Innovations 6th Edition: Medicine & Mentorship by Riverside University Health System

CONTENTS Echoes of Healing: The Journey of a Family Doctor through the Halls of RUHS

Healthcare Horizons: Riverside University Health System’s Educational Contribution to the Community

Emergency Medicine Residency

Orthopaedic Residency Program: Treating Trauma and Healing Families

Pharmacy Residency Program: Evolving Excellence

Nurturing Knowledge: Real Life Skills in Nursing Education at RUHS

Medicine with Meaning: Q&A with the RUHS Internal Medicine Residency Program

General Surgery Residency Program: Limb Preservation Specialties

Inland Empire Influence: Cultivating My Medical Career at RUHS

You Know the Drill: Using Emergency Simulations for Impactful Learning

Shining Stars of RUHS: Honoring Jenni Shieck

RUHS Innovations

Innovations Magazine

6th Edition

FOREWORD: DR. DANIEL KIM I am excited to write the foreword of this edition of RUHS Innovations Magazine. This edition highlights the rich historical mission and advances of medical education at RUHS. The RUHS Mission - “To Improve the health and well-being of our patients and communities through our dedication to exceptional and compassionate care, education, and research” - reflects the commitment and importance of education of everyone at RUHS. RUHS has been teaching residents since 1971 when it started one of the oldest Family Medicine Residencies in existence. RUHS continues to experience incredible growth in its training programs with twelve residencies and fellowships. RUHS now has training programs in Anesthesiology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, Neurology, Neurosurgery, Orthopaedic Surgery, Radiology, Psychiatry, Sports Medicine and Surgical Critical Care. RUHS will train over 220 resident physicians this year from its programs. RUHS’s educational mission has produced a great impact beyond RUHS. Over the years, RUHS has also trained thousands of residents and medical students from Loma Linda University School of Medicine, University of California, Riverside (UCR) School of Medicine and Western University College of Medicine. In addition, RUHS trains Physician Assistant students from California Baptist University and Podiatry students from Western University. RUHS serves as a pipeline for health careers locally through its participation in teaching High School Health Academy Students and UCR Health Coaches. These training programs have also been led by outstanding physician educators. The high-quality RUHS faculty have brought outstanding clinical care, teaching, collaboration and research to the Inland Empire. bit.ly/RUHS_Innovations

RUHS faculty and residents have published hundreds of articles and book chapters and presented at regional, national and international conferences. The inland California region, Riverside and San Bernardino, is a largely underserved region with a significant shortage of physicians per capita. RUHS residencies have trained hundreds of physicians and many of these physicians have continued to practice in the Inland Empire. The impact of these physicians in the community have been profound in increasing the access and quality of medical care in the Inland Empire. Having trained as an internal medicine resident at the old Riverside General Hospital (former name of RUHS) in the mid-1990’s, I can honestly say that we have made great strides but one thing that hasn’t changed is the outstanding education everyone receives at RUHS. RUHS has always been a favorite training site for students and residents for its outstanding faculty, strong dedication to the underserved patients and excellent caring staff. As RUHS continues to grow its educational platform and programs, the future is even brighter for outstanding quality medical care in Riverside.

Echoes of Healing: The Journey of a Family Doctor through the Halls of RUHS By: Vivian Yang, MD When I walk down a particular hallway on a particular floor, I flashback to the time I delivered a baby on the way to the Labor and Delivery floor. My favorite Panera lunch order is copied from a rotating UCR medical student. I have had serious, silly, and deeply personal conversations in nearly every patient room in the hospital. And I still remember from which taco shop we ordered tacos for a patient with Covid who was prone for more than 3 weeks. My office at Moreno Valley Community Health Center is decorated with cards from six and a half years of working with patients, staff, residents, and physicians, starting from intern year in June of 2017 to present as associate program director of the family medicine residency. My relationship with Riverside University Health System began before I ever stepped foot in Riverside County. As a third-year medical student on my way to my first political advocacy event with California Academy of Family Physicians, I was full of energy and passion. Kismet placed me on the plane next to Dr. Moazzum Bajwa, a RUHS family medicine intern coming from his night shift and on his way to the same conference. We shared a dedication to community outreach and serving a vulnerable population, and our conversation sparked my interest and eventual match into residency at RUHS. Dr. Bajwa continues to lead our residency’s community health and social medicine initiatives while directing longitudinal rotations for medical students at UC Riverside. As a resident, I was assigned to faculty advisor Dr. Adolfo Aguilera, who has built his 25-year career as a resident physician in training with Riverside General Hospital to physician leadership at RUHS. Our initial advising meetings consisted of questions like “How do I present this complex patient?” and “How do I get 8 hours of sleep?”. Now, our conversations revolve around legacy, vision and direction, and parenting differences between my baby boy and his adult sons. Dr. Aguilera serves as co-associate program director as well as the Physician-in-Charge for our residency clinic and the many hats that position comes with.

Our institution of RUHS boasts numerous family medicine physicians at all levels of patient care, from the day-to-day work at community health centers to the high stakes decisions made by administrators. Many of these physicians are graduates of our residency program. As a frontline resident in the height of COVID, I saw Dr. Shunling Tsang and Dr. Geoffrey Leung attend meeting after meeting after meeting, adapt to rapidly changing guidelines, and erect an Emergency Operations Center overnight. Corona native and alumna Dr. Ashlee Erskine completed a public health fellowship and was promoted to Physician-in-Charge just 1 year after graduation. Our residents rotate through every other department in the hospital, and we embody the vision of RUHS to “lead the transformation of healthcare and inspire wellness".

Top: Dr. Vivian Yang and Dr. Heidi Pang. Bottom: Dr. Adolfo Aguilera

But not every square foot of RUHS is filled with happy memories. When I walk past a certain intersection, I can hear her wailing as I did compressions on her husband. I recall the first patient for whom I called time of death, and the most recent, and every one in between. I still suffer the sleepless nights, the urgent phone calls, the knot in the pit of my stomach when I sit down with a patient to disclose a metastatic cancer diagnosis. Medicine is not an easy career, not for the medical knowledge with a doubling time of 73 days, but for the nuance, the emotion, the daily interaction with life and death. When I reflect on my most recent transition from resident to faculty to associate program director, I bring to mind words that were written by our program director, Dr. Nathan McLaughlin. In the middle of the worst of the Covid pandemic, he sent a logistical email detailing our increased inpatient capacity from one team to three, and 25 patients per team from 20. Dr. McLaughlin tells the story much better than I, but at the end of the email he quotes Sargent Ranney from Band of Brothers, “I cherish the memory of a question my grandson asked me the other day, when he said: ‘Grandpa, were you a hero in the war?’ Grandpa said, ‘No. But I served in a company of heroes.’” During graduation that year, Dr. McLaughlin was awarded the Inpatient Attending of the Year. I do not equate our daily work as family physicians with the devastation of World War 2, however, every day in clinic we are fighting many battles all at once against health inequity, social injustice, false information, opioid epidemic, childhood and adult obesity epidemic, black maternal mortality, gun violence, food insecurity, among many, many others. At Moreno Valley Community Health Center, Dr. Ray Kramer oversees the only Medication for Addiction Treatment clinic in our county safety net system. A doctor who returned to the community of his family, Dr. Uziel Sauceda runs the sports medicine clinic and the primary care sports medicine fellowship. Senior resident Dr. Emily Nguyen spearheaded our first lactation elective with the objective to boost breastfeeding continuation and decrease childhood obesity. Each of our faculty and residents finds their special place in the spectrum of full spectrum family medicine, with dedication and compassion to the unique patient population that we serve. This company of heroes is why I am proud of be a family doctor at RUHS. Photos (top to bottom): Dr. Tsang and Dr. Aguilara, Dr. Kim accepts a certificate, Dr. Leung addresses Family Residency program, Family Residency poses for a group photo.

Healthcare Horizons:

Riverside University Health System’s Educational Contribution to the Community By: Doris Heath, RNP Photos by: Shaan Johri Riverside University Health System (RUHS) is one of the biggest contributors to healthcare educational experiences in the Inland Empire. We have several contributing educational partners that have learners in various fields of studies that will be the future of health endeavors serving our community members. Our faculty of experts in their field of study are eager to share their experiences and knowledge with our learners. Our Residents and Nursing students find that the shared values and mission of RUHS gives them unique opportunities to learn about the human condition, autonomy to practice patient care and decision making in real time. They have shared how grateful they are to have had their rotations within our health system. They often rave about the plethora of specialty cases and rotations that they can participate in and how that has contributed to their overall educational and professional growth.

Dr. Sara Edwards addresses RUHS Staff before a drill

Dr. Charles Schoepflin begins a maternal-fetal simulation with RUHS staff

Perhaps the most compelling compliment is how they felt embraced by all members of the collaborative team and mentored through their learning journey. RUHS Clinics have received several certificates of appreciation from community medical assist programs for being emersed in the clinic setting and being able to perfect their technical skill set so that they can sit for their certification exams. RUHS offers our educational community partners preceptorships in healthcare management for those obtaining their undergraduate and graduate degrees in Healthcare Administration. RUHS also offers volunteer Health Coach positions for students that are readying themselves for entry into Medical School as well as positions for Psychology Interns that are completing patient care hours for licensure. Learners are welcome at RUHS from various areas of study in the healthcare field as this poses an opportunity for bidirectional information exchange. As a leader in healthcare RUHS will continue to support our learner community in the coming years and look forward to the collaborative on going relationships with our educational partners.

Emergency Medicine Residency Helicopter Medicine, Teaching in Africa, Dive Medicine, Transesophageal Resuscitative Echoes, Naloxone Distribution: an explosion of service, training, and opportunity! Editors: Michael Mesisca, DO, EM Chair and Melanie Randall, MD, EM Quality and Research Director RUHS Emergency Medicine Residency Program: Oscar Salaiz, D.O., Chief Resident, Academics RUHS Department of Emergency Medicine (EM) residency program will graduate its first class in June of 2024 and has made tremendous strides in an incredibly short period of time. Our program and department prides itself on a family-oriented and collegial culture that values academic excellence, innovation, leadership, and lifelong learning. In addition, we are adding two post-graduate fellowship programs beginning in July 2024. The following article highlights our educational programs, key resident-driven operational improvements, and our growing rotations.

Didactics also include a plethora of invaluable workshops. Some highlights include HALO procedure workshops in the cadaver lab, advanced suturing on animal pro-sections, difficult airway scenarios, splinting, point-of-care ultrasound, pediatric mock codes, tactical medicine, disaster and mass casualty drills, and interdisciplinary team building (Performance Under Pressure by author and international performance coach Dr. Dan Dworkis). Other educational activities are the annual resident retreat, monthly educational wellness days (pool side BBQ's in sunny SoCal while constructing DIY ultrasound models for central line placement and pericardiocentesis), quarterly journal clubs at faculty houses, and annual “Great Case Day.”

For more details about the program: www.ruhsemergency.org And follow our Instagram at #ruhs_em_residency DEM Educational Highlights: The residency holds a 5 hour didactic session every Thursday morning. These conferences consist of a wide array of learning modalities including traditional and flipped classroom based lectures. Instructors include attendings, residents, and guest content experts with decades of EM experience. Some of the topics include podcast style live discussions, social topics in EM (DE&I, social disparities, substance abuse), radiology grand rounds, board review competitions, QI/M&M’s, personal finance, risk management and metacognition.

Resident Driven Naloxone Distribution Program (NDP): RUHS ED, in partnership with the RUHS Pharmacy team, is one of the first academic centers in the Inland Empire to launch a Naloxone Distribution Program to provide a life-saving antidote free of charge for patients, visitors, and staff. To eliminate barriers and stigma, no check-in process or personal information is required. The ED boast that “anyone with a RUHS badge” can save a life by accessing one of the three functional storage sites, scan the QR code and dispense take-home intra-nasal Naloxone for anyone. The program was started by ED Clinical Pharmacist Jimmy Hernandez and EM Resident Dr. Oscar Salaiz in 2022. Given the huge demand for take-home Naloxone in our community, the duo had the program up and running within months with the help of hospital leadership. From the first shipment of just over 400 kits to now regularly requesting 1200 kits monthly, RUHS has dispensed over 6000 kits since inception. Due to the success of the program, there are plans to expand to all four floors of the medical center, as well as to the outpatient surgical center, county jails, and several satellite RUHS clinics

Emergency Medical Services\Disaster Medicine: Director: Andrew Pachon, M.D., Base Station Medical Director and Assoc. Director Disaster Medicine RUHS EM Residents work firsthand with local prehospital providers during their clinical shifts and during their EMS Rotation. They gain observational experience with fire, ground, and air helicopter EMS transport ride-along shifts. The residents refine their medical oversight skills during supervised Mobile Intensive Care Nurse (MICN) shifts. Residents learn the fundamentals of Disaster Management and Emergency Preparedness with asynchronous trainings through the Federal Emergency Management Agency. They participate in disaster exercises, observing direct patient care and integration into the Hospital Incident Command System.

Ultrasound Residency Post-Graduation Fellowship, EM Elective, and Medical Student Rotation: Korbin Haycock, M.D., Director of EM Ultrasound and Ultrasound Fellowship Director

Starting in July 2024, with support from the GME and RUHS administration, RUHS will have a one year postgraduate Emergency Ultrasound Fellowship with two fellows per year. In addition to more traditional point of care ultrasound applications, the program will have a unique focus of integrating ultrasound with resuscitation and hemodynamic management. This includes critical care echocardiography and resuscitative transesophageal echocardiography (TEE).RUHS is one of only a few emergency departments in the county training in the use of TEE. Dr. Haycock, our ultrasound fellowship director teaches nationally and internationally on the use of point of care ultrasound in resuscitation. Our ED has multiple ultrasound machines from diverse manufactures to give the trainees experience with various ultrasound platforms. Additionally, our residents and medical students are exposed to advanced training throughout their training, both during shifts and on Ultrasound electives.

Ultrasound Residency Post-Graduation Fellowship, EM Elective, and Medical Student Rotation: Korbin Haycock, M.D., Director of EM Ultrasound and Ultrasound Fellowship Director Starting in July 2024, with support from the GME and RUHS administration, RUHS will have a one year postgraduate Emergency Ultrasound Fellowship with two fellows per year. In addition to more traditional point of care ultrasound applications, the program will have a unique focus of integrating ultrasound with resuscitation and hemodynamic management. This includes critical care echocardiography and resuscitative transesophageal echocardiography (TEE).RUHS is one of only a few emergency departments in the county training in the use of TEE. Dr. Haycock, our ultrasound fellowship director teaches nationally and internationally on the use of point of care ultrasound in resuscitation. Our ED has multiple ultrasound machines from diverse manufactures to give the trainees experience with various ultrasound platforms. Additionally, our residents and medical students are exposed to advanced training throughout their training, both during shifts and on Ultrasound electives.

Wilderness Medicine/Riverside Search and Rescue Fellowship: Grant Nelson, M.D., Wilderness Medicine Fellowship and Clerkship Director Starting July 2024, the EM will also have a new postgraduate training program in Wilderness Medicine. We matched our first fellow, Dr. Marisa Evers! This program will enhance the didactic and training programs for our medical students and residents. The fellow will train to become an active member of the Riverside County Search and Rescue Team. They will have the option to do a 3-week NOAA Physician Dive Medicine and Swift Water Rescue Course in Seattle, optional deployment on an oceanic dive mission, Altitude Medicine Training in Nepal, India, a tropical medicine rotation in Kauai, HI, and field medicine in Joshua Tree National Park. More details can be found at www.cvem.us/wilderness

Global Health Elective: Stephanie Loe, M.D., International Medicine Director RUHS EM residents have opportunities to travel abroad for global health outreach during their elective months. They gain clinical experience in austere environments, learning about different health care systems, lack of resources, and poverty. They gain exposure to different pathologies including HIV/AIDS, tuberculosis, diarrheal diseases, vaccine-preventable diseases, malaria, and viral hemorrhagic fevers. Most importantly, they serve as educators for local health care staff in underdeveloped countries to promote sustainability. Our ED faculty, two EM residents, and 6 RUHS nurses spent a month in Ondo State, Nigeria in October 2022. They provided lectures and didactics to over 500 health care workers. They taught CPR, ACLS, airway management, trauma life support, pediatric resuscitation, point of care ultrasound, and emergent procedures. Our faculty, three EM residents, and 8 RUHS nurses spent a month in Maputo, Mozambique in March 2023 and again in October 2023. They worked side-by-side with Mozambican residents in a newly developed Emergency Department. They guided resuscitations and procedures on local patients and provided daily lectures to the Mozambican residency team. For more details www.riversideinternationaloutreach.org or Follow the team on Instagram #Riversideoutreach

Orthopaedic Residency Program: Treating Trauma and Healing Families By: Wade Faerber, DO Our program provides a wide variety of training in orthopedics for residency program. Our Attending staff are all fellowship trained in all of the Orthopaedics subspecialties. There are 15 orthopaedic attending’s at the University Hospital. We have affiliations with both Kaiser Permanente/Riverside and Children’s Hospital of Orange County with additional core faculty at both institutions. this allows them to get a great diversity of patient exposure from both sports medicine, foot and ankle and total joint training as well as pediatric orthopaedic training. We care for a multitude of patients from skydiving injuries to motocross injuries to various traumatic injuries as a level one trauma center. We also care for Division I university at Cal Baptist University, as well as care for the single, a baseball team , the 66ers of the Anaheim Angels based in San Bernardino we also are a center of excellence for total joint surgery and hip fracture pathway, which is a nationally recognized distinction from an early onset, the residents are given responsibilities, both clinically and surgically that allows them to matriculate to a highly qualified orthopedic surgeon at the end of their five years of training.

Dr. Wade Faerber

Over the past 24 years, we have trained over 60 orthopaedic surgeons, and the majority have gone onto specialty fellowships (Hand, elbow, shoulder and elbow, total joints, sports, spine, pediatric Orthopaedics, and trauma, ) but all provide service to the community from a general orthopaedic standpoint. When they are on call. This sets us apart from most other residences from a patient care standpoint. Our graduates can take care of the entire family from the children to grandma, which in turn serves the community as best as possible from a musculoskeletal standpoint. The biggest strength of the residency, however, is the camaraderie amongst the residents during their training. This gives the ability for the program to be stronger as a whole and promote a team approach, and hence produce a well-rounded orthopaedic surgeon.

Pharmacy Residency Program: Evolving Excellence By: Christina Qi, PharmD Our program is unique in many ways. Being part of a safety net organization, we have a patient population with a wide variety of illnesses spanning different levels of acuity which provides ample opportunities for clinical learning. Additionally, we are innovative in our approach to ensure the success of all learners through a layered learning model that incorporates learners with various levels of training and experience into daily patient care activities and pharmacy workflow. We offer career development opportunities to help residents continue to grow as a lifelong learner. The pharmacy team is progressive in ensuring that we partner with our frontline care providers to explore additional therapy optimization opportunities, and our pharmacy residents are often at the forefront of piloting novel clinical services. There had been a number of residents who stayed on employment due to the success of their pilot clinical programs. Riverside University Health Systems (RUHS) has always been synonymous with innovation and quality in healthcare. A shining example of this commitment is found in its Pharmacy Residency Program, which Dr. Christina Qi has been instrumental in developing since joining RUHS in 2010. This article delves into the program's evolution, its unique aspects, and the impact it has had on both its participants and the wider health community. When Dr. Qi arrived at RUHS, there was no existing pharmacy residency program. Seeing a great opportunity, she proposed the idea to her director, who enthusiastically supported it. Starting with just two residents in 2016, the program has grown steadily, reflecting the increasing demand and the quality of training offered. By 2020, the program expanded to four residents annually, a number that aligns well with the institution's size and capabilities. One of the hallmarks of the RUHS Pharmacy Residency Program is its adaptability and responsiveness to the needs of its learners.. Each year, the program undergoes modifications based on

Pharmacy Retreat 2022

feedback from residents. This approach ensures that the curriculum remains relevant, challenging, and tailored to the evolving landscape of pharmacy practice. Whether it's adjusting rotations or adding new elements like nutritional support training, the program is consistently fine-tuned to maximize educational value. The program boasts impressive outcomes, with many residents pursuing further specialization in areas like ambulatory care, cardiology, emergency medicine, and psychiatry. Alumni of the program have gone on to work in prestigious institutions and roles, showcasing the program’s impact on professional trajectories. Dr. Qi proudly notes that their first two residents are now making significant contributions in critical care and informatics. An important aspect of the residency is its interdisciplinary nature. Pharmacy residents at RUHS not only gain clinical experience but also engage with a range of healthcare professionals. This interaction fosters a comprehensive understanding of patient care and strengthens collaborative skills – essential components in today’s healthcare environment. Looking ahead, Dr. Qi envisions further expansion of the program, potentially in areas like internal medicine and emergency medicine. The program’s adaptability and commitment to growth ensure that it will continue to be a leading choice for aspiring pharmacists. The RUHS Pharmacy Residency Program, under Dr. Qi’s stewardship, stands as a testament to RUHS’ dedication to advanced medical education and patient care. Its dynamic nature, responsive curriculum, and successful alumni are just a few highlights of this thriving program. As it continues to evolve and expand, the program is set to further solidify its reputation as a premier training ground for future pharmacy leaders.

Nurturing Knowledge: Real Life Skills in Nursing Education at RUHS By: Barbara Coatney, MSN-Ed, RN and Edward Bacho, MD In the world of healthcare, the pursuit of knowledge is endless, and the importance of collaborative learning cannot be overstated. As the director of the nursing education department at Riverside University Health System (RUHS), my journey has been rich with experiences that emphasize the significance of an integrated, multidisciplinary approach in medical training and patient care. Our department primarily focuses on ensuring that our nursing staff remains certified, educated, and compliant with regulatory authorities, with patient safety at the forefront of our endeavors. Our team structure is a testament to our commitment to multidisciplinary collaboration. Comprising eight nursing educators from diverse specializations, two office support staff, two IT professionals managing our online learning system, and a data analyst, our team is uniquely equipped to provide patient-centered education. The courses and training we offer are meticulously designed to cater to a broad spectrum of medical professionals. We provide certification classes crucial for our nursing staff, such as American Heart Association classes including ACLS, PALS, BLS, and NRP. Our curriculum extends beyond the basics, offering cognitive development courses and collaborations with physicians, thereby enriching the learning experience for CNAs, LVNs, RNs, and others. Understanding the diversity in learning styles, we have tailored our educational methods to accommodate visual, auditory, and kinesthetic learners. Our innovative techniques range from interactive online modules with quizzes to practical applications, ensuring that each individual’s learning needs are met. Our department’s reach is extensive, serving around 2300 employees across RUHS inpatient settings and Community Health Centers (CHC) in Riverside County. Our focus is not just on immediate patient care but also on bridging gaps from emergency care to discharge, significantly reducing readmission rates.

Compliance with regulatory bodies like the Joint Commission and CMS is a cornerstone of our educational framework. This ensures that our nurses are more than just proficient at the bedside; they are integral in maintaining the high standards required for specialty programs. Collaboration is at the heart of our department’s ethos. We work closely with various disciplines such as diagnostic imaging and pharmacy, highlighting the importance of teamwork in comprehensive patient care. This interdepartmental cooperation is a key component in our approach to medical education and patient treatment. Our innovative training methods include unique approaches like RUHS Skills Day reverse escape rooms, where staff identify and address safety violations in simulated settings. This creative method enhances practical learning and fosters a deeper understanding of safety protocols in a controlled environment. To ensure the effectiveness of our training, we diligently track and analyze outcome data. This continual assessment allows us to refine and evolve our methods, ensuring they remain effective and relevant. Our training programs aim to do more than produce skilled nurses; they strive to integrate them into a cohesive, multidisciplinary team. This approach ensures that each team member understands the role of different disciplines in providing optimal patient care. Looking ahead, our challenges include enhancing our simulation center with advanced equipment to better cater to varied learning styles. Collaborating across departments, particularly with physicians, and ensuring staff diversity to reflect all areas we teach, like respiratory or diagnostic imaging, remains a top priority. This will enable us to provide the most comprehensive and effective education possible. The journey in medical education and training is an evolving one, driven by the need for comprehensive, collaborative, and adaptive learning methods. As we continue to navigate this path, our focus remains steadfast on improving patient care through enhanced education and teamwork.

Medicine with Meaning: Q&A with the RUHS Internal Medicine Residency Program Contributors: Shunling Tsang, MD and Roger Garrison, DO Q: What is something that you find that most people aren’t aware of about your program? Dr. Garrison: The community we serve is about the size of the state of New Jersey. The residents and trainees here can take great pride in that. We have regional importance and also at the state level - including one of three receiving centers during COVID. Also, at the national level when the plane landed at March Airforce Based during COVID. The fact that we are a community based program situated centrally in Southern California that affords the trainee to work with an underserved population within a health system that not only has a level 1 trauma center but also PH, BH and 13 FQHCs. The clinical environment is phenomenal for the learners. We are also very fortunate to have grant funding that allows us to support the trainee for outside elective rotations or research which allows us to do amazing things around team building, bonding and supporting research and scholarly activities. We are here as a pipeline program to create more physicians to serve the underserved in the region. Highlighting the ratio of physicians to patients and the shortage that we have in this region and how our residency is here to help fill that gap and need.

Q: Given your involvement with teaching medical students and residents, can you describe how your collaboration with local medical schools and health programs has evolved? How do these interactions enhance both your teaching methods and the overall educational experience at RUHS? Dr. Garrison: Speaking to our affiliations - we go back to LLU for decades and many trained at LLU for residencies and approx 20 former chief residents are now faculty. Strong ties there. Strong ties with UCR school of medicine - and many students rotate with us. We have Loma Linda, UCR and Western medical students rotate with us. We would also like more CSUM med students rotating with us. Q: How has your direct involvement with RUHS's in-house or partnered residency programs influenced the curriculum or the teaching methods employed? What feedback have you received from residents that helped shape the programs? Dr. Garrison: We have the ability to focus on education over service so we have been able to build the curriculum on the merits of the educational needs rather than service. We really paced the educational experience so we never have back to back call months. This allows for a strong focus on their education as wellbeing. We don't want our residents to be overwhelmed and overworked.

Our pulmonary critical faculty are some of our best educators and even though it is a very intense experience, so the rotation was then broken up into 2 week sessions with a break in between based on resident feedback. This is how we can provide a rigorous clinical experience with wellness built in. At the GME level, we advocated for a space for the residents and this has come together as the Resident Village - where there are workstations, a lounge, snacks, and a treadmill and exercise bike. We are looking for other opportunities to expand on this. We have heard from the residents via the resident committee so they have a forum and opportunity to share what they would like to have for wellness and support. RUHS has responded and supported the request including a small redesign of the area in order to respond to the resident request. Culture of safety is also important and we have engaged our residents to provide feedback and input into this very important work. We have ensured that the residents have participated and that they have a voice in these issues and that the institution has taken the time to sit down and talk with the residents and bringing it back to the respective departments to see how we can make this place a better place to work. We are a mission driven health system dedicated to the wellness and well-being of Riverside County with a focus on underserved and underrepresented patients. It is this mission which defines the culture and working environment of Riverside University Health System (RUHS). Faculty and residents are recruited based on their alignment with our mission to the underserved and underrepresented, which has created a culture of compassion and collaboration that makes training at RUHS a wonderful experience. Our faculty are dedicated to resident education

Regional Affiliations The collaborative relationship between Riverside University Health System (RUHS) and its affiliated academic institutions epitomizes the profound impact of comprehensive residency training on community health. This partnership, encompassing a myriad of specialties, weaves a rich tapestry of medical expertise, benefiting not only the aspiring medical professionals but also the diverse community of patients they serve. The breadth of this collaboration reflects a commitment to offering an expansive and nuanced medical education, ensuring that the future of healthcare is nurtured in the hands of well-rounded, compassionate, and skilled clinicians. RUHS is honored to train side-byside with the affiliated programs. Affiliated Residency Programs Loma Linda University Medical Center Cardiology Dermatology Emergency Medicine Family Medicine / Preventive Medicine Gastroenterology General Surgery Head, Neck & Otolaryngology Internal Medicine Neonatal / Perinatal Medicine Neurology Ophthalmology Oral MaxiofacialSurgery Otolaryngology Pediatrics Plastic Surgery Pulmonary Diseases / Critical Care Medicine Rheumatology Urology University of California Riverside Internal Medicine Psychiatry

General Surgery Residency Program: Limb Preservation Specialties By: Beatriz Leong, MD Vascular surgery at Riverside University Health Systems (RUHS) has recently expanded to offer a more comprehensive and contemporary approach to vascular surgery patients. Among the newer technologies that have been approved by the federal drug administration (FDA) and are newly being offered at RUHS include transcarotid artery revascularization (TCAR) as well as comprehensive approach to limb preservation for patients with advanced critical limb threatening ischemia. TCAR- transcarotid artery revascularization (TCAR) was initially approved by the FDA in 2015, however at that time it was only approved for high-risk surgical patients needing carotid revascularization. These highrisk criteria included those of advanced age, greater than 75 years, high surgical risk dur to co-morbidities, high anatomic risks such as redo neck surgery patients, neck radiation patients among a few others. Thankfully TCAR technology has excellent outcomes when selection criteria is applied rigorously and when performed by TCAR certified physicians. TCAR has performed so well that just recently in May 2022, they TCAR technology approval by the FDA was expanded to standard risk patients. Trans-Carotid Arterial Stenting offers a lower risk approach to treat patients with carotid stenosis and the Vascular Surgeons at RUHS are glad to be TCAR certified and be able to offer all surgical and medical treatment options to our patients. Limb Preservation - The Vascular surgeons at RUHS have been eagerly developing a multi-disciplinary team whose mission is to preserve limb and function among patients with chronic limb threatening ischemia (CLTI). CLTI patients suffer from particularly challenging circumstanced, most importantly they often suffer from many advanced disease states which contribute to limb threatening issues.

Our goal is to partner with other specialists such as Podiatrists, Vascular Medicine Specialists, Orthopedic Specialists, Plastics and Reconstruction Surgeons, Endocrinology specialists, Behavioral Health Specialists, wound care specialists among many others to deliver state of the art and comprehensive and individualized care. Among our vascualr specialists we specialize in comprehensive medical, open surgical and advanced endovascular techniques, as well as often a combination of techniques to preserve limbs and function.

Inland Empire Influence:

Cultivating My Medical Career at RUHS By: Joshua Winn, MD I first started working within the RUHS system while I was enrolled in the medical school at the University of California, Riverside. At the start of our third year, when clinical rotations began, there was a lottery for which hospitals and clinics the medical students would be placed. As luck would have it, I landed at the RUHS Hospital in Moreno Valley, where it helped lay the foundations of how I wanted to work in the profession. I wasn't entirely sure at the beginning of which specialty I wanted to pursue, but I knew I wanted to do something that would have a broad and flexible impact to the community. With the hospital teeming with Residents of many backgrounds, and with the diverse population it serves, it became obvious to me that the culture of working with the County at the Community Health Centers was what I was looking for. Here, there was a focus on the development of interdisciplinary relationships more than what I had previously seen. After my time at RUHS, I decided to stay with UCR at their Family Medicine residency located in the Coachella Valley. When our Residency moved to San Bernardino in the middle of our training, I was placed back into contact with previous medical school mentors, including Dr. Bacho, and later Dr. Lopez, who were able to get us valuable patient time at the RUHS clinic in Banning and Jurupa Valley. With their help, we completed our training and move on into the role of an Attending Physician.

Dr. Joshua Winn

Although many opportunities exist in Southern California, I couldn't help but remain drawn to the Inland Empire. I chose to remain with the RUHS system because of the broad impact that it has on the community, as well as the support that we as medical professionals receive from the county administration and broader public entities. Not only do I get to work for those that often need medical care the most, I am also working alongside other medical professionals who feel the same. Working with RUHS appears to be unique in the Southern California landscape of large medical entities. It has this sort of open door policy with higher administration, and there has always been room to brainstorm ideas about how we can make a greater impact and increase our involvement with the direction of the organization. For myself and others, it has given the ability to continue personal and professional autonomy that is becoming increasingly rare in medicine. and as a county servant, we have pensions, significant healthcare and savings benefits. Many of us, myself included, are even eligible for education repayment programs, which can decrease or even eliminate the entirety of debt that we have taken on through the years of schooling. These are just a few of the many perks that can come along with being an RUHS medical professional.

YOU KNOW THE DRILL:

Using Emergency Simulations for Impactful Learning By: Lesley Anne Bellows Photos by: Shaan Johri

Photos L-R: Dr. Bryan Oshiro addresses the RUHS team before a maternal -fetal emergency drill in 2023, CPR Practice dummy, NICU team practices during emergency drill “Our simulations have saved lives at Riverside It’s 7:00 a.m. on a Wednesday at Riverside University Health System (RUHS) by early University Health System Medical Center and a identification of emergencies and drills,” said hospital room is filled from wall-to-wall with Pasca. “Nurses from RUHS who went to other healthcare professionals ranging from hospitals called us to report saving lives at other physicians, nurses, operating room staff, hospitals because of the interdisciplinary anesthesiologists, and a few simulation simulation drills that they experienced here!” dummies for good measure. The goal: improving communication during trauma October’s simulation involved an Obstetric emergencies via emergency simulation Emergency with the patient being a pregnant exercises, which will ultimately result in mother experiencing maternal cardiac arrest. improved patient outcomes. According to the informational packet that was Currently, these emergency simulations take place every other month, and are very popular with the staff at RUHS, as they allow for handson learning across multiple teams. Attending Physician Ioana Pasca fully supports these drills, as they offer tremendous learning opportunities for staff, which leads to better patient care. 20

provided to all of the simulation attendees, maternal cardiac arrest (MCA) is a rare event occurring in approximately 1:12,000 women hospitalized for delivery. If MCA occurs, both maternal and fetal lives are at great risk. Communication and coordination among multiple care teams have a major impact on maternal and neonatal outcomes.

Before the simulation exercise started, Dr. Bryan Oshiro, Director of Maternofetal Medicine shouted out in a clear, firm voice: “Remember folks…the only way to get better, is to get in there! NOW is the time to learn! NOW is the time to ask questions!” From that moment on, the energy change is palpable. Questions and discussions are encouraged and mistakes are welcomed. It’s clear that every moment here is viewed as an opportunity to learn. Throughout the simulation, leaders call out scenarios that could occur and the team responds accordingly, providing the best care that they are able. The exercise is well-planned and informative, offering an in-depth opportunity to tackle a specific medical emergency. This simulation was comprehensive, and provided attendees with potential contributing factors, cardiopulmonary resuscitation (CPR) for pregnant patients, perimortem cesarean delivery, and postresuscitation care. It concludes with an opportunity for feedback, which will allow the program to improve over time. Amy Siegfried, lead nursing educator, has also developed a checklist for emergencies for staff to review. Emergency drills and simulations are an incredible way to offer learning opportunities to staff in impactful, memorable ways. There are regular drills that take place on the RUHS Campus that offer staff practical training for a future emergency and they are one of the many ways that RUHS staff shows their commitment to improving patient care.

RUHS emergency simulation drill - October 2023 21

INNOVATIONS RIVERSIDE UNIVERSITY HEALTH SYSTEM

Edward Bacho, MD EDITOR-IN-CHIEF Lesley Anne Bellows COPY EDITOR AND WRITER Shaan Johri PHOTOGRAPHY Cameron Cramer PHOTOGRAPHY

CONTRIBUTORS Lesley Anne Bellows Barbara Coatney, MSN-Ed, RN Doris Heath, RNP Wade Faerber, DO Roger Garrison, DO Daniel Kim, MD Beatriz Leong, MD Michael Mesisca, DO Christina Qi, PharmD Shunling Tsang, MD, MPH Joshua Winn, MD Vivian Yang, MD

INNOVATIONS WORKGROUP Adriana Rosato, MD Edward Bacho, MD Frank Flowers Jr., MD Geoffrey Leung, MD, M.Ed Mahbuba Khan, MD Matthew Chang, MD Michael Mesisca, DO Raul Coimbra, MD, Ph.D., FACS Ronald Johnson, MD Shunling Tsang, MD, MPH Vikram Kumar, MD, MBA

David Macamay DESIGN

26520 Cactus Ave Moreno Valley, CA 92555 marketing@ruhealth.org www.ruhealth.org

SHINING STARS OF RUHS Honoring Jenni Shieck - Former Graduate Medical Education Program Manager. Retired 2023. By Dr. Roger Garrison, Dr. Daniel Kim and Dr. Arnold Tabuenca In the annals of RUHS history, specific individuals stand out as transformative figures, leaving an indelible mark on our institution's journey to excellence. Jenni Shieck, with her 16 years of dedicated service, unquestionably belongs to this elite group and we would like to take the opportunity to recognize and celebrate her enduring legacy. Jenni Shieck has been the driving force behind the remarkable growth of our graduate medical education programs, serving as a cornerstone of progress. Over her tenure, she played a pivotal role in establishing eight new residency programs and securing ACGME accreditation for three others. Notably, this has led to our medical resident count surging from 85 to an impressive 211, a testament to her leadership. However, what truly sets Jenni apart is not just her unparalleled knowledge of ACGME regulations or her astute understanding of the complexities involved in starting and maintaining residency programs—it is her unwavering commitment to the pursuit of educational excellence. She has overseen a staggering 25 accreditation visits, two ACGME institutional visits, and two Clinical Learning Environment Review (CLER) visits, all of which have achieved remarkable success. Jenni's steadfast dedication has ensured that RUHS remains at the forefront of medical education. Beyond her professional achievements, Jenni Shieck's impact extends deeply into the personal realm. Her unwavering commitment to a harmonious and supportive atmosphere, inspirational leadership, and remarkable ability to connect with Program Directors, residency coordinators, and residents have cultivated an environment where growth and excellence thrive. Her caring mentorship has transformed RUHS into more than just an institution; it has become a tight-knit family.

“Jenni Shieck's tireless work at RUHS has opened doors for countless medical residents, providing them with unparalleled training opportunities and shaping the future of healthcare.”

Jenni set the standard for professionalism and service for the GME Office and staff. With a servant’s heart and wonderful sense of humor, she was responsible for developing and expanding the GME Office to provide the full scope of services required for our growing educational programs. Jenni worked tirelessly on behalf of all residents, and it was her vision and inspiration that led to the creation of the Resident Village which has helped strengthen interdepartmental ties between the residents. Jenni has been greatly missed after her retirement; however, her legacy at RUHS will remain timeless. She was foundational to the growth and development of the RUHS GME programs over the years. She cared so much for our residents, coordinators and program directors. Everyone loved and appreciated Jenni and her no nonsense yet caring style. We owe a debt of gratitude for all Jenni's efforts and contributions to RUHS.

Jenni’s work helped create educational opportunities for countless residents and has contributed to the training of multiple physicians who have remained in the Inland Empire to continue the mission of RUHS to care for the underserved and underrepresented.

As we acknowledge and celebrate Jenni's unparalleled contributions to RUHS, we extend our deepest gratitude for her enduring dedication, her exceptional expertise, and her remarkable leadership. Her legacy is not only woven into the fabric of RUHS but also into the hearts and minds of those who have had the privilege of working alongside her.

Jenni Shieck's tireless work at RUHS has opened doors for countless medical residents, providing them with unparalleled training opportunities and shaping the future of healthcare. Her influence will continue to echo through the years as these residents embark on impactful careers in the medical field and contribute to our community's well-being.

Congratulations, Jenni, on a career filled with achievements, and may your retirement be as rewarding and fulfilling as your time with us. While you may be stepping away from your daily responsibilities, your legacy will continue to inspire and shape our ongoing pursuit of excellence in medical education and patient care.

26520 Cactus Ave., Moreno Valley, CA 92555 www.ruhealth.org