Tampa Bay Medical News August 2015

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PHYSICIAN SPOTLIGHT

Kevin Makati, MD

ONLINE:TAMPABAYMEDICALNEWS.COM

ON ROUNDS

USF Health: An Integral Cog Coming to Downtown Tampa’s Wheelhouse

By LyNNE JETER

The University of South Florida (USF) is moving ahead with a bold plan to build its new medical school in downtown Tampa, buoyed by state lawmakers’ allocation of $17 million for the project. The funding was approved as part of the state budget in an early summer special session.

The USF Health Morsani College of Medicine (MCOM), to be co-located downtown in a single facility with the USF Health Heart Institute, will bring together medical education, translational research and clinical care under one roof.

The co-location will help transform healthcare in the region by putting students closer to major teaching partner

(CONTINUED ON PAGE 7)


By LYNNE JETER

On the night of June 21, 2012, Greg Miday, MD, scribbled a note before settling in for a hot soak with candles fl ickering, music playing – and a scalpel in hand: “This is just the end of the line for my particular train,” he wrote in a goodbye note. The following morning, his body was dis-covered, major arteries severed.

Miday, 29, an instructor of medicine for the Washington University School of Medicine (WUSM) and a hospitalist with Barnes-Jewish

The Plight of Physicians-in-TrainingStarting in medical school, stress and depression impact rising percentage of students; profession-wide, suicide claims a doctor a day

W H O ’ S T E N D I N G O U R D O C T O R S ?

The Times They Are a-Changin’Undergoing transformative change, this industry has been tasked with fundamentally altering delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement. ... 4

Editor’s Letter

Heart Health Institute will Center USF Medical Corridor

2 > AUGUST 2015 t a m p a b a y m e d i c a l n e w s . c o m

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t a m p a b a y m e d i c a l n e w s . c o m AUGUST 2015 > 3

By JEFF WEBB

LUTZ - If Kevin Makati had not become a very specialized cardiologist, he most likely would have become a very special carpenter.

“I spent most of my childhood as an apprentice to a carpenter, repairing homes” in suburban Boston, he said. “So many of the structures were old, and if you can’t build new, you have to repair old. … Essentially you are restoring old to new.” said Makati, who now sees why “cardiol-ogy seemed to be a perfect fit.”

“It requires an understanding of fluid mechanics, is highly dependent on manual dexterity as a craftsman would need, and it has benefitted from technological inno-vation to fix and restore old parts to new,” said Makati.

In carpentry, “there is a satisfaction one gains from creating something and knowing the attention to detail, and the patience required has paid off in the final product,” Makati continued, extrapolat-ing his analogy with cardiology. He gets a similar gratification from helping patients. “I have been teased that sometimes I take more time admiring work than it actually takes to create it,” he said. “I take pride in what I do …”

Indeed, Makati’s accomplishments thus far indicate a determined combina-tion of academic acumen, hard work and innovation. He has five board certifica-tions: Cardiovascular diseases, clinical cardiac electrophysiology, internal medi-cine, nuclear cardiology and echocar-diography. But it is Makati’s expertise in the subspecialty of electrophysiology that has brought him notoriety in treat-ing atrial fibrillation with the Convergent Procedure, a minimally invasive cardiac operation that integrates the expertise of electrophysiologists with cardiovascular surgeons.

Makati is using an as-yet-unnamed hybrid technique that combines Conver-gence with cryoablation balloons. “The actual catheter was invented in North Carolina, but we were the first to combine the catheter with cryo balloon technology. We were the first in the world to apply that,” said Makati.

When Makati says “we” he is re-ferring to St. Joseph’s Hospital Heart Institute, where he is co-director of the electrophysiology labs at both the main campus in Tampa and St. Joseph’s-North in Lutz. Since becoming the only hospital in Hillsborough County to offer Conver-gent in 2012, St. Joseph’s has grown to be one of busiest of 10 Convergent sites in the world, according to spokeswoman Nancy Gay. The hospital was the first Convergent training center in Florida and physicians travel from all over the world to learn the procedure from (Makati) and

cardiothoracic surgeon Andrew Sherman, MD, said Gay.

“We were already recognized as a Center of Excellence,” Makati said earlier this year before making a presentation to the 2015 Heart Rhythm Society confer-ence, “but now we are recognized as hav-ing the expertise to allow people to be trained by us.”

Makati said he “wears a lot of hats” outside the labs. In addition to his private practice in Lutz, Tampa Cardiac Special-ists, which he co-founded in 2009 with interventional cardiologist Christopher

Pastore, MD, Makati also does clinical re-search, and is working on two grants now. He also sits on the board of directors of the BayCare Physicians Partners Clinically In-tegrated Network, which serves as an um-brella organization for the health system’s 13 not-for-profit hospitals, 17 outpatient clinics and more than 2,800 physicians. “I probably spend about 25 percent of my time” doing administrative duties, he said.

Unlike many physicians who decide as children they want to be doctors, Maka-ti’s interest in medicine did not blossom until “very late in college,” he said, when

his father, who emigrated from India and is a civil engineer in Tampa, was diag-nosed with chronic diabetes. But after earning the prestigious Scholar of the Col-lege award at Boston College, he enrolled at the University of Connecticut School of Medicine, where he knew early on he was destined to be a cardiologist.

Upon graduation, Makati completed his internal medicine residency at Wash-ington University School of Medicine in St. Louis. He then returned to Boston, where he did a residency in interventional

PhysicianSpotlight

Restoring Old to New Electrophysiologist Kevin Makati, MD, Making History at St. Joseph’s


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Editor’s Letter

Undergoing transformative change, this industry has been tasked with fun-damentally altering delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement.

While the above statement is cer-tainly representative of the healthcare industry … in this case, we are actually referencing the media’s role in the dis-semination of information.

The way we consume news has dra-matically changed over the past decade. Yet, how, when and where we receive information is often a matter of personal choice. Some people love the feel of news-print between their fi ngers. Others like to get information on their tablet. Still oth-ers want the highlights in 140 characters or less, giving them control of whether or not the topic is worthy of a click through to more information.

Recognizing our readers embody these varied preferences, Tampa Bay Medi-cal News is excited to announce major changes to our product. If you love the monthly paper (and we certainly hope you do), no worries … you’ll still receive it faithfully each month in the mailbox.

However, we’ve long realized the static nature of our websites left much to be desired from both an aesthetic stand-point and the ability to adequately offer information between print cycles. Ad-ditionally, the editorial and publishing teams have looked at various solutions to quickly alert our readers to major break-ing news stories and to have a platform to put important information in your hands in the immediate fashion audiences have come to require.

To achieve these goals and meet your personal expectations, we are debuting our new website this month and offering you the fl exibility of following us on so-cial media platforms to receive updates.

Knowing how many journals, magazines and e-mails you receive on a daily basis, we promise not to fl ood your devices with a constant stream of data. Instead, we will format key information into brief updates and breaking news alerts as warranted.

For many of you, we already have your email addresses on fi le so you will au-tomatically receive an e-blast. If you aren’t currently receiving electronic notifi cations from us, feel free to contact me at [email protected] with your email address, and I’ll make sure you are added. You can also make such a request online at www.TampaBayMedicalNews.com.

Our mission … as it has always been … is to make sure we get the latest clini-cal, business, research and regulatory news in your hands, in addition to updating you on industry events and happenings among colleagues. The new format of the website makes it easier than ever for you to see the latest information in each of these categories, fi nd related content, and share articles on your own social media platforms. Addition-ally, the design was created to be scalable to desktop, tablet and smartphone formats.

As Bob Dylan aptly noted – The Times They Are a-Changin’ – and we’re excited to embrace that change with enhanced ca-pabilities to deliver the best possible prod-uct to you in a manner that suits your busy life. We hope you enjoy the new look, fl ex-ible formats, and ability to receive industry updates in between print cycles. Please feel free to share your thoughts and comments with us. As always, we’re open to sugges-tions on how to continue to improve our publication and our performance.

Sincerely,

Lynne [email protected]

The Times They Are a-Changin’


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By LYNNE JETER

Two years ago, Stuart Slavin, MD, MEd, stepped onto the po-dium at the Association of American Medical Colleges’ annual meeting to pick up one of the nation’s most prestigious teaching awards for his career accomplishments, most notably spearheading a plan to re-structure Saint Louis University’s medical school curriculum to help students reduce stress, depression and anxiety – and to make a dent in reversing the national trend of rising medical student suicides. The revised four-year curriculum has been heralded as a national model.

“Dr. Slavin is very courageous,” said Keith Frederick, DO, a Missouri state representative who proposed legislation also aimed at reversing the trend via the “Show-Me Compassionate Medical Edu-cation Act.” “Academics were concerned about test scores going down as a result of changes, but it didn’t happen. In fact, it had the opposite effect and blew the lid off this problem.”

Slavin took an interest in medical stu-dents’ mental wellbeing soon after joining Saint Louis University (SLU) School of Medicine as director of curriculum, after a 21-year run at UCLA, where he logged 75 to 80 hours a week as a professor of pediat-rics and full-time pediatrician.

“No singular event occurred to pique my interest,” said Slavin, who gave up a pediatric practice to focus on his admin-

istrative role. “I kept reading in medical education literature about problems with mental health issues among students, in-terns, residents and physicians. I viewed medical student mental health as my re-sponsibility. Medical schools place a great deal of emphasis on academic outcomes … if a medical student comes out of four years with good clinical skills, has done well on all exams, but they’re depressed and suicidal, what’s really been accomplished?”

Slavin began walking the campus, talk-ing to students about their medical school experiences. “Our students seemed really happy,” he said. “They smiled a lot, seemed pleased with administration and education. I developed good relationships with them.”

Still, Slavin wanted hard numbers. “Trying to understand what students are experiencing traditionally hasn’t been part of the medical education culture,” he said.

In May 2008, he dispatched program evaluation questionnaires to SLU’s 175 medical students to be answered anonymously.

“I remember the day I got the survey results,” he said, shaking his head. “It was like a kick in the gut. It was devastating to see how many negative mental health outcomes we had in the school. Medical students are very good at hiding the pain they’re suffering. It can be very in-visible from faculty and administra-tion, and they’re hiding it from each other. I felt a sense of urgency with this problem.”

Survey results showed that, in the first year of medical school, 57 percent of students expressed moderate-to-high symp-toms of anxiety; 27 percent reported mod-erate-to-severe symptoms of depression. Similar results were found for second-year students. They cited the volume of material, level of detail of material, and competition for grades among their greatest stressors in the first two years of the curriculum.

“I really started thinking about ways to design and implement curricular changes that would directly address these stressors and produce a less toxic educational en-vironment,” said Slavin. “I knew if we let students get further down the road without addressing this issue, the problem would only grow worse.”

With the blessing of SLU leaders, Slavin implemented initial curricular changes in the 2009-10 academic year for the incoming class of 2013. First, a pass/fail grading system for preclinical courses re-placed the existing grading system. Second, contact hours were reduced across the first two years of the curriculum by 10 percent to allow students more time to participate in new learning communities and longitudinal electives. Third, longitudinal electives were instituted.

“Before, electives for first- and second-year students included a half-day per week over seven weeks,” said Slavin. “In the new system, electives extended across the major-ity of years 1 and 2, with a half-day session every two weeks for a total of 12 days per academic year. This change allowed stu-dents more freedom to explore their inter-ests, to create mentorship relationships with faculty and School of Medicine alumni, and to engage in service and/or research with more continuity. We retrofitted existing electives to fit the new system and devel-oped new electives designed specifically to take advantage of the longitudinal nature of the experience.”

Fourth, five learning communities were established – service and advocacy, re-search, global health, wellness, and medical

education – to include students and faculty who share common interests and passions for research and/or service beyond the classroom.

“We charged the learning communi-ties with designing and implementing new electives, developing a lunch lecture series, identifying faculty mentors, and expanding service and research opportunities,” said Slavin.

In the 2010-11 academic year for the incoming class of 2014, Slavin implemented additional curricular changes. A required resilience and mindfulness (R/M) pro-gram, spanning six hours of curricular time in the fall semester, was added to the Ap-plied Clinical Skills 1 course. R/M sessions, Slavin explained, focus on energy manage-ment, mindfulness cultivation, stress reduc-tion, cognitive distortions/restructuring, optimistic explanatory styles, and character strengths.

Slavin also refined the pass/fail grad-ing system by eliminating norm-referenced exam performance data from feedback given to students.

In the 2011-12 academic year for the incoming class of 2015, SLU implemented a third set of changes. For example, after students identified the Human Anatomy course as the most demanding and chal-lenging in the preclinical curriculum – and a major source of stress – Slavin made two changes to the course. The medical school dean instructed course directors to produce exams that yielded a higher mean score, to be consistent with other courses in the pre-clinical curriculum “so that fewer students would feel at risk of failing,” Slavin noted. Also, the course was moved from its tradi-tional position as the first course in the first year to follow courses in Cell Biology and Metabolism.

Because students typically have less than three months to choose a specialty, “we allowed them more time,” said Slavin.

Slavin has continued surveying stu-dents with questionnaires, resulting in im-provement every year.

“In first year students, we have it down to 8 percent (moderate-to-severe symptoms of depression),” he said. “Moderate-to-se-vere symptoms of anxiety are down to 23 percent in our first-year students.”

“We wanted to impact the curricu-lum in a completely different way to give students better coping skills and to re-duce stressors in the environment,” said Slavin. “Other medical schools haven’t looked at (this issue) hard enough.”

Editor’s Note: Please see series companion articles in this month’s edition: “Missouri Leads States on Medical Student Well-Being Advocacy” and “The Plight of Physicians-in-Training.”

Medical School Answers: The Saint Louis University ExperimentProgram Helps Medical Students Build Resistance to Stress, Maintain Happiness


cardiology, followed by a fellowship in elec-trophysiology, at Tufts Medical Center.

Before moving to Florida, Makati seized a unique opportunity to advance electrophysiology skills. “I had the good fortune to spend time (about 6 months) as a temporary resident in Bordeaux, France to learn a procedure from the pioneer (of atrial fibrillation ablation), Michel Haisseguerre MD. The experience was immeasurable,” said Makati, adding that “as far as I know, I may be the only one from the U.S.” who has done so.

As busy as Makati is in his professional life, he is thankful for the help he has at home. “I’m highly efficient with my time,” said Makati, but he relies heavily on his wife Poonam to raise their two girls, aged 10 and 7. “She has more responsibilities than I do,” he said.

Makati also was “bitten by the en-

durance sports bug” about two years ago, he said. “Triathletes are a special breed because a successful competitor must be competent in multiple sports (running, biking and swimming) within the same competition. Understanding exercise physiology in multiple sports and how each one relates with the other has been very rewarding,” said Makati, who is on pace to complete seven events by the end of this year.

Although he can’t find much time for it now, Makati said he would like to revisit a creative hobby he has had since he was at Boston College. “I came close to double-majoring in Fine Arts,” he said. “I enjoy painting in acrylics, oil, pastel and water-colors. … I have a very neat stack of paint-ings somewhere in my house,” he laughed.

And he is still drawn to woodworking. “I dabble,” he said.

Kevin Makati, MD, continued from page 3

PhysicianSpotlight


Tampa General Hospital and the univer-sity’s state-of-the art simulation learning center (CAMLS), enhancing opportunities to recruit National Institutes of Health-funded researchers and creating syner-gies with biotechnology companies and other community partners, said Charles J. Lockwood, MD, senior vice president for USF Health and dean of MCOM.

“It’s a unique opportunity to bring USF Health closer to our primary teach-ing hospital, into what will be a thriving downtown waterfront district with tremen-dous appeal to both students and faculty,” Lockwood said.

The move bodes well for the USF medical school, the only one of the top 100 ranked NIH grant-funded medical schools located more than 25 minutes away from its teaching hospital – a com-petitive disadvantage in attracting the best and brightest millennial students. In addi-tion to USF, three highly regarded schools are also addressing this problem and mov-ing closer to their academic teaching hos-pitals – SUNY at Buffalo, Michigan State, and the University of California at Davis.

USF’s current 40-year-old medical school facility -- designed for a large lec-ture hall based curriculum – can no longer support the demands of modern medical education that emphasizes newer modes of smaller, team-based and technology-intensive, simulation-dependent learning.

“The existing MCOM facilities on cam-pus were designed for a different era of medi-cal teaching, when classroom instruction was the primary focus rather than hands-on clini-cal exposure,” Lockwood said.

Co-locating the USF Health Heart Institute, originally slated for the USF main campus in North Tampa, with the Morsani College of Medicine building downtown puts the institute within five minutes of the Tampa General campus, where students do most of their clinical ro-tations and the primary site where USF’s cardiology faculty provide inpatient and outpatient services and inpatient clini-cal trials. It would connect the institute to CAMLS Innovation Center, allowing greater collaboration among cardiovascu-lar researchers, clinicians and engineers to assist companies in developing and testing medical devices at the forefront of ad-dressing heart disease.

The USF Board of Trustees unani-mously approved the ambitious plan to relocate the medical school and heart in-stitute to downtown Tampa at its Dec. 4 board meeting; and the move was subse-quently approved in February by the Flor-ida Board of Governors, which oversees the State University System.

The project will be built with a com-bination of state funds and private money. The $17 million from the state is part of a $62-million multi-year request. Addition-ally, an $18 million gift received in 2011 from Carol and Frank Morsani to assist in construction of a new College of Medi-cine facility will be supplemented by pri-vate donations that USF has committed to raise.

The location proposed for the new

$152.6-million co-located MCOM/Heart Institute is a one-acre site at the intersection of Channelside Drive and Meridian Avenue to be donated by Tampa Bay Lightning owner Jeff Vinik and his partners. It would anchor Vinik’s proposed 30-acre redevelop-ment of the Channelside district.

While an additional $15.8 million re-quested for the USF Health Heart Institute was not included in the state budget this year, the state has already allocated $34.4 million for the heart institute since March 2012. That funding, plus the $17 million for the Morsani College of Medicine, posi-tions USF to launch the planning and de-sign of a downtown facility to house both.

A downtown location will also free up academic space on the university’s main Tampa campus to expand programs in nursing and physical therapy – healthcare occupations considered in high demand and undersupply by the state. The relo-cation of the medical school would also provide more room to grow interdisci-plinary research programs in such areas as neurosciences, cancer and biomedical engineering, university officials noted.

Confluence of EffortsThe state green lighted the project

funds around the same time the medical school’s MD program was reaccredited by the Liaison Committee on Medical Edu-cation (LCME) through 2023, the maxi-mum period allowed.

The news also comes at a time when the medical school marked a record num-ber of applications – 5,235 applicants for the incoming class of 175 students expected this August, a 24 percent increase over 2014. Additionally, the average MCAT score for the newly admitted students showed a 7 percent increase from the previous year, placing the incoming class in the top quartile for average MCAT scores among medical schools ranked by U.S. News & World Report.

The LCME highlighted USF’s ongo-ing efforts to minimize medical student debt as a notable strength. Among Lock-wood’s priorities since arriving at USF in 2014: reducing student debt by freezing tuition, and also boosting the number of medical student scholarships.

“Student tuition and fees will not in-crease as a result of the downtown facil-ity,” he emphasized.

Over the last seven years, scholarship and grant funding has increased 300 per-cent, and USF’s student debt rate remains below the national average for all LCME-accredited medical schools.

“This successful (reaccreditation) outcome speaks volumes about our com-prehensive and meticulous preparation,” said Bryan Bognar, MD, MPH, vice dean for educational affairs at MCOM. “It wouldn’t have been possible without the hard work, collaboration and dedication of our administration, faculty, staff and students, including our colleagues at the Lehigh Valley campus in Allentown and our incredible Tampa Bay area hospital and community partners.”

More MomentumFor the first time, the LCME reviewed

USF Health’s MD SELECT Program – a new partnership with the nationally rec-ognized Lehigh Valley Health Network (LVHN) --- which graduated its first 16 students this spring. The program admits medical students demonstrating a high level of emotional intelligence and leader-

ship potential, and develops their skills in medical leadership, values-based, patient-centered care and health systems. After two years of classes in Tampa, SELECT stu-dents spend two years at the USF Lehigh Valley campus in Pennsylvania to focus on their clinical education.

“This is a huge victory for everyone, both on the USF Tampa campus and the Lehigh Valley campus. Even though we’re 1,000 miles apart, there’s no distance be-tween us when it comes to working to-gether to improve medical education,” said Robert Barraco, MD, associate dean for educational affairs at MCOM’s Lehigh Valley campus.

The move downtown is expected to make MCOM even more attractive to top medical student talent in the near future. The project was overwhelmingly sup-ported by USF medical students who see its value for those who come after them. A recent survey indicated 84 percent of student respondents said that establishing the Morsani College of Medicine down-town will have a “large” to “very large” positive impact on students’ educational experiences.

“We look forward to being there well before our next LCME visit,” Lockwood said. “USF Health will continue to pursue academic excellence wherever we conduct education, research and clinical care.”

USF Health: An Integral Cog, continued from page 1


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Missouri Leads States on Medical Student Well-Being AdvocacyProposed State Legislation Could be Model for Proactive Mental Health Measures at Medical Schools Nationally


By LYNNE JETER

On an unusually chilly spring day, a fourth-year medical student in northern Missouri completed his mission with such surety that only dental records could iden-tify his remains.

“He was going to get it right this time,” lamented his father, who declined to have the family identifi ed. His son, who died from a self-infl icted gunshot wound, was weeks away from earning a DO.

More than 300 mourners were on hand for the premature burial of the 26-year-old, including state lawmakers attempting to push through legislation to deter the alarming rate of depressions and thoughts of suicide amid medical students in Missouri. Among them, Keith Frederick, DO, one of four doctors serving in the Missouri Legislature, and a state representative (R-Jefferson City) who proposed House Bill 867, the “Show-Me Compassionate Medical Education Act” in the 2015 regular legislative session.

By the time Frederick’s bill had churned through the legislative process and was awaiting a fi nal look acknowledging the acceptance of a conference committee report, a Senate fi libuster over a Right-to-Work vote killed it, along with a couple of dozen bills awaiting similar action during the volatile last week of session.

“This topic – a dirty little secret of med-ical education for decades – badly needs the light of day,” said Frederick. “One of the biggest problems is that medical schools say, ‘we’ve got this covered,’ but they don’t.”

Even though HB 867 nearly crossed the fi nish line, medical school deans balked early on. As originally drafted, the bill would have established an anonymous on-line survey to screen medical students for depression and provided for access to im-mediate help through an existing 24-hour hotline for students in crisis. It would have also required the state’s six medical schools – two public, four private – to conduct the screening. Results would have been made public after three years.

Strong opposition came from the Washington University School of Medi-cine (WUSM) in St. Louis, consistently ranked among the nation’s top medical schools by U.S. News & World Report, and world-renowned for its 124-year history of groundbreaking research.

“Washington University’s primary concern – voiced by all six Missouri medical schools – was a provision that would have required the State of Missouri to publish the rates of depression among MD students at each of the state’s medical schools,” said Lisa Moscoso, MD, PhD, associate dean

for students affairs at WUSM. “In its ear-liest form, House Bill 867 would’ve required the Missouri De-partment of Mental Health to determine rates of depres-sion using a state-mandated survey tool, though student participation in the survey would’ve been optional. We noted that a voluntary survey instrument would give schools an unreliable view of the scope of any mental health challenges. We also wor-ried that a government-mandated survey and reporting process for what is unquestionably a sensitive matter would undermine the culture of trust each school strives to build with its student body.”

Frederick modifi ed the bill while it was held for more than a month in the Social Services Committee, and then medical schools unoffi cially removed their opposi-tion to the bill, which Frederick plans to pre-fi le this fall.

“The measure that was before the Senate in the fi nal weeks of the session rep-resented a reasonable approach to raise awareness about medical students’ mental health and to encourage Missouri medical

schools to collaborate to identify best prac-

tices, particularly those efforts that are most ef-fective at de-stigmatizing mental illness and encour-aging students

to seek support and services to cope with mental health

issues,” said Moscoso.

M a r g a r e t Wilson, DO, dean of

A.T. Still University’s Kirksville School of Os-

teopathic Medicine in Kirksville, Mo., expressed concern about “confi dentiality and potential to cause stigma to students.” Since modifi cations have been made, “the bill meets with my school’s support,” she said.In its fi nal form, HB 867 dropped the re-quirement that medical schools undertake this study, but protected medical students and medical student organizations from interference or retribution from the medi-cal schools when planning or conducting screening for depression or other mental health issues among medical students.

Britani Kessler, MD, immediate past president of the American Medical Student Association (AMSA), traveled from Virginia to testify before the Social Services Commit-

tee that “mental wellness” is the organiza-tion’s most frequently clicked-on website link.

“The culture of the current medical ed-ucation system is that you can’t show weak-ness,” said Kessler. “The rigors of medical school make you sometimes think this sus-tained high level of stress is normal.”

The AMSA Board of Trustees has ex-pressed interest in launching a national pilot program to survey medical students anony-mously at various intervals of their educa-tional training. To Kessler’s knowledge, Missouri is the only state to have attempted to pass legislation relating to medical stu-dents’ mental well-being.

“The purpose of the AMSA is to help pre-med and medical students learn things they aren’t taught in traditional medical education,” said Kessler. “We’re very feisty about medical education reform and making sure the social determinants of health are included.”

Frederick said more changes are needed in medical education, like national award-winning modifi cations made to the four-year curriculum at Saint Louis Univer-sity (SLU) School of Medicine in St. Louis, Mo., to reduce the damage rather than em-phasize that medical students need to learn to cope with the existing medical education structure and harshness.

“As SLU’s groundbreaking study revealed, medical education can greatly reduce the harm infl icted on medical stu-dents,” he said, “without adversely affecting achievement and board scores.”

THE STRENGTH TO HEAL and learn lessons in courage.

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for students affairs at WUSM. “In its ear-liest form, House Bill 867 would’ve required the Missouri De-partment of Mental Health to determine rates of depres-sion using a state-mandated survey tool, though student participation in the survey would’ve been optional. We noted that a voluntary survey instrument would give schools an unreliable view of the scope of any mental health challenges. We also wor-ried that a government-mandated

schools to collaborate to identify best prac-

tices, particularly those efforts that are most ef-fective at de-stigmatizing mental illness and encour-aging students

to seek support and services to cope with mental health

issues,” said Moscoso.

M a r g a r e t Wilson, DO, dean of

A.T. Still University’s Kirksville School of Os-

teopathic Medicine in Kirksville, Mo., expressed concern about “confi dentiality


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The Plight of Physicians-in-Training, continued from page 1


Hospital, was days from beginning an oncology fellowship when he committed suicide. In his obituary, his parents – both MDs – wrote: “With all his talents and ac-complishments, he struggled in a world that didn’t fully understand him.”

“Greg knew it was a career killer to ask for (mental health) help,” said his mother, Karen Miday, MD, a psychiatrist from Ohio. “At the end, he must’ve felt there was no way out.”

Every day, a medical student or doctor calls it quits in the most permanent way.

Because of the stigma surrounding mental health issues, medical students re-main wary of seeking help.

“We must see change to de-stigmatize mental illness,” said Miday. “From the beginning, medical students should be al-lowed to seek help if they’re struggling. Un-fortunately, medical people seem to be the most judgmental when it comes to mental illness.”

Colin West, MD, PhD, co-director of the Mayo Clinic Department of Medicine Physician Well Being Program, told The New York Times: “If this is the way that stu-dents view each other – survival of the fit-test – how do they view their patients who are depressed or struggling with mental ill-ness?”

Medical students are prone to mal-adaptive perfectionism and imposter syn-drome disorders, cautioned Stuart Slavin, MD, MEd, director of curriculum for Saint Louis University School of Medicine, where he successfully implemented pro-gram changes to improve the wellbeing of medical students and received a national teaching award for restructuring medical education.

“Maladaptive perfectionism is always setting the bar so high for yourself that you’re continually disappointed,” explained Slavin. “Imposter syndrome is the belief of being incompetent despite overwhelming objective evidence to the contrary. Both maladaptive perfectionism and imposter syndrome are particularly risky when medi-cal graduates are starting residency. All of a sudden, they have their MD, they’re writ-ing orders and making decisions for which they may feel terribly unprepared. They’re terrified of doing something wrong. Both can be setups for emotional distress and potentially suicide. The fear of being ‘dis-covered’ or disappointing those who have supported you along the way … suicide is sadly an out as having potential advantages when you’re desperate.”

Haunting ActionsBecause of their intrinsic knowledge of

medicine, suicide success rates are alarm-ingly high among medical professionals. Nearly every physician knows of colleagues who took their own life.

Many remain haunted by their ac-tions.

Jay Bitar, MD, FACC, an interven-tional cardiologist at Cardiology Care Center in Lake Mary, Fla., recalled an in-tern – Brent Branham, MD – from Detroit,

Mich., who committed suicide in 1985.

“On the night Dr. Branham was on call (alone), he’d start hav-ing anxiety as my time to leave approached,” said Bitar, then Bran-ham’s rounding resident on the infectious disease floor of a medical complex in downtown Detroit. When Bra-nham’s one-month rotation ended without incident, Bitar wrote a favorable evalua-tion.

Two months later, as he was about to take night call on another medical floor, Branham had a meltdown at the nurses station. A psychiatrist called to evaluate Branham determined he wasn’t suicidal and recommended the night off, calling for further psychiatric evaluation.

Branham didn’t return home that night. Instead, he checked into a hotel room, injected himself with insulin he’d stolen from the hospital, and lapsed into a hypoglycemic coma.

“The next morning, when the hotel maid found him unconscious, he’d already sustained permanent brain damage,” la-mented Bitar. “He lived for a few months in a vegetative state before succumbing.”

Over the years, Bitar has wondered what went wrong, how the signs were missed, who was to blame, and if actions could have been taken to positively impact Branham.

“Each one of us has a Brent Branham inside,” said Bitar. “The system is quick to weed out physicians who cannot survive long, sleepless nights, withstand the pres-sure, and take abuse from senior staff … with pride. The system of residency train-ing doesn’t address collateral damage like the physician’s marriage getting destroyed, or when the children become neglected, or when the physician’s physical or mental health is permanently degraded.”

After hearing about a nearby physi-cian who committed suicide, Pauline Chen, MD, wrote in The New York Times that his death came up repeatedly in conversations for days afterward.

“It wasn’t the details of his life that haunted us; it was the details of his death,” she noted. “He’d locked himself in a room in the hospital, placed a large needle in his vein and injected himself with a drug that so effectively paralyzed his muscles, he was unable to breathe. Or call for help.”

Pam Wible, MD, a family physician from Oregon and a national voice for phy-sician suicide prevention, pointed out the ripple effects of such tragedies. A year after Kaitlyn Elkins, a third-year medical student at Wake Forest School of Medicine, died by asphyxiation due to helium inhalation, Wible attended the funeral of Kaitlyn’s mother, who chose the same method to end her life.

Miday was so devastated by her son’s suicide that “the first year after Greg died, I don’t think I could string three words to-gether,” she said.

Wible admitted: “Many of us have considered suicide, but we’re so resilient that we smile and head back into the next room to see the next patient.”

Seeking SolutionsMissouri jumped ahead as arguably

the first state to introduce legislation aimed at facilitating change at the medical school level. Keith Frederick, DO, one of four doc-tors serving in the Missouri Legislature, and a state representative (R-Jefferson City), proposed the “Show-Me Compassionate Medical Education Act” in the 2015 regu-lar legislative session. House Bill 867 raises awareness about medical students’ mental health and encourages Missouri medical schools to collaborate to identify best prac-tices, particularly those efforts most effec-tive at de-stigmatizing mental illness and encouraging students to seek support and services to cope with mental health issues.

In June, the American Medical Asso-ciation (AMA) launched an ambitious new initiative to address physician burnout, a step toward addressing mental health well-ness in the profession. The interactive prac-tice transformation series, AMA STEPS Forward, was developed after research revealed the overall burnout rate of U.S. physicians approaching 40 percent.

That’s “more than 10 percentage points higher than the general popula-tion, which is why the AMA is taking a hands-on approach to meeting their day-to-day concerns,” said AMA CEO James L. Madara, MD.

The Accreditation Council for Gradu-ate Medical Education requires that pro-grams assess fatigue and burnout among trainees and provide access to confidential counseling, “but these regulations should go further to require specific strategies to promote mental health among all trainees,” according to an article published March 4 in JAMA Psychiatry by Matthew Goldman, MD, of Columbia University Medical Cen-ter and New York State Psychiatric Insti-tute and colleagues.

Depression and burnout are separate entities, some medical professionals cau-tioned, noting that some overlap exists.

West believes that mental health well-ness begins eroding with “first-years”: “We have to assume that starting in medical school, a pipeline of experiences leads to an increased risk of suicide,” he said. “That’s where we need to start.”

Editor’s Note: Please see series companion articles in this month’s edition: “Missouri Leads States on Medical Student Well-Being Advocacy” and “The Saint Louis University School of Medicine Experiment.”

Dr. Jay Bitar


Moffitt Cancer Center Teams Up with MD Anderson to Discover, Test Novel Agents to Prevent Cancer

Moffitt Cancer Center has joined MD Anderson’s National Cancer Insti-tute (NCI) Phase 0/I/II Cancer Preven-tion Clinical Chemoprevention Trials Consortia. Sponsored by the NCI’s Divi-sion of Cancer Prevention, the consor-tia conducts early clinical development of promising new preventive agents through its Phase 0/I/II Cancer Preven-tion Clinical Trials Program. As part of the drug discovery process, researchers will look at a number of new agents that intervene in specific molecular path-ways thought to be critical to cancer development. Since cancer prevention studies focus on high-risk populations that do not necessarily harbor a de-tectable cancer, these studies require extensive biomarker analysis, investiga-tion of the biologic effects of the can-cer preventive agents on their intended molecular targets and correlation with clinically relevant endpoints. The Mof-fitt team has developed several agents using this systematic approach for the past few years according to Nagi B. Ku-mar, Ph.D., R.D., F.A.D.A., consortium principal investigator and director of Cancer Chemoprevention.

Other cancer centers in the MD An-derson consortium include Dana Far-ber, Columbia, the University of Michi-gan, Memorial Sloan Kettering, Cornell and an international site in Italy.

Dr. Douglas Stevens Recognized as a ‘Top Doctor’ by National Industry Resource

Dr. Douglas Stevens of Douglas M. Stevens, MD, Facial Plastic and Laser Center, has been awarded the recognition of the Castle Connolly ‚ÄòAmerica’s Top Doc-tors.’ Castle Connolly is a company dedicated to helping the public identify the very best in healthcare resources. The award is recognized nation-wide as one of the most respected and sought after phy-sician awards. Only those doctors who are among the very best in their special-ties and in their communities are select-ed to be a Castle Connolly Top Doctor and included in related publications. Dr. Douglas Stevens, American Board of Facial Plastic and Reconstructive Sur-gery and the American Board of Otolar-yngology Head and Neck Surgery, has been recognized numerous times over his career for his work in the industry. His most recent accomplishments include the development and trademarking of his in-office facelift procedure, the Ac-tive Lift¬Æ, and appointment to the Su-neva Medical Physicians Advisory Coun-cil as a designated expert in his field. Each year, Castle Connolly receives over

100,000 nominations. Those recognized as a Top Doctor are nominatewd by their peers in an extensive survey pro-cess of doctors all over the country. The physician-led research team carefully reviews the credentials of every physi-cian being considered, and the Castle Connolly editors, the Chief Medical and Research officer, and the research staff ultimately determine who is selected for inclusion. For more information about Dr. Douglas Stevens and his practice, visit DouglasStevensMD.com.

Sarasota Memorial Welcomes New Physicians to South County

Sarasota Memorial Health Care System wel-comed two new primary care physicians into its First Physicians Group (FPG) network. In July, Mitchel Beasley, DO, and Rachel Dahlborg, MD, began accepting new patients at FPG’s Venice and Blackburn Point practices. A Fam-ily Practice physician, Dr. Beasley joined Drs. Christopher Jefferson and Veronica Nabizada at their family medicine practice on the Venice Bypass. Dr. Beasley earned his osteopathic medicine degree at Lake Erie College of Osteopathic Medicine in 2012. He completed his internship

and residency at St. Petersburg General Hospital. He came to Sarasota from St. Petersburg, where he served as a resi-dent physician at Family Care at Bard-moor, the practice of Bridget Bellingar, DO, and Community Health Centers of Pinellas. Dr. Dahlborg, an Internal Medicine & Pediatrics physician, joined Drs. Karen Hamad, Alan King, Jack Rod-man, John Wassenaar and Joseph Yeh at the Internal Medicine & Pediatrics practice located in Sarasota Memorial’s Health Care Center at Blackburn Point, 929 S. Tamiami Trail, Ste. 101, Osprey. Dr. Dahlborg earned her medical de-gree at New York Medical College in 2011. She completed her residency in Internal Medicine/Pediatrics at Medical University of South Carolina in Charles-ton, SC. She came to Sarasota from the Charleston, SC, where she served as chief resident at Medical University of South Carolina.

St. Joseph’s Hospital Opens $43 Million Operating and Interventional Radiology Suites

In July, St. Joseph’s Hospital began operating in one of five new state-of-the-art surgical suites. The new suites are part of an 18-month, $43 million, expansion project that brings the total number of operating suites at St. Jo-seph’s Hospital to 18. The new suites are connected to the existing surgical unit, which provides the ideal layout for minimally invasive and conventional procedures.

One of the new operating suites is the VISIUS Surgical Theatre with intra-operative MRI (iMRI) Suite, an advanced neurosurgical operating room where a diagnostic quality scanner can move to the patient using ceiling-mounted rails. This incorporates imaging and surgery in the same setting without introduc-ing additional risk to the patient asso-ciated with transport, while delivering real-time information to clinicians to improve patient outcomes.

The new operating suites also offer:· More Space- The new operat-

ing rooms are at least 100 sq. ft. larger than the older suites to accommodate advanced technology and equipment allowing physicians to perform com-plicated orthopedic and neurological cases.

· System Integration and Technolo-gy- Everything from patient information systems to audio, video, lighting and medical equipment is functionally con-nected, allowing surgeons to control all devices from a single touch screen. Plus, the operating rooms now have teleconferencing capabilities and ev-erything, including wires and cords, are up and off of the floor reducing safety hazards.

· Pediatric Surgery- The pediatric surgery area will be converted into a single space for admitting, pre-op hold-ing, surgery and post-anesthesia recov-ery care.

In addition to five new operating suites, the newly renovated interven-tional radiology suite will be home to a sophisticated imagining system, giving patients safe, effective alternatives to surgery. The renovations allow for:

· Advanced 3-D Images- These 3-D CT, MR, PET and SPECT scans help to plan and assess procedures, which as-sist the interventional radiologist who will perform the exam.

· Blended Road mapping- This helps the interventional radiologist navigate easily and clearly in complex anatomy using quality digital images.

· TrackVision- By providing live 3-D guidance to move the needle as planes, TrackVision helps radiologists precisely plan needle procedures and show any deviations from the desired path.

· AngioViz- Shows the vascular flow on a single image, while digital sub-traction angiography (DSA) generates vascular flow data, which allows radiolo-gists to easily compare images with just a glance.

· 3T MRI-Ultra Field Tesla MRI- This is the strongest clinically available scanner and it allows for more comfort, quicker exams and the highest quality images.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

Nursing Director at Blake Medical Center Honored by DoD with Patriot Award

Blake Medical Center is proud to announce that the Florida Committee for Em-ployer Support of the Guard and Reserve (ESGR), an agency of the Department of Defense, announced that Jody Nader, Nursing Director at Blake Medical Center, was honored with a Patriot Award in recognition of extraordinary support of employee(s) who serve in the Florida National Guard and Reserve. U.S. Air Force Reservist and Blake Medical Center Registered Nurse Staff Sergeant Christopher Dziuban nominat-ed Nader. Dziuban noted Nader hired him for the nursing position at Blake and that from the very beginning of his employment she has fully supported his military service. According to James Dicks ESGR Florida State Chair, the Patriot Award was created by ESGR to publicly recognize individuals who provide outstanding patriotic support and cooperation to their employees, who like the citizen warriors before them, have answered their nation’s call to serve.

GrandRounds

Dr. Rachel Dahlborg

Dr. Mitchel Beasley

Dr. Douglas Stevens

4656 McIntosh Road, Dover, FL 33527813-659-0008 • www.rvone.com

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Tampa Bay Medical News August 2015