Residents Report - Summer 2013 by GME UCSF

Summer 2013

10 Questions .... Incident Reporting Page 6

Out & About .... Destination Spa Therapy Page 10

Diversity at UCSF Page 18

The Residents

sue in this issue Excellence in Communication 1 Incentive Update 4 10 Questions 6 Incident Reporting SFGH 8 Incident Reporting SFVA 9 Out and About 10 Lean Launchpad 11 CTSI Update 13 Mindfulness Exercises 14 Radiology Tips 16 Patient Safety Bulletin 17 Diversity at UCSF 18 GME Diversity Update 19 Housestaff Awards 20 GME Cypher 24 Sustainability Box 24

Report

The Patient and Family Experience at UCSF: Achieving Excellence in Communication By Diane Sliwka, MD Associate Professor Department of Medicine, UCSF The Institute of Medicine defines quality medical care as “patient centered” in addition to safe, equitable, timely, effective and efficient. Improved healthcare provider communication with patients has been shown to improve many facets of care including: patient safety, compliance with plan of care, patient anxiety, readmissions to the hospital, malpractice claims, and clinical outcomes. In improving the value hospitals provide to patients, the Centers for Medicare and Medicaid Services now use patient feedback data to determine reimbursement to hospitals as part of a greater “value based purchasing”

program, further compelling improvement in this area. As healthcare providers, we play an integral role in the patient and family experience. What are patients asked? Patients give feedback about physician care by a survey that is mailed following any medical encounter. Currently, inpatient physician care is rated based on what percent of patients answer “always” to the following questions: How often did doctors 1) treat you with courtesy and respect? 2) listen carefully to you? 3) explain things in a way you could understand? Improvement depends largely on moving the answer from “usually to always.” Continued on page 2

What works? Improvement is dependent on consistently using the fundamentals of communication with all patients and guests. The AIDET SMiLe framework captures fundamentals which are highly effective when used in every patient interaction. Organizationally, UCSF Medical Center staff, physicians and nurses are all being trained in communication through an initiative called Living Pride.

Acknowledge Introduce Duration Explanation Thank Sit Down Manage Up Listen

Acknowledge the patient and family: use the patient’s name (preferred name or formal name if preferred is unknown). Acknowledge family by introducing them and their relationship to the patient. Examples: “Hi Mrs. Smith, My name is ….. Is there a name you prefer to go by?” “I see you have some family/ friends here. (Turning to family) How are you related?” Introduce yourself (by first and last name) and your role on the healthcare team. Write your name on white board. Use a business card or face card to reinforce your name and role. Patients meet many providers in a teaching hospital. In the literature, only 10% of patients could correctly name one physician involved in their inpatient care. This leads to confusion about who is responsible for what part of care, how people are communicating with each other, and whether anyone is responsible.

to the hierarchical dynamic. Get down to the patient’s level if possible. Sitting down is known to increase the patient’s perception of time spent with a physician.. Listen. Start by asking open ended questions. Elicit the patient’s concerns first, before moving on to your own. Avoid interrupting for the first couple minutes. Examples: “I’d like to review your medical history with you today, but first, is there anything you or your family would like to make sure we talk about today?” “We’re going to spend some time talking about what we’ve found so far, but first I want to make sure I understand what your main concerns are.” Duration. Address how long things will take. Patients spend a lot of time waiting in the hospital, and often they are unsure about what happens next. Explain the work that is happening behind the scenes and approximately when they can expect to see you again, have an answer, or be discharged. Example: “You are scheduled to go to the operating room to have your gall bladder removed later this afternoon. The surgery should take a couple hours and you’ll come back to this room this evening. Most people can go home the day following surgery, and we expect you will be able to go home tomorrow. I will speak with your family when the surgery is completed.”

Explain. Simplify medical language and avoid acronyms. Consider using analogies or drawings to help explain medical conditions. For patients with a non-English primary language, ask what the patient’s preferred language is and if they would prefer to have an interpreter. At MoffitLong, interpreter phones are now available at Example: “My name is John Smith, I’m one of the every patient’s bedside for this purpose. Recap residents on the surgical team. I work with Dr. the assessment and plan into a lay-person two Jones who is the supervising doctor on the team. line summary at the end of your visit so that the We are the primary team taking care of you while patient is left with a clear understanding of what is you’re in the hospital, though you may also see happening. some other specialists. I’m putting our names Example: “I want to recap what we talked about to here on the white board.” be sure I’ve been clear about what the plan is. You Sit down. Standing over the patient can contribute were admitted with bleeding from your stomach that we think was caused by an ulcer. In you, we 2

Lastly, remember that the patients and families that come through our doors are experiencing illness, often some of the most trying experiences of their lives. As physicians, we are in a unique position to impact those experiences. Slight changes in how we communicate with patients, incorporating the techniques above, can go a long Ask what questions the patient and family have at way to reassure, decrease anxiety and build trust the end. between the patient/family and healthcare team. Neglecting these can have the opposite effect. Example: “It’s my job to make sure we’ve explained Engagement from each member of the healthcare everything well. What questions do you have?” team is critical to our vision of providing the best care. Maya Angelou said, “I’ve learned that people Manage Yourself and Others Up. When will forget what you said, people will forget what introducing yourself, it is helpful to share any you did, but people will never forget how you made information about yourself that instills confidence them feel.” UCSF Smile AIDET Card 2013 Front.pdf 1 5/10/13 and reduces anxiety. Share your expertise and experience when appropriate. As housestaff, emphasize that you work within a team of experienced physicians. Remember that we are a healthcare team, working together to provide the best patient care. It is our collective responsibility to deliver excellence, and conflict within the team deteriorates the patient’s trust. Speak well of other healthcare team members when appropriate, and avoid speaking negatively of others. Address conflict with healthcare team members outside of the patient and family’s presence. think the ibuprofen you were taking contributed to the ulcer forming. The treatment for this is to avoid ibuprofen and to start a new pill which blocks acid in your stomach and allows the ulcer to heal. The new pill is called lansoprazole, and you take it once daily.”

Examples: “I’m working with Dr. Smith to take care of you. He’s a national expert in the type of tumor you have.” “I know you’ve heard some different opinions from some of our specialists. Often there are multiple correct approaches to your medical problem, and we have a lot of really smart people thinking about what’s best for you specifically. Let me communicate with the team and hopefully we can present you with a clearer picture of the options and get your thoughts on what you think you’d like to do next.” C

CMY

Thank the patient and family on closing the interview. Example: “Thank you.” “Thank you for your time.” “Thanks for letting us take care of you.” To family, “Thank you for helping me understand your mom’s medical history. It’s been very helpful to understanding what’s going on.” 3

1:02 PM

Housestaff Incentive Update Glenn Rosenbluth, MD Director, Quality and Safety Programs, GME The Resident and Fellow Quality Improvement Incentive Program for 2012-13 is almost complete. As you know, we have three goals which apply to all residents and fellows who spend at least 12 weeks at UCSF Medical Center. Each of these goals is worth $400 per eligible resident.

Goal 3: Discharge Process: Complete 20% of all inpatient discharges before 12 PM, for at least six out of 12 months. Overall we are at about 19%, so we are MUCH closer to the goal. We won’t make it for 2012-13, but this will continue to be a goal for the Medical Center, so keep up the great work.

Services that are above 20% for the most recent Goal 1: Patient Satisfaction: Maintain an period include: Adult General Surgery, OMFS, annual average mean score of 91.6 on the Ophthalmology, Otolaryngology, Pediatric Surgery, likelihood of recommending question. Plastic Surgery, Urology, and Vascular Surgery! For this goal, we are currently at 91.0, so this goal will not be achieved for 2012-13. However, it will remain a goal for 2013-14, so there is still benefit to improving! This score is based on the degree to which our patients would recommend UCSF Medical Center to others. It is a team effort, including physicians, nurses, environmental services, nutrition, etc. We are all doing our part! Quick tips: • Avoid jargon – most patients don’t know what it means to take a “po med,” be transferred “to the floor,” or even whether “intern” means that you’re a doctor. Pretend you’re talking to your grandmother! • Sit down – patients like it and you get to rest your feet. • Introduce yourself when you enter and say “thank you” when you leave – in the hustle-and-bustle of hospital work, it can be easy to forget these simple things. For more tips, take a look at the cover article by Diane Sliwka in this issue of The Residents Report Goal 2: Hand Hygiene: Achieve 85% compliance by physicians, for at least six of 12 months. This effort has been amazing! The physicians have met this goal for EVERY month this year! This is an incredible accomplishment and speaks highly of your commitment to patient safety. Our patients thank you! 4

What can you do to expedite the discharge process? About 20% of our patients are discharged between 12 and 2pm. Focus on those patients. They are often the ones who you know are going home right after lunch. Is there a reason they can’t go home before lunch? If an additional two out of every 100 patients go home before lunch, we will achieve our goal! Unfortunately, the time measured is when the patient leaves, not when the order is written. This makes it a team effort. If you want to get a patient out early, be sure the whole team knows it! Quick tips: • Start early. Long before discharge, start the discussion about needs for home tube feeds, PT/OT, other medical equipment, etc. • Think 24-hours in advance. If we identify patients who may be ready in the next 24 hours, there is time to ensure that all of the discharge planning is complete. Make this a part of daily rounds! • Alert nursing and pharmacy staff early in the morning. Even if the order is written at 11:00am, if no one was expecting the order it can be a challenge to get patients out the door by 12:00pm. • Tell the patient! Don’t forget that many patients need time to arrange transportation home.

Housestaff Incentive Update The UCSF Resident and Clinical Fellow Quality Improvement Incentive Program Poster Symposium was held on May 30th. At this end-of-year celebration, resident and fellow champions from 18 program-specific projects displayed posters and presented their incentive project findings.

JP Yu, MD discusses the Radiology quality improvement project.

Jennifer Kaplan, MD presents General Surgery’s housestaff improvement Project.

Amanda Whitaker, MD answers questions regarding Orthopaedic Surgery’s poster.

CLINICAL HOUSESTAFF INCENTIVE GOALS SCORECARD: FY2012-2013 June Immediate Attention (>5% below target)

PATIENT SATISFACTION: For the period of July 2012-June 2013, on the patient satisfaction survey likelihood of recommending question, maintain an annual average mean score of 91.6. Percentile rankings shown are national benchmarks. Due to change from received date to date of discharge information will be lagging by 3 months.

100

On Target (meets or exceeds target)

91.3

91.4

91.3

91.0

91.0 91.0

80 60

40 20

PATIENT SAFETY AND QUALITY:

Mar-12

Apr-12

May-12

Jun-12

Jul-12

Aug-12

Sep-12

Oct-12

Monthly percentile

Axis Title Monthly mean score

Running average mean score

Linear (Running average percentile)

Nov-12

Dec-12

Jan-13

Feb-13

Running average percentile

Overall Hand Hygiene Summary Rolling 12 Month Period

100% Compliance Rate

For the period of July 2012-June 2013, achieve 85% hand hygiene compliance by physicians for at least six of twelve months.

Warning (≤5% below target)

Likelihood of Recommending by Date of Discharge

80%

60% Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 MD/NP/IPA (Provider)

Complete 20% of all inpatient discharges before 12 PM, for at least six out of twelve months. This will include completion of all elements of the discharge process.

Inpatient Discharges Completed before 12 PM Percent Completed

Resource Utilization/Discharge Process:

IAP-Goal

25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Actual

Heather Leicester - Patient Safety and Quality Services

Target Metrics Collected - 6/6/2013

10 Questions from the Resident and Fellow Affairs Committee 1. What is an Incident Report? Incident reports are an important tool used by the Medical Center to identify adverse events and near misses, so that we can improve systems to support patient safety. 2. How do I file an Incident Report and what should be included? The incident reporting system can be accessed from the “CareLinks” page, the link is in the second column labeled “UCSF Pages.” You will need to complete some basic demographic information, answer some questions about the event, and then describe the event in free text. It is most helpful to be brief, but include enough detail to facilitate the next steps in the investigation of the event. It is important to be objective. The IR system is not a good place to speculate, assign blame, or vent about an event. Event details should include: what happened, who was involved, and the outcome of the patient if that is known. 3. What type of thing should I be reporting? What are the goals of an Incident Report system?

Adrienne Green, MD, Professor of Medicine and Associate Chief Medical Officer at UCSF Medical Center answers resident and clinical fellow questions about Incident Reporting at UCSF Medical Center patient on 14L falls, the IR will be routed to the 14L nurse manager, the medicine service chief and the category manager for “falls.” They would investigate and review the circumstances of the fall as well as the patient outcome. If needed, improvement activities and follow-up plans would be initiated. This would be documented in the IR system before “closing” the IR. Serious incidents, a fall with injury for example, are quickly escalated through the IR system to Medical Center and medical staff leadership for review and consideration of a root cause analysis.

We encourage reporting of both serious events or errors and near misses. Reporting of serious or sentinel events, such as a retained sponge or death from a medication error, allows for rapid review with a root cause analysis and timely reporting to the state. Reporting of near misses allows us to perform a review and implement system improvements, so that we 5. How many Incident Reports are submitted can avoid errors in the future. An example of at UCSF? a near miss is a medication error that is caught before reaching the patient. 10,000 incident reports are filed each year. The four categories with the most IRs are 4. What happens when I send in an incident medication related events, skin issues (for Report? hospital acquired pressure ulcers), IVs tubes and drains (largely for IV infiltrates), and falls. Incident reports are categorized into 32 categories. Each category has a category 6. Is my name used if I file an incident report? manager. When an IR is filed it is automatically What happens if someone files an incident routed to the category manager, the nurse report about me? manager or supervisor of the area where the event took place, and to the service chief and/ Yes, when you complete an incident report or quality improvement representative for the you will be asked to include your name. involved service. For example, if a medicine This is helpful for further investigation of the 6

event beyond what is written in the IR. Some institutions have anonymous reporting of IRs, but UCSF does not.

likely it is that you will be a part of the review process and thus hear about the outcomes. If you have filed an IR but haven’t received feedback, it would be appropriate to ask your service chief for follow up.

The most frequent IRs about residents and fellows involve unprofessional behavior, poor communication, slow response time to pages, 10. How can I learn about what comes out of and slow response to requests for orders. If the UCSF Incident Report and Root Cause an IR is filed about you, it will be sent to your Analysis system? program director and/or service chief for review. He or she will contact you to hear The Patient Safety Committee and the Office of about the event from your perspective. GME are partnering to develop Patient Safety Bulletins highlighting key events, what we 7. Is an Incident Report charted in the patient’s have learned about the root causes, and what medical record? Does it go in anyone’s we have done to improve our systems. We personnel file? also conduct a Patient Safety Grand Rounds each year in March. An upcoming GME Grand The incident reporting system is independent Rounds will focus on the IR system and root of the electronic health record. It is always cause analysis. best to consult Risk Management before documenting possible errors in a patient’s record. Incident reports may not be copied and placed in an employee’s personnel file. In fact, they may not be copied for any purpose. An IR is a confidential and privileged communication and must be appropriately handled to protect that privilege. 8. What is a Root Cause Analysis, how is it organized, and who does this? A root cause analysis is a multidisciplinary, structured, retrospective review of an event. At UCSF we perform RCAs on serious, sentinel events as well as near misses. The UCSF Patient Safety Committee has oversight over the RCA itself and is accountable for assuring that improvement actions identified at the RCA are implemented, sustained, and disseminated. Some examples of recent RCAs and the changes that were put in place, have been nicely described in the GME Patient Safety Bulletins that have recently been distributed. 9. Will I hear what happened to the situation about which I submitted an Incident Report? One of the pitfalls of our current system is that we do not do a great job of closing the loop with each person who has filed an IR. In general, the more serious the error, the more 7

Submitting an Incident Report at San Francisco General Hospital & Trauma Center Incident reports at SFGH are called Unusual Occurrence Reports or UOs and the UO system is web based and housed on the secure DPH/SFGH intranet. There are two ways to submit a UO depending on whether it is patient related or non-patient related: 1. Patient Related: SFGH Electronic Medical Record [Invision/LCR (Lifetime Clinical Record)] • If the UO is related to a specific patient, access the patient in Invision/LCR. On the menu bar on the left side of the first screen, click on “UO/Suggestion Box” link. • The first time you access the UO system, you will be asked to enter your active directory account. This is the same log on that you use to access the Citrix portal for Invision/LCR. • The UO category screen will then appear. Click on the appropriate category of UO, then hit “Next”. • The UO template will appear and will automatically be populated with the patient’s identifying information. You then type a description of the incident in the text box and click ”Next”. • If you are unable to finish, click on the “Save as Draft and Quit” and you can return later to complete it. • UOs are triaged by Risk Management and sent to the appropriate category manager for investigation. The category manager enters her or his investigate report into the system. 2. Non-Patient Related: CHN intranet site: http//insidechnsf.chnsf.org • On the SF Department of Public Health’s CHN intranet website, click on the UO Icon • The first screen provides an explanation for how to proceed. • On this screen the second line has a “click here” link for a non-patient related UO that will take you to the system. • The first time you access the UO system, you will be asked to enter your active directory account. This is the same log-on that you use to access the Citrix portal for Invision/LCR. • After entering your active directory account, you will be asked to enter the correct risk management office which for SFGH is “SFGH-COPC”; you will then be directed to the screen where you select the UO category, proceed as above. • You may also enter a patient related UO by this approach, but the patient data will not automatically be populated on the form. If you need assistance in submitting a UO, please call Risk Management at 206-6600. 8

Adverse Event, Close Call, and Risk-Prone Condition Reporting at SFVA Medical Center Reporting to the Quality Management Office is crucial for the patient safety program. Through analysis of incident reports and a focus on system errors rather than on the actions of individuals the patient safety process can lead to the development of measures to prevent future patient harm. Although reporting is voluntary, it is strongly encouraged, and is confidential. Events that should be reported: · Adverse Event: Unplanned, unexpected, and undesired outcomes that result from medical care rather than from the natural course of the disease. · Close Call: An event or situation that might have resulted in an accident, injury, or illness but didn’t either by chance or through timely intervention. · Risk-Prone Condition: Any circumstance (exclusive of the disease or condition in which the patient is being treated), which significantly increases the likelihood of a serious adverse outcome. How to report an Adverse Event, Close Call, or Risk-Prone Condition: If you have CPRS access: A. Select Patient in CPRS B. Select ‘Tools’ from the toolbar C. Scroll down to ‘More’, hover with the mouse: select ’QI Reporting’ from the menu and click D. Type in your Access and Verify codes again E. The ‘On-line QI Reporting” screen will appear: 1. You will be entering information in the left hand box ‘Find Patient’. Please skip the Find Employee box and the Visitor box. 2. To the left of the “find Patient” radio button: type in the patient’s full social security

number or full patient name. Click once on ‘find Patient’. 3. Click TWICE on the applicable patient’s name/number from the white box. 4. Click on the radio button that applies to the type of incident (falls, medication error, missing person, parasuicide or other). 5. Click on the calendar icon, select date and time that the incident occurred, and click ‘okay’. 6. Hit ‘next’. Pop-up box(es): These will vary depending on the type of incident that you selected, use the ‘next’ button after entries to move through the screens. 1. Complete the location of the incident and related information, as applicable 2. Briefly describe the incident (please be as objective and factual, as possible), and click on radio buttons with further description, as applicable Completing the report: 1. If you want to report anonymously, click on “Anonymous”. (Otherwise, your CPRS logon automatically assigns your name to the report. The Patient Safety Managers will use your name ONLY for purposes of contacting you if they have questions). 2. Click on “Save to QI database”; a dialogue box will appear confirming that the QI report has been filed. If you do not have electronic (CPRS) access, or if you have questions, you may report via telephone to the SFVA Patient Safety Managers: 415-221-4810, extension 4756 or extension 2018.

OUT & ABOUT from the Resident and Fellow Affairs Committee Where members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF

DESTINATION SPA THERAPY

Ginger Xu, MD, Fifth Year Resident in Plastic Surgery My favorite indulgence on a rare day off is a trip to the spa! As surgeons, we work hard - really hard - and I have learned during residency that it is also important to rest and restore yourself. Getting a massage, facial, or body wrap in a completely removed and serene setting is my way of “getting away from it all.” Sometimes, I will just treat myself to a quick morning massage, but if I can, I will usually make a little trip out of it. As luck would have it, there are a bounty of spa and massage destinations in the bay area from which to choose.

VISTA BLUE SPA @ THE MONTEREY PLAZA HOTEL This is my number one spa. I used to live in Monterey and would always pass by the incredibly beautiful oceanfront terraces of the Plaza Hotel. It wasn’t until my intern year that I found out there was a spa, too! Take the scenic drive from San Francisco down Highway 1 and valet park at the Plaza Hotel (it’s covered by the spa). The spa itself is located on the roof top deck where you will find a bird’s eye view of the deep blue water of the Monterey Bay, the courtyard with a lovely dolphin fountain, and a small secluded beach below. This is an open-air space with hot tubs overlooking the ocean, deck chairs for lounging or sunbathing, a steam room with fresh towels and 10

strawberry water, and a fireplace for chilly days. They will even bring you lunch a la carte. The deck is shielded from wind, and on sunny days it is just pure bliss. Make a day of it. At night, you have a view of the stars. There is also a boutique, which offers an array of lotions and fragrances, as well as stylish spa shoes. And if you join as a spa member (free), they offer all sorts of discounts. There is an extensive spa brochure with signature treatments such as foot and scalp massage, facials, wraps, scrubs, skin care, nail care, and even a “for men” section. For couples, there is a special bubble bath room with an ocean view. It’s a wonderful place to visit alone, with a partner, or a group of friends. Just go, you won’t regret it.

WATERCOURSE WAY in PALO ALTO An old favorite of mine, this spa is completely unique with private tub rooms combined with steam or sauna and cold plunge wells. It has a tasteful zen vibe and asian-inspired decor. Every time I go, it is like entering a different world of utter relaxation; I have yet to find another place like it. You can book a one hour tub room and combine it with a massage -- deep tissue is my favorite. The therapists are excellent at working with you on problem areas (good for those knots after long surgeries!). You can easily add aromatherapy and hot stones to your massage. They also have holiday treatments, monthly specials and couples massages. Definitely splurge on the rooms that offer steam or sauna options -- my top picks are “Six Dragonflies” which has a lovely wooden tub and warm natural light, and “Nine Bats” which is modern with sleek glassy decor and a tiled hot tub under a “dome of starlight.” I can’t think of a better way to unwind. Nearby Stanford, my alma mater, is a place I love to roam afterward. I like to do a morning treatment, then go shopping next door at Anthropologie, walk through the Stanford Quad, and end with lunch at the Cantor Art Museum Cafe. A perfect day.

ESALEN INSTITUTE in BIG SUR The most dramatic setting of all combined with the best massage of my life was at Esalen. It is a

retreat in a world of its own, with sweeping vistas of the big sur coastline and steep cliffs dropping into the ocean. What’s special here are the hot springs which reside on the grounds of Esalen, and are open only to 1) guests participating in a workshop, 2) renegades who show up during the 1am-3am time slot for “public access”, and 3) those who have booked a massage. I recommend the 3rd option. Of note, the baths are clothing optional, so come at your own comfort level! The grounds are large, and you will enter a common changing area with an eco-modern design. There is a large open air shower room with a glass wall looking out at the Pacific Ocean. You really feel one with nature. This leads to a perch with a number of individual claw foot tubs, and a scattered pools on different levels, all filled with the water from the hot springs. This is a place of complete serenity, quietude, and spirituality. You will marvel at an unforgettable view of the immense ocean. You might be brought into an indoor or outdoor space for a massage. With eyes closed you will hear the waves and feel enveloped by and connected with the sea. It is an amazing experience. My masseuse was incredibly in tune and used special “Esalen-style” massage

Lean Launchpad Launches for Life Science/Healthcare Entrepreneurs at UCSF The Entrepreneurship Center at UCSF is offering a unique course for entrepreneurs starting this Fall. Lean Launchpad for Life Science/Healthcare is an exciting new UCSF course taught by acclaimed entrepreneur/educator Steve Blank and a life sciences teaching team for people who have an interest and passion in discovering how an idea can become a real company. This is a team-based, experiential, hands-on opportunity to learn how to build companies in the real world. Class starts on October 1 for 10 weeks and meets in the evening. This class is not about writing a business plan or doing library research. You will be talking to actual customers and partners for your idea and learning the chaos and uncertainty of how a startup actually works. You’ll learn how to use a business model to brainstorm each part of a company and customer development to get out of the classroom and talk to real prospects to see if anyone other than you would want or use your product. Each week will be a new adventure as you test another part of your business model and share this knowledge with the rest of the

techniques that left me feeling totally rejuvenated. If you are looking for the ultimate massage, Esalen is not to be missed. Afterward, check in to the nearby Ventana Inn for a luxurious escape -- it’s worth the splurge. This is another haven in Big Sur with hundreds of acres of woodlands and its own on-site Spa and Japanese hot baths. Some rooms will have a deck with a private hot tub and distant ocean views -- a mini spa experience in your own room. I celebrated my last two birthdays at the Ventana; you’ll know where to find me next year!

class. The experience of working with your team will help you learn how to build, manage or interact with others in a venture. You will be assigned a mentor to support and inform you who will interact weekly. Class is organized around a lecture on one of the nine building blocks of a business model, student presentations on “lessons learned” from the week’s interviews and the team’s progression as captured through an online blog/journal/wiki. The Entrepreneurship Center will be holding an information session and mixer on July 17 to tell you more. If you don’t have a team or are looking for an idea, come to the mixer and find others with whom you can collaborate. Information is also available on our website: cbe.ucsf.edu, and on the links below: http://www.businessmodelgeneration.com/canvas For more on the Lean Launchpad, go to www. steveblank.com. Steve’s lectures for his techoriented class can be found on www.udacity.com. Contact Stephanie Marrus (Stephanie.Marrus@ ucsf.edu) or Kyra Davis at the Entrepreneurship Center for more information.

OUT & ABOUT from the Resident and Fellow Affairs Committee Where members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF

BAY AREA CLASSICAL MUSIC Tippi C. MacKenzie, MD Associate Professor in Residence, Surgery Pediatric and Fetal Surgeon in the Division of Pediatric Surgery

San Francisco is a classical music loverâ&#x20AC;&#x2122;s dream. There is something for every taste, with prices ranging from free to fancy. I grew up playing classical piano and singing, so this list is a bit biased, but can hopefully be a good start. SF Gate and KDFC (the classical music station) both have listings for current concerts. Happy listening!

OPERA SF Opera is a wonderful way to enjoy great music and theater at the same time. They feature worldclass artists each season as well as divas-intraining who sing some of the minor roles in the operas. Each season features some well-known, popular operas as well as music by modern composers. Check out their schedule at http://sfopera.com/Home.aspx. They have many options for half-season tickets that can save you about 15-30%. If you are new to opera, the best way to get a taste for it is the free simulcast in AT&T Park, where you can enjoy your garlic fries with great music. Bring a blanket! Also, many movie theaters such as Kabuki in Japantown and West Portal now also do simulcasts of operas either sung in SF or at the Met in New York- see http://www.metoperafamily.org/metopera/liveinhd/ 12

LiveinHD.aspx or the theater schedules. In the summer, they also put on Opera in the Park, which is always a fun afternoon of picnicking and listening. This year it is on September 8th. http://sfopera.com/ Season-Tickets/Opera-in-the-Park.aspx If your taste runs more modern, check out Opera Parallele at Yerba Buena Center: They are superb musicians not afraid to try new works and multidisciplinary art. http://operaparallele.org/ SF Symphony: Something for everyone! In addition to standard symphony fare, they also have kidfriendly family concerts and a youth orchestra. You can find the schedule at http://www.sfsymphony. org/. They also have great discounts such as sameday rush tickets that are detailed here: http://www. sfsymphony.org/Buy-Tickets/Discount-Tickets Stern Grove Music Festival: This is an incredible opportunity to hear a range of music options, all free. Sundays in the summer, June 16 - August 18. Say hello to SF summer fog and remember to wear layers! http://www.sterngrove.org/home/2013-season/

CHORAL MUSIC There is a lot of excellent choral music in the area. The SF Bach Choir is an excellent option. http:// www.sfbach.org/ In early December, multiple groups hold Messiah sing-alongs to help get you in the holiday spirit. For those of you with children, the SF Girls chorus is a wonderful opportunity to introduce kids ages seven and up to classical music (they sing a Holiday concert at Davies symphony hall each year).

OTHER VENUES There are several churches that have their own concert series. Check out: Old First Church: they usually have a lineup of talented musicians in a beautiful, intimate setting. http://www.oldfirstconcerts.org/ Grace Cathedral is an incredible place to hear classical music, especially organ. http://www.gracecathedral.org/visit/concerts-andevents/

2013 UCSF Resident Clinical & Translational Research Symposium On May 8, 2013 the Resident Research Training Program (RRTP) of UCSF’s Clinical and Translational Science Institute held its annual Resident Clinical & Translational Research Symposium in Millberry Union. The symposium provides an opportunity for residents to present their work and to develop cross-departmental collaborations. The event began with an overview of RRTP by Co-Director Emily von Scheven, MD and all the opportunities it offers. Sam Hawgood, MD, Dean, School of Medicine then shared some opening remarks about the scope and innovation of the work being presented. Five oral presentations were selected from among the resident abstracts submitted for consideration. Jennifer Jarvie, MD, presented “Prospective Association of Physical Activity and Markers of Inflammation and Insulin Resistance in Outpatients with Coronary Heart Disease: Data from the Heart and Soul Study;” Rushi Parikh, MD, presented “HIV Elite Controllers Have Lower Asymmetric Dimethylarginine and Improved Endothelial Function as Compared to Individuals with Treated and Suppressed HIV;” David Solomon, MD, PhD, presented “Frequent Truncating Mutations of the STAG2 Gene in Bladder Cancer;” Julian Villar, MD, MPH, presented “The Diagnostic Accuracy of Emergency Ultrasound for Acute Cholecystitis Using a Simplified Definition of a Positive Test;” and Matt Zinter, MD, presented “Impact of Cancer Type on Complications and Outcomes in the Pediatric ICU.” In addition, there was a poster viewing and a reception. In all, 24 resident posters were presented from many programs across campus from Anatomic Pathology to Radiology. The event was informative and entertaining. Many residents had the opportunity to present for the first time. Residents were exposed to the experience of presenting, the chance to learn, and the exchange of ideas with peers and mentors. If you are interested in learning more either about the Symposium or the other opportunities of the Resident Research Training Program, please go to http://accelerate.ucsf.edu/training/resident.

Connecting to Interpreting Services is as easy as 1, 2, 3! When communicating clinical information with a patient who does not speak English fluently, UCSF policy requires you use a professional interpreter to bridge the language barrier. UCSF policy recommends using an in-person professional interpreter for complex communication with substantial psychosocial or educational content and for patients with impaired hearing or using American Sign Language. Call 353-2690 to schedule an in-person interpreter; choose Option 1 to access an interpreter over the telephone 24/7. In the hospital, look for the dual-handset telephones and follow the instructions on the label for rapid telephone interpreter access.

Locate your patient’s preferred language for healthcare in the APeX header. 13

Brief Mindfulness Exercises for the Busy Physician studies show gray matter increases in the areas of the brain associated with memory, empathy and emotional self-regulation following mindfulness training. In addition to the long term benefits of Imagine you are about to make an important case mindfulness training, there are immediate benefits presentation to your medical team. All the residents, including relaxation, reduced stress, and improved fellows, your attending, and other senior faculty emotional regulation. At UCSF, the Osher Center members are present. The room is across the hall for Integrative Medicine, teaches the full eightfrom a very noisy nursing station and the audio/ week MBSR class and has an active research visual systems are not working; you won’t be able program investigating applications of MBSR to a to use your Powerpoint presentation and you will wide variety of health conditions (http://www.osher. virtually have to yell to be heard in the back of the ucsf.edu/classes-and-lectures/meditation-androom. Suddenly, you feel your chest tighten, your mindfulness/). Participating in an MBSR class can palms begin to sweat, your heart is racing, and your be a life changing experience. During Residency, breath shallow. You begin thinking about how your however, it may be impossible to take a full class colleagues will judge you during the conference. due to its significant time commitment (8-weekly You feel light-headed and fear kicks in--you know 2-hour classes, 45-minutes of daily practice and a you are not well enough prepared! This thought full day retreat). Fortunately, there are many ways pumps up your worry and you remember an old you can begin to develop mindfulness. When the idea that you are a bad presenter. You begin to time is limited, short practices throughout the day recall how terribly you have presented in the past have beneficial effects. and in your mind, you screw up this presentation too. You will do a terrible job and end up humiliated Kabat-Zinn defines mindfulness as a way of “paying and criticized by your supervisors and colleagues. attention in a particular way: on purpose, in the You are now frozen in fear. In this mind/body present moment, and non judgmentally.” When state, it will be nearly impossible for you to deliver truly in the immediate moment our perception the presentation you have so well prepared. This is more accurate, and we respond simply and is an example of how easily our mind and its appropriately to the issue at hand by recognizing future-tripping habits can control us in the present. our feelings, thoughts or emotions and without Fortunately, we can learn to observe our thoughts identifying with them. This is very different from and feelings in the present moment without getting how we usually get caught up in our mental and caught up by them. This is called mindfulness. emotional reactions, which are based on a story we tell ourselves based on past experience. With In 1979, at the University of Massachusetts, Jon mindfulness training, we learn to recognize our Kabat-Zinn Ph.D., began to teach mindfulness stories and begin to free ourselves from their push meditation to chronic pain patients who had and pull on our mind. exhausted all other medical and surgical alternatives. He brought this 2500-year-old Re-imagine the presentation situation at the practice into the medical setting without the beginning of this article. This time, when you religious component of its origins and developed a notice your body tightening and heart racing, you curriculum, Mindfulness Based Stress Reduction are able to acknowledge these feelings and the (MBSR), which is now taught and researched thought: “Here I go again – always screwing up in over 400 universities and medical centers presentations.” Instead of believing this thought as across the United States. Research studies have true, you take a deep breath, feel your feet on the demonstrated MBSR training reduces symptoms ground and notice how your body relaxes and your of depression, anxiety, and perceived stress; it has thoughts slow down. Simply observe the thoughts, been shown to help patients with GI distress, high sensations and feelings that arise without fighting blood pressure, cardio-vascular disease, sleep them, acting them out, or even judging them. problems and chronic pain. Recent neuroimaging This frees you from old ideas and bodily tensions and allows your energy and attention to re-focus Manuel Manotas, Psy.D. UCSF Faculty & Staff Assistance Program

on your current presentation. The sooner you recognize old patterns and refocus, the easier it will be to disengage from unhelpful thoughts and reactions. When you are pressed for time, there are many simple practices that are helpful. Below are a few you might want to give a try:

One minute meditation: • Stop what you are doing/thinking • Close your eyes • Feel your body sensations as they are (do not think about your body, but actually feel its sensations) • Focus your attention on your breath, notice how it feels in your nostrils when the air flows across them—cool on the in-breath, warm on the outbreath. • Choose an area of bodily sensation and focus your breath there. For example, you might focus your breath on the tension in your abdomen and notice how it expands and contracts with each inhalation/exhalation. o Expect your mind to wander and get distracted. This is what minds do. o Every time you notice your mind wandering, simply bring it back to your breath, without judgment. o Letting go of judgment and self-criticism is an important part of this practice. o Practice frequently, and extend your practice time (5-10 minutes) as your schedule permits.

Daily Mindful Activity: It can be very helpful to develop this habit. Choose an activity that you do on a daily basis (e.g., teeth brushing) that is simple and repetitive and does not require much thinking. Commit to bringing your full attention to this activity. For example, while brushing your teeth, feel how you hold the brush, how your hand moves, the sensation of the brush in your mouth, the flavor of the toothpaste, etc. Be prepared for your mind to wander and get distracted into thinking about something else (Did you order those patient labs?!). As soon as you notice that you have drifted, bring your attention back to the sensations of your body as you do your activity. Remember that the mind’s tendency is to drift and this will happen repeatedly--don’t use this as an excuse to beat yourself up. Beginning

this practice can be very challenging and you may get lost in distraction the whole time. As you practice bringing your attention back again and again, your mind will begin to habituate to being in the present moment.

Mindful Movement: You don’t have to take a yoga class to get the benefits of mindful movement. Throughout the day, you can introduce very brief times (as little as one to two minutes) when you simply stretch while being aware of your body sensations. This simple exercise connects and grounds you. Our body is how we operate in the world, it is not separate from our mind and it is a powerful tool that is always available to bring our attention back to the present moment.

Mindful Deep Breathing: Deep, purposeful breaths have a very powerful calming effect. It is easy to undervalue the power of this simple practice. When tensions are high and anxiety rampant, we tend to take very shallow breaths or hold the breath. Counter this by taking a few deep, regular breaths to activate the parasympathetic nervous system and the relaxation response. Although mindfulness and other coping mechanisms can be effective strategies in coping with everyday stress, at times work or personal problems can interfere with your functioning and you could benefit from some extra support. The Faculty and Staff Assistance Program can help you by providing you with counseling services as well as referrals for therapists in the community. FSAP services are free and confidential and available for both personal and work-related issues.

Faculty and Staff Assistance Program

(415) 476-8279 For more information, please visit our website:

http://www.ucsfhr.ucsf.edu/assist 15

Tips for Effectively Working with Radiology Vignesh Arasu & Hriday Shah, Second Year Residents in Radiology Interacting with radiologists is like requesting a consult – it’s all about knowing how to think about your diagnostic question and how to communicate it. The following suggestions will help you (and the radiologist) figure out the right study for your patient, and receive the most relevant interpretation. 1. Providing a “radiology” clinical history: Location, location, location Radiologists analyze studies by finding abnormal anatomy and making an interpretation on the clinical context provided. Thus, if possible, think about your diagnosis in terms of likely anatomic location to help radiologists improve detection of subtle findings and give a more narrow interpretation. In addition to giving the chief complaint or relevant signs/symptoms, consider the following: a. What is your preliminary differential diagnosis? It helps to know a ddx instead of only one diagnosis to exclude. b. How specific can you anatomically pinpoint the pathology? For example, right lower quadrant? organ? C7 spinal level? 5th right DIP? c. Is there any existing abnormal anatomy the radiologist should know about? For example, history of surgery, cancer, trauma, XRT, etc. 2. Requesting the appropriate study Once you know the diagnostic question you want to answer, choosing the right radiologic study for your patient can be difficult. Here are ways to start: a. Do-It-Yourself: Go to acsearch.acr.org or google “ACR appropriateness criteria,” to find guidelines published by the American College of Radiology. b. Call a radiologist: Call the reading room for a radiologist to help choose the best study. As always, have the patient’s history, clinical question, and MRN ready. c. GFR: Know your patient’s GFR (not just creatinine) and google “UCSF radiology contrast” to find UCSF’s official policies if a contrast-enhanced study is safe d. Priors: Perhaps a study has been done previously, that may already have answered your question. Which is a perfect segue to…

3. PRIORS! PRIORS! PRIORS! It cannot be emphasized enough, but comparing current studies to priors are one of the most important tools for radiologists. It is the best way to strengthen an interpretation of findings. Always try to obtain prior studies done on a patient. a. Outside hospital studies: If you have the CD, bring it to the film library at the hospital you are working at: at Moffitt: M381 (x31640) at SFGH: 1x42 (x68033) b. Push studies: If the study was done at one of the UCSF sites, call the reading room at the original study site to “push” it to the site you are at. c. Formal dictations: Sometimes, there may be a need for a formal dictation in the medical record of an outside study. If so, please provide the original outside report to the radiologist. Also, bear in mind that these “over-read” reports will be billed to the patient. 4. Consulting radiology about results of a study When seeking a radiologist consultation in person or over the phone, keep the following in mind: a. Know your clinical history: See tip #1 to optimize communication b. Call/visit us: Once a study is completed, it may be necessary to expedite interpretation for urgent cases. Please call or visit the reading room and a radiologist will do their best to interpret in a timely fashion. c. Patience: Please also be patient if a radiologist cannot respond immediately. Radiologists handle many urgent/emergent studies simultaneously, and the on-call resident takes more than 100 phone calls overnight. If the study is non-urgent, consider waiting for the final read during the daytime. d. Read the full report: Radiologists try to mention the most important findings in the impression, but still make many other observations in the findings. Radiologists truly enjoy reviewing cases with the clinical teams. This year, the Department of Radiology will be distributing a pocketcard at GME orientation listing the phone numbers for the different radiology reading rooms, so that it is easier for clinical teams to open discussions with radiologists. These conversations are essential to interdisciplinary teamwork and ensure that miscommunication is reduced. Carrying out these conversations in an effective manner can help all of us improve patient care.

1 2 3

PATIENT safety bulletin Patient stories and quality of care improvement updates for residents and fellows at UCSF

MAY, 2013

Vaccination RESULTING IN vision loss CASE DETAILS:

A 19 year old male with a severe underlying immunodeficiency was given varicella vaccine as a part of health maintenance visit. Due to his immunocompromised state, he developed severe varicella retinitis, retinal necrosis, and loss of vision in one eye.

MEDICAL OUTCOME:

A prolonged hospital stay and surgical interventions were required. The patient has permanent vision loss in one eye and requires ongoing VZV suppressive therapy.

CASE REVIEW:

Record review noted unclear information regarding which vaccinations to administer. An immunology note and email did note contraindication to live vaccines, however, these communications were not prominent in the chart such that the ordering provider was aware. The patient noted that was never told of a contraindication to live vaccinations.

RCA Process:

To better understand this incident and to prevent similar events in the future, a root cause analysis (RCA) was performed. The following improvement actions have been implemented: ¥ A departmental M&M was performed, highlighting the issue and bringing attention to populations at risk from live vaccine administration. ¥ It was noted that no visitindependent place existed in the paper medical record to prominently display vaccine contraindications. APeX was configured to document live vaccines so that a pop up reminder of these contraindications appear to providers trying to order live vaccines. ¥ A drug-disease interaction alert for live vaccines and their contraindicated use in patients with an immune-compromising diagnosis was developed and is now fully functional in APeX.

From the UCSF Patient Safety Committee and Office of GME Editors: Herman S. Bagga, MD (Resident, Urology) and Mary H. McGrath, MD (Surgery and Office of GME) Questions? David Buchholz, MD (Pediatrics; Executive Medical Director, UCSF Primary Care) buchholzd@peds.ucsf.edu

Incident reports (IRs): ¥ Important, even if the situation is resolved! We want to learn from “near misses!” ¥ Allow review of adverse events and unsafe conditions to optimize processes – do not serve to punish individuals ¥ Safe, blame-free, confidential ¥ IR system may be accessed from the CareLinks Page: http://carelinks/

Root cause analyses (RCAs): ¥ In-depth, multidisciplinary review of an event ¥ Focus on systems and process improvements to prevent future events ¥ Safe, blame-free, confidential

Residents/Fellows: ¥ Play a large role in quality of care improvement at UCSF ¥ Often the first to identify patient events ¥ Can improve quality of care by filing incident reports 17

Diversity at UCSF J. Renee Navarro, MD, Pharm D Vice Chancellor, Diversity and Outreach “Diversity – a defining feature of California’s past, present, and future – refers to the variety of personal experiences, values, and worldviews that arise from differences of culture and circumstance. Such differences include race, ethnicity, gender, age, religion, language, abilities/ disabilities, sexual orientation, socioeconomic status, and geographic region, and more.” As Vice Chancellor, Diversity and Outreach, I would like to welcome new and returning trainees to our campus community. The Office of Diversity and Outreach established in December 2010, strives to ensure that the University of California, San Francisco embraces and nurtures our commitment to a diverse and just campus community. We recognize that our strength as an institution lies in the full participation and contribution from individuals of different backgrounds and that your participation is an essential component of maintaining our excellence in education, research, patient care and service. We are committed to providing an environment that is a supportive place to work, learn, discover, teach, and care for patients; and we strive to serve local and global communities to eliminate health disparities. To nurture this environment, several principles of community have been established to guide campus life at UCSF. Adherence to these principles is essential to ensuring the integrity of the University and achieving our campus goal of a diverse, open and inclusive community. A copy of these principles can be found on our website: http://diversity.ucsf.edu/POC/. We ask that you read them and abide by these principles during your time at UCSF. Our office offers ongoing cultural competency training, support for first generation, underrepresented minorities, GLBT, women, disabled and others within our community. We host an Annual Leadership Forum on Diversity, the Inside UCSF campus-wide outreach event, 18

Diversity Month Celebrations each October, a joint diversity celebration with Graduate Medical Education in December, and provide ongoing enhancements to our curriculum. We encourage you to get involved with diversity initiatives within your department or training program. Rene Salazar, MD, Director of Diversity, GME is an excellent resource and provides guidance and support through annual diversity outreach events including involvement in annual medical conferences and activities for top-tier URM undergrads interested in training programs at UCSF. Please visit the Diversity and Outreach website for information on campus resources, events, and demographics, diversity.ucsf.edu/. You may also subscribe to the Diversity Listerv by going to sending me an email to diversityoutreach@ucsf. edu. We invite you to engage in a dialogue directly with us. When there is a concern or something exciting to report, we want to hear about it. Please don’t hesitate to contact our office (diversityoutreach@ ucsf.edu). Follow us on Facebook (facebook. com/UcsfDiversity) and twitter (@UCSFODO) for information on events, workshops and research opportunities. I hope your time here at UCSF is both fruitful and rewarding.

GME Diversity Calendar of Events 2013-14

July

Association of American Indian Physicians (AAIP) Annual Meeting and National Health Conference July 29-August 4, 2013 - Santa Clara, CA

August

UCSF GME Diversity Advisory Group MeetingWelcome Mixer for New Trainees August 28, 2013 6-8PM Location TDB For more information or to learn how you can get involved, please contact Dr. René Salazar, GME Director of Diversity via email (salazarr@ medicine.ucsf.edu) or phone (415) 514-8642

GME Diversity Update Rene Salazar, MD Associate Professor of Clinical Medicine GME Director of Diversity

Meeting Update: Drs. Fernando Maldonado (PGY2, Family and Community Medicine) and Cynthia Maldonado (PGY2, Emergency Medicine) attended the Latino Medical Student Association Annual Meeting held on March 15 and 16, 2013 in Miami, FL. Over 300 Latino medical students from across the county attended. The UCSF Office of Graduate Medical Education participated in the residency fair, and provided attendees with information on UCSF residency training programs and scholarship opportunities for visiting students.

Diversity Advisory Group:

The newly created GME Resident and Fellow Diversity Advisory Group (DAG) met on April 9, 2013 in the Multicultural Resource Center to discuss plans for 2013-14. Some plans for next Drs. Rene Salazar (Director of Diversity, GME) and year include: Renee Navarro (Vice Chancellor of Diversity and • Establishment of a medical student Outreach, UCSF) attended the Student National organization liaison program for interested Medical Association Annual Medical Education housestaff and fellows to serve as liaisons Conference held on March 27-31, 2013 in to UCSF student groups including LMSA, Louisville, KY. In addition to providing information SNMA, LGBTQSA, APAMSA, and NAHA to attendees on training opportunities at UCSF, • New resident and fellow welcome event Dr. Salazar participated in two workshops (“How with diverse faculty and campus leaders to Provide Culturally Sensitive Care to Diverse on August 28, 2013 Patient Populations” and “How to Successfully • Creation of “Diversity Profiles,” which Navigate the Residency Program Application profile current diverse resident and fellows Process”) sponsored by the Physicians Medical on the Diversity Section of the GME Forum (PMF) of Oakland. Dr. Navarro participated website in a workshop on “Women in Medicine.” Anyone interested in joining the DAG should contact Dr. Salazar for more info.

Visiting Scholarship Opportunities:

Drs. Rene Salazar and Renee Navarro attend the SNMA Conference in Louisville, Kentucky

The Departments of Anesthesia, Emergency Medicine and Internal Medicine have partnered with the UCSF Clinical and Translational Science Institute (CTSI) to provide scholarships of up to $1500 for visiting students interested in completing a fourth year visiting elective at UCSF. Additional funds are available for students interested in other rotations through the Physicians Medical Forum (PMF). Current trainees (housestaff and fellows) are encouraged to share these opportunities with anyone who may be interested in completing a visiting elective at UCSF. 19

2012-2013 Honors and Recognition for Housestaff ANATOMIC AND CLINICAL PATHOLOGY

2012 CTSI Resident Research Funding Award Tami Rowen, MS, MD 2013 Society for Pediatric Pathology’s Young Investigator Research Grant Gabrielle Rizzuto, MD 2013 Stowell-Orbison Award David Solomon, MD, PhD Krevans Award Jonathan Esensten, MD, PhD David Solomon, MD, PhD Pathologist-in-Training Award, Society of Hematopathology Benjamin Buelow, MD

ANESTHESIOLOGY

2013 CTSI Resident Research Travel Award Jina Sinskey, MD

EMERGENCY MEDICINE

2012 CTSI Resident Research Funding Award Hangyul Chung-Esaki, MD Daniel Kievlan, MD 2013 CTSI Resident Research Travel Award Julian Villar, MD, MPH 2012-13 Department of Emergency Medicine Intern of the Year Kalie Dove-Maguire, MD 2012-13 Department of Emergency Medicine Graduating Resident of the Year Aaron Kornblith, MD 2012-13 Department of Emergency Medicine Medical Student Teaching Award Kendall Allred, MD 2013 Krevan’s Award for Clinical Excellence Juan Carlos Montoy, MD AAEM Resident-Student Association At-Large Board Sean Kivlehan, MD

SAEM Emergency Medicine Student Interest Group Grant Julian Villar, MD

FAMILY AND COMMUNITY MEDICINE AAFP Bristol-Squibb Myers Award Heather Bennett, MD Hearts Grant Recipient Brigitte Watkins, MD

INTERNAL MEDICINE

2012 CTSI Resident Research Funding Award Jonathan Budzik, MS, MD, PhD Rushi Parikh, MD Victoria Parikh, MD Sahael Stapleton, MD Tyson Turner, MD, PhD 2012 CTSI Resident Research Travel Award Sara Kalkhoran, MD Charles Langelier, MD, PhD 2013 CTSI Resident Research Travel Award Jonas Hines, MD Jennifer Jarvie, MD CFAR Mentored-Scientist Award Carina Marquez, MD Clinical Fellow Award Carina Marquez, MD Community Service Awards Mohammed Bailony, MD, M.Sc. Mai-Khanh Bui-Duy, MD Floyd Rector Basic Science Research Award Rushi V. Parikh, M.D. Floyd Rector Clinical Science Research Award Sara M. Kalkhoran, M.D. Jeffrey Weingarten Award (R3 award) Ari B. Hoffman, MD Keith Johnson Award (R2 award) Christina Cho, MD Professionalism Award Leticia Rolon, MD Reza Gandjei Humanism Award

2012-2013 Honors and Recognition for Housestaff Daniel E. Westerdahl, MD Teaching Excellence Awards for Cherished Housestaff (T.E.A.C.H.) Charlotte M. Carlson, MD Robert Y. Lee, MD Thomas Evans Teaching Award Sophia Monica Soni, MD

MEDICAL GENETICS

Ted Adams Award (Pacific Coast Obstetrical and Gynecological Society) Ben Li, MD Dr. Koch Memorial Scholarship (National PKU Alliance) Chung Lee, MD

NEUROLOGY

2012 CTSI Resident Research Funding Award Lara Zimmermann, MD 2012 CTSI Resident Research Travel Award Sunil Sheth, MD

NEUROLOGICAL SURGERY

2013 Boldrey Award for research project in neuroscience, San Francisco Neurological Society, CA Rajiv Saigal , MD 2013 The Congress of Neurological Surgeons (CNS) Socioeconomic Fellowship John Rolston, MD 2013 Harold Rosegay Young Investigator Award, San Francisco Neurological Society, CA Aaron Clark, MD 2013 John Hanbery Award for Best Clinical Neurosurgery Paper, San Francisco Neurological Society, CA Dario Englot, MD 2013 Krevan’s Award for Outstanding Surgical Intern of the Year, UCSF/SFGH Department of Surgery Faculty Selected Joe Osorio, MD Neurosurgery Research and Education

Foundation (NREF) -Section on Brain Tumors Award Michael Ivan, MD Resident Award, Approaches for Brain Tumor and Vascular Neurosurgery Surgical Course Joe Osorio, MD Steinhart Scholarship Award, UCSF School of Medicine Joe Osorio, MD

OBSTETRICS AND GYNECOLOGY

2012 CTSI Resident Research Funding Award Adam Lewkowitz, MD Molly Quinn, MD 2012 Infection Diseases Society for Obstetricians and Gynecologists Scholarship Michelle Khan, MD, MPH Award of Excellence in Female Pelvic Medicine and Reconstructive Surgery Victor Long, MD Best PGY1 Teaching Award Wael Salem, MD Best PGY2 Teaching Award Melinda Lorenson, MD Best PGY2 Teaching Award Christopher Jones, MD Best PGY3 Teaching Award Craig Mayr, MD Best PGY4 Teaching Award Wayne Lin, MD James Green Memorial Award Rasha Khoury, MD Krevans Award, SFGH Siri Gardner, MD North American Menopause Society, Resident Scholar Meera Shah, MD Pfizer President’s Presenter Award, 60th Annual Meeting of the Society for Gynecologic Investigation Hakan Cakmak, MD

2012-2013 Honors and Recognition for Housestaff SMFM, Best Poster Award Stephanie Valderramos, MD Special Resident in Minimally Invasive Gynecology Jessica Chan, MD Wayne Lin, MD Teaching Excellence Award for Cherished Housestaff Tushani Illangasekare, MD Ted Adams Award (Pacific Coast Obstetrical and Gynecological Society) Ben Li, MD UCSF Selected Research Presenter at San Francisco Gynecology Society Jessica Chan, MD

OPHTHALMOLOGY

2013 CTSI Resident Research Travel Award Noelle Layer, MD

OTOLARYNGOLOGY

2012 BARRS Award for Best Basic Science Presentation Kevin Burke, MD 2012 CTSI Resident Research Funding Award Megan Durr, MD Daniel Faden, MD American Head and Neck Society Alando J. Ballantyne Resident Research Pilot Grant – 2012 Jonathan George, MD Krevans Award for Excellence in Patient Care 2013 Jonathan Overdevest, MD UCSF OHNS Resident Research Symposium – Third Place Megan Durr, MD

PEDIATRICS

2013 ATS Fellows Track Symposium, Selected Attendee Aaron Spicer, MD 2012 CTSI Resident Research Funding Award

Kendell German, MD Emily Levy, MD Matt Zinter, MD AGA 2013 Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease Emily Perito, MD Ahmad Ghanea Bassiri, MD Pediatric Intern Award Enrique Escalante, MD AST Fellows Symposium Travel Award Audrey Lau, MD Brown-Coulter Award Kaitlyn Bailey, MD Compassionate Physician Award William DeGoff, M.D. Dr. Koch Memorial Scholarship Chung Lee, MD Faculty Teaching Award Ilse Larson, M.D. Grossman Award Adam Schickedanz, MD Investigator Travel Award, CTSA Consortium Child Health Oversight Committee Monique Radman, MD Krevans Award Cheryl Cohler, M.D Lucy S. Crain, MD Award Michelle Kaplinski, MD Mentored Clinical Scientist Development Program Grant Efrat Lelkes, MD NIAID/IDSA Career Development Conference Eileen Foy, MD NIH FIC GloCal Health Fellowship Hilary Wolf, MD Postdoctoral Fellow Teaching Award Jacob O. Robson, MD Resident Teaching Award Sabrina R. Santiago, MD David Young, MD, PhD Matthew Zinter, MD

2012-2013 Honors and Recognition for Housestaff Roy Rodriguez AIDS Fellowship Research Fund Hilary Wolf, MD Rudolph Award Trevor Williams, MD Stanford University Institute for Immunity, Transplantation and Infection Young Investigator Award Audrey Lau, MD Ted Adams Award (Pacific Coast Obstetrical and Gynecological Society) Ben Li, MD UCSF CTSI-SOS-CRS Early Career Investigators Pilot Award Emily Perito, MD Volunteer Faculty Teaching Award Neelesh Kenia, M.D. Young Investigators’ Travel Award, Pediatric Academic Society, Washington DC Monique Radman, MD

PSYCHIATRY

2012 CTSI Resident Research Funding Award Karen Mu, MPH, PhD 2012-2013 CTSI Resident Research Scholar Michael Hoefer, MD

RADIATION ONCOLOGY

2012 CTSI Resident Research Funding Award Christopher Tinkle, MD, PhD 2012 CTSI Resident Research Travel Award Moshiur Anwar, MD, PhD Charles Hsu, MD, PhD Christopher Tinkle, MD, PhD

RADIOLOGY

2013 CTSI Resident Research Travel Award David Tran, MD American Roentgen Ray Society (ARRS) Residents in Radiology Executive Council Award Ronnie Sebro, MD

American Society for Human Genetics (ASHG) semifinalist Epstein Award Ronnie Sebro, MD Association for University Radiologists (AUR) Residents in Research Award Ronnie Sebro, MD Krevans Award Melinda Yeh, MD Society for Computed Body Tomography and Magnetic Resonance Imaging Poster Finalist Award Ronnie Sebro, MD

SURGERY, PLASTIC SURGERY & EAST BAY SURGERY

2012 CTSI Resident Research Travel Award Jessica Beard, MD, MPH Natalie Lui, MD 2013 CTSI Resident Research Travel Award Lucy Kornblith, MD Anne Peled, MD Victoria Trinh, MD

UROLOGY

2012 CTSI Resident Research Travel Award Sarah Blaschko, MD

Confidential GME Help Line

415-502-9400 Confidential Line for housestaff, faculty, and program administrators to voice their questions, comments, or concerns 24 hours a day. The Office of Graduate Medical Education will respond to all messages.

Summer 2013

GME CYPHER

The Residents Report

“DKC XDJQF UJI DIQG HA CAJUMAO ZMCDKXM J PAMTUQA DY J LQJI, TI VMTUM VA WKFZ YACPAIZQG HAQTAPA, JIO KLDI VMTUM VA WKFZ PTXDCDKFQG JUZ. ZMACA TF ID DZMAC CDKZA ZD FKUUAFF.”

Editorial Staff: Robert Baron Andrea Cunningham Amy Day

--LJHQD LTUJFFD Instructions: The above is an encoded quote from a famous person. Solve the cypher by substituting letters. Send your answers to CunninghamA@medsch.ucsf.edu. Correct answers will be entered into a drawing to win a $50 gift certificate!

Cover Photo: Dr. Tina Dasgupta Radiation Oncology Cover photo by: Elisabeth Fall

Many thanks to the following contributors: Vignesh Arasu Herman Bagga Paul Day Adrienne Green Christian Leiva Tippi MacKenzie Manuel Manotas Mary McGrath Renee Navarro Glenn Rosenbluth Rene Salazar Hriday Shah Diane Sliwka Sandrijn van Schaik Ginger Xu GME Contacts GME Confidential Help Line: (415) 502-9400 Amy Day, MBA Director of GME (415) 514-0146 daya@medsch.ucsf.edu Robert Baron, MD, MS Associate Dean, GME (415) 476-3414 baron@medicine.ucsf.edu

The Winter/Spring 2013 Cypher Answer was: Congratulations Steve Braunstein MD, PhD Radiation Oncology Resident

Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not. Theodor Seuss Geisel, The Lorax

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 www.medschool.ucsf.edu/gme

Water & sustainability What does water have to do with sustainability? Everything! Clean, fresh water has become a scarce resource: less than 1% of the earth’s water is suitable for consump>on yet in the US we use gallons of water everyday. Keep our water clean. Conserve water. Everything you flush down the Don’t let faucets run, toilet or pour down the drain shorten your showers, ends up in one of the waste report or fix leaky faucets water treatment facili>es of San and pipes. A leaky faucet Francisco, where solids are that drops one drop per separated out and the water is second can waste more disinfected before it ends up in than 3,000 gallons of the Pacific Ccean or the bay. water, per year! Drink it…. but not from a bottle. San Francisco’s tap water comes from the Hetch Hetchy reservoir and is considered amongst the cleanest water available, cleaner than most boNled water! And did you know that boNled water produces up to 1.5 million tons of plas>c waste per year? Even though these boNles can be recycled, over 80% are thrown away, and it costs an es>mated 47 million gallons of oil per year to produce those boNles. Comments or ques,ons? Email Sandrijn van Schaik at vanschaiks@peds.ucsf.edu