SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE | WINTER 2018 | 41-1
LITTLE LEAPS, BIG POTENTIAL FOR POPULATION HEALTH
ASPECTS SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE SIUMED.EDU/ASPECTS
VOL. 41 | NO. 1
SIU SOM’s focus on population health strengthens.
2 Campus News
11 From Clinic to Community
Aspects of a Learner
5 Research 21 Alumni News
15 Moving the Dial
Alumnus Sameer Vohra, MD, JD, ‘11, sees his formidable mission as executive director of the Office of Population Science and Policy as an appealing challenge.
18 Radical Change: Y3T a Success
The revamped third-year curriculum celebrates its first year.
20 Triple Aim Architect Visits SOM
Dr. John Whittington shares his brainchild that became a national model to improve health care.
25 Dr. Kruse and the Triple Aim + 1
Dean and Provost Dr. Jerry Kruse discusses his innovations with the Triple Aim + 1 at SIU Medicine
The mission of SIU School of Medicine is to assist the people of central and southern Illinois in meeting their health care needs through education, patient care, research and service to the community.
ASPECTS CAMPUS NEWS
Aspects is published quarterly by Southern Illinois University School of Medicine Office of Public Relations & Communications.
Dean and Provost Jerry Kruse, MD, MSPH Executive Editor Karen V. Carlson, MA Contributors Lauren Crocks, MS Christi Mathis Steve Sandstrom Jordan Hammer Photographer Jason Johnson Address Correspondence: Office of Public Relations & Communications SIU School of Medicine P.O. Box 19621 Springfield, IL 62794-9621 217.545.2155 firstname.lastname@example.org SIU School of Medicine and SIU Medicine comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SIU School of Medicine and SIU Medicine cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. SIU School of Medicine and SIU Medicine respecte les lois fédérales en vigueur relatives aux droits civiques et ne pratique aucune discrimination basée sur la race, la couleur de peau, l’origine nationale, l’âge, le sexe ou un handicap.
Southern Illinois University is an Equal Opportunity/Affirmative Action institution in accordance with civil rights legislation and does not discriminate on the basis of race, religion, national origin, sex, age, handicap or other factors prohibited by law in any of its educational programs, activities, admissions, or employment practices.
41-1 WINTER 2018 | ASPECTS
PEDIATRICS’ CLINIC EARNS NATIONAL RECOGNITION The Department of Pediatrics’ Primary Care Clinic at Southern Illinois University School of Medicine has earned a new status: PatientCentered Medical Home. The recognition, awarded by the National Committee for Quality Assurance, signifies that the Springfield practice has met quality standards and taken steps to reduce costs and improve patient and staff satisfaction. The clinic received the highest level of recognition, Level 3. “This designation means our patients are consistently receiving the best, evidencebased, comprehensive care available,” said SIU Medicine Department of Pediatrics Professor and Chair Doug Carlson, MD. Research has shown that Patient-Centered Medical Homes reduce hospital and emergency department visits, reduce health care disparities and improve patient outcomes. Patient-Centered Medical Homes also provide direct benefits to parents and children including: • Personalized, whole-person care to manage children’s physical and mental health needs, including prevention and wellness, acute care and chronic care • Medication reviews to help families understand and track prescription medications. • Coaching and advice to help families follow their health plans and reach their goals • Enhanced technology, including email and after-hours phone calls, to ensure parents and adolescents can readily access their health information • Greater, more organized access to care, including specialty care, hospitals, home health
care, community services and long-term care supports SIU Pediatrics’ designation reflects a national shift from a volume-based payment system to a value-based system. Using the medical home framework, families are more likely to seek the right care, at the right time, in the right place. “With better coordinated care, providers are less likely to duplicate tests, labs or procedures, and patients are less likely to visit the ER or delay treatment,” said Carlson. “It’s a win-win for patients and providers.” Matt Dunmire, a licensed practical nurse, led SIU Pediatrics in the transition to a PatientCentered Medical Home. “Knowing that we’re taking the right steps to make sure children in central Illinois can get the best care from the best doctors is an incredible feeling,” Dunmire said. SIU Pediatrics is home to eight boardcertified primary care pediatricians and a dozen subspecialties. To find a provider, visit www.siumed.org/peds. To make an appointment, call 217-545-8000.
EAR NOSE AND THROAT, COSMETIC CLINICS OPEN IN RENOVATED SPACES Two specialty programs have opened renovated clinics in Springfield. The Division of Otologyngology Head and Neck Surgery will benefit from a renovated 22,000 square-foot clinic at 720 Bond Street in Springfield to treat adults and children needing ear, nose and throat care. This new facility features new audiology booths, advanced diagnostic equipment and a computerized arrival system. The site also includes the region’s largest hearing and balance program, with nine graduate-trained clinical audiologists offering comprehensive diagnoses and treatment. The clinic consolidates locations and integrates academic and clinical faculty and coordinates audiology services. “This new facility allows us to deliver state-of-the-art ear nose and throat care all under one roof. The entire facility is built around optimizing the patient experience,” said Carol Bauer, MD, chief of otolaryngology. Included in the new facility is the academic and teaching space for the SIU otolaryngology program, with more than 20 resident and faculty physicians. The Institute for Plastic Surgery opened a new cosmetic clinic at 2201 W. White Oaks Dr. in Springfield. The clinic offers cash-based services, including wrinkle fillers, BOTOX® injections, spider vein treatment and laser and cosmetic surgery consultations. Led by Nicole Sommer, MD, FACS, associate professor of surgery at SIU Medicine, the west side SIU Cosmetic Clinic sees patients on Tuesday and Friday afternoons. “The SIU Cosmetic Clinic aims to help patients maximize their health, wellness and peace of mind,” said Dr. Sommer, who has
LONGTIME EMPLOYEES HONORED SIU School of Medicine honored 56 employees for their years of service:
more than 20 years of experience and is certified by the American Board of Plastic Surgery. She specializes in breast surgery, facial rejuvenation, body contouring and nonsurgical cosmetic treatment for the face and body. Dr. Sommer also sees patients at the SIU Institute for Plastic Surgery, 747 N. Rutledge St., Springfield.
45 YEARS: Carl Faingold, PhD 40 YEARS: Allen DevlescHoward, MD 30 YEARS: Mary Aiello Kim Hodgson, MD Risa Kirkpatrick Anita Weinhoeft 25 Years: Kelli Beard Teresa Benshoof Amy Hoffman Stacy Miller Brian McCloskey Vickram Ramkumar, PhD Linda Savage Sara Shaw 20 YEARS: Janet Albers, MD Marcella Ashby Tammy Bowser Mikal McGary Michael Neumeister, MD Amy Richey Tracy Smith, DNP, MS Margaret Utterback Robert Wesley 15 YEARS: Brenda Bigley Thomas Brozoski, PhD Donna Clark Janet Connor Sibyl Cox Sheri Daniels Patty Gillespie Kimberly Hall Steve Jones Matthew Koch David Kotowski Michelle Miner Becky Murray Diane Paap Sriya Ranatunga Krishna Rao, MD, PhD Sheila Simmons Linda Snyder Stacy Stoppelwerth Lori Thompson Kendra Yociss, PharmD Michael Zagotta
41-1 WINTER 2018 | ASPECTS
‘CYBERCOUNTRY DOC’ DR. DEBRA PHILLIPS RETIRES IN QUINCY Debra Phillips, MD, has retired from SIU School of Medicine’s Quincy Family Medicine program after 34 years of service as a professor and physician. During her career, she was involved in the education of more than 120 family medicine physicians, the majority of whom have gone on to practice in the region. In an Aspects profile in 1998, Dr. Phillips credited a preceptorship during her second year of medical school at the University of Iowa for putting the rural doctor hook in her. The university and the American Medical Association sponsored a program for students to train in rural areas. “I had a doctor who was an excellent role model for how to handle the lifestyle, integration and professional isolation.” She embarked on the family physician career path, and looking back, says “it’s much more fun and interesting to treat 95 percent of presenting issues, and see the assessment and treatment plan on the 5 percent that are referred.” Dr. Phillips went from being a resident in Carbondale in 1983 to being a member of the Quincy faculty. “There were two of us as faculty, seeing 5,000 patients a year. We now see 40,000-plus patients each year.” When local community members began advocating for a clinic in eastern Adams County, Dr. Phillips worked with SIU, St. Mary Hospital and Blessing Hospital to start the East Adams County Clinic in 1991. The rural clinic became a national model for training family medicine residents in rural medicine. The interdisciplinary care available at the clinic included onsite physical therapy, counseling, pharmacy and later psychiatry. This integrated approach is now becoming the standard. Dr. Phillips has always been an early
adopter of technological advances in medicine, and she measured their merits within rural settings. As the East Adams Clinic expanded, she tracked procedures and developed the practice’s multiplier effect to show regional value. In 1997, East Adams became the first clinic in the county with electronic health records. Phillips became the Chief Medical Information Officer of Blessing Hospital in 2004, a position she retains today. Blessing’s electronic record system has received many national awards for excellence. Dr. Phillips’ academic papers were twice chosen as the Outstanding Research Paper of the year by the American Academy of Family
Dr. Phillips and friend in 1998. Physicians Scientific Assembly. She has been honored as Illinois Rural Health Practitioner of the year and National Rural Health Association Distinguished Rural Educator of the year. She was also recognized by the U.S. House of Representatives in 1996 for her rural service. Dr. Phillips will now serve as professor emeritus within SIU’s Department of Family and Community Medicine. She also plans to spend time visiting family and traveling around the United States.
ACCREDITATIONS AND HONORS FOR PROFESSIONAL DEVELOPMENT, QUINCY LAB SIU Medicine received recent accreditations for two programs. SIU School of Medicine received the distinguished status “Accreditation with Commendation” from the Accrediting Council for Continuing Medical Education (ACCME ®) as41-1 a provider continuing WINTERof2018 | ASPECTS medical education (CME) for phy-
sicians. The Office of Continuing Professional Development was commended for demonstrating that its program “is a learning organization and a change agent for the physicians and patients you serve.” The ACCME noted that SIU SOM demonstrates engagement with the environment in support
of physician learning and change that is part of a system for quality improvement. The SIU Center for Family Medicine – Quincy has met all criteria for Laboratory Accreditation by the Commission on Laboratory Accreditation Review (COLA), a national health care accreditation
organization. The lab received no deficiencies and received the Laboratory Excellence Award, which represents the lab’s “commitment to performing quality patient testing and overall laboratory practices.”
ASPECTS OF A LEARNER
Dr. Sudhakar Shenoy, Child & Adolescent Psychiatry, Class of 2019 Between medical school in India and my residency at SIU, I got an opportunity to learn research at Harvard Medical School and that was inspiring.
I grew up in Bangalore, India. Bangalore is known for awesome weather and great food. It’s the Silicon Valley of India. When I was a child, I was playing cricket with my friends when our ball went onto a roof. When I retrieved it, I was electrocuted and needed nine surgeries. The experience motivated me to be a doctor.
I have a motto that captures my role as a doctor: “Learn to serve; serve to learn.” SIU School of Medicine provides a commitment to academics coupled with a strong service mission, so being here has been a good fit. I love to travel and have visited 23 states in the last five years. When I started traveling, it was more by chance than by choice; however, I realized that travel makes you humble and wiser. That helped me to reflect within and made me happier.
My quest is threefold: Be a good doctor, be a good researcher, and be a good teacher.
I’ve always had an observant eye but my love for photography began as a means of sharing my travels with my mom and dad back home in India.
41-1 WINTER 2018 | ASPECTS
ADVANCES IN SICKLE CELL DISEASE Hemoglobins are proteins in red blood cells that carry oxygen throughout the body. Humans produce two major types of hemoglobin. The first, fetal hemoglobin, is produced before a baby is born. After birth, fetal hemoglobin is replaced by the adult hemoglobin. Individuals with sickle cell disease (SCD) are born with a mutated form of adult hemoglobin (called sickle hemoglobin) that was passed along to them from both parents. Occurring most frequently in people of African descent, SCD is the most commonly inherited blood disease in the world, with an estimated 4.4 million people living with the disease. The Centers for Disease Control estimates one in every 365 black or African-American people is born with SCD and one in 13 black or African-American babies is born with the sickle cell trait that can be passed along to his or her children. The disease is painful, leads to a high incidence of stroke and carries with it a much shorter life expectancy than the average person living in the developed world. Andrew Wilber, PhD, associate professor in the Department of Medical Microbiology, Immunology and Cell Biology at SIU School of Medicine, and his team are working to change that. Thanks to funding over the years from the National Institutes of Health and Doris Duke Charitable Foundation, the MMICB research team has been working to introduce genes into specialized cells, called hematopoietic stem cells. These cells have the unique ability to give rise to all blood cells in the body — including red blood cells. “We’re focused on developing curative therapies for patients with severe hemoglobin disorders. When babies are developing they produce fetal hemoglobin, which is able to carry oxygen from mom to baby,” Dr. Wilber explains. “Once babies are born, the fetal
41-1 WINTER 2018 | ASPECTS
hemoglobin is replaced by adult hemoglobin.” This “switch” in hemoglobin type marks the onset of these diseases. In SCD patients, when red blood cells release oxygen to tissue, they “sickle,” forming a rigid crescent shape. Those cells get stuck in the blood vessels, and most with the disease don’t live past their mid-50s. In another hemoglobin disorder, severe betathalassemia, patients do not produce adult hemoglobin at all. As a result, red blood cells don’t contain as much hemoglobin leaving those with the disease severely anemic, with a similar reduced life expectancy. “The only cure is to transplant hematopoietic stem cells from a matched donor,” Wilber says. “The problem is there are not very many matched donors. That limits the possibility of curative therapy.” To negate the need for donors, the SIU team is using a modified virus to introduce new genes into the patient’s own hematopoietic stem cells. Wilber stresses that clinical studies are proving the safety of these modified viruses. When a lentivirus infects a hematopoietic stem cell, it transfers its cargo into the chromosome. “By doing this, we’re able to stimulate the red blood cells to produce fetal hemoglobin. Because unborn babies do not show any signs of SCD or severe beta-thalassemia, we anticipate that continued production of fetal hemoglobin into adult life will essentially lead to a cure for those patients,” Wilber says. They’ve tried several strategies over eight years since they first began studying adult versus fetal hemoglobins, but for the past two years they’ve been attempting to turn back time. “We believe there is a clock that regulates all developmental time,” Wilber says. “That goes from early development, like embryonic, into the fetal stages and then to the adult stage.” Wilber’s team and a group at the NIH simultaneously identified a specific gene by looking at maturing red blood cells (RBCs) that produce either fetal or adult hemoglobin. This gene is highly expressed in fetal RBCs and not at all in adult RBCs. When re-expressed in adult cells, the team is able to turn adult
Sickle cell disease results from a change in a single base pair out of billions that make up human DNA. Source: National Institutes of Health, National Heart, Lung and Blood Institute.
cells into fetal cells so they produce the fetal hemoglobin. The process is not without challenges. “We are identifying elements that would drive expression of this gene only in maturing RBCs. By doing this, we can limit the reactivation of the fetal gamma globins to just the RBCs,” Wilber says. “This would prevent any unexpected consequences of expressing this gene in other types of blood cells which might impact cell growth or development.” Thus far, Wilber and his team have been able to express these genes in adult cells and show that corrective levels of fetal hemoglobin can be achieved, thanks to hematopoietic stem cells isolated from healthy donors. Presently, they’re working on testing this therapy in cells obtained from patients with SCD or beta-thalassemia and eventually in mice. “We want to determine what happens when we express this gene in all blood cells versus only RBCs,” Wilber says. “If these mice do not develop cancer, that’s a very good sign. If successful, these early studies would pave the way for additional studies in larger animals. We have a long way to go but our initial findings are quite promising.” The following grants funded this work: NIH/NHLBI P01 HL053749; Doris Duke Foundation Innovations in Clinical Research Award.
GRADUATE PROGRAMS CELEBRATE COMMENCEMENT Surrounded by faculty, family and friends, five Southern Illinois University School of Medicine graduate students received their diplomas at a commencement ceremony on September 22 at the South Auditorium at SIU School of Medicine. Donald S. Torry, PhD, professor and chair of the Department of Medical Microbiology, Immunology and Cell Biology (MMICB), and Yueh-Ting Lee, PhD, professor and graduate school dean of SIU Carbondale spoke at the ceremony. Rana Alfardan received a doctorate degree in Medical Microbiology, Immunology and Cell Biology. Mark Schroeder received a masterâ€™s degree in MMICB. Sumana Ghosh, Melissa McGovern and Sarah Sottile received doctorate degrees from the Department of Pharmacology and Neuroscience. The five graduates were honored for their years of hard work and are excited for their future endeavors, which includes post-doctorate positions in St. Louis, Houston, Kansas City and Springfield. To view more photos, visit http://siumed.zenfolio.com/p483490969 41-1 WINTER 2018 | ASPECTS
41-1 WINTER 2018 | ASPECTS
From Clinic to Community Population Health Focus Strengthens written by Karen Carlson | photographed by Jason Johnson Between birth and age 3, a child’s brain undergoes an impressive amount of change. The brain doubles in size in its first year, and by age three, it reaches 80 percent of its adult volume. This period of a child’s life is the most important for brain development—and it has inspired a new project from SIU Medicine’s Office of Population Science and Policy. Called “Little Leaps,” the program, under way at Hillsboro Area Hospital, strives to increase parent engagement. One part of the program provides parents with bags filled with toys, games and activities. “At home, we do this instead of turning on the TV. You can learn and play with your kids,” said parent Meghan Maretti, who has two children in the program. “I love how Little Leaps is educating not only the community, but the parents too, to give us the information and education we need to reassure us. It reiterates what I’m doing at home,” said Brooke Lang, another parent of two. “It gives me confidence that I’m doing the right thing and headed in the right path. The security of knowing my daughter is getting it here, and at home, gives me confidence that she is one step ahead of the other kids.” Little Leaps is just one effort of the growing Office of Population Science and Policy (OPSP), led by Sameer Vohra, MD, JD, ’11. OPSP celebrated its one year anniversary last fall. SIU Medicine joins a select number of US medical schools that have formal offices aimed to provide solutions to population health challenges. The creation of OPSP is the latest indicator of the strengthening direction of the “service” mission of SIU School of Medicine. The medical school was founded to address the health care needs of a specific population – a unique mission among medical schools. “Our historic identity is the 66-county population of central and southern Illinois,” notes Jerry Kruse, MD, MSPH, dean and provost. “In the past few years, we have brought that into even clearer focus by designing programs aimed to improve the health of populations, not just the people who ask for care, but finding the people who need care.”
“We used to treat people who came to see us in the clinics,” adds Janet Albers, MD, professor and chair of the Department of Family Medicine. “But now, we are actively working with whole communities to improve their health.” The need is critical. According to the 2016 County Health Rankings, 22 of the 25 counties with the worst health outcomes in Illinois are in SIU SOM’s service region. Long-established offices such as the Office of Regional Programs (ORP) and Family and Community Medicine, along with newer offices such as Population Science and Policy, topped with a plethora of new and innovative programs, are bringing SIU SOM’s population-focused mission to the forefront. These efforts address the social determinants of health – the factors of life that contribute to disease that include education, socioeconomic status, health behaviors and home and community environments. According to the Robert Wood Johnson Foundation and the CDC, these conditions make up around 80 percent of health outcomes. “Our goal in medicine is to make our patients as healthy as possible,” Dr. Vohra says. “As we continue to learn more about the defining role social determinants play in an individual’s health, it our responsibility as a profession to better understand, discover, and devise strategies to address them.”
HELPING THE NEXT GENERATION
Little Leaps is one example of the focus OPSP is bringing to improve quality of life and health for children. The Little Leaps program provides training in parent engagement. It also provides interventional resources if a developmental delay is discovered in the children from ages birth to 51/2. The program will track the same group of 75 children at Hillsboro Area Hospital’s day care over the next two to three years. “We can learn more about how to help them with early success and figure out what more interactive and play-based activities families need,” says Jeanne Koehler, PhD, OPSP’s social innovation director and assistant professor of medical education. “We can get 41-1 WINTER 2018 | ASPECTS
The Office of Population Science and Policy
in there and give them more activities and more things to learn that strengthen those areas. We try to capitalize on that fastgrowing brain so it can have a lasting impact.” Sheri Reynolds, the day care coordinator, says Little Leaps is bringing a lot to the program and has potential beyond the day care. “Once the research is in, we will be able to share it with others in the community.” Rex Brown, president of Hillsboro Area Hospital, says the partnership with the medical school, along with support from the Hillsboro Hospital’s Foundation, is making a difference for his community. “Youth programs like ‘Little Leaps’ help us partner with others and connect with families.” The baby-brain development effort is in partnership with Office of Regional Programs, which has additional outreach offices in Canton, Mattoon and Carbondale. The Center for Rural Health and Social Services Development also has numerous projects underway, serving children and the elderly in southern Illinois, advocating for physical health and assisting in transportation to medical services. One new program is the community paramedicine program, aiming to lower readmissions and improve chronically ill patient care.
HELPING THE UNDERSERVED
As a Federally Qualified Health Center, the Department of Family Medicine in Springfield has taken the lead on integrating population health with existing services to address the social determinants of health with the underserved population. “For so long, I felt helpless that all I could do was treat them in the 10
41-1 WINTER 2018 | ASPECTS
office,” Dr. Albers says. “Now we have so many wrap-around services available to help patients in family medicine and in other SIU departments.” One of those programs is the Medical-Legal Partnership, launched with $215,000 in federal grant funds in 2015. SIU partners with The Land of Lincoln Legal Assistance Foundation attorney Rachel Miller, who works on-site at FCM to meet with patients twice a week. Miller has already helped patients in more than 300 cases. The clients are grateful for free assistance with personal issues that can affect their health. This includes divorce, housing, or applying for food stamps or disability insurance. Some get help finding mental health counseling and even find volunteer opportunities. Family medicine instructor Meghan Golden, LCSW, notes that Miller has helped domestic violence victims maintain housing, clients obtain social security payments and others understand the process and the paperwork of the complex medical and legal systems. A national movement, nearly 300 Medical-Legal Partnerships are at work in 41 states. “SIU was selected as one of the original six FQHCs that Health Resources and Services Administration (HRSA) funded to use Medical-Legal Partnerships as an enabling service,” notes Carolyn Pointer, JD, OPSP policy director and assistant professor of medical humanities. “One thing that is different about our program is that we teach second-year medical students to screen patients in the hospital for legal issues affecting health needs. Other programs use residents, not students.” SIU is evaluating this problem-based approach to teaching students about the social determinants of health and providing a valuable service to our
patients. This work, Pointer notes, addresses the “upstream” issues that affect patients’ health, such as mold remediation in apartments. Pointer and Vohra are working on policy issues related to poor housing conditions, domestic violence or access to food in the Springfield area in conjunction with the Community Roundtable, a collection of community leaders. The Nurse-Family Partnership (NFP) brings another national movement to the SIU School of Medicine community. As an evidence-based program, nurses visit the homes of first-time pregnant women and mothers to offer advice, support and resources through their child’s second birthday. More than 42 states have a nurse-family partnership program. Since launching last August, the SIU program has enrolled 18 clients among three nursing staff. Two babies have been delivered. The moms’ average age is 22, and twothirds are African-American. “New moms are getting the resources and support they need to give their child a healthy start in life,” says Hope Cherry, program administrator. One young mom says the visits from her nurse helped her overcome her anxiety. “The nurse let me know that everything would be fine and that everything I do now is for my son. Once I heard those words, everything changed. She helped push me past my comfort zone, and that’s what I needed. I’m thankful for this program because it’s showed me I can do anything I set my mind to. I schedule appointments now, and I want to get my nursing degree. I want to make more of myself and be the best mom I can.”
PATIENT-CENTERED These complex and collaborative efforts into population health activities are “keeping SIU Medicine in step with the changing landscape of health care, which is moving toward a value proposition-model,” notes SIU Medicine Chief Medical Officer Harald Lausen, DO. He says that SIU Medicine has been working for years to address population health with SIU patients through safety, quality measures, costs and improvements in clinical care activities. Examples include an event reporting system, community electronic health record, standardized documentation, and partnerships with clinical integration networks. “This results in a downstream impact for the patients and the region we serve,” he says. “Focusing on efforts to improve patient care, quality, and access improves the health status of the patient and addresses the value proposition. The more engaged our patients are, the more preventive screenings they receive, the better control of chronic disease management — the less they become ill and the less they will need the emergency department or hospital. That results in cost savings.” Valuing patients’ health can result in increased reimbursements from insurance providers, such as Medicare, which has transitioned to the Quality Payment Program. “The better we do as a whole health-care community, the more we will all benefit,” Dr. Lausen says. From patient care to partnerships from research to relationships, SIU is strengthening its foothold in the 66 counties.
‘PARAMEDICINE’ MAY HELP PATIENTS AVOID EMERGENCY ROOM Two southern Illinois organizations have partnered to develop a new “community paramedicine” program. The Center for Rural Health & Social Service Development at Southern Illinois University Medicine and SSM Good Samaritan Regional Health Center in Mt. Vernon say a community paramedicine program could prevent unnecessary emergency department visits and reduce the likelihood a patient must return to the hospital for care. A one-year, $100,000 grant from the Health Resources and Services Administration – Federal Office of Rural Health Policy is funding the program’s research and development phase. Community paramedicine programs
have gained popularity in recent years as health care and emergency medical services are asked to deliver higher levels of care with decreasing financial resources. In southern Illinois, community paramedics will be tasked with delivering better care coordination and in-home clinical monitoring of patients, as well as providing community resource referrals, including home health care and social services. The group hopes to help residents better manage chronic illnesses, including diabetes, COPD, high blood pressure and heart disease. According to the 2016 County Health Rankings, southern Illinois is home to some of the state’s
– and nation’s, highest rates of chronic disease. Coupled with the region’s aging population, high poverty rates and scarce medical resources, experts describe the region’s health status as “dismal.” Five health care systems, including Clay County Hospital, Fairfield Memorial Hospital, Crawford Memorial Hospital, Good Samaritan Hospital (Vincennes, Ind), and SSM Good Samaritan Regional Health Center, and five ambulance services, including those from Robinson, Fairfield, Mt. Vernon, Lawrenceville and Flora, have already joined the new Southern Illinois Collaborative for Innovative Care Coordination (SICICC) network.
41-1 WINTER 2018 | ASPECTS
by Steve Sandstrom Photographs by Jason Johnson
Moving the dial As a pediatrician, Sameer Vohra, MD, JD, ’11, was trained to focus on the children seen in his clinic. Now his task has expanded to healing entire segments of Illinois’ population. It’s a role he has been preparing for most of his life. When the SIU Office of Population Science and Policy was launched in the fall of 2016, Sameer Vohra, MD, JD, was named executive director. As an assistant professor of pediatrics and medical humanities, his mission was formidable: Assemble a team from scratch to study the health and societal hurdles that have the greatest impact on residents within SIU’s service region and create programs to improve their health. Providers recognize that only 20 percent of a person’s health outcomes are determined by what he or she encounters in the health care setting. The other 80 percent are affected by one’s socio-economic status – income, education, employment, community safety, the physical environment in which the person lives, and their behaviors. To treat the whole patient and achieve better health outcomes requires a paradigm shift in focus. It requires thoroughly understanding the social determinants of health. “It’s a difficult problem to tackle and scale,” says Vohra. But he sees the challenge as part of the appeal. Vohra, 35, credits Dr. Jerry Kruse, dean and provost at SIU School of Medicine, for the belief that a research and policy organization should not only provide information but also be socially accountable
41-1 WINTER 2018 | ASPECTS
and make an impact. “We constructed the office to be both a think tank and a ‘do’ tank,” Dr. Vohra says. He began by putting together a talented senior leadership team that makes him “excited to go to work each day. It makes you feel like anything is possible.” It’s a familiar feeling to the young physician.
Vohra is the eldest son of Indian immigrants, born in Chicago and raised in Westmont in DuPage County. As a boy, teachers and friends boosted his confidence that he could be successful in whatever he pursued. His mom was a dentist and his dad a pharmacist. While his parents encouraged healthcare career paths for Sameer and his siblings, a young aunt’s death from breast cancer shook his early faith in medicine. Eventually, as he spent time volunteering and working with his father in a hospital, he began seeing the unique ability of health care to change and positively impact the life of an individual. And he was also thinking of a bigger picture. “Growing up, there were a lot of moments when I wondered, ‘How do you change social structures and social engines to create change?’ That was being done in government, in politics and in law.” As an undergrad, when Dr. Vohra first heard about a dual medical degree/juris degree program, he realized a path was available to become both a doctor and a lawyer. However, at the time there were fewer than a dozen MD/JD programs in the country and less certainty about what one could do with a dual degree, he says. Vohra felt he could have a greater impact as a physician, so he applied to medical schools and a few of the MD/JD programs. During his SIU admissions interview, Vohra met Ted LeBlang, JD, then chair of the Department of Medical Humanities and founder of the six-year MD/JD program. When Vohra spoke of wanting a career that could affect whole regions of Illinois, LeBlang outlined how matriculating in Carbondale and Springfield would give him a better understanding of the state. “He convinced me that everything that I wanted to do in my career and during the next six years would be realized,” Vohra says. “He promised me that I would not regret my decision.” The conversation stuck with Dr. Vohra. “Coming here provided me with the foundation for the opportunity that would come later. Ted LeBlang was one hundred percent right.” Other SIU mentors fostered his growth. Gene Basanta and Tom Britton were boosters at the School of Law. “They pushed me to do things even when I was a medical student that hadn’t been done,” he says. “In Springfield I had Dr. Dorsey, Dr. Klamen, Dr. Constance, Dr. Albers, and so many people who believed that I could do and achieve anything in my career.” Dr. Vohra spent a summer studying in Cairo, Egypt after his first year in law school and then worked for the CDC Public Health Law program. He was named a Fulbright Scholar after his third year in medical school and performed pediatric health outcome research in India for eight months. He took on some executive national leadership positions as a student at the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC). “It proved to me that I
could succeed at the highest level with people who had gone to universities across the country, and I could lead them. I had valid ideas that in situations could mobilize action.” Fortunately, the hectic pace didn’t occur at the expense of his personal life. Dr. Vohra met his wife-to-be, Tasnim, on a blind date in Chicago during his second year of medical school. When the Fulbright Scholarship occurred at the 15th month of the relationship, Dr. Vohra acted decisively and proposed. “I knew I wanted to spend the rest of my life with her,” he says with a smile.
During his undergraduate years at Northwestern, another mentor had planted a seed that is now bearing fruit. Vohra majored in political science and science in human culture. Dr. Ken Janda was the chair of the political science department and encouraged the second major. “To go to most medical schools, you major in biology or chemistry. Ken told me that understanding politics, philosophy, sociology, and the psychology around medicine would make me a more interesting and understanding physician.” Vohra champions a holistic view of health care within his new career at the OPSP. “Doctors live in a world driven by the natural sciences. But the world is complicated and comes increasingly in shades of gray. The decisions that we make around medicine, when you have to figure out how to best treat the patient, how to best change their behavior, how to allow them to be as healthy as they can be, those lines aren’t as clear,” he says. “The physicians who can balance the science and the art of medicine are the ones who are going to make an impact and change behavior to make individuals healthy.” With a better understanding of a patient’s life circumstances, treatments can be refined and prevention emphasized, creating new efficiencies, he says. Like patients, rural communities are also different from one another, and the devil is in the details. The OPSP has a traditional science division led by Wiley Jenkins, PhD, to analyze and understand data in order to create effective solutions, as well as a policy division led by Carolyn Pointer, JD, to understand how to shape policy using those evidenced-based solutions. “The challenge is to create the types of policy to make a change sustainable, not something that relies on a grant cycle,” Vohra says. “We want to create a plan that a community can take ownership of and use to move forward.” One of the group’s pilot programs is now underway in Hillsboro. As a pediatrician and father of two young daughters, Vohra is a passionate advocate for early childhood development.
Progress = Victory
In January the OPSP launched its social innovation division led by Jeanne Koehler, PhD. “Complicated problems need multi-disciplinary answers,” says Vohra “and you need to build the path to change.” The office wants to spur new organizational thinking built around groups that aren’t usually involved in medicine.
41-1 WINTER 2018 | ASPECTS
Vohra believes it’s a logical way to address a major societal problem. “We spend so much money on health care, but we don’t have good outcomes overall compared to our developed country peers. If we can combine a model for public health science with social innovation and sustain it through policy change, we can create a solid system.” This is where a background as a policy wonk can come in handy. Vohra has observed the state and national political arenas and seen how the promise of a new approach can entice an audience fed up with the status quo. “You want to make a change. But you have to understand how complicated our political and social systems are if you want to move the dial and truly accomplish something. You have to accept compromise, take small victories.” “If you want to have everything, you often get nothing,” Vohra says. “It’s been a great lesson for us around the office. One of our mottos is ‘Aim big, but settle for progress.’” Vohra was named an Edgar Fellow in 2016, one of 40 emerging political and policy leaders in Illinois. This honor allows him the opportunity to spend time with legislators, government officials and others who have served the state and country. Vohra knows the importance of working with policymakers to educate them on improving the health of their constituents. Although public service has always ap-
“I’m not ready to die.”
pealed to him, he knows how important his current work is. “I love my job, and I see the unique ability to make an impact on the residents of central and southern Illinois. It is a great honor to have a job that is so meaningful.” He’s been helped by a familiarity with the SIU system and some established relationships here and in the downstate region. “Much of the way we’ve built our office is, we think of it as a start-up. We have the reputation of this great medical school behind us, but we’re small and our task is so big, we have to be nimble. And we’re allowed to be as creative and imaginative as necessary to tackle and solve problems.” Since 21 of the 25 top counties with the worst health outcomes are in the SIU service region, there’s a lot of work to do, says Dr. Vohra. “Change is going to take time. Health outcomes are generational-type shifts. We’ll need to celebrate the small victories that show progress even if it’s slower than we want when you’re dealing with entrenched societal problems.” He adds that the community can help the progress by donating to OPSP through the SIU Foundation (www.siumed. edu/foundation/giving.html). “There’s a lot to do and a lot still to learn, but we’re finding that communities are interested. We’re getting a lot of calls for help. We’re getting our pilot programs out. We’re beginning to make the small differences.”
#Forward For You: Diane Stone A non smoker, Diane Stone was diagnosed with Stage 4 lung cancer. An SIU clinical trial saved her life. Press play: http://bit.ly/ sci_dianestone
Associate Professor of Internal Medicine Dr. Meghna Desai and Diane Stone
41-1 WINTER 2018 | ASPECTS
Triple Aim Architect Visits SIU Medicine written by Karen Carlson photographed by Jason Johnson Dr. John Whittington Speaks with Dr. John Flack at Grand Rounds
“It’s not about health care. It’s about the health of the population. That’s the most important thing.” So said John Whittington, MD, senior fellow at the Institute for Healthcare Improvement (IHI) in Cambridge, Mass. Dr. Whittington has more than 30 years’ experience in medicine, population health and patient safety and was one of the co-authors of the Triple Aim framework published in 2007. The Triple Aim is “one aim with three dimensions: improving the health of populations, improving the patient experience of care and reducing the per capita cost of health care.” A family physician living in Antioch, Ill., Dr. Whittington is working with 141 organizations throughout the world on Triple Aim principles. Last November, Dr. Whittington visited SIU Medicine as the guest speaker for an Internal Medicine Grand Rounds. He also discussed the Triple Aim with SIU Medicine leaders and the Office of Population Science and Policy.
“The Triple Aim is a movement from a purely medical model of diagnosis and treatment to a psychosocial model to think about the needs of populations,” he said. “Physicians are aligned with the experience of care, not populations. We need to equip people to think more from a society and public health basis than individual transaction basis.” The Triple Aim has become the new vision for SIU Medicine. Through Dr. Kruse’s leadership, it has been coined the Triple Aim+1: “Health care that is more effective, efficient, equitable and enjoyable.” (see page 18). Dr. Whittington’s talk echoed the principles and values heard throughout SIU Medicine. The Triple Aim’s success, he said, relies on good strategy, a strong portfolio and a good measurement system. Dr. Whittington was impressed after hearing about some of the SIU Medicine portfolio, including the population health activities, such as the hotspotting program and education initia-
tives such as the new third-year curriculum and MEDPREP. “SIU has had success with rural health and so should continue that focus to make a difference,” Dr. Whittington says. “Because of your rural nature, any contributions you make is a positive thing and can be shared with other parts of the United States.” He closed his talk with the notion that “The Triple Aim will not be achieved until it is achieved for all.” Below are excerpts from his presentation and discussions. DR. WHITTINGTON ... ON HEALTH DISPARITIES Imagine if we built cars and 80 percent of the cars look terrific, but 20 percent don’t have wheels. The US health system has these disparities from a variety of aspects. Start with the underserved population for improvement design and work to build
CONTINUED ON PAGE 17
41-1 WINTER 2018 | ASPECTS
Dr. Kruse & Triple Aim+1 SIU MEDICINE AND ITS PROGRAMS HIT THE MARKS written by Karen Carlson photographed by Jason Johnson
Dean and Provost Jerry Kruse, MD, MSPH, closes nearly every presentation with a particular slide: The Triple Aim + 1. The Triple Aim is a nationally known health care philosophy that has been steadily woven into the fabric of SIU Medicine for years. The Institute for Healthcare Improvement (IHI) published the Triple Aim in 2007. Great minds think alike: the SIU School of Medicine Department of Family & Community Medicine (FCM) had been promoting similar principles for nearly a decade and extending them even further. FCM first began thinking of a new philosophy of patient care when Dr. Kruse became chair of the Department in 1998. With several faculty members having formal training in public health, Dr. Kruse and the FCM team began focusing on population-based statistics as part of the vision for the department. “We began to understand the reasons that health care spending was highest in the world while population-based outcomes in the US paled in comparison to those of other wealthy, industrialized nations, and we thought that we could be a part of the solution,” Dr. Kruse says. 16
41-1 WINTER 2018 | ASPECTS
In 2004 and 2005, landmark studies that defined effective systems of health care were published. Two were written by Dr. Barbara Starfield of Johns Hopkins Bloomberg School of Public Health. Other researchers validated Starfield’s research, and FCM began with new rigor implementing effective systems of care and studying what family physicians, as usual sources of comprehensive longitudinal care, could do to advance care that improved outcomes, lowered cost and improved access. “It became our focus to build the system across the department,” Dr. Kruse says. As FCM was building that system of certified Patient-Centered Medical Homes, IHI published the Triple Aim 2007. The Triple Aim, Dr. Kruse notes, simplified the concepts that FCM had studied. “IHI recommended that health systems and medical education systems focus on improving population-based health care options, lowering per capita cost of care and improving patient experience.” At SIU,
“We established the Triple Aim + 1 as something we aspire to as an organization.” — Dr. Jerry Kruse the FCM team saw potential to expand the three simplified principles. “Improving patient experience doesn’t exactly communicate the essential concept of access for all, and it didn’t communicate the importance of experience for those who provide care and education; we thought that was important too,” Dr. Kruse says. He added the concept of “equity” — justness and fairness for all — and “enjoyable” to the Triple Aim, coining the term “The Triple Aim + 1.” As it turns out, SIU wasn’t the only one with ideas of expanding the Triple Aim. In 2014, Drs. Thomas Bodenheimer and Christine Sinsky published the “Quadruple Aim,” which added one of the same concepts that FCM had been touting – improving the experience for those who provide health care.
In 2013, Dr. Kruse was named Executive Associate Dean and CEO of SIU HealthCare, and he gave the Triple Aim + 1 institutional standing at SIU Medicine. “We established it as something we aspire to as an organization.” SIU Medicine has a robust network of programs today that reflect Dr. Kruse’s vision of the Triple Aim + 1 as the vision of the institution. “Our strategic initiatives, mission and vision all funnel through the 4 E’s of the Triple Aim + 1. We intend that effectiveness, efficiency, equity and enjoyment are characteristics of our goals and strategic initiatives. And these four E’s apply not only to outcomes for our patients but also to the relationships we have with our learners and with each other.” The development of a school-wide program for population science and health, which includes the Office of Population Science and Policy, led by Dr. Sameer Vohra, the SIU Medicine Office of Population Health, led by Dr. Harald Lausen, and the Office of Clinical and External Affiliations, led by Lori Williams, are examples of the intentional, strategic effort to use the Triple Aim + 1. These offices are building relationships and creating new models of care delivery that enhance the care experience for patient and provider and improve outcomes for the people and communities to whom SIU Medicine is accountable. Specific programs for broad-based inclusion, women in medicine, global health, national leadership, signature conferences, student groups and workshops on dismantling systemic racism are only a few of the initiatives that bring the principle of equity to the forefront. In 2016, the Office of Diversity and Inclusion was established. As new Associate Dean Wendi Wills El-Amin, MD, was hired, “Equity” was added to the name of the office. This addition signaled an intent to establish more programs to promote the justice and fairness across the organization SIU Medicine is also a partner in the Midwest Healthcare Quality Alliance (MHQA) – a partnership among SIU Medicine, Memorial Health System and Springfield Clinic, which Dr. Kruse says, is a big step toward fulfilling the Triple Aim+1. The MHQA aims to improve quality, safety, efficiency and outcomes through research, training and new methods of analysis. For example, the MHQA has promoted training in Lean Six Sigma techniques for health care professionals and provides physicians a vehicle to submit quality improvement projects for maintenance of certification requirements. Dr. Kruse is pleased with the progress of the Triple Aim+1 at SIU, and envisions an even greater role for this concept. He sees the potential of large databases, big data, and registries to further develop population-based programs for the highrisk, vulnerable populations. “There are a lot of people at SIU now who think in this way. Their efforts have been roundly accepted by everyone. I’m very happy with that. We as an organization strive to be more effective, efficient, equitable and enjoyable.”
their trust. With some efforts, the mean or median improves, but 10 percent of population still gets left behind. Organizations should build a multi-stakeholder coalition and work with willing partners to align the Triple Aim with your mission and determine best practices without losing sight of the whole. For example, health providers in Shelby County in Tennessee partnered with businesses and the faith community to successfully educate people about their goal to improve end-of life-care. Organizations must understand the value proposition for the population. How are you improving their health? How do we close the gap? Are we creating barriers? We need to see with new eyes the issues we have. For example, access: One woman went to the ER 30 times in a month. A $20 investment into a bus pass for her reduced her need to go to the ER. Another example: At Health Partners of Minneapolis there was a problem of women of color getting mammograms. Transportation was an issue. The group gave women the opportunity to get a mammogram anytime they were in the clinic for any reason. It turned out to be a solution for all, which is not always the case. ...ON PER CAPITA COSTS Health care costs too much. Doctors are big contributors to the per capita cost, yet we seldom think about it. Working on population health by itself doesn’t make sense; the practical focus should be on per capita or it’s not sustainable. The challenge is to think through the financial models that can work in these communities over time. Policy will help but won’t solve the problem. England, for example, has good policy and still has gaps. ...ON STRUCTURAL RACISM AND UNCONSCIOUS/IMPLICIT BIAS Most health care providers have implicit racial/ethnic bias at the same rates as the general population. That’s why we have randomized, double-blinded controlled experiments. This bias may affect how physicians interact with patients: how we communicate, deliver treatment and manage pain. Perfect care will still have disparities. We have to modify it and organize around the concept. Strategies to reduce implicit bias include putting yourself in the other person’s shoes; increase opportunities for interracial contact; See the person as an individual; imagine the individual as the opposite of the stereotype; stereotype replacement — recognize the response is based on stereotype and consciously adjust.
41-1 WINTER 2018 | ASPECTS
Radical Change: Y3T a Success written by Karen Carlson | photographed by Jason Johnson
Summer 2017 marked the end of the first year of the new third year curriculum. Dubbed the Year 3 Transformation, (Y3T), it was the first update to the SIU School of Medicine curriculum in more than a dozen years, developed through a $577,000 Macy Foundation grant awarded in 2014. Building on SIU’s nearly 50-year history of risk-taking, Senior Associate Dean Debra Klamen, MD, and the medical education team saw the opportunity to make the curriculum even more student-centered. The goal? To help students improve their clinical skills and decision-making skills and better prepare for residency. The result? Success. Back in 2013, Dr. Klamen began envisioning a new third-year curriculum. Reviews of the third year of medical education had found that clinical experiences were largely random, leading to little growth in clinical reasoning. Students had a long list of more than 600 goals and objectives they were expected to learn in the six core clerkships. Dr. Klamen thought, “What if we embraced the realities of our data and directly addressed the problem?” With the Macy grant, a Critical Clinical Competency subcommittee created the Critical Clinical Competency (Triple C) longitudinal curriculum, an online,video-based, standardized streamer that develops students’ clinical reasoning skills in 12 chief complaints. Students work through 144 discrete diagnoses largely seen in ambulatory and acute care settings. Instead of struggling to meet those goals all in the third year, the Triple C begins in year one and ends at the end of year 18
41-1 WINTER 2018 | ASPECTS
three, leveling the playing field of exposure to undifferentiated diagnoses. What changed? In the third year, core clerkships of four-week stints in eight clinical disciplines replaced six rotations of varying length; there are no more shelf exams and no lectures. Instead, there is more face-to-face patient time, and more personalized coaching to help students “find their people.” Faculty serve as coaches, providing frequent feedback. An added bonus is the 15-week Personalized Educational Plan (PEP) that gives students and advisors time to develop a plan, or “deep dive,” into professional development. This could mean immersion in a specialty in students’ area of interest, remediation, or even graduation by the end of their third year. Students helped design the PEP, and almost 100 faculty are trained as coaches. Also in the PEP, students have the option of taking humanities courses, optional shelf exams or time off. During the three-week intersession between the Core and the PEP, students take a 14-station standardized patient exam, as well as a week of humanities. “It was a radical idea,” Dr. Klamen acknowledges of Y3T. But it has been well accepted, despite some initial concerns expressed by busy clinicians, like Susan Hingle, MD. “I think the realities of the clinical environment with the need for clinical productivity still makes the curriculum a challenge, but overall it went quite well,” Dr. Hingle says. Class of 2018 student Allen Ghareeb
says his classmates were a little skeptical of the changes, especially the lack of shelf exam and didactics. “Having been at SIU for two years we’d been conditioned to move away from didactics, but it was still scary,” Ghareeb says. What worked? Dr. Klamen admits she, too, was nervous about making such big curricular changes. “But it went even better than I had hoped,” she says with a smile. Initial results have found that the revamped third year left no student uncertain of their future in medicine and increased their satisfaction. Here are some highlights of the results: • Students doubled their contact with patients • Faculty formed close ties with students • Students doubled their number of procedures • Clerkship ratings were the highest ever recorded • NBME Shelf Exams in PEP – No decline in scores • USMLE Step 2 Exam – Initial 50 takers had no decline in Scores (20 to go as of September) • Students used their patient encounters as case studies from which to learn • Students say they worried less about studying for the shelf and step exams and enjoyed the increased feedback and the close ties they formed to faculty members. They also enjoyed the range of options available in the PEP and more time with
Coachability Curriculum Students involved in the curricular changes through the Student Medical Education Interest Group took an active approach to the revised third year. They recognized that as the curriculum moved to a coaching model, the students needed to shed the impressionmanagement style of always acting as if they know the answer and learn to become more coachable. “Some were uncomfortable asking for feedback,” Allen Ghareeb says. “Feedback is now a crucial component of the third year. It required a change in the culture to help attendings and residents give regular feedback and teach students when and how to ask for feedback, and how to respond to it.”
patients. • Faculty and residents embraced the new curriculum and preferred the apprenticestyle model — getting to really know the students and not having to refer to mug shots to recognize them. A few tweaks and re-evaluations were needed. Some students received more verbal than written feedback from faculty, which made grading difficult. This also made it hard to determine honor status, so honors rankings have been removed, leaving the basic pass/fail grading system. The emergency medicine clerkship has been extended from two to four weeks. Additionally, some faculty and students struggle with the four-week core clerkships and prefer a longer model. Others want more electives in the PEP. The Y3 Curriculum Advisory committee is reviewing these suggestions. For Ghareeb and his fellow students, the increased clinical experiences assuaged their fears. Ghareeb’s favorite part and the “gemstone” of third year was the PEP, which allowed him the freedom to design experiences for him to explore specialities. He dove into subspecialties in internal medicine, psychiatry and a self-designed selective on HIV care in central Illinois and on a pharmacy team to learn that aspect of medicine. “Both were incredibly beneficial,” he says. His HIV project has morphed into a research project, addressing barriers of access to care in rural communities. “We were done with the cores by February and had five months to explore. That set us ahead of the other third-year
students in the country,” Ghareeb adds. He ultimately “found his people” in OB-GYN and as he entered residency interview season, he says the additional experiences reaffirmed his choice. The future: SIU School of Medicine’s history of risk-taking and innovation in curriculum development continues — and continues to succeed. The concept and initial success of the third year has also been well received by other medical schools, Dr. Klamen says. She has presented the Y3T to many audiences, and says that SIU SOM is so renowned for medical education that she, as the school’s representative has become somewhat of a celebrity in medical education, complete with autograph requests. The team praises the faculty, residents, clerkship directors and nurse educators who were essential in making Y3T a success. The Triple C online curriculum is available to medical schools who request it. Data collection continues and Dr. Klamen plans to publish results in upcoming months. Dr. Klamen is very proud of the curriculum, a 10-year project from concept to implementation. “SIU SOM is the only place this could have been done,” she says emphatically. “I’m so proud of the think-tank in medical education, the incredibly dedicated faculty and residents and the support of two deans to make this happen. It took SIU to make it happen. It would not have happened anywhere else. I’m proud that our school was up to the challenge.”
Ghareeb, Max Crouse, Lacey Wood and Julianne Allen created a “coachability” curriculum with the help of faculty mentor Anna Cianciolo, PhD, with a fourfold focus: goal setting, growth mindset, emotional intelligence and feedback. They developed their own coachability curriculum with more than 20 hours of training for the second-year students, who are now in their third year. It comprises didactics and interactive sessions. Coachability is catching on. The group has taught it to first- and secondyear medical students. “So every current class has had some coachability training,” Ghareeb says. Internal medicine residents are adapting coachability for their graduate medical education. Ghareeb and Crouse presented it to the Academy of Medical Educators of Europe (AMEE) last summer in Helsinki. “We’d been working on it since 2015. I really invested emotionally into it. To be at the mecca of medical education and present it to physicians and academics from all over the world and have it wellreceived was exciting,” Ghareeb says.
41-1 WINTER 2018 | ASPECTS
In Memory APRIL DAWN STRADER, PHD, 47,
passed away peacefully Tuesday, Oct. 3, in St. Louis. April joined SIU School of Medicine in 2005. She became an associate professor with tenure in the Department of Physiology. She studied surgical methods of treating obesity and type II diabetes. April was an outstanding teacher who owned the renal physiology curriculum and taught actively in the year 1 curriculum as a tutor and topic expert, delivering resource sessions on acidbased physiology and the kidney. She was highly regarded as a teacher and mentor to her active laboratory group and PhD, MS and undergraduate physiology and biomedical engineering students. She was gaining an international reputation in diabetes obesity surgery and was awarded a prestigious NIH RC1 Challenge Grant (RO1) for her proposal ‘The role of bile as a mechanism in the
CHANDRA M. “BAN” BANERJEE, MD, PHD, 85, emeritus professor of physiology passed away peacefully at home on Nov. 19, 2017. Ban received his medical degree at the University of Calcutta Medical School and then migrated to London where he practiced medicine at Northampton General Hospital. After a year in England he sailed to North America and did residency training at Staten Island, NY, Thunder Bay, Canada, and Rochester, NY. He then pursued a PhD in Physiology at the Medical College of Virginia (now Virginia Commonwealth University). After completing his PhD and working as a researcher at Hazelton Laboratories in Reston, Va., Ban began his academic career at Jefferson Medical College where he taught respiratory physiology. In 1974 Ban joined the faculty at SIU School of Medicine. Ban’s clinical and basic science expertise positioned him well to design a successful respira-
41-1 WINTER 2018 | ASPECTS
improvement in glucose homeostasis following bariatric surgery.’ A p r i l was a rising star in diabetes research, pioneering the use of cutting-edge obesity surgery as a therapeutic approach. Obesity surgery is the most effective treatment for morbid obesity, and most type-II diabetic patients who undergo obesity surgery experience complete resolution of their diabetes. The intriguing aspect of this remission is that it often occurs prior to any substantial weight loss. Her research studied the role of the small intestine and bile as contributors to the improved glucose
metabolism following obesity surgery. Her landmark contribution was developing specialized surgical procedures that highlight the role of the lower intestine in glycemic control, paving the way for improved surgical treatment of obesity and metabolic disorders. April was also a talented artist in the areas of painting and photography, as well as an animal enthusiast, rescuing many sick, injured and abandoned creatures. She was a devoted mother to Olive LaRose (age 9). By her own example, April encouraged Olive to be creative and tenacious. Memorials may be made to the Olive LaRose Trust, P.O. Box 2101 Carbondale, IL 62902.
tory unit which he coordinated until his retirement in 2001. Ban was a truly gifted teacher who could simplify difficult concepts and generate great enthusiasm for learning. He was a popular professor who received multiple teaching awards, and his lectures were highly praised for his emphasis on the “elephants” (facts of great import) rather than trivial facts. In addition to his formal teaching in the classroom, Ban held many impromptu discussions with students while sitting on the front steps of Lindegren Hall. He cared that med students learned the things that are important for patient care rather than science triv-
ia that may have been interesting but not helpful. This undoubtedly derived from Ban’s prior medical training which gave him great credibility with students. Dr. Banerjee was a devoted family man who leaves behind his wife Janet, four sons (Kyle, Aaron, Dean and Neal) and seven grandchildren. He will be missed. Memorials can be sent to: Southern Illinois Chamber Music Society, 1000 S. Normal Ave., Mail Code 4302, Carbondale, 62901; or the Carbondale Unitarian Fellowship, 105 N. Parrish Lane, Carbondale, 62901.
— Written by Dale “Buck” Hales, PhD, professor and chair, Dept. of Physiology
— Written by former physiology faculty members Ron Browning, PhD, Rick Steger, PhD and David Wade, PhD. Kevin Dorsey, MD, PhD, dean emeritus, also contributed.
ALUMNI CAMPUS PROFILE NEWS
Alumni Spotlight: Dr. Karen Broquet ’84 By Christi Mathis, SIUC Wonderful physicians don’t just happen by accident. Dr. Karen Broquet is one of the incredible people at the SIU School of Medicine who work closely with our physicians-in-training to help assure they become caring, excellent medical providers when they graduate and launch their careers. As the associate dean for graduate medical education, Karen has a number of responsibilities, including overseeing the 28 different residency programs located in Springfield, Decatur, Quincy and Carbondale to make sure they meet accreditation standards, incorporate the best curriculum and are providing the appropriate training for SIU trainees. She works closely with residents as well as with the partner facilities that sponsor them and pay their salaries as they train. She also handles residency program logistics. “There are a lot of frustrating things about medicine and the education system but every day I walk around and talk with our residents and with our partner medical facilities and know I’m making a difference,” Karen said. “I’m also very proud that we are able to keep so many of the physicians we train in the region. It’s very gratifying to see them caring so well for their patients.” A board-certified psychiatrist, Karen also continues to counsel patients and works closely with the medical residents who share her specialization, supervising and mentoring them. She also advises the SOM House Staff Board of Directors and handles a variety of other tasks. She’s quick to say that she’s “never bored, but that’s a good thing” and
likewise quick to acknowledge her favorite part of the job. “Hands-on teaching and education is definitely the most fun,” she said. “Working with individual learners is the most rewarding part of my job.” Although Karen has held her current position since 2001, her connection to SIU actually goes back much farther. She and her husband Greg celebrated their 35th anniversary this fall and they met while both were undergraduates at SIU Carbondale. Karen completed her bachelor’s degree in physiology in 1981 and three years later, earned her medical degree at SIU School of Medicine. She completed her residency in psychiatry at the University of South Alabama in Mobile but by 1988, she was back at SIU, this time on staff. She’s held a variety of positions, including the psychiatry clerkship director, overseeing third-year student rotations and serving for about a decade as the director of the psychiatry training program. “SIU will always have a special place in my heart,” Karen said. “I spent many happy hours on the Carbondale campus and in the Shawnee and met my husband there. But that is not why I’ve chosen to spend my career at SIU.” “There are many facets of an excellent medical school: clinical care, research, community involvement and teaching,”
she added. “In some medical schools, the teaching mission is given lip service because it does not typically generate income. The SIU SOM treats education with the same level of respect as research or clinical service, and faculty are recognized and rewarded in the promotion process. This is not true everywhere. Whenever I meet with colleagues at national meetings, I come home appreciating what we have here.” Oddly enough, Karen didn’t plan to become a doctor or a teacher. At various times during her early years, she pondered a career in ministry, owning a restaurant, or even becoming a standup comic. “Growing up, I never really knew anyone who was a doctor. None of my family were physicians and I was rarely sick,” she explains. “I didn’t seriously consider a career in medicine until I was in college. As I went through my medical training though, I realized that my passion and my talents both found a home in medical education.” Karen was born in Detroit and lived in American Samoa and Huntington, W. Va., as a child. She and Greg are longtime Springfield residents and the parents of grown daughters, Roxane and Lillian. Nowadays, when Karen isn’t immersed in her work or family, you’re likely to find her bike riding, lost in a great book, or cooking. “I make the best seafood gumbo outside of New Orleans,” she proudly proclaims. For all you do for your patients, your students and SIU, we say “Thank you, Karen.” -originally published in SIU System Connection
‘TEAM MD AND THE WANNA BE’ Emily Jones, MS 2, and her dad, Terry Jones, MD ‘81, raised more than $5,600 for the Simmons Cancer Institute together as “Team MD and the Wanna-Be” by finishing 76 marathons in 50 states in 7 years and 11 months. Their project, “1336.2 Miles for Simmons Cancer Institute“ began in 2009 and honors family, mentors and friends who have been lost to cancer. And they’re not done: Emily says that the team hopes to join the 100 Marathon Club. Way to go, Team MD and the Wanna-Be!
41-1 WINTER 2018 | ASPECTS
‘TEACHING AND LEARNING IN MEDICINE’ JOURNAL MARKS 30 YEARS If you love medical education, your bedtime reading likely includes Teaching and Learning in Medicine (TLM), a prestigious international journal established at SIU School of Medicine. TLM will publish its 30th volume this year. TLM provides a peer-reviewed forum for scholarly investigation of teaching and learning in medical education. Howard Barrows, MD, and Terrill Mast, PhD., co-created the journal in 1989. Dr. Barrows was one of the school’s groundbreaking medical educators, a physician who pioneered the use of standardized patients in the 1980s. Dr. Mast made his mark on medical education on many fronts, but his legacy as co-creator of TLM was one of the most prominent. These medical educators recognized a need for scholarly research on teaching and learning in the health professions, and they honed their vision with persistence to produce a quarterly publication now known around the world. “Their collaboration represents the lasting value TLM has placed on integrating medical expertise with behavioral science to address modern challenges in teaching and learning,” says Anna Cianciolo, PhD, associate professor in the Department of Medical Education. The journal’s articles address common challenges faced by all medical teachers: fostering the acquisition, application, and maintenance of knowledge and skills in a complex and constantly changing clinical environment. Authors address practical issues and concerns and analyze issues in professional development and educational decision-making. In 2013, Dr. Cianciolo assumed the editor position from Jerry Colliver, PhD Dept of Medical Education, editor since 2001. Eric Niederhoffer, PhD, biochemistry and molecular 24
41-1 WINTER 2018 | ASPECTS
biology, is the associate editor. Deputy editors from SIU SOM are Heeyoung Han, PhD, Debra Klamen, MD, MHPE, both medical education, and Anneke Metz, PhD interim director, MEDPREP. Mindy ConleeStevens, TLM’s managing editor, coordinates production, which involves managing manuscript submissions, reviews, preparation and publication. She works closely with staff from TLM’s publisher, Taylor & Francis, to ensure timely issues every quarter. Other milestones include a 25th anniversary special issue, early online publication, the annual Editors’ Choice Award supported by the Terrill Mast Foundation and an annual “Conversation Starters” Series. TLM also has established a growing social media presence (@TLMedEd). TLM is becoming increasingly recognized as a leading journal, known not only for its articles and initiatives, but also for the high-quality feedback it provides to its contributors. Submissions have more than doubled and both the journal’s subscriptions and its impact factor have increased. “With each issue, TLM disseminates some of the world’s most innovative ideas and techniques for understanding medical education and improving its quality, Dr. Cianciolo said. “To continuously increase its impact, TLM, its contributors, and its readership learn from each other, carrying out the vision of TLM’s founders to make a positive difference.”
It’s been one heck of a ride! For ten years, friends and family of Natalie Goebel have made it their mission to fulfill Natalie’s wish to help send kids growing up with cancer to Camp COCO. This year’s gift of $46,284.50 from the Natalie Goebel Memorial ride will support 66 campers. Since the first memorial ride in 2008, Natalie’s family and friends have covered the costs of sending 279 kids to Camp COCO – a total of more than $195,000! Establishments in Morrisonville, Taylorville, Harvel, Bulpitt and Nokomis have opened their hearts and their doors to hundreds of friends and family to help Natalie’s wish come true. Pictured at right: Michelle Goebel, Dr. Douglas Carlson, Justine Morgan, Necole Powell, Dr. Gregory Brandt and Deanna Goebel.
Calling all friends of SIU
Raising for Research
This past fall, some of our medical students called nearly 250 alumni to thank them for their gifts, seek their advice and ask them to make gifts to the school in honor of their class reunion. If you missed our call, call us back at 217.545.2955!
Thanks to your support, Denim & Diamonds 2017 was record-breaking year. The event raised more than $300,000 for cancer research and patient programs.
Save the Date Harbinger Society Dinner
4/7/18 Denim & Diamonds
41-1 WINTER 2018 | ASPECTS
Office of Public Relations & Communications SIU School of Medicine P.O. Box 19621 Springfield, IL 62794-9621
CHANGE SERVICE REQUESTED
SIU School of Medicine maintains a toll-free service for physicians to make referrals or request consultations. The phone number for calls from outside Sangamon County is 1-800-DIAL-SIU (1-800-342-5748).
SOM alumni, students connect at SIU Homecoming Alumni, medical students, MEDPREP and PA students, guests and friends gathered for the SIU SOM tailgate on October 14 in Carbondale for SIU’s homecoming. The event was sponsored by the SIU School of Medicine Alumni Society. Thanks to our alumni ambassadors for this event: Jeff (’80) & Sherrie Parks and Larry Jones ‘76. See more photos: http://bit.ly/siusomtailgate
41-1 WINTER 2018 | ASPECTS
Non-Profit Org. U.S. Postage PAID Springfield, IL Permit No. 680
Little Leaps, Big Potential: Population Health Focus Strengthens