UBMEDICINE CONNECTING ALUMNI, FRIENDS AND COMMUNITY
JACOBS SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES UNIVERSITY AT BUFFALO
New Ways to Learn and Teach Medical education institute established
Photos by Sandra Kicman
Shawn Gibson, Class of 2022, far left, welcomes participants to the Rx for Success program at the Jacobs School of Medicine and Biomedical Sciences.
UB undergraduate students Bianca S. St. Cilien, left, and Kwesiann C. Regent practice their suturing techniques during one of the Rx for Success workshops.
Rx for �ucce�:
PREPARING FOR MEDICAL SCHOOL
PROGRAM HELPS UNDERREPRESENTED STUDENTS GAIN CONFIDENCE
BY DIRK HOFFMAN
The importance of self-conﬁdence was stressed during the annual “Rx for Success: Preparing for Medical School” program held last the fall at the Jacobs School of Medicine and Biomedical Sciences. Approximately 200 high school and college students from underrepresented groups throughout New York State attended. Belief in Oneself Plays Important Role Activities included informational sessions on the medical school admissions process and the clinical practice of medicine course, as well as hands-on workshops in which students had an opportunity to learn suturing skills and perform lab tasks. During a tour of the Jacobs School building, participants met with current students, who talked about their experiences applying to and attending medical school. “During my welcome address, I brieﬂy shared with the attendees my journey to medical school as a ﬁrst-generation college student and the lessons that I needed to learn throughout my academic career to remain conﬁdent throughout my journey to medical school,” says second-year medical student Shawn Gibson, Class of 2022, president of the Jacobs School’s chapter of the Student National Medical Association (SNMA). “Lack of conﬁdence may deter someone from achieving their lifelong dream, and I hope all students who attended Rx for Success left inspired and conﬁdent to continue their path to medicine,” he adds. Hard Work Erases Barriers to Success Keynote speaker Adam Aponte, MD, chief medical oﬃcer of NYC Health + Hospitals, focused on motivating all the attendees to realize that pursuing a career in medicine is possible regardless of their background. He shared his own story of growing up on the streets of East Harlem and working hard to become a pediatrician. The free program is sponsored by UB’s Collegiate Science and Technology Entry Program and the SNMA, which supports current and future underrepresented minority medical students. According to data from the University at Albany Center for Health Workforce Studies, even in a diverse state like New York, where AfricanAmericans, Hispanics and Latinos comprise more than 30 percent of the population, they make up only 12 percent of the physician workforce. “I believe that Rx for Success 2019 was a huge triumph. We received a lot of positive feedback from many attendees, and it was a pleasure to interact with and inspire many high school and college students to continue pursuing a career in medicine,” Gibson says.
TA B L E O F C O N T E N T S
UB MEDICINE MAGAZINE, Winter 2020, Vol. 8, No. 1
MICHAEL E. CAIN, MD Vice President for Health Sciences and Dean, Jacobs School of Medicine and Biomedical Sciences
Eric C. Alcott Associate Vice President for Advancement, Health Sciences, Senior Associate Dean of Medical Advancement
VITAL LINES Progress notes
Editorial Director Christine Fontaneda Executive Director of Medical Advancement
Editor Stephanie A. Unger
Reflections on careers
Editorial Advisor Jennifer E. Britton Senior Director of Constituent Engagement, Health Sciences
Contributing Writers Ellen Goldbaum Susan Kreimer Grove Potter Mark Sommer
Conversations with experts
Copyeditor Tom Putnam
PATHWAYS People in the news
Photo by Douglas Levere
UB Medicine is published by the Jacobs School of Medicine and Biomedical Sciences at UB to inform alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in Buffalo, Western New York and beyond.
Photography Douglas Levere Meredith Forrest Kulwicki Sandra Kicman
Medical education is not what it used to be. Increasingly, learning takes place in small groups where teaching is less formal and more interactive.
VISIT US: medicine.buffalo.edu/alumni
6 CHANGING THE WAY MEDICINE IS TAUGHT COVER IMAGE Second-year students Timothy Hellerer, left, and Jarrett White, right, studying together. Photo by Douglas Levere
Newly established Medical Education and Educational Research Institute supports best practices for teaching and learning.
10 COMMUNICATION AS A FOUNDATION FOR CARE Teaching good ways to deliver bad news.
ESSAY CONFRONTS PHYSICIAN STRESS AND BURNOUT Written by a UB clinical associate professor of psychiatry, the article has resonated nationally.
16 A MEDICAL EDUCATION SECOND TO NONE
Head and neck surgeon Gregory Antoine, MD ’76, looks back on an exceptional career, launched at UB.
Art Direction & Design Karen Lichner Editorial Chair John J. Bodkin II, MD ’76 Aﬃliated Teaching Hospitals Erie County Medical Center Roswell Park Comprehensive Cancer Center Veterans Affairs Western New York Healthcare System Kaleida Health Buffalo General Medical Center DeGraff Urgent Care Gates Vascular Institute John R. Oishei Children’s Hospital Millard Fillmore Suburban Hospital Catholic Health Mercy Hospital of Buffalo Sisters of Charity Hospital Correspondence, including requests to be added to or removed from the mailing list, should be sent to: Editor, UB Medicine, 916 Kimball Tower, Buffalo, NY 14214; or email email@example.com
U B M E D V I TA L L I N E S
SETHI RECEIVES STOCKTON KIMBALL AWARD Sanjay Sethi, MD, professor of medicine, chief of the Division of Pulmonary, Critical Care and Sleep Medicine, and assistant vice president for health sciences, is the recipient of the 2019 Stockton Kimball Award. The award, presented annually, is the Jacobs School of Medicine and Biomedical Sciences’ highest honor, bestowed on a faculty member who has achieved worldwide recognition for his or her research and who has demonstrated significant academic accomplishment and service to the University at Buffalo. Sethi’s clinical and research interests focus on chronic obstructive pulmonary disease (COPD) and respiratory infections, especially in the causation, treatment and prevention of COPD exacerbations. He is listed as one of the top five COPD specialists in the country. “Dr. Sethi has exemplified excellence in its broadest sense, and we at the Jacobs School of Medicine and Biomedical Sciences are fortunate to have the benefit of his extensive contributions to his
field, the university and school,” says Suzanne G. Laychock, PhD, senior associate dean for faculty affairs and facilities. Sethi is currently funded as co-principal investigator on a Department of Defense grant and site investigator for a National Institutes of Health (NIH) trial. He also was a co-investigator on the Clinical and Translational Science Award given to the Jacobs School in 2015 and has served as principal investigator Sethi on single and multisite research grants funded by the NIH, industry and Veterans Affairs Merit Awards. Sethi will deliver the Stockton Kimball Lecture in 2020.
ESTEEMED SCHOLAR JOINS BIOMEDICAL ENGINEERING B. Rita Alevriadou, PhD, a renowned researcher in the field of cardiovascular bioengineering, has joined the Department of Biomedical Engineering as a SUNY Empire Innovation Professor. Alevriadou, who has joined UB from The Ohio State University (OSU), focuses her research on understanding the molecular basis of cardiovascular diseases such as atherosclerosis, ischemia/reperfusion Alevriadou injury and diabetes. Her studies are supported by the National Institutes of Health (NIH) and the American Heart Association (AHA). She regularly reviews for federal and local funding agencies including the NIH, AHA and National Science Foundation, as well as for bioengineering journals. Additionally, she has been an editorial board member of the American Journal of Physiology-Cell Physiology since 2002.
At OSU, Alevriadou was director of the Vascular Mechanotransduction and Oxidative Stress Laboratory and a member of the Dorothy M. Davis Heart and Lung Research Institute, as well as an associate professor in the Department of Biomedical Engineering and the Division of Cardiovascular Medicine in the Department of Internal Medicine. Prior to joining OSU, she was an assistant professor of biomedical engineering at Johns Hopkins University. Alevriadou received her doctoral degree in chemical engineering from Rice University in 1992, followed by postdoctoral training at the Scripps Research Institute. The Empire Innovation Program (SUNY EIP) is a state-funded competitive grant program dedicated to recruiting and retaining world-class faculty at the State University of New York. EIP scholars drive innovation, enhance partnerships with business and industry, increase tech transfer, create opportunities for student research and increase the competitiveness of SUNY’s education programs. The UB Department of Biomedical Engineering is a collaboration between the School of Engineering and Applied Sciences and the Jacobs School of Medicine and Biomedical Sciences.
POPESCU CHAIRS AAMC’S COUNCIL OF FACULTY Gabriela K. Popescu, PhD ’99, professor of biochemistry in the Jacobs School of Medicine and Biomedical Sciences, has been elected chair of the Council of Faculty and Academic Societies (CFAS) of the Association of American Medical Colleges (AAMC). A UB faculty member since 2006, Popescu began her two-year term as CFAS chair in November 2019. As chair, she will serve as a member of the AAMC’s board of directors until November 2021. CFAS—the largest of the AAMC Councils—was formed in 2013 with the goal of more directly engaging and representing faculty views and issues and voicing them to the AAMC to help shape the development and implementation of its programs and policies. The AAMC is currently developing a new strategic plan for the organization, and Popescu is leading a concurrent effort across CFAS to better align faculty priorities with the AAMC’s mission. Popescu believes that her experiences as a bench scientist, a woman in academic medicine and an immigrant serve her well in
this leadership position. Popescu currently directs research funded by three NIH awards totaling more than $3.5 million. She has invested much of her career studying a family of brain receptors—called NMDA (N-methyl-D-aspartate) receptors—that are critical to learning and memory. Her research on these receptors may lead to more effective strategies to treat neurological and neurodegenerative conditions. To learn more about Popescu’s priorities as chair of the CFAS, go to buffalo.edu/news.html and search “Popescu.”
CORRECTION: GENE THERAPIES FOR MACULAR DEGENERATION In the fall 2019 issue of UB Medicine, we featured ophthalmic researcher Jack Sullivan, MD, PhD, in an article titled Gene Therapies for Macular Degeneration. The research we described in the article is supported, in part, by a VA Merit Review award from the United States Department of Veterans Affairs (Biomedical Laboratory Research and Development Service) and, in part, by a National Eye Institute award. In addition to being a professor of ophthalmology at UB, Sullivan is a staff physician scientist at the VA Western New York Healthcare System in Buffalo. We also described a $1 million bequest commitment made by George and Roberta Stevens in support of the UB Department of Ophthalmology and research into age-related macular degeneration. In the article, we incorrectly stated that George is a UB alumnus. Roberta, his wife, is the alumna of UB, having earned a bachelor of arts degree in psychology and English at the university in 1970 and a master’s degree in library and information studies in 1974. She also holds a master’s degree in English from SUNY at Binghamton. In addition to their commitment to the medical school, the Stevens have made a $1 million bequest pledge to the UB College of Arts
Roberta and George Stevens
and Sciences (CAS). Roberta serves on the Dean’s Advisory Council for CAS, and she and George both serve on the Boldly Buffalo campaign committee.
U B M E D V I TA L L I N E S
UB BIOREPOSITORY OPENS Brings the power of precision medicine to Western New York
he UB Biorepository, a critical new facility in the Clinical and Translational Science Institute, opened in October, providing a powerful resource regionally and throughout the state for driving biomedical innovation in academia and industry. From molecular profiling of samples to integration with clinical data about patients, the facility has the capacity to collect, process, store and distribute millions of biological specimens that will allow UB and its research and industry partners to harness the discoveries that ultimately benefit patients. The UB Biorepository strengthens the ability of researchers in academia and industry to advance precision medicine by developing new drugs and diagnostic tools targeted to specific disorders and even individual patients. Funded by UB and New York State, the UB Biorepository is a critical part of the Buffalo Institute for Genomics and Data Analytics (BIG), which connects life sciences companies to technical expertise and high-tech facilities at UB. BIG is supported by Gov. Andrew M. Cuomo’s economic development efforts in Buffalo, and is one of the key initiatives helping to build the region’s innovation economy by leveraging its life sciences assets to drive economic growth. According to Andrew Brooks, chief operating officer and director of technology development at RUCDR Infinite Biologics at Rutgers University and a consultant to the UB Biorepository, a centralized biorepository is an essential ingredient today in advancing biomedical research and collaborations. While in the past the emphasis was on the safe storage and preservation of biospecimens, the exponential growth of big data in biomedicine has created major new opportunities for innovation based on the far more detailed information now available about each biospecimen. The UB Biorepository provides comprehensive annotation of biospecimens, through which the functions and locations of genes and coding regions in a genome are identified, as well as big data integration.
B y E l l e n G ol dba um
John E. Tomaszewski, SUNY Distinguished Professor and the Peter A. Nickerson Chair of Pathology and Anatomical Sciences in the Jacobs School, adds: “With each individual sample potentially providing as many as hundreds of thousands of annotations, or datapoints, whether you’re studying the genome, the proteome or the microbiome, the biospecimens in the biorepository are an incredibly rich resource.” Having a biorepository in Western New York allows local researchers in both academia and industry to target diseases that have a high incidence in Western New York, such as multiple sclerosis (MS), explains Norma J. Nowak, PhD, executive director of UB’s New York State Center of Excellence in Bioinformatics and Life Sciences, and faculty leader with Tomaszewski of the biorepository. Nowak adds that the biorepository will become an especially valuable resource since it will eventually reflect the ethnic and international diversity of Buffalo and Western New York. “The biorepository will capture that diversity,” she says. For more information about the UB Biorepository, visit buffalo.edu/news.html and search “biorepository.”
A MEDICAL EDUCATION PIONEER GIVES BACK Hilliard Jason, MD ’58, EdD ’61, is grateful for his unique opportunities at UB
illiard (“Hill”) Jason, MD ’58, EdD ’61, an early pioneer in medical education, made a substantial gift (together with his wife, Jane Westberg, PhD) to the Jacobs School of Medicine and Biomedical Sciences in support of the school’s newly established Medical Education and Educational Research Institute (see article on page 6). In 1956-58, Jason was part of a group at UB that started this country’s first-ever program in medical education research and faculty development. At the time, he was a medical student disenchanted with a medical education process that he felt did not adequately “focus on the learning process, human communication or the real needs of future clinicians.” When he shared his concerns with his UB Jason professors, he was surprised to find that some agreed with him. Serendipitously, the school was in the process of initiating what it called the “Project in Medical Education,” and Jason was asked to join the group as a student representative. “The Buffalo program became the first in the United States (and, probably the world) to begin a systematic program in faculty development for medical teachers,” Jason wrote in a retrospective article on medical education in the 40th anniversary issue of the journal Medical Teacher in 2018. “I had the unearned good fortune to be at UB’s medical school at just the right time. My complaining, amazingly and delightfully, led to an invitation that proved lifechanging,” he recalls in that article. “George E. Miller, the founder and leader of ‘The Project,’ invited me to become the student voice, a role that had not been anticipated in the original plan.”
B y S. A . Un g e r
Jason subsequently sought and received permission to attend medical school half time for two years so that he could fully participate in The Project. He also applied to the UB Graduate School of Education, where he was accepted and completed a doctorate in education in 1961, and to which he and Jane have also made a philanthropic gift. Medical education became the focus of Jason’s 60-plus year career, which has taken him to universities around the country, most notably, the University of Colorado, where he has been clinical professor of family medicine since 1990, and Michigan State University, where he was founding director of the Office of Medical Education Research and Development. He also served the Association of American Medical Colleges as founding director of its Division of Faculty Development. Today Jason is co— HILLIARD JASON, MD founder and director of academic affairs at iMedtrust.org, a higher education charity based in England and Wales, where he is leading the design of the educational programs. “Our gifts to UB were prompted by my gratitude for how well I was treated when I was a student in both the medical and education programs,” Jason says. “In particular, I appreciate the flexibility shown by both programs, which allowed me to become the first person globally, as far as I know, to be able to pursue doctorates in medicine and education simultaneously. These experiences became the foundation of my rather lengthy and still-active career.”
“I had the unearned good fortune to be at UB’s medical school at just the right time. My complaining, amazingly and delightfully, led to an invitation that proved life-changing.”
Jennifer Meka, PhD, director of the Medical Education and Educational Research Institute and assistant dean for medical education, center, with students.
CHANGING THE WAY Medicine IS TAUGHT
STORY BY GROVE POTTER PHOTOS BY DOUGLAS LEVERE
TODAY’S STUDENTS LEARN DIFFERENTLY, AND THERE IS MORE TO KNOW
walk through the new Jacobs School of Medicine and Biomedical Sciences’ building makes it clear that the teaching of medicine has changed. Large lecture rooms are scarce. Now you’re more likely to find rooms where small groups of people work closely together.
That design is one signal that the days of lecture-learning are fading fast. Team-based and case-based interactive learning have been shown to create the kind of learning that leads to better, more durable retention of material and to improve problem-solving skills. But how does one learn to teach that way?
New medical education institute Enter Jennifer Meka, PhD, director of the Jacob School’s newly established Medical Education and Educational Research Institute (MEERI) and assistant dean for medical education. Working in concert with faculty, she is helping to transform the way medicine is taught at the school, aligning it with how students today learn and with best practices as defined by educational research. Her mission is to teach the teachers how to utilize evidence-based approaches to making learning more interactive, deep and durable, to promote the success of future physicians.
“The goal for MEERI is to equip our faculty with the tools they need to train students as critical thinkers, able to clinically reason, while utilizing the ever-expanding volume of medical information they will need as future physicians,” says Meka, who holds a doctorate in education. “To do this, faculty need to understand how people learn and approaches to integrating this in their teaching methods. Layering the content with teaching students how to learn effectively prepares them for future learning.” Changing long-held teaching practices can be daunting, but Meka says she has been warmly welcomed and many teachers are eager to learn. “It’s an amazing place to be because everyone has their own area of expertise, but they all are open and willing to learn how they can be better teachers.” But the change is not easy. “It’s difficult to adapt to new ways of teaching for two reasons,” says Meka, who started at the medical school last March after serving
Melissa Rayhill, MD ’10, clinical professor of neurology, seated left, teaching a small group of second-year students. In the foreground are Jordan Gaston, left, and Daniel Olutalabi, right.
for six years as director of cognitive skills at the Penn State College of Medicine and director of the Woodward Center for Excellence in Health Sciences Education. “First, when many of the faculty were in medical school, they were in lectures from 8 a.m. to 5 p.m., so that is what they are accustomed to. The second challenge is it takes time to learn new strategies and to design the teaching, and it shifts the faculty member’s role in the classroom. Instead of pulling out the PowerPoint from the talk you gave last year on diabetes and updating some of the slides, you might have to write up a case and think through what questions you are going to ask and be deliberate in the sequencing of the questions. It can be more work up front and less work during the actual session, but the students get more out of it. And we know from the science of learning that this is the direction we should be taking in our teaching.” Another important facet of MEERI is the recognition of outstanding educators. To this end, Meka has worked with students, residents and faculty to implement the Moments of Excellence in Education: Recognition & Inspiration (MEE:RI) Program. “The program is designed to give students an opportunity to acknowledge the best practices in teaching strategies that they have experienced,” Meka explains. Students submit examples of these exceptional moments and each month the MEE:RI Program features one moment along with associated teaching tips and educational research to inspire faculty. Meka also is “working with programs and departments to develop additional longitudinal programming and to explore ways to collaborate around existing resources and initiatives across the university and beyond.” And her mission has support from the top. “Dean Cain has been incredibly supportive,” she says. “Early on, he invited me to the medical school’s executive council to talk about some of the programs we are working on. Department heads then reached out to me, and we started to look into some of their individual department needs.”
Kassidy Amburgey, left, and Laura Artim, right, discussing a case.
Internet has changed how students learn Alan Lesse, MD, senior associate dean for medical curriculum and vice chair for education in the Department of Medicine, says that efforts to reassess the educational process and the creation of MEERI are outgrowths of the school’s 2017 strategic plan. “If you basically summarize the first two goals of the strategic plan for medical education, strategic goal one is to improve the curriculum. Strategic goal two is to teach the teachers to be able to do goal one. So they are intertwined,” he says. “Essentially, we want to improve the curriculum, but we can’t improve the curriculum until we help the teachers teach it better and differently.” Students today also learn differently than in the past, Lesse says. “They don’t have to remember reams of information. They can look up something on the internet in a second, which impacts their attention, so I don’t think they memorize as well as students did in the past. “But the amount of information we needed to know when I went to school was much smaller,” he adds. “We didn’t have ready access to any information we wanted in our pockets on our phones. I used to carry around spiral books that had information I could look up if I couldn’t remember it.” Lesse is quick to point out that changing the way classes are taught is not an indictment of the old ways. “It’s clear that the old system works. I don’t consider myself a bad physician or handicapped because I did it the old way, which was lecture based,” he says. “But lots of studies now show that retention from lecture is lower than other forms of learning.” Basically, the internet has changed how students learn, he concludes, which calls for a fundamental shift in how they are taught.
From left: Arthur Gribachov, Gurkaran Johal, and Amit Bhambhani.
Fourth-year student Steven Foulis, in foreground, teaching second-year students. Facing him are Timothy Kung, left, and Shannon Coleman and Thomas Barbaccia, right.
Elle Fisch, MD, chief resident, Department of Obstetrics and Gynecology, left, and Suzanne Griffith, MD, clinical assistant professor of OB/GYN, right, teaching small group.
ne step toward changing teaching practices is to Lesse says case-based learning does require a different approach. introduce evidence-based principles to both faculty and “It’s the concept of active learning where, instead of standing students so that they can use them effectively in their and lecturing, we pose problems. And it’s the concept of team-based teaching and learning. “An example of this is introducing learning, where people work together in teams to come up with an faculty to the concept of deep questions and having them answer,” he explains. “It really is a different sort of mindset.” ask two or three such questions during a session as well as at the Preparing to teach involves deconstructing the old lessons and end,” Meka explains. This exchange and the focus on the students’ presenting them differently. explanation of the material, helps cement the knowledge. It also can “It’s called backwards design, where you determine exactly what show a teacher what students you want to teach the students and might not be understanding. how you’re going to ask questions Another tool is to give students to assess how much they know, cases to work through. and then you derive the content,” Lesse notes. “It’s not preparing the “Our clinicians are really good content first and then figuring out at talking through cases and what the questions are later.” describing their approaches to patient care,” Meka says. “So one In short, today’s educators are approach is for them to present benefiting from new data about a case and pose questions related how information is processed and to that case, then ask the students are learning how to refashion their to turn to a neighbor, generate an teaching techniques accordingly. – ALAN LESSE, MD answer, debrief them and explain “The teaching method is SENIOR ASSOCIATE DEAN FOR MEDICAL CURRICULUM their rationale, then have the separate from the material faculty member do that, and give being taught,” says Meka, who them different tools for how to do that. acknowledges that this can be a challenge. “This requires a shift in the teachers’ thinking because they’re “The difficult part is getting the instructors to step away from used to saying ‘Here’s the case and here’s what we did,’” she adds. the medical knowledge or the clinical skills piece and focus on the “A lot of times our teachers are already employing effective teaching piece. You don’t want them to get caught up in ‘Why didn’t strategies, but they don’t have the label for it. Or they don’t know you give this medication?’ or ‘Why didn’t you suggest they have this why it works or how they could use it elsewhere and so have more test?’ You want them to focus on how they asked a question when they of an impact. When our faculty use cases in a deliberate way, they were engaging with a student.” can promote cognitive flexibility in our students, which is essential Of course the material is vitally important, Meka says, as is the in preparing them for future learning and practice. ability to continue to learn. “The key task ahead for MEERI,” Meka concludes, “is to help “The more we can teach students about the best ways to go about our teachers learn how to build on what they are already doing to learning—how to develop stronger critical thinking skills, critical improve their teaching and the students’ learning.” analytical skills, clinical reasoning skills—the better skills they will
“It’s the concept of active learning where, instead of standing and lecturing, we pose problems. And it’s the concept of team-based learning, where people work together in teams to come up with an answer,”
Students participating in an exchange. Pictured at the head of the table is Katelyn Benson, left, and Jenna Betz, right.
have when they encounter new diseases and new protocols.” Meka also is working with teachers to approach the process as valid educational research that can be shared with the entire medical teaching profession. “We want to do our work in a scientific way so that we can contribute to the educational field,” she says. “In addition to promoting best practices, we want to showcase the outstanding work that we are doing here at UB.” To support this endeavor, a MEERI Scholars Award program has been established to encourage Jacobs School faculty and staff to generate promising teaching and learning projects. Through the program, which launched in January 2020, award recipients receive feedback, educational programming and cross-collaborative support to help them develop their ideas into prototypes, pilots and smallscale innovations that lead to implementation in the curriculum and dissemination to the broader medical education community.
A step in the right direction All these efforts and more are aimed at helping students achieve their greatest potential by being immersed in a learning environment that consistently reflects best practice as defined by education research. One crucial tool used to assess whether they are reaching this potential is the United States Medical Licensing Exam. The first part of the exam is known as the Step 1 exam and covers all the scientific knowledge they have studied. For residency programs around the country, it has become a type of screening tool. At the Jacobs School, students take the Step 1 exam at the end of their second year. “The Step 1 exam makes students recall what they had in the first semester, first year,” Lesse says, “so we want to make that knowledge more durable.” The new teaching approaches are hard work and students initially do not like them, he notes, “but studies have shown that when something is harder to learn, that’s when you put in the effort, and it’s recalled much better than when learning it was easy.” Student readiness for the Step 1 exam will be taken into account as the new curriculum—set to launch in 2022—is being designed. “We
“The key task ahead for MEERI is to help our teachers learn how to build on what they are already doing to improve their teaching and the students’ learning.” – JENNIFER MEKA, PhD, DIRECTOR OF MEERI
don’t want to teach to the test, we never want to do that,” Lesse says. “But given the importance of the test, we want to make sure that our curriculum provides a solid foundation so that students will do well.” Meka may have earned some credibility with students preparing for the Step 1 exam this year. Soon after beginning in her new role, she worked with the Office of Medical Curriculum to organize workshops in which she and upper-class students presented research-informed approaches to designing study plans. Students could also schedule individual consultations, and Meka met with 95 percent of the students in the second-year class and many of the first-year students. “Results are coming in, and the average score is higher than it was last year,” she says. “I think our students have found it very helpful to have a variety of options and resources to support their preparation for such an important exam.” Results like that will go a long way in helping transform the school’s teaching strategies. “It’s about elevating and cultivating this excitement and passion for education, while also providing support and resources for our teachers and students to implement evidence-based teaching and learning strategies,” Meka says. “The ultimate purpose of MEERI is to develop the best educational programs for our students.”
Cďż˝unicatiďż˝ AS A FOUNDATION Teaching good ways to deliver bad news
for Care STORY BY MARK SOMMER
PHOTOS BY DOUGLAS LEVERE
edical educators understand that if they focus too heavily on the science of medicine, they risk overlooking the art of medicine, an art perhaps best exemplified by good physician-patient communication.
In recent decades, this understanding has grown out of difficult lessons that caused medical professionals to step back and acknowledge that high technology, while a tremendous boon, also served to undermine their relationships with patients. This in turn affected adherence to treatment plans and patient satisfaction, contributing to an increase in malpractice suits. Recognizing these trends, the Accreditation Council for Graduate Medical Education mandated in 2007 that residents be formally taught communication skills. At about this same time, medical professionals also began acknowledging a responsibility to communicate more effectively when talking with patients about life-altering or terminal diagnoses and issues related to informed consent. The Jacobs School of Medicine and Biomedical Sciences anticipated these trends when it established the Standardized Patient Program in its Clinical Competency Center in the early 1990s. The program
grew out of concerns that third- and fourth-year students were not being adequately trained in communication skills. Since that time, the program has been expanded to include first- and second-year students, as well as residents. Other courses, established in the late 1990s, focused on teaching students how to compassionately and effectively deliver difficult news to patients. These groundbreaking programs continue to thrive today and are being expanded by a new generation of faculty devoted to sustaining excellence in this aspect of medical education in the Jacobs School.
Early exposure to lifelong skills First-year medical students in the Clinical Practice of Medicine 1 course are introduced to a six-step protocol for how best to present distressing information in a caring and organized manner to patients and their families. Known by the acronym SPIKES, the protocol was developed in the early 2000s by British oncologist
Pictured left, center, Sarah Moses, Class of 2022.
Robert A. Buckman, MD, PhD. In the Clinical Practice of Medicine 2 course, second-year medical students are scheduled to take the How to Deliver Bad News module, developed at UB in 1999, which uses actual cancer survivors for role-playing. In their third-year, students participate in three Communication in Serious Illness workshops where they learn how to engage in “values-based” conversations with patients to arrive at a course of action. A palliative-care elective gives medical students an opportunity to learn about hospice and palliative care. This includes their spending time at a facility and making home care visits with doctors, nurses, social workers and chaplains. Students also take part in team meetings and family conferences. First-year surgical residents at UB are required to spend a week in the palliative care elective. Jason Edwards, MD ’16, chief resident in internal medicine at Erie County Medical Center (ECMC), says the training he received in physician-patient relationships at the Jacobs School has been invaluable. He is particularly drawn to palliative care’s holistic approach. “The first thing you learn to do is listen,” he says. “It’s not about talking and reacting. It’s about taking in a patient’s perspective over a whole lifetime and fusing that into their care. “It takes time, and it takes patience,” Edwards adds, “but it forms a foundation to make decisions about their health care and empowers them to make decisions aligned with their values. When done correctly, it is a communal endeavor more than a hospital-system endeavor.”
Nicholas Primiano, second-year student, practicing communication skills in the Clinical Competency Center.
Eric Hansen, MD, assistant professor of medicine in the Jacobs School of Medicine and Biomedical Sciences, and palliative care physician at Roswell Park Comprehensive Cancer Institute, teaching How to Deliver Bad News module.
Learning from patients In the late 1990s, Hillary Ruchlin, former director of the Cancer Wellness Center in Buffalo, approached Alan Baer, MD, thenassociate professor of medicine at UB, about using actual cancer survivors instead of commonly used scripted actors to help medical students understand how best to inform patients that they have cancer. Ruchlin had been troubled by the accounts she had heard about how poorly doctors, in general, had delivered bad news to patients. “It’s a life-altering moment,” Ruchlin says. “I had thought that communicating with cancer patients was something they taught medical students, so it was news to me when I learned that they didn’t.” Baer turned to Buckman’s pioneering work to develop materials. He was aided by Jack Freer, MD ’75, a UB clinical professor of geriatrics and palliative medicine, who teaches students about SPIKES and oversees the palliative care elective. The How to Deliver Bad News module began in 1999 in a large lecture hall and later moved to more intimate settings, where it was presented to groups of 24 students. Cancer survivors volunteered to participate in the module, willing to relive painful memories to help the next generation of physicians be more compassionate about how they talked to patients with difficult diagnoses. Ruchlin says the medical students were captivated by the cancer survivors’ stories of how physicians had informed them of their cancer. “You could tell just by looking at them that they were very immersed in and affected by what these people had gone through,” she recalls. “This is a very important moment in a patient’s life, one they’re never going to forget, and doctors need to be aware of the situation,” she says. The medical students in the module also role-play with survivors, who pretend to be patients. To do this, the students present a fictitious case history they’ve been informed about prior to the 20-minute session in which they interact with the patient. After this practice exchange, five minutes are allocated for the patient to give
Donna Price, RN, Erie County Medical Center, left, and Jason Edwards, MD ’16, chief resident in internal medicine at ECMC, right, teaching Communication in Serious Illness Workshop.
Katie Grimm, MD ’93, clinical assistant professor of medicine, right, teaching Communication in Serious Illness small-group workshop at Erie County Medical Center (ECMC).
Sandra Lauer, BSN, RN, at ECMC, co-leads the workshop with Katie Grimm, MD, and Mehak Swami, DO, clinical assistant professor of medicine.
the most positive evaluations,” she explains. the student feedback on how effectively he “Student comments often include statements or she felt the diagnosis was communicated. such as: ‘Thank you; this is why I came to The volunteer patient then completes medical school in the first place.’” a written evaluation checklist on the student’s performance. Questions include In another part of the module, William whether the student asked how much the Potter, a retired research scientist in patient wanted to know about his or her oncology, discusses the need to “detoxify illness, and if they used the word “cancer” statistics,” reminding students that statistics as opposed to simply “a tumor” or “growth,” and whether the student ended the interview with a polite and appropriate closure. In October 2000, Baer presented an abstract on the project’s findings at the annual meeting of the Association of American Medical Colleges, describing significant differences in the students’ approaches to delivering stressful news based on pre- and —HILLARY RUCHLIN, FORMER DIRECTOR OF THE post-test results. Baer found that after CANCER WELLNESS CENTER IN BUFFALO completing the module, students were more apt to use personal, empathetic and reassuring language rather than impersonal and technically specific language, signaling its success. are predictive of outcomes for large groups, “When we first started the program, we but make no determination for individuals. got calls from doctors who said they wished “What we say is that it is an individual they had had this opportunity when they situation, and you always have to remember were students,” Ruchlin says. that anything is possible,” Potter says. “It’s Karen Zinnerstrom, PhD, administrative good medicine to try to get the patient director of the Clinical Competency and to perceive the situation from a more Behling Human Simulation centers at the optimistic point of view.” Jacobs School, oversees the How to Deliver Bad News module with cancer survivors. She says that feedback from the second-year An ongoing challenge medical students consistently demonstrates Eric Hansen, MD, an assistant professor the value of the module, under course of medicine in the Jacobs School and a director Nasir Khan, MD, clinical associate palliative care physician at Roswell Park professor of medicine. “Of all the small Comprehensive Cancer Center, trains groups that students are exposed to in their students in the Clinical Competency Center. first semester, this module receives some of
“When we first started the program, we got calls from doctors who said they wished they had had this opportunity when they were students.”
In this role, he talks with students about the personal challenges physicians face when they need to deliver bad news to patients and their families, and ways to cope with the emotional toll it can take on doctors over time. Hansen says it’s good for medical students to have this training as early as possible, but acknowledges that they don’t fully appreciate its importance until they begin working regularly with patients in their third and fourth years and in residency. “We try and support them, acknowledging these conversations are challenging emotionally for all physicians, even experienced physicians,” Hansen says. “It helps to go in prepared, but you’re still dealing with a very difficult and often sad situation. We try to give them skills to work with colleagues—ways to productively debrief with them after the visit—and to develop self-care strategies to deal with inner-personal challenges.”
A factor in burnout The Communication in Serious Illness workshops are led by Katie Grimm, MD ’93, clinical assistant professor of medicine, and Mehak Swami, DO, clinical assistant professor of medicine, both in the Division of Geriatrics and Palliative Medicine, Department of Medicine; and Sandra Lauer, BSN, RN, director, continuum of care, supportive care and palliative medicine at ECMC. For the workshops, the educators use a guide developed by Ariadne Labs in Boston to help teach students how to conduct difficult conversations, Grimm explains.
PALLIATIVE CARE INTEREST GROUP FORMED
Second-year student Julie Adams practicing communication skills in the Clinical Competency Center.
All third-year medical students now receive this training as part of the two-week Core Topic intersessions held between fall and spring semesters. The students then have an opportunity to apply these skills in their remaining clerkships to improve communication with patients, families and health care teams. “I think there is a tremendous amount of what we call ‘burnout’ when residents try to deal with difficult situations and come away feeling angry or defeated,” Grimm says. “Their distress may be directed at the patient and the family for not understanding what they are trying to tell them, but it’s because there is a gap in communication at a basic emotional level.” Lauer says it takes time to connect with patients, listening carefully when they express their values and goals. It’s all the more important because patients look to doctors to initiate a conversation, she explains. “We have data that shows physicians are not always comfortable talking about serious illnesses and death,” says Lauer, “yet there is this idea that because physicians are smart people, they should be able to communicate well.” Lauer reports that students respond positively to the training. “Fairly consistently, they say they wish it were longer and that it involved more role playing,” she says.
A powerful thing For Edwards, the chief resident in internal medicine at ECMC, taking the workshops opened doors he has continued to step through in a career he sees as dedicated to palliative care. “It goes from the idea of ‘I don’t know if I should be doing this’ to ‘I have to do this.’ It’s a very powerful thing to do correctly. Once you’re trained in palliative care, it becomes part of your foundation and your thought processes.” Palliative care has changed Edwards’ view of medicine, since he says he now looks at the whole person more. “You go to medical school and learn disease processes, but at a certain point all the concrete knowledge you have is futile,” he observes. “It reaches a point where medicine can only go so far. But with palliative care, there is no end point because you are evaluating the whole ethos of a person. It’s all part of being human beings first, and doctors second.”
In 2018, Timothy Felong and Samantha Loria, Class of 2021, established a Palliative Care Interest Group in the Jacobs School of Medicine and Biomedical Sciences in an effort to inform their peers about the importance of providing specialized medical care, including better quality of life, for patients living with a serious illness. The students were inspired to form the group after participating in a mercy doula training program at Erie County Medical Center (ECMC) begun by Elder Wiggins, the medical center’s chaplain; Sandra Lauer, BSN, RN, director, continuum of care, supportive care and palliative medicine; and Katie Grimm, MD ’93, director of palliative care, and clinical professor of medicine in the Division of Geriatrics and Palliative Medicine at the Jacobs School. Felong says the training exposed the students to emotionally difficult physician-patient interactions, such as how to talk to dying patients who don’t have family or friends in their lives, and how to listen to patients without judgment. “After completing the program, we wanted to provide an avenue for other students interested in seeking out this type of training, now and into the future,” Felong says. Since its inception, the Palliative Care Interest Group has worked to create opportunities for students to interact with and shadow local palliative care physicians and specialists. Group members also hosted a panel discussion on physician-assisted dying and different approaches to end-of-life care. The Palliative Care Interest Group resonated with Tara Daly, Class of 2022, who now leads it with classmate Maria Geba. “I find that a lot of students feel unprepared when it comes to interacting with a patient who might be facing end of life or decisions around end of life,” Daly says. “I hope we can help expose our colleagues to the field of palliative care—what it is, what it entails and how it fits into the whole field of medicine.” “Palliative care is still a young field,” Geba adds. “Hopefully, what we’re doing will put it on people’s radar.” A Palliative Medicine Excellence Fund for Medical Students has been established at the Jacobs School. If you are interested in supporting our students by investing in a new model of care in palliative medicine focused on humanism and the reduction of barriers to health equity, please consider giving to this endowment fund. To learn more, contact Jennifer Seth-Cimini, senior director, medical advancement, at firstname.lastname@example.org, or 716-829-3732. WINTER 2020
Photo by Sandra Kicman
Sourav Sengupta, MD, MPH, lecturing.
ESSAY CONFRONTS BURNOUT AND STRESS AMONG PHYSICIANS RESONATES ON A NATIONAL SCALE
n essay by Sourav Sengupta, MD, MPH, assistant professor of psychiatry and pediatrics, detailing how he worked through issues of stress with the help of a therapist, is resonating on a national scale. Last March, JAMA Network published online his essay, “Rebuilding More of Me.” Sengupta wasn’t sure how the essay would be received, but in the weeks following its publication, he received personal email messages from dozens of physicians around the U.S. who reached out to share perspectives and their experiences. Altmetric (a citation-impact measurement) rated the essay in the top 5 percent of publications. In less than a month after publication, it had been viewed more than 6,500 times and downloaded more than 500 times. Sengupta received emails from physicians at every career stage, telling him it was a relief to know that others have also gone through this kind of stress and have succeeded.
BY ELLEN GOLDBAUM
Difficulty in finding help It’s no secret that physicians have stressful jobs. Figuring out how to mitigate and deal with that stress can be a key part of a successful medical career. But while individual physicians seek and find help for their mental health issues privately, the prevailing public perception among physicians is that it just isn’t done. A few years ago, Sengupta, who also treats patients, had reached a point where he knew that escalating professional and personal demands were impacting his effectiveness. His essay describes the barriers he encountered in trying to access the help he needed. “I am an attending physician in the field from which I need support,” he writes. “Many of the best clinicians and treatment settings are not options. I know them too well.” Once he found a psychotherapist he could work with confidentially — who wasn’t a colleague — he began to open up. Sengupta writes: “[The therapist’s] willingness to acknowledge that clinical work is stressful and can become toxic establishes a life raft upon which I can hoist myself, build new strategies, and shape a different perspective.”
GLOBAL HEALTH SPOTLIGHT
Documentary spurs action Prior to publishing the essay, Sengupta didn’t consider formally sharing his experience with others. He had received help, the struggle had lessened, and he was ready to move on. That changed in December 2018, when he attended a screening of the provocative documentary “Do No Harm: Exposing the Hippocratic Hoax.” The event was organized by Christian R. DeFazio, MD ’94, clinical assistant professor of emergency medicine and director of the emergency medicine residency program; Carolyn A. Wiech, MD ’07, clinical assistant professor of emergency medicine and assistant director of the emergency medicine residency program; and Susan M. Orrange, PhD, assistant dean for education and resident services. Lauren Dube, DO, an emergency medicine resident, is credited with bringing the documentary to their attention. The film and the following panel discussion addressed the issue of physician mental health and suicide. Among the alarming statistics discussed were:
> Suicide accounts for 26 percent of deaths among physicians ages 25 to 39 compared to 11 percent of deaths in the same age group in the general population
> 45.8 percent of physicians reported experiencing at least one symptom of burnout
> Doctors commit suicide at a rate more than twice the national average
> A study of more than 4,000 medical students at seven schools found that more than half of all students experience burnout while in medical school
> Approximately one of every nine students reported having suicidal thoughts while in medical school
Don’t be afraid to ask for help The event struck a chord. Of the 300 people in attendance, the vast majority were trainees, including medical students, medical residents and fellows. As Sengupta listened to the discussion that followed the screening, he realized he needed to share his story. “One of the most distressing themes in the discussion afterward was how scared or resistant or hesitant the trainees were about seeking any therapeutic support,” he says. “I had the chance to share a little of my experience and a number of residents privately came up and wondered aloud if it might be helpful for more attendings and medical education leaders to open up a bit more about these kinds of things. “I eventually wrote the essay for a very particular reason,” he further explains. “There were hundreds of trainees in the room, but the vibe around seeking support was quite negative. It wasn’t that people thought physicians shouldn’t get help, but that there were lots of factors that
would probably keep them from seeking help, such as stigma, having enough time, and concern for how it might impact their careers. “My hope was that I could convey to other physicians what actually happens when you work with a therapist— that it’s a collaborative process that can lead to really positive outcomes.”
Seeing others struggle Sengupta, who directs UB’s child and adolescent psychiatry fellowship program, has a close-up view of the difficulties that students, especially medical residents, undergo. “I do see them struggling sometimes,” he says. “Medicine is such a challenging field to be in in this day and age. Trainees are such a critical part of the system, and at the same time, they may need more support than they are getting. It can be a tough system to work in. You can lose track of what brought you into the field.” Among the factors contributing to physicians’ reluctance to seek help are the traits that led them to medicine in the first place, Sengupta says. “Who is the type of person that ends up wanting to be a physician and then succeeding?” he asks. “We are pretty intelligent and we’re hard-working, but we are probably not talking about the struggles we’re having. We’re internalizers.” At the same time, the nature of medical training itself also contributes. “The training values toughness and grit and perseverance. That shouldn’t be to the exclusion of getting help and support, but somehow it can be translated into that,” Sengupta says. “Taking care of oneself can seem to represent weakness or incompetence. Sometimes it’s the message that is given or sometimes it’s a message that trainees perceive. “Doctors are supposed to be larger-than-life figures— take in everything, be wise and be helpful,” he adds. “We do a really good job of stigmatizing ourselves, when, really, getting support when needed could help us get back on track to finding meaning in helping others.”
Change noted with trainees Sengupta knows, however, that the challenges to changing the culture are significant. For one thing, he says, trying to find someone who can help is complicated and sensitive. “How interesting would it be if we created some sort of way for physicians who are struggling to communicate with each other . . . a support group of sorts?” he ponders. In the essay, Sengupta describes how he shared his experience with his trainees; it came up in the context of a broader conversation about self-care. Afterward, he noticed a change in the way they interacted with him. “I sense a subtle shift in the way some of them approach me—they are a bit more willing to discuss challenges and vulnerabilities, and are more open to reflection and selfimprovement,” Sengupta says. “A few clinicians even ask for help in finding therapists for themselves, allowing me to transform my process of seeking help into a way to help others.”
BY MARK SOMMER
Gregory Antoine, MD
Head and neck surgeon Gregory Antoine, MD ’76, looks back on an exceptional career, launched at UB
regory Antoine, MD ’76, has been both a trailblazer and a witness to history in a long and distinguished medical and military career that began with his having to confront formidable racial barriers while growing up in the South. At an age when many doctors are hanging up their stethoscopes, Antoine, 69, began a new position last September as chief medical officer and senior associate dean for clinical affairs at Morehouse School of Medicine in Atlanta, Georgia. “I wanted to take this job because I always wanted to work at a historic black college,” he says. “People are very excited about my being here, and think I have a skill set that matches what they need.”
Surmounting racial barriers Antoine grew up in a military family. He was born in a military hospital in San Antonio, Texas, then there were stops that included Plattsburgh in upstate New York, Japan twice and the town of Pass Christian on Mississippi’s Gulf Coast. In Pass Christian, Antoine was the first AfricanAmerican to attend the whites-only high school. “When my dad told me I was going to a white high school, he said
he felt I, as one of the first, should set an example,” says Antoine, a father of five. “I said I didn’t want to go, and he said he didn’t care, I was going.” Antoine found sports to be a great equalizer with his peers and something that helped surmount racial barriers. “Athletics overcome a lot of things. I maintained a circle of friends—black kids and white kids—which was kind of unheard of then,” he recalls. “I remain friends with these guys to this day.” Antoine played quarterback on the junior varsity football team and cornerback on the varsity squad. He had 11 interceptions his junior year, but when it came time for names to be submitted for the state’s all-conference team, the head coach broke precedent by declaring that only seniors would be eligible. Dispirited by the blatant racism, Antoine didn’t go out for football his senior year despite interest from college recruiters. The story of how Antoine’s paternal grandfather died in 1947 after being refused admittance to a segregated hospital influenced the young man’s decision to become a physician. “It was one of those things that, when you hear that sort of story, it lights a fire under you,” he says, adding that not much had changed by the time he graduated: waiting rooms in the local hospital were still segregated.
Photo by Sandra Kicman
A MEDICAL EDUCATION SECOND TO NONE
A witness to history Antoine attended Jackson State College (now university) as a premed and biology major during a tumultuous time for the school and the nation. He was a freshman in 1968, the year the Tet Offensive in Vietnam took place, which caused the U.S. to escalate its involvement in Southeast Asia and antiwar protests across the country to explode. Shortly after midnight on May 15, 1970, after an evening of unrest, 14 students on the Jackson State campus were shot by city and state police, resulting in two deaths. The shootings occurred just 11 days after national guardsmen opened fire at Kent State University in Ohio, killing four students. Antoine saw the police, armed with rifles, march in formation to Alexander Hall, a women’s dormitory and take their positions. He was about 60 feet behind them for the 30-second barrage of gunfire—smoke from their rifles was visible as the bullets discharged. “It was like in a movie,” he recalls. “I had never witnessed anything like this—people trying to kill other people.” Antoine was the first to reach a bleeding Phillip Gibbs, one of the two students who died. After he called for an ambulance, a policeman arrived and shouted, “There’s a n— shot.” Antoine later told a congressional committee in Washington, D.C., that he saw no acts of violence prior to the shooting, nor heard gunshots that some later claimed provoked the police into firing. He called for an investigation of the Mississippi Highway Patrol and met with John Ehrlichman, an advisor to President Nixon. Back in Jackson, he was part of a committee that organized a three-day boycott by black workers and shoppers of white businesses to express the black community’s outrage and anger over the shootings.
Antoine found UB to be a supportive environment. Biochemistry professors Alastair Brownie, PhD, and Murray Ettinger, PhD, were particularly popular with minority students because of the personal interest they showed. Following graduation, Antoine was the first black surgical resident accepted at Millard Fillmore Hospital. After residency, he went on active duty, serving on a submarine base in New London, Connecticut, where he was a general medical officer. It was the first of numerous assignments in a career that saw him switch from the Navy to the Army and rise in rank to colonel with the United States Army Medical Corps. Along the way, Antoine returned to UB to undergo subspecialty training in otolaryngology, which he completed at Walter Reed Army Medical Center.
A trailblazer in academic medicine Antoine went on to work as chief of otolaryngology for head and neck surgery at Blanchfield Army Community Hospital in Fort Campbell, Kentucky. At Tripler Army Medical Center in Honolulu, Hawaii, he served as assistant chief and co-director of residency training, and later, as director of the head and neck surgery clinics. A residency in plastic and reconstructive surgery at Georgetown University School of Medicine was followed by a fellowship in craniomaxillofacial surgery at Eastern — GREGORY ANTOINE, MD ’76 Virginia Graduate School of Medicine. That training led to his being named residency director of otolaryngology and medical director of the maxillofacial trauma section at Case Western University’s School of Medicine’s Metro Health Medical Center in Cleveland, Ohio. Boston University School of Medicine beckoned next. There, Antoine served as chair of the Department of Plastic and Reconstructive Surgery from 2001 to 2013, becoming the first African-American to serve in this capacity outside of a historically black medical school. In 2013, he excepted a position as chief of staff for the Department of Veterans Affairs in Fayetteville, North Carolina. Over the years, Antoine pursued advanced degrees to further his administrative competence, earning an MBA at the University of Tennessee at Knoxville, an MS degree at Brandeis University in Waltham, Massachusetts, and a master of public administration from the University of North Carolina at Chapel Hill. Looking back on a rich and varied career, Antoine says he owes a debt to the medical education and training he received in Buffalo. “UB gave me a strong foundation to succeed in my medical career, no matter what I was doing, and I have enjoyed my career. “
“What I found out as I got more and more into being a doctor was that my exposure and training at UB was actually second to none.”
Medicine and military service The Antoine family traces its military history back to the Revolutionary War, and Antoine wanted to serve despite his opposition to the Vietnam War. He passed a Navy recruiter’s test to be a pilot in case he didn’t get into medical school. However, when the Navy learned that he had been accepted to UB medical school, he was given a full scholarship, launching his military career. Antoine was excited to attend medical school at UB. “I was just really grateful that they accepted me and gave me the opportunity to be a doctor and fulfill my dream,” he says. “What I found out as I got more and more into being a doctor was that my exposure and training at UB was actually second to none.”
UB MED DOCTOR VISITS
Photos by Douglas Levere Photos by Sandra Kicman
“I hope to help create conditions that help trainees and physicians ﬂourish despite the challenges of our work.”
CARE FOR PATIENTS AND PHYSICIANS
Archana Mishra, MD, confronts the stresses of medicine Recently, in the middle of a busy day, Archana Mishra, MD, clinical associate professor of medicine in the Jacobs School Su san K reimer of Medicine and Biomedical Sciences and a physician at the Buffalo VA Medical Center, was asked to evaluate a patient for transfer to the intensive care unit. As she walked into the room, she was embraced by the patient’s wife and daughters. To her surprise, the patient was someone she had cared for more than a decade ago during a critical illness. The family not only recognized Mishra, but said they had prayed to meet her again, attributing the care she had provided to their being able to share so many more years with their loved one. Moments like this are what make being a physician immensely rewarding, says Mishra, who specializes in pulmonary and critical care medicine and serves as clerkship director for fourth-year students at UB. “It gives you the energy to thrive.” In addition to providing patient care, Mishra has a strong interest in helping faculty enhance their mentoring skills and in encouraging trainees to develop into compassionate, well-rounded physicians who exhibit sound clinical judgment combined with humanistic qualities. In patient interactions, she believes it’s paramount for practitioners to provide their expertise while acknowledging that each individual knows his or her body best. The goal, she says, “should be to work together toward improving the quality of life and St ories by
gaining professional fulfillment as a result of that.” Helping to prevent physician burnout is another area of interest for Mishra, who teaches mindfulness and other preventive tactics to faculty, students, residents and fellows. Being a burnout survivor herself, she is dedicated to sharing her experience with others. She says that “it was a life-altering experience” and that it led her to discover better ways to cope with the stresses of being a physician and to rediscover joy in her work. “Joy is something that’s fundamental to our existence, and I hope to help create conditions that help trainees and physicians flourish despite the challenges of our work and training,” she says. Mishra, who joined UB in 2001, see patients and conducts research at the Buffalo VA Medical Center, Veterans Affairs Western New York Healthcare System. She has received many awards for teaching, including the Women Leaders in Medicine Award from the American Medical Student Association, and the Humanitarian Award from the CHEST Foundation. She has also received the Leonard Tow Gold Humanism Award given for clinical excellence and outstanding compassion in the delivery of care. Regina Makdissi, MD, a clinical assistant professor of medicine, considers Mishra a role model, having trained under her as an intern and resident before joining the Jacobs School faculty in 2006. Under Mishra’s guidance, Makdissi says she learned to be her own selfevaluator and to acknowledge positive moments that transpire every day in tending to sick and challenging patients, a perspective that continues to motivate her today. “It is still invigorating to watch her do what she does best,” Makdissi says of Mishra.
“I try to help children find ways to get the most out of their lives based on the conditions they have.”
NEUROLOGIC CARE FOR CHILDREN
Osman Farooq, MD, is expanding treatments The brain’s inner workings intrigued Osman Farooq, MD, unlike anything else in medical school. A heart or liver can be transplanted, but not the brain. “It’s the one organ,” he explains, “that controls everything our body does and helps process information.” Farooq also felt a calling to care for sick children, so pediatric neurology presented him with an opportunity to integrate his passions in a fulfilling career. “I try to help children find ways to get the most out of their lives based on the conditions they have,” says Farooq, clinical associate professor of neurology in the Jacobs School of Medicine and Biomedical Sciences, and division chief of pediatric neurology at UBMD Neurology. A specialist in comprehensive neurologic care of infants, children and adolescents, Farooq joined the faculty in 2012 after completing residency training in pediatric neurology and a fellowship in neurophysiology at UB. “Dr. Farooq has been instrumental in starting new programs to benefit children with neurological issues in Buffalo,” says Arie Weinstock, MD, professor of clinical neurology and director of the epilepsy monitoring unit and the electroencephalography labs at Oishei Children’s Hospital, a UB teaching affiliate. As director of the Pediatric Neuromuscular Clinic at Oishei, Farooq established a program for newborns diagnosed with spinal muscular atrophy. All cases in Western New York identified through New York State’s newborn screening program are referred to him. “It is an exciting time to be treating neuromuscular disorders given
that new treatments have emerged for some conditions that never had meaningful therapies in the past,” says Farooq. “These new medications can potentially slow disease progression and help patients retain muscular function.” In 2017, Farooq identified a gap in managing children and adolescents with concussions, and worked with other departments, including trauma surgery and neurosurgery, to develop a pediatric concussion center. At the center, he arranges for patients to be seen soon after their head injury in order to expedite potential care and limit ongoing symptoms. Farooq’s research includes unraveling the mysteries of autoimmune, demyelinating and infectious processes within the nervous system. The 2009 influenza A-H1N1 pandemic spurred him to delve into the neurologic complications affecting the region’s pediatric patients and compare these findings to communities globally. He has presented UB’s results at international conferences. Excelling as a teacher and mentor, Farooq has garnered awards yearly at UB for best educator in pediatric neurology. “Above all,” says Weinstock, “Dr. Farooq’s compassion and humanism resonate with patients, families and those he teaches and mentors.” Humanism is something Farooq views as essential to practicing medicine, but acknowledges that it can dissipate during “relentless hours” of training. “When doctors are constantly busy, it is easy to develop a distance from our compassion,” he notes. As a result, Farooq continually reminds residents to tap into the heart of why they became doctors. “It’s important that we not allow encounters with our patients to turn into mere business transactions,” he says. “What good is a doctor if he or she cannot empathize with their patients?” WINTER 2020
UB MED Q&A HOW HAS THE NEW BUILDING IMPACTED EDUCATION AND TRAINING? —A conversation with Mary Gallo, MD-PhD, Class of 2020
It has been two years since the Jacobs School of Medicine and Biomedical Sciences’ new building opened on the Buffalo Niagara Medical Campus (BNMC), marking a pivotal milestone in the school’s 174-year history. How has the new facility impacted students and their education and training? In this issue of UB Medicine, we asked this of Mary Gallo, a student in the MD-PhD Program, who in June of 2018 completed her PhD work in microbiology and immunology and will receive her MD and PhD this spring as a member of the Class of 2020.
A native of Western New York, Gallo grew up in Lewiston, New York. She earned her undergraduate degree at Niagara University, where she majored in biology and minored in chemistry and philosophy. She completed her doctorate at UB in the laboratory of SUNY Distinguished Professor Timothy F. Murphy, MD. Her research project focused on characterizing strains of a bacteria—nontypeable Haemophilus influenzae— during persistent infection in the lower airways of patients with chronic obstructive pulmonary disease. Gallo’s goal is to pursue a career as an OB-GYN physician-scientist, seeing patients as well as conducting research related to infectious diseases during pregnancy and the neonatal period.
What is your strongest impression of the new building?
What are some of your favorite spaces in the building?
How have you used the new building in your third and fourth years? Is this different from how it would have been if the medical school had stayed on the South Campus?
A: I think the architectural “wow” factor of the new building is most striking. The history of architecture in Buffalo is rich, and this structure adds to the diversity of building styles in the city and will continue to do so for years to come. The locally sourced terra cotta creates a beautiful façade, symbolizing the changing landscape of medical education within its walls.
I find myself drawn to the seating areas off the staircase featuring couches and coffee tables, between the first and second floors. They are sophisticated little nooks that strike a balance between privacy and quiet for studying, and openness and accessibility for impromptu socializing with classmates or professors.
Like all third- and fourth-years, most of my time is spent on the wards, so to speak. However, I study in the new building a lot, as do many of my classmates. We also attend lectures and seminars and take practical examinations there for some clerkships. We also appreciate having the Clinical Competency Center and Behling Simulation Center closer to our clinical sites because these facilities are crucial to helping us prepare for interactions with patients and for our national clinicalskills examinations. If the medical school had remained on the South Campus, it would have been more difficult and time consuming for us to get to our clinical sites, most of which are located downtown within walking distance of the BNMC. Too, I think that the learning spaces for formal lectures and clinical preparation would not be as state-of-the-art as they are now.
“So when faculty encourage us to turn and talk with our neighbors to discuss questions or to participate in more formal small-group discussions, the space is designed to do this.” 20
How has the move impacted your MD training and your PhD training?
Do you feel the new building has changed the culture and atmosphere of the Jacobs School for students?
I completed my PhD in [UB’s] Clinical and Translational Research Center (CTRC), so I made the move downtown before many other students, staff and faculty did. For awhile, however, the Department of Microbiology and Immunology was still on the South Campus, so I had to commute between downtown and the South Campus a couple of times a week for classes and departmental seminars. Once the department’s laboratories moved to the fifth floor of the new building, all of my classes and seminars for my PhD program, as well as the longitudinal MD-PhD seminar series, were located within a short walk of the CTRC, and the efficiency of my days increased tremendously. My third and fourth years of medical school—which I returned to after completing my PhD—have included clinical rotations at various sites and across specialties. Having one home base where the majority of my education and examinations take place simplifies and better integrates the student experience.
The spaces in the building feel as though they were designed with students in mind, both educationally and socially. Medical-education innovations that focus on provider collaborations are a priority for curricula across disciplines, and having areas like the Sol Messinger Active Learning Center—which features small-group tables—helps to nurture a culture of support versus competition. The large lecture halls, like the M&T Auditorium and the Dozoretz Auditorium, also accommodate this type of learning because the chairs pivot. So when faculty encourage us to turn and talk with our neighbors to discuss questions or to participate in more formal small-group discussions, the space is designed to do this.
“Having one home base where the majority of my education and examinations take place simplifies and better integrates the student experience.”
The building was intentionally constructed to create more collaborative learning and research spaces. Do you feel it accomplishes this?
The design of the scientific research areas—featuring joint lab spaces and open banks of desks and work stations—does promote collaboration between and among laboratory groups. If you are interested in learning a new technique and you see somebody performing that method through the glass walls, you have an opportunity to learn from them. However, I will admit, when the time comes to focus and get work done, the open desk areas can present a challenge. Wearing headphones has become somewhat of a universal cue for “Please only disturb me for something very important!” or “Please take your social conversations elsewhere.”
As a physician-scientist in training, what impresses you the most about having the school downtown?
I feel that having the school downtown as part of the BNMC is helping to propel it—and UB—toward becoming a comprehensive biomedical powerhouse. Having Buffalo General Medical Center, Oshei Children’s Hospital, Roswell Park [Comprehensive Cancer Center], the CTRC, Conventus, the Gateway building, the Gates Vascular Institute and other facilities located within a couple-of-block radius fosters collaboration between biological research and clinical practice, and helps scientists and clinicians to realize the power of translational research and medicine. Bridging the gap between scientific innovation and medical practice is the epitome of cutting-edge health care, and this is absolutely necessary for advancing the human condition, not just in Buffalo, but globally.
How has your experience at the Jacobs School inﬂuenced your career goals?
It has influenced me in a very positive way. My goal is to stay in Buffalo to train and to practice. I just love this institution, the people and city! —S. A. Unger
Photos by Douglas Levere and Sandra Kicman
U B M E D PAT H WAY S
BEYDER RECEIVES NIH DIRECTOR’S NEW INNOVATOR AWARD Arthur Beyder, MD-PhD ’07, an assistant professor of medicine and physiology and a physician in the Division of Gastroenterology and Hepatology at the Mayo Clinic, has received a NIH Director’s New Innovator Award from the National Institutes of Health. The title of his project is: “Does the Gut Have a Sense of Touch?” Beyder The prestigious award, established in 2007, supports unusually innovative research from early career investigators who are within 10 years of their final degree or clinical residency. Beyder received his MD and PhD degrees in 2007 from the Jacobs School of Medicine and Biomedical Sciences, where he did his thesis work with Frederick Sachs, PhD, SUNY Distinguished Professor, one of the founders of the field of mechanosensitive channels. He then joined
Mayo Clinic’s Clinician Investigator Program, where he completed clinical training in internal medicine and gastroenterology and postdoctoral work with Gianrico Farrugia, MD, a world leader in gastrointestinal physiology and pathophysiology. During this time, Beyder focused on ion channel mechanosensitivity and precision medicine in functional gastrointestinal (GI) disorders, which are common and complex gut-brain disorders, with nearly half the patients having disruptions in GI mechanosensation. Recently, Beyder’s group discovered a novel population of mechanosensitive epithelial sensory cells that are similar to skin’s touch sensors, which prompted a potentially transformative question: “Does the gut have a sense of touch?” Beyder has received K08 and R03 awards from the NIH, and a Research Scholar Award from the American Gastroenterological Association.
REUNION WEEKEND AND SPRING CLINICAL DAY 2020
FRIDAY, JUNE 5 – SATURDAY, JUNE 6, 2020 REGISTRATION IS NOW OPEN Events include the all-alumni welcome back reception, building tours, Spring Clinical Day and Distinguished Alumni Awards, and reunion class dinners.
WE ARE PLEASED TO INVITE OUR REUNION CLASSES: Every 5th year class from 1945–2015. FRIDAY, JUNE 5TH
All-Alumni cocktail reception
SATURDAY, JUNE 6 Spring Clinical Day
FEATURING ROY VONGTAMA, MD ’00
Doctor by Day, Actor by Night—alumnus, actor, producer, director and radiation oncologist
SATURDAY, JUNE 6–REUNION CLASS DINEAROUNDS
For full event details and registration, visit www.medicine.buﬀalo.edu/reunion
IN MEMORIAM C. JOHN ABEYOUNIS, PhD ’65, professor emeritus of microbiology, died June 14, 2018, four years after being diagnosed with frontallobe dementia. He was 79. A native of North Carolina, Abeyounis completed his doctorate in microbiology at UB in 1965. After serving a postdoctoral fellowship at the Arthritis Foundation, he joined the medical school’s faculty as an instructor in the Department of Microbiology. In 1969 he was named an assistant professor and associate director of graduate studies, and in 1972 was named director. Abeyounis was promoted to full professor in 1977 and retired in 2000. Under his leadership the graduate program ﬂourished and attracted students and fellows from all over the world. He was a highly respected mentor known for stressing rigor and reproducibility in research and as someone whom students could look to for professional guidance. Abeyounis’ research resulted in the publication of many papers, with later studies focusing on the then-emerging field of transplantation immunology.
HERBERT E. JOYCE, MD ’45 —A founding father of family medicine in Buffalo Herbert E. Joyce, MD ’45, a founding father of family medicine in Buﬀalo and a leading figure in the establishment of family medicine as a specialty, died October 25, 2019, at his home in Canterbury Woods, Williamsville. He was 98. Following graduation from UB medical school in 1945, Joyce served in the United States military, retiring in 1960 as a lieutenant colonel in the Air Force. In 1951, he founded the Highgate Medical Group PC, one of the largest family medicine groups in New York State. In the ensuing years, he was instrumental in the early movement to promote family practice as a specialty. Joyce and other family practitioners in Buﬀalo deserve much credit for the creation of the second-oldest family practice residency in the United States, the Deaconess Family Practice Residency. They also are credited with establishing a Department of Family Medicine at UB, among the first of 15 university departments in the United States. Joyce was a professor of family medicine at UB from 1970 to 1993, and served as interim chair of the Department of Family Medicine from 1982 to 1983. He was president of the local American Academy of General Practice from 1959 to 1960, and president of the New York State Chapter of the American Academy of Family Physicians (AAFP) from 1974 to 1975. In later years, he served as president of the Medical Society of the County of Erie. A community leader, he also continued to volunteer in social, medical, educational and political organizations within and outside of the Jacobs School of Medicine and Biomedical Sciences. He received numerous awards over the years, including the President’s Award in 1987 from the American Academy of Family Physicians; the Max Cheplove Medal in 1993, the highest honor awarded by the Erie County Chapter of the New York State Academy of Family Physicians; the Dean’s Award for service to the Jacobs School of Medicine and Biomedical Sciences; and the 2009 Distinguished Medical Alumnus Award, also from the Jacobs School. Contributions in memory of Herbert E. Joyce, MD can be made to the Department of Family Medicine Endowment Fund, c/o University at Buffalo Foundation, P.O. Box 730, Buffalo, NY 14226-0730.
KEVIN B. KULICK, MD ’76, a dermatologist in private practice and later with Buﬀalo Medical Group, died February 25, 2019, of pancreatic cancer. He was 68. A native of Buﬀalo, Kulick earned his bachelor’s degree from Wesleyan University in Middletown, Connecticut, then attended medical school at UB, followed by two years of residency in family practice and a three-year residence in dermatology, both at UB. In his final year of residency at UB, he worked in a research lab studying lupus erythematosus. Kulick then spent a year doing research with the Oklahoma Medical Research Foundation in Oklahoma City. He returned to Buﬀalo and spent the next two years researching at UB as a Dr. Henry C. and Bertha H. Buswell Fellow, a program that selects early-career medical doctors who will pursue careers as physician-scientists. In 1981, Kulick began part-time private practice as a dermatologist and in 1984, he began a full-time private practice. He maintained an office on Delaware Avenue in the Town of Tonawanda for 25 years. In 2009, he joined Buﬀalo Medical Group, with an office on Essjay Road in Williamsville, until he stopped practicing due to illness. Certified by the American Board of Dermatology, Kulick was a fellow in the American Academy of Dermatology. Between 1983 and 1986, medical journals published four studies on lupus erythematosus he co-authored. In 2007, an article he co-authored on an unusual skin disease in a patient with lymphoma was published.
U B M E D PAT H WAY S HAROLD J. LEVY, MD ’46 —Prominent psychiatrist, philanthropist, educator Harold J. Levy, MD ’46, of Canterbury Woods, a physician leader, teacher and philanthropist, died October 2, 2019, in Millard Fillmore Suburban Hospital after a short illness. He was 94. A Buﬀalo native, Levy was the only child of Evelyn Sperling and Sidney H. Levy, MD, a pioneering radiologist and a 1915 graduate of the Jacobs School of Medicine and Biomedical Sciences. Levy graduated in UB medical school’s centennial class of 1946, becoming, at age 21, its youngest graduate and youngest inductee to the local chapter of the Alpha Omega Alpha Honor Medical Society. Levy completed his internship, residency and fellowship at the old E.J. Meyer Memorial Hospital, now Erie County Medical Center. Levy was certified in psychiatry by the American Board of Psychiatry and Neurology in 1955. He was the first physician to complete a research fellowship in psychosomatic medicine at UB, reﬂecting a lifelong interest in the mind-body connection. In 1968, Levy was named chief of psychiatry at Millard Fillmore Hospital, a post he held for more than 30 years. He also was medical director at Bry-Lin from the 1950s through the 1980s. For more than 50 years, Levy taught UB medical students and psychiatry residents. At the time of his death, he was emeritus clinical associate professor of psychiatry at the Jacobs School of Medicine and Biomedical Sciences. A founder of the WNY Psychiatric Association, Levy was a Distinguished Life Fellow of the American Psychiatric Association. He was a past president and a board member of the UB Medical Alumni Association. After graduating from medical school, Levy donated to UB every year except for the two years he was in the Army. He chaired his medical school class reunions, including his 70th reunion in 2016. At his 65th reunion, he was presented a Medical Alumni Association Lifetime Achievement Award. The Dean’s Conference Room in the Jacobs School of Medicine and Biomedical Sciences is named for Dr. and Mrs. Levy. Levy also endowed a fund through the UB Department of Psychiatry to encourage research in psychosomatic medicine, and personally supervised residents working on such projects. In addition, he endowed an undergraduate scholarship, a lecture and a conference fund in the UB Department of Jewish Thought. Levy is survived by his wife of 61 years, Arlyne G. Levy; three sons, Sanford (MD ’86), Richard and Kenneth; and six grandchildren.
ROCCO C. VENUTO, MD ’67, professor of medicine, a former chief of the Division of Nephrology and a leading researcher on chronic kidney disease and treatment, died July 11, 2019, at his home in Williamsville, New York. He was 77. A UB alumnus and physician with UBMD Internal Medicine who cared for generations of chronic kidney disease patients in Western New York, Venuto’s name had been synonymous with the field of nephrology in Buﬀalo and nationwide for half a century. He was seeing and caring for patients up until the day he died. Venuto contributed significantly to research focused on how to improve care for kidney patients, whether they were being medically managed or were transplant recipients. An internationally recognized expert on hypertension in pregnancy, his research contributed significantly to the understanding of the pathophysiology of preeclampsia. A tireless advocate for organ donation, in 2011 he received a Lifetime Achievement Award from Upstate New York Transplant Services, which he co-founded. He and his UB colleagues collaborated on studies that revealed the inadequacy of early detection and treatment of chronic kidney disease, and he was an advocate for earlier diagnosis. As division chief of nephrology, Venuto partnered with UB’s Institute for Healthcare Informatics in a major New York State-funded study of kidney disease that utilized big data in order to improve the care of chronic kidney disease patients in Western New York. As medical director of renal transplant and director of the chronic kidney disease program at Erie County Medical Center (ECMC), he treated patients, as he put it, “with virtually every aspect of kidney disease,” from those undergoing dialysis to those receiving transplants. He also cared for high-risk pregnant women with renal dysfunction at Oishei Children’s Hospital. He collaborated with researchers from ECMC and UB’s School of Pharmacy and Pharmaceutical Sciences to improve the clinical impact of medications used in transplant immunosuppression regimens. To read the full obituary, go to medicine.buffalo.edu and search “Venuto.”
Photo by Douglas Levere
Mary Twarog, a 2019 Western New York Medical Scholarship recipient
By S.A. Unger
When Mary Twarog learned that she had been awarded a Western New York Medical Scholarship, which covers the majority of her medical school tuition, she thought of her hometown of Buﬀalo and what she could give back to it in the years ahead. “To me, the scholarship represents the faith Buﬀalo has in me and in the medical education I am receiving at UB, which is incredibly motivating,” says Twarog, Class of 2022. The Western New York Medical Scholarship Fund, now in its fifth year, provides four-year scholarships to local students to attend the Jacobs School of Medicine and Biomedical Sciences. The goal is to train and retain more doctors in the eight counties of Western New York, stemming a steady decline in the number of physicians who practice here. Scholarship recipients are awarded about $30,000 annually and must pledge to practice in Western New York for five years upon finishing medical school and resident training. The highly selective criteria require recipients to have excelled academically, to have graduated from a high school in the eight-county region of Western New York and to have demonstrated financial need. Twarog was raised in a tight-knit family of five children. Her mother worked as a pharmacist and her father as a deputy in the U.S. Marshal’s Office. Both volunteered extensively in the community. “They taught me the importance of going above and beyond to care for everyone around you,” Twarog says. When her father was shot in the line of duty, Twarog “was truly moved by how the community rose to help him, including the doctors and other health care professionals who helped him get back to work.” Twarog is grateful that the scholarship provides her with an opportunity “to go into any field of medicine without concern for the great burden of loans I would have originally had.” Determined to work with pediatric patients, she is hoping to pursue subspecialty training—a hope that stems from experience she gained during a gap year, when she worked as an endocrinology research assistant at UBMD Pediatrics. “I was inspired every day by the children and teenagers in Western New York growing up with serious chronic illnesses who showed more grace and resilience than I could have imagined possible,” she says. “It would be an honor to someday provide care for such a special group of children.” To learn more about the Western New York Medical Scholarship Fund, email Eric Alcott, senior associate dean and executive director of medical philanthropy and alumni engagement, at email@example.com, or call (716) 829-2773.
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My Bold Moment “Someone I didn’t know gave me this scholarship money and it taught me to pay it forward. In the grand scheme of things, that’s what I’m here for. That’s why I chose medicine—to help others.” Amandip Cheema, third-year Jacobs School of Medicine and Biomedical Sciences student
Bold means keeping communities healthy. Whether it’s providing free health care to our uninsured neighbors, alleviating Western New York’s physician shortage, or pioneering the discovery of life-saving treatments, we make a huge impact on our community and
around the globe. The Boldly Buffalo campaign provides countless opportunities for students to discover their passions and achieve their dreams. To learn how you can help create a better world, visit buffalo.edu/campaign.