue to make improvements in all areas:
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Goal #3: Resource Utilization
Reduce average cost per discharge by 0.5% to $26,326 (this metric accounts for outpatient services in addition to inpatient services) Results: We continue to reduce our costs, and in March we were 1.38% below target!
Program Specific Goals
• Anesthesia and Perioperative Care: prescribe oral acetaminophen to 50% of eligible surgical patients preoperatively • Child & Adolescent Psychiatry: measure and document weight and height every four months for patients in the fellow LPPI child continuity clinic currently prescribed a stimulant medication (goal of >70%) • Dermatology: provide written information on timing and method of communication for biopsy results to of patients (goal of >60%) • Emergency Department: increase the percent of lung protective ventilation used on patients for whom there are no immediate contraindications to 70% • General Adult Psychiatry: Increase the percentage of outpatients prescribed benzodiazepine who have completed a benzodiazepine prescription agreement, from 0% to 65% • Gynecologic Oncology: screen at least 90% of preoperative gynecologic oncology patients, and refer at least 50% of those who screen positive to social work pre-operatively • Hematology/Oncology Fellowship: increase the use of pharmacologic venothromboembolism prophylaxis in eligible patients from <1% to 30% • Hospice and Palliative Care Medicine: Among inpatients with a DNR/DNI, HPM fellows will increase the percentage of patients with completed POLST forms at the time of discharge to 75% • Internal Medicine: increase the percent of patients on the hospital medicine service who have had all medications reconciled before discharge to 70% • Maternal Fetal Medicine/ Neonatology: increase the number of times a patient at risk for a periviable delivery gets joint counseling by Maternal Fetal Medicine and Neonatology physicians about the decision for neonatal resuscitation by 20% • Medical Genetics: Residents will provide each patient who has a genetic diagnosis in the Genetics Clinic with information for a support group/and or a patient tailored educational materials for 85% of visits • Neurological Surgery: participate, champion, and ensure 80% compliance with a new preoperative
checklist in which the hematocrit, platelet count, INR, and PTT are specifically reviewed and documented prior to all neurosurgical operations • Neurology: provide delirium counseling to at least 50% of patients over the age of 65 years and their caregivers • Obstetrics and Gynecology: for 80% patients with hypertensive disorders who deliver at UCSF, residents will send communication to the PCP about the diagnoses and risk for CVD, and provide an AVS discussing the risks to the patient • Orthopaedic Surgery: Improve the percentage of foley catheters (goal of >90%) that are removed on post-operative day one after orthopaedic operations • Otolaryngology: improve the preoperative and postoperative counseling and education for patients and their families who are undergoing tracheotomy by providing a detailed, educational brochure for at least 75% of potential patients • Pediatric Critical Care: document at least 90% of RRT’s using the APeX RRT navigator • Pediatrics: notify patients’ primary care physicians within 24 hours of admission via APeX-transmitted letter, for 75% of patients admitted to the Pediatric Hospitalist service • Plastic and Reconstructive Surgery: complete a “Discharge checklist” as an APEX note and as patient instructions for patients on the Plastic Surgery service who have undergone free flap reconstruction (goal of >80%) • Radiation Oncology: increase the rate of assessment of patient readiness to quit tobacco use from 11% to 22% • Radiology: have at least 75% compliance for using standardized documentation of communication of critical findings for cross sectional studies interpreted on-call • Rheumatology Fellowship: increase the rate of PCV-13 (Prevnar 13) vaccinations in rheumatology patients on long-term immunosuppressive therapy to 25% • Urology: screen at least 80% of admitted patients for >5% weight loss in prior month, and offer referral to outpatient nutrition for those who meet this criteria
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2015 Honors and Recognition for Housestaff Dermatology
American Academy of Dermatology Resident Jeopardy - 2nd Place Iris Ahronowitz, MD Roberto Ricardo-Gonzalez, MD, PhD Dermatology Foundation, 2015 Fellowship in Pediatric Dermatology Sarah S. Asch, MD Dermatology Foundation, 2015 Dermatologist Investigator Research Fellowship Marlys Fassett, MD, PhD Roberto Ricardo-Gonzalez, MD, PhD Everett C. Fox, MD Memorial Lecture Award 1st place for Clinical Research Amanda Raymond, MD UCSF CTSI, 2014 Resident Research Training Program Grant Marlys Fassett, MD, PhD Victor Newcomer Award Recipient at Pacific Dermatologic Association Amanda Raymond, MD Women’s Dermatologic Society’s Mentorship Grant Tina Bhutani, MD
Emergency Medicine
CTSI Fall 2014 Resident Research Funding Award Maria Beylin, MD Department of Emergency Medicine Graduating Resident of the Year Sean Kivlehan, MD Department of Emergency Medicine Intern of the Year Gretchen Fuller, MD Department of Emergency Medicine Medical Student Teaching Award Julian Villar, MD Krevans Award Rosny Daniel , MD National Vice Speaker for the Emergency Medicine Residents’ Association Nida Degesys, MD Teaching Excellence Award for Cherished Housestaff Sean Kivlehan, MD
Family and Community Medicine
2015 CIR Regional Vice President Diana Wu, MD 2015 Family Medicine Congressional Conference Scholarship Recipient Moira Rashid, MD Family Health Center Award for Exemplary Service Erica Brode, MD
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Marianna Kong, MD Krevans Award Nicole Person-Rennell, MD UCSF OB/Gyn, Medical Student Standout Teaching Award Suzanne Barakat, MD David English, MD Samali Lubega, MD
Infectious Disease
Excellence and Innovation in GME Award Bryn Boslett, MD Lawrence S. Linn Award Mike Reid, MD, MA SFGH DOM Clinical Fellow Award Rachel Rutishauser, MD, PhD UCSF-DOM Clinical Fellow Award Mike Reid, MD, MA Rachel Rutishauser, MD, PhD UCSF SOM Teaching Award Mike Reid, MD, MA
Internal Medicine
Community Service Awards Fayola A. Edwards, MD Marlene Martin, MD Kim T. Nguyen, MD Odayme Quesada, MD Daron J. Williams Award Thomas M. Cascino, MD Emergency Medicine – MedConsultant of the Year Jenny Cohen, MD, MPH Floyd Rector Basic Science Research Award Joseph A. Hippensteel, MD, MS Floyd Rector Clinical Science Research Award Trilokesh D. Kidambi, MD Floyd Rector Medical Education Research Award Talia R. Kahn, MD Krevans Award Malia Paik-Nicely, MD, MS Keith Johnson Award Emily A. Abdoler, MD Jeffrey Weingarten Award (R3 award) Reza Sedighi Manesh, MD Professionalism Award Jennifer R. Mandal, MD Reza Gandjei Humanism Award Elizabeth V. Imbert, MD Teaching Excellence Awards for Cherished Housestaff Vivek Murthy, MD Katie Raffel, MD
2015 Honors and Recognition for Housestaff Chris Vercammen-Grandjean, MD Thomas Evans Teaching Award Geoffrey V. Stetson, MD
Internal Medicine – SFGH Primary Care
Chancellor’s Diversity Award for Disability Service Bliss Temple, MD Community Service Award Kim Nguyen, MD Genentech’s 2014 Scientific Project Support Activity Award Josh Tarkoff, MD Melvin Grumbach Award Recipient Dawn Gano, MD NASPGHAN Fellow to Faculty Award in IBD Research Roy Nattiv, MD Reza Gandjei Humanism Award Elizabeth Imbert, MD, MPH Thomas Evans Teaching Award Geoffrey Stetson, MD
Obstetrics and Gynecology
2014 American Society for Reproductive Medicine Corporate Member Council In-Training Travel Grant Eleni Greenwood, MD 2015 Resident Award for Excellence in Obstetrics Adam Lewkowitz, MD ABOG-EF Awarded Trainee Travel Scholar Recipient Colleen Denny, MD Andrea Knittel, MD, PhD Best 2nd Year Teaching Resident Award Claudia Díaz, MD, MPH Chief Teaching Award Molly Quinn, MD Excellence in Female Pelvic Medicine/Reconstructive Surgery Marron Wong, MD James R. Green, M.D. Memorial Award Megan Swanson, MD, MPH Krevan’s Award Amaranta Craig, MD National American Menopause Society Resident Scholar Jacqueline Ho, MD Wael Salem, MD, MPhil R1 Teaching Award Martha Tesfalul, MD R2 Teaching Award Elissa Test, MD, MPH R3 Teaching Award Marron Wong, MD
Rising Star Award Julia Newman, MD Special Resident in Minimally Invasive Gynecology Wael Salem, MD, MPhil
Occupational Medicine
2015 UCSF Academic Senate Chancellor’s Fund: Sustainability Conference Grant Latifat Apatira, MD
Otolaryngology
AAO-HNS Resident Leadership Grant Ryan Goepfert, MD Jeff Markey, MD Seth Pross, MD AAO-HNS Humanitarian Travel Grant Awardee Jeff Markey, MD Bay Area Resident Research Symposium, Clinical Research Award 2014 Seth Pross, MD Best Presentation in Head and Neck Cancer at the 12th Annual Middle East Otolaryngology Update Dan Faden, MD CTSI Grant Winner Jeff Markey, MD Jonathan Overdevest, MD, PhD Great Catch for Patient Safety Program Ruwan Kiringoda, MD Krevan’s Award Winner Divya Chari, MD Surgical Consultant of the Year Jonathan Overdevest, MD, PhD Triological Society 2015 Western Section Shirley Baron Resident Research Awardee Ryan Goepfert, MD
Pediatrics
Ahmad GhaneaBassiri, MD Pediatric Intern Award Margaret Emmott, MD Alex Lemonade Stand, Young Investigator for 15-17 Elliot Stieglitz, MD American College of Rheumatology Distinguished Fellow Award Nicole Ling, MD ‘Best of the Best’ Abstract at the SCAI Gurumurthy Hiremath, MD Brown-Coulter Award Neeti Doshi, MD Compassionate Physician Award Elizabeth Rogers, MD Faculty Teaching Award Steven Bin, MD
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2015 Honors and Recognition for Housestaff Grossman Award Brittany Blockman, MD Krevans Award Bao Truong, MD Leukemia and Lymphoma Society Career Development Program Grant Craig Forester, MD Lucy S. Crain, MD Award Enrique Escalante, MD Merle A. Sande/Pfizer Fellowship Award Mary Prahl, MD Pediatric Research Award from the Rheumatology Research Foundation Nicole Ling, MD Postdoctoral Fellow Teaching Award Rachel Chevalier, MD Resident Teaching Award Peter Cooch, MD Amy Chong, MD Rachel Jordan, MD Rudolph Award Emily Levy, MD T32 NIH HIV Translational Training Grant Mary Prahl, MD Volunteer Faculty Teaching Award Tara Greenhow, MD
Psychiatry
2014 UCSF Chancellor’s Office Thomas N. Burbridge Award Bibhav Acharya, MD 2015 Psychiatry QI Poster Symposium Winner Mikel Matto, MD 2015 UCSF Department of Psychiatry Research Award Bibhav Acharya, MD 2015 UCSF Department of Psychiatry Academic Scholarship Award Bibhav Acharya, MD AAGP Honors Scholarship Tua-Elizabeth Mulligan, MD APA Child and Adolescent Psychiatry Fellowship Jorien Breur, MD APA Leadership Fellowship Tua-Elizabeth Mulligan, MD APA/SAMHSA Minority Fellowship Chuan Mei Lee, MD CTSI Resident Research Symposium Stefana Morgan, MD CTSI Resident Research Travel Award Chuan Mei Lee, MD Edwin F. Alston Award for Leadership in Psychiatry Mikel Matto, MD
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GMHF Honor Scholarship Christine Chiu, MD Laughlin Award of the National Psychiatric Endowment Foundation Eric Chan, MD Pernilla Schweitzer, MD Outstanding Teacher Award Monique James, MD Public and Community Service Award Anand Iyer, MD
Radiology
AC-AUR Research Scholar Program Jacob D. Brown, MD, PhD Nicholas S. Burris, MD Robert R. Flavell, MD, PhD Marc C. Mabray, MD ACR Scientific Trainee Prize (3rd) Marc C. Mabray, MD ASSR, Louis A. Gilula MD Mentored Paper Award (3rd) Marc C. Mabray, MD Krevans Award Kevin R. Connolly, MD RSNA/AUR/ARRS Introduction to Academic Radiology Program Zhixi Li, MD UCSF Department of Radiology & Biomedical Imaging, Margulis Society Outstanding Resident Researcher Marc C. Mabray, MD UCSF Department of Radiology & Biomedical Imaging, Elmer Ng Outstanding Resident Award Aaron C. Miracle, MD
Rheumatology
Rheumatology Division Clinical Fellow Award Matt Cascino, MD
Urology
Best Poster at AUA Annual Meeting 2015 Thomas Sanford, MD Rachel Selekman, MD California Urology Foundation Grant Lindsay A. Hampson, MD CaringWisely Proposal Winner Lindsay A. Hampson, MD CTSI Resident Research Funding Award Lindsay A. Hampson, MD Earle C. Anthony Travel Award Lindsay A. Hampson, MD Resident Research Travel Award. Lindsay A. Hampson, MD
MAY 2016
Patient Safety Bulletin Patient stories and safety improvement updates for providers at UCSF Medical Center
Activities that promote transparency and reporting of near misses, hazardous conditions or errors ensure continuous focus on systems improvement. The “Great Catch for Patient Safety” program seeks to formally recognize staff, faculty and trainees who report safety issues and take action to prevent or mitigate harm. Nominations are obtained from the incident reporting system or word of mouth, vetted by the Patient Safety Committee and publicly acknowledged at the monthly Medical Center manager’s meeting. Recipients receive a certificate and letter of appreciation. Below are the awardees from June 2015 to April 2016 and the actions they took to “stop-the-line” for patient safety. Infections and Infection Control:
Radiation Safety:
Facilities Team–prevented potential infections by conducting a proactive assessment of air handling in patient rooms
Sherman Lim, Chief Technician, Radiation Oncology– ensured administration of the correct radiation therapy plan
Robert Lukas, Supervisor, SPD–prevented potential infections by identifying improvements in disinfection processes for channeled endoscopes
Madeleine Bogdanov, Technician, Radiation Oncology– ensured safe radiation therapy procedures and initiated review of alarm protocols
Normando Tadeo, LVN, Urology Practice–prevented potential infections by ensuring appropriate sterilization of flexible cystoscopes
OR Safety:
Felicia Powe-Flores, RN, SPD–prevented potential infections by ensuring correct reprocessing of neurosurgery probes Abraham Osequera and Victor Tse, Patient Support Assistants, Hospitality–recognized breaches in room cleaning following C.diff exposure and ensured rooms adequately cleaned Daniel Grisales, RN, PACU–proactively identified a patient at risk for schistosomiasis and facilitated appropriate testing
Cristianne Kabongo and Rachel Gunabe, RNs, OR– prevented misuse/misplacement of a wipe mistaken for a surgical sterile dressing
Medication Safety: Ashlyn Levesque, RN–corrected patient weight in EHR to ensure accurate medication dosing Joanie Naify, Technician, Pharmacy–ensured administration of correct dose of glycopyrrolate Patty Nevarez, Technician, Pharmacy–ensured administration of correct dose of folic acid
Jessica Pullins, PhD, Psychologist, UCSF Pain Management Center–facilitated diagnosis and treatment of C. diff based on patient’s history and learnings from C. diff myths
Steve Pletcher, MD–ensured administration of correct local anesthetic during endoscopic surgery
Aurora Gonzalez, RN, Procedure Unit–recognized sepsis in a patient being prepared for discharge
Jennifer Shields, RN, PCICU–ensured administration of correct dose of oxycodone
Security:
Jason Phillips, Pharm D, Pharmacy–ensured administration of correct dose of methadone
Al Scott, Supervisor, Security–ensured patient and staff safety by facilitating enforcement of a safe visitation plan for disruptive family members
Audrey Jeffers, Pharm D, Pharmacy–ensured administration of correct concentration of ketamine infusion Stephanie Chambers, RN, ED Mission Bay–ensured administration of correct fluid bolus
From the UCSF Patient Safety Committee and Office of GME. Editors: Adrienne Green MD (Professor of Medicine, CMO), Jim Stotts RN (Assistant Clinical Professor of Nursing, Patient Safety Manager) , and Kiran Gupta, MD, MPH (Assistant Clinical Professor of Medicine, Assistant Medical Director for Patient Safety). Please contact Kiran Gupta at Kiran.Gupta@ucsf.edu with questions. Disclaimer: Clinical details of cases have been altered to protect patient & provider confidentiality.
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Spring 2016 The Residents Report
GME CYPHER Stte xcid iwpi spgzcthh ettgxcv, adcv X hidds iwtgt, ldcstgxcv, utpgxcv, sdjqixcv, sgtpbxcv sgtpbh cd bdgipa tktg spgts id sgtpb qtudgt. – Tsvpg Paatc Edt
Editorial Staff: Robert Baron Andrea Cunningham Amy Day
Cover Photo by: Elisabeth Fall
Many thanks to the following contributors: Kemi Amin Mary Cook Sullivan Michelle Deng Loma Flowers Julia Kochi Mary McGrath Roger Mohamed Erin Morrow Glenn Rosenbluth Rene Salazar Tom Shimotake Ruth Thomas-Squance Joseph Zamaria Evans Whitaker GME Contacts GME Confidential Help Line: (415) 502-9400 Amy Day, MBA Director of GME (415) 514-0146 Amy.Day@ucsf.edu Robert Baron, MD, MS Associate Dean, GME (415) 476-3414 baron@medicine.ucsf.edu
Instructions: The above is an encoded quote from a famous person. Solve the cypher by substituting letters. Send your answers to Andrea.Cunningham@ucsf.edu. Correct answers will be entered into a drawing to win a $50 gift card! Congratulations to Abdominal Imaging Fellow Brett Mollard, MD
The most recent Cypher Answer was: “As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” -John F Kennedy
UCSF School of Medicine Graduate Medical Education 500 Parnassus Avenue, MU 250 East San Francisco CA, 94143
tel (415) 476-4562 fax (415) 502-4166 meded.ucsf.edu/gme