Department of Medical Education | Contact Us Quarterly eNewsletter | Winter 2019

Welcome to the Winter Newsletter

Welcome to our Winter Newsletter. We are delighted to announce that Dr. Scott Marsal, MD will be joining our depart-

ment in January as our new Garnjobst Chair of Medical Education. Scott will also serve in the role of Chief Medical Officer

for PPMC. Many of you know Scott from his years serving on the medical education faculty at PPMC. He returns to us

after spending the past 4 years as the Division Chief of Medicine at Providence St. Vincent Medical Center. We have lots

of other exciting news to share in this newsletter. You can read below about where our wonderful recent graduates are

working and training. Learn about a Providence system project on expanding access to treatment of opioid use disorder

that Mari Kai and I helped to lead, recently published in JAMA Network. You can also read about Dr. David Gilbert’s most

recent publication on Sustainable Antibiotic Discovery and Development in NEJM.

Our residents recently participated in the Oregon American College of Physicians meeting, with a total of 19 enthusiastic

residents presenting posters and oral vignettes. Dr. Hayden Smith won first place in the clinical vignette category, Dr. Hiro

Park won 3rd place in the clinical research category, and Dr. Jeff Smith won first place in the basic research category! On

a more somber note, Helen Compo will be retiring in January 2020, though will be helping us part-time for a few more

months. Almost all of you know Helen from her 41 years of service in the Medical Education department, the last 31 years

as the residency program coordinator.

Lastly, this is the season where we ask for your generous support of our department. If you are moved to donate, please

find information below on how you can do that.

We appreciate you all, and your ongoing support for our residency program and department. May your holiday season be

filled with peace and joy.

With best regards,

Brinton Clark, M.D., M.P.H. Associate Program Director Clinic Medical Director General Medicine Faculty

Brinton Clark, MD

Providence Giving Campaign

The fourth quarter of 2019 is reaching its close. This is the time when many of us consider our charitable giving for the year. Providence Portland

Medical Foundation supports a number of worthy programs at PPMC including the Internal Medicine Residency Program at PPMC. We use

funds donated towards the Medical Education Department to support many important programs, including resident and faculty research projects,

and attendance at educational and research conferences. The Internal Caregiver Link below provides access from any Providence-based

computer. Caregivers are able to support programs important to them. For those outside the Providence system, you can also support your

favorite program by clicking on the External Giving Link.

Philanthropy is an increasingly important source of funding for many programs. Medical Education has long been a beneficiary of Foundation

funds. The Endowment to support the Garnjobst Chair of Medical Education has been in existence for more than ten years. The Garnjobst Chair

enhances the quality of patient care on this campus by supporting leadership for PPMC’s Internal Medicine Residency Program. The Garnjobst

Chair can be supported through the ‘drop down’ opportunities listed on both the internal and external sites.

Contact the Foundation office at 503-215-6187 for any special questions.

Make a Donation: Internal Caregiver Link | External Giving Link [Give Now]

*if you would like to make a donation to the Internal Medicine Residency program, after clicking on the link then click Our Foundation then Providence Portland

Medical Foundation, Then towards the middle of the page click on Give Today. In the I would like to support box, Click on the down arrow to Internal

Medicine Residency Program.

Welcome to our new Garnjobst Chair

I am pleased to share with you Scott Marsal, M.D., is joining our leadership team at Providence Portland Medical Center. He will serve as Chief Medical Officer and will hold the Garnjobst Chair as director of graduate medical education. In this work, Dr. Marsal will lead our Medical Education department, our quality and patient safety efforts, and our medical staff governance and engagement. He will build collaborative partnerships in each of these areas to ensure excellence in the development of our future physicians and in patient care at Providence Portland. This is a homecoming for Dr. Marsal. He is currently Division Chief of Medicine at Providence St. Vincent Medical

Center. He previously served as a staff physician and as a member of the medical education faculty at Providence

Portland for 11 years – receiving Teacher of the Year honors multiple times during his tenure.

Dr. Marsal received his medical degree from The Ohio State University College of Medicine and completed his

residency at Oregon Health & Science University. He practiced at Portland Veterans Affairs Medical Center and North

- west Permanente before joining Providence in 2004.

I want to call out one of Dr. Marsal’s many honors – in 2018 he received the Spirit of Emilie Gamelin Mission

Inspiration Award. This is an excellent indicator of the leadership skills he brings to us. Dr. Marsal is a servant leader,

he leads through his service to others.

Dr. Marsal will begin his new role at Providence Portland on January 2, 2020. Please join me in welcoming him back.

Krista Farnham

Providence Portland Medical Center Chief Executive

Scott Marsal, MD

Farwell and best wishes to Residency Coordinator Helen Compo

Our Residency Coordinator Helen Compo announced her retirement in 2020. As most of you know, Helen has been

the backbone of our program for over 40 years, helping residents on to their successful career paths and helping

guide the support staff and faculty. She has been an integral part of maintaining accreditation and recruitment of new

residents. In 2012 the residents awarded Helen with the Residency Appreciation and Service award. The Spirt of

Emilie was awarded to Helen in 2017, for her inspiration and commitment to the mission of Providence.

We will greatly miss her guidance, wealth of knowledge and positivity. Helen will be helping us transition by staying

on part-time through the Spring to help with accreditation and training her replacement. Look for a future announce-

ment about a celebration of Helen’s many years of service. Helen Compo

Faculty Publication

David Gilbert and his co–authors, Travis Neilsen, PhD, Eric Brass, PhD, John Bartlett, MD and Brad Spellberg, MD., article titled:

Sustainable Discovery and Development of Antibiotics—Is a Nonprofit Approach the Future? Published in the August 9th 2019 New

England Journal of Medicine. Below is the link to the complete article.

Click Here for the full article

Faculty Members Brinton Clark, MD, MPH, Mari Kai, MD, Sheldon Levy, PhD, and Ryan Dix, PsyD, the Regional Manager of Clinical

Behavioral Health, article titled: Association of a Multimodal Education Intervention for Primary Care Physicians with Prescriptions of

Buprenorphine for Opioid Use Disorders was published by JAMA on October 23, 2019. Below is the link to the article.

Click Here for the full article.

Emeritus Faculty and retired Garnjobst Chair John Heffner Honored in CHEST Journal

John Heffner, MD, was honored as a Giant in Chest Medicine with both an article and interview featured in May 2019 CHEST. The

interview of John reminds us of what an inspirational role-model he is for our profession.

Oregon Chapter American college of Physicians Competition Recap

Congratulations to all of our residents who participated in the ACP poster competition on

November 7, 2019. We had a big year and were represented by 18 resident posters and by

our oral presenter, PGY-1 Sam Itzhakov, D.O.

PGY-3 Hiro Park, D.O. won 3rd place in the clinical research category, and PGY-1 Jeff Smith,

M.D. won first place in the basic research category. PGY-1 Hayden Smith, M.D. won first

place in the clinical vignette category out of over 80 clinical vignette posters! We are proud of

the accomplishments of all of our presenters.

IM Residency Graduate Update

On behalf of the Medical Staff, Providence Portland Medical Center Administration and PPMC Teaching Faculty, we are delighted to

congratulate the 2019 graduation Internal Medicine Residents. Please join us in wishing then well in their future endeavors. Below is a listing

of the graduate’s new positions.

Jesse Powell’s Illustration Corner

The labels are missing. Jesse is challenging you to complete it. Are you up for the challenge?

Calling all Alumni

The PPMC IM Residency Program seeks current contact information for alumni. If you are an alum and would like

to provide/update your information, please submit your Name/Title, Practice, Institution, Address, City and State by

email to Mikal’ Ortlief and let us know if you would like to be listed on the new Alumni page. We will not publish

your contact information on the page.

Save the Date!

Our 5th Annual Academic Achievement Day will be on April 29, 2020 in lieu of Grand Rounds. This year’s event

will be held in the Social Room. We will also have additional participants this year with more details to come!

Resident Report Pearls

Andrew presented a very interesting case of a young woman presenting with chest and abdominal pain as well as dyspnea on exertion.

Work up was notable for a right sided pleural effusion and a large adnexal mass. She also had an elevated CA-125 of ~1500. She

ultimately underwent a thoracentesis that revealed dark, old appearing blood, the pleural fluid was characterized as a hemorrhagic,

exudative effusion. Andrew reviewed Light’s criteria for an exudative effusion (pleural protein/ serum protein > 0.5, pleural LDH/ serum

LDH > 0.6 (or pleural LDH > 2/3 ULN). Pleural fluid cytology was negative for malignancy. Pulmonology was consulted and ultimately

the effusion was thought to be secondary to a catamenial effusion due to endometriosis. The patient was discharged with plans to

follow up with gyn for outpatient resection of the pelvic mass. Andrew also reviewed an approach for the differential of pelvic pain with

findings of a pelvic mass including ruptured ovarian abscess, ruptured ovarian cyst, endometrioma, malignancy. He also clarified that a

low CA-125 can help rule out ovarian malignancy, (however, multiple factors including systemic illness/ effusion can lead to an

increased CA-125 and that an elevate4d CA-125 in itself does not make ovarian malignancy more likely). Amy Dechet also brought up

the teaching point that the patient’s significant leukocytosis (wbc 27) may have been due to “blood where its not supposed to be” ie the

hemorrhagic effusion could have been the inciting factor for a reactive leukocytosis.

Monday 12/9/19- Emma, May, & Zach presented an excellent case from the wards of a middle aged male with a history of severe

systolic dysfunction, CAD, PVD, DM, HCV, and methamphetamine use presenting with a chief complaint of swollen, painful feet with

ulcerations.

Discussion focused on the differential for lower extremity ulcerations, and included causes which the team identified as:

“The Big Four + two”

1. arterial insufficiency

2. venous insufficiency

3. diabetic ulcerations

4. pressure ulcerations

5. Infectious

6. Vasculitis

o Emma Reviewed a paper on “Physical Examination and Chronic Lower Extremity Ischemia”, Arch of Internal Medicine, 1998,

which supported that an exam with absence of BOTH PT & DP pulses was associated with a +LR of 9-44.6 for vascular disease.

o Ultimately in this case there was concern that this patient’s LE ulcerations may have been due to Cryoglobulinemia in the setting

of Hep C. While the patient had a positive serum cryoglobulin, Emma clarified that serum testing is not specific for the diagnosis of

cryoglobulinemia, as cryoglobulins can present without symptomatic infiltrative involvement. Steve Campbell pointed out that a skin

biopsy would be helpful for diagnostic clarification, however, this was not pursued due to the patient leaving prior to completion of

his medical w/u.

Upcoming Events

January 31, 2020

April 23-25

May 6-9

2020 Regional Meeting Portland, OR Learn More

ACP Internal Medicine Meeting

Los Angeles, CA

Learn More

SGIM Annual Meeting

Birmingham, AL

Learn More

5th Annual Academic Achievement Day

April 29th Join us on Wednesday, April 29, 2020 from 7:30—10:00am (in lieu of MGR) in

the Social Room for the 5th annual Academic Achievement Day.

PPMC Medical Grand Rounds Spring Conference Schedule

Location: PPMC Cancer Center Auditorium

Time: 8:00 - 9:00 AM

January 8 BPH – The Next Frontier

Nicholas Boncher, MD, Urologist, Men’s Health PDX and Providence Urology Clinic East

January 15 Richard Wernick, MD Memorial Lectureship

How to Keep Up With New Information in Medicine

Vinay Prasad, MD, MPH, Associate Professor of Medicine, Division of Hematology Oncology, Knight

Cancer Institute, Senior Scholar in the Center for Health Care Ethics, OHSU

January 22 Update in Outpatient Medicine

Robert Gluckman, MD, MACP, Chief Medical Officer, Providence Health Plan

January 29 Topic: TBD (Melanoma)

Sancy Leachman, MD, PhD, Professor and Chair, Department of Dermatology, OHSU; Director, Melanoma

Research Program, Knight Cancer Institute; John D. Gray Endowed Chair in Melanoma Research & Chair

of the Southwest Oncology Group Melanoma Prevention Working Group

February 5 Is There a Doctor On Board? In-Flight Medical Events

Riana Wurzburger, MD, MPH, OHSU

February 12 Embracing the Management of Substance Use Disorders in the Hospitalized Patient

Andrew Mendenhall, MD, Senior Medical Director for Substance Use Disorder Services,

Central City Concern

February 19 Thieves’ Market

Alexander D. Schafir, MD, FACP, Clinical Instructor, Providence St. Vincent Internal Medicine Residency

Program; Assistant Clinical Professor of Medicine, Oregon Health & Science University

February 26 Allen M. Boyden, MD, Memorial Visiting Lecture

The Forgotten Denouement: Writing to Finish Doctors’ Stories

Torree McGowan, MD, FACEP, Staff Emergency Physician, St. Charles Clinic Medical Group, Bend

March 4 Hepatitis C Treatment

Kent Benner, MD, The Oregon Clinic – Gastroenterology East

March 11 The Year in Review: A Selection of the Latest in Geriatrics

Kathleen Drago, MD, Co-Director, OHSU Inpatient Geriatrics Program, Assistant Professor, Division of

General Internal Medicine & Geriatrics

March 18 “The Best of Chief’s Report”- Applying Recent Practice Changing Trials to Clinical Practice

Elizabeth Hutchinson, MD, Chief Resident, PPMC Department of Medical Education

March 25 Happy Spring Break—No Medical Grand Rounds

If you are interested in receiving weekly Medical Grand Rounds emails, please send your request to Stephanie Munoz.

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