MAY 2015 - a monthly and evolving snapshot of GME news & highlights

WALTER REED DOM GME Snapshot

highlights

Graduate Medical Education

Department of Medicine

Walter Reed Bethesda

Three members of the Walter Reed Internal Medicine Residency Doctor's Dilemma Team, representing the Army Chapter of the American College of Physicians (ACP) at the annual INTERNAL MEDICINE 2015 meeting in Boston, placed 3rd in International Finals.

The team (left to right: CPT Adam Barelski, CPT Jack Hutter and CPT Michael McMahon had a tremendous

run through 3 rounds, ending up tied for 3rd out of 47 finalist teams, all of which were the winners/selectees of their respec-tive ACP chapters from around the globe (including teams from Saudi Arabia, SE Asia, Canada and Central America). The win-ning Albert Einstein team, affiliated with Thomas Jefferson Medical College in Philadelphia, has won 7 of 19 competitions since 1997, including the last 4 in a row. Cleveland Clinic placed second.

"All-Star" Navy Medical Jeopardy Team Shines The Navy Medical Team, which included LT Christa Eickhoff and colleagues from NMC San Diego and NMC Portsmouth, had very tough competition in the first round but showed well also.

Congratulations CDR Michael Keith for taking on your new role as Navy Governor (term: May 2, 2015 through the end of April 2019) of the American College of Physicians.

WRB IM Residency Army Doctor’s Dilemma Team

“All-Star” Navy Medical Jeopardy Team

Walter Reed Team Places in International Medical Knowledge Final

2 May 2015 Walter Reed DOM GME Snapshot

highlights

CPT Cynthia Philip (IM PGY-1) presenting the

clinical vignette "A Case of Supplement-Associated Acidemia and Acute kidney Injury in an Active Duty Soldier."

CPT Michael McMahon (IM PGY-2) presenting

his Army ACP-winning abstract as a clinical poster "A Dab of Danger: A Case of Severe Respiratory Failure following Inhalation of Butane Hash Oil."

LT Ian Grasso (IM PGY-1) presented his Navy ACP

Chapter-winning research abstract as a Poster “Do Non-Benzodiazepine Sleep Aids affect the ECG Diag-nosis of Sleep Apnea?” at the meeting.

Walter Reed Bethesda Highlights from IM 2015 in Boston

CPT Cynthia Philip presenting at IM 2015

CPT Michael McMahon presenting winning abstract at IM 2015

LT

Ian G

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resents w

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ing

abstract

NEED A PROCEDURE COMPLETED?

Lumbar Puncture Thoracentesis Paracentesis Arthrocentesis Exercise Stress Test GXT

WANT TO HELP OUR HOUSESTAFF

BECOME MORE PROFICIENT? Page IM CONSULT PAGER

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Connect with IM residents needing various procedures listed above when you don't have a rotating resident readily available (or fellow who also needs the procedure). Thanks in advance for thinking of the resi-dents.

3 May 2015 Walter Reed DOM GME Snapshot

education, scholarship, and outreach

Every year around this time, thousands of residents are caught up in the stress of preparing for certification examinations or ‘the boards’. While trying to master the clinical and procedural knowledge can be task enough, Dermatologists are also required to mas-ter Dermatopathology. This requires the use of a microscope. Only two specialties require the use of a microscope during their board examination and while although you might expect that Pathologists must do this, you might not expect that Dermatologists are also required to do the same. As you would expect, Dermatologists get less experience ‘driving the scope’ than Pathologists and therefore, any venue where Dermatologists can have some ‘time at the wheel’ before taking their actual examination is a welcome event (especially one free of charge as the one hosted by Walter Reed was). To provide an opportunity to use actual microscopes and glass slides to those residents taking their boards this summer, the Dermat-opathologists at Walter Reed organized a board review course. The course differed from other Dermatopathology board review clas-ses. Typical ‘glass and scope’ courses not only may cost hundreds of dollars, but also, differ in that residents are given an individual slide for 1-2 minutes and then ‘pass’ it on to the next person, repeating this for sometimes over 100 slides. For the review at Walter

Reed, each resident was given a tray of 15 slides to review for ½ hour for a total of 45 slides. This is similar to the actual boards where each resident is given a tray of 18 slides for 45 minutes for a total of 36 slides. Providing the slides in this fashion allowed residents the opportunity to train their time management skills with a tray of slides. For instance, some diagnosis are straightforward, requiring little time while others re-quire more time to thoroughly evaluate a slide, such as if you were searching for an infectious agent like leish-maniasis. The event was hosted by Dr. Nicholas Logemann (current Dermatopathology Fellow at Wal-ter Reed) and attended by Dermatology residents from Walter Reed NNMC, Washington Hospital Center and Johns Hopkins Hospital. “The plan is to continue this as a yearly event”, said Dr. Logemann. “Hopefully we can continue to involve other programs, not only as an educational opportunity for other residents, but also as an opportunity where residents can come to-gether to meet residents from other programs, espe-cially those in the local area.” The review took place

on May 2, 2015 in the Dermatology Department at Wal-ter Reed.

“This photo is a histologic image of one of the infectious diagnoses found on the test. The picture demonstrates Leishmaniasis. The small little dots are the organism found within histiocytes."

Walter Reed Dermatopathologists host board review for Dermatology Residents from

WRNMMC and area civilian residencies. Thanks to LCDR Nick Logemann for your

hard-work in organizing this highly successful recurring event.

Dr. Pat Young, WRB GI Program Director, was highlighted in

ACP Internist newsletter for his discussion at Internal Medicine

2015 in Boston on — “6 keys to managing the cirrhotic inpatient”

“At a Friday-morning session on inpatient gastrointestinal (GI) consults, [CDR] Patrick E.

Young, MD, FACP, aimed to put attendees at ease regarding cirrhotic inpatients.”

“I know these folks make people a little bit nervous, because they can get quite sick,” said Dr.

Young, director of the Division of Digestive Disease at Uniformed Services University in Bethes-

da, Md. He offered his 6 keys to managing such patients.”

To read more…http://www.acpinternist.org/im2015/2015-5-2-index.html#1

Dr. Pat Young

4 May 2015 Walter Reed DOM GME Snapshot

education, scholarship, and outreach

LT Sadowski and CPT Masel conduct civil-military operations aboard USNS Comfort

LETTER FROM THE COMFORT Dr. Shimeall, Just wanted to give you an up-date on our progress with CP15. We completed our mission stop in Belize and have moved down the Caribbean coast to Guatema-la which has turned out to be a much different experience. Their country is much poorer, speaks only Spanish, and has a much weaker healthcare infrastructure than Belize, meaning that our impact here has been that much greater. We have had to think on our feet and learn a good amount of medical Spanish along the way to be functional (with the help of our translators). Jen and I are at separate medical sites for this mission and have been seeing a lot of IM relevant disease. We are currently seeing between 30-40 patients per 6 hour clinic day (with about 4 hours of commuting from the ship 10 miles offshore and back). You wouldn’t believe the amount of DKA that just walks around the streets in these countries. Some patients seem like it is just their baseline. Most of the cases are a mix between weakness, fevers, and musculoskeletal complaints (some of which were consistent with Chikungu-nya infection, although we have no way to confirm it) and dyspep-sia (high prevalence of H. pylori) but we have had quite a few of mystery cases that we do what we can with before tying them back into their host nation with our recommendations. We say lots of goiters as well. One big frustration that we have all have experienced is knowing what the patient needs (e.g. sur-gery for torn meniscus) but not being able to provide for them because of time constraints or

surgical interventions and limited resources. The surgeons were already completely booked up after one day of surgical screen-ing. We do what we can never-theless with whatever formulary and lab tests we have left in stock. One extra collateral day that the residents on board have taken on is taking time at the end of the day to help the corpsman who have been assigned as food ser-vice assistants for the entire de-ployment stay up on their medi-cal skills. Jen and I recently led group discussions on assessment of vital signs and basic history and physical taking to a group of corpsman who seemed some-what desperate to get back to the job that they had initially been trained to do out of corps school. Other talks on splinting and casting, BLS/ACLS basics, and pediatric resuscitation have been led by other residents from both WRNMMC and NMCP. It has given me a lot of ideas on what we can poten-tially offer to our corpsman at WR as well. VADM Nathan was onboard while we sailed from Belize to Guate-mala and gave a great admiral’s call with a lot of inspirational words about our mission as well. Thanks very much for your time and support of our participation in this great mission. The DOM as a whole and the residency pro-gram are definitely contributing in a great way. The residents that follow us are going to just have a more and more fantastic experi-ence as time goes on. Very respectfully, Brett Sadowski, M.D. LT, MC, USN Internal Medicine, PGY-2 [Friday, April 24, 2015]

For those with Facebook accounts LT Brett Sadowski (Walter Reed IM PGY2 Resident) made the Operation Continuing Promise Facebook site. Link, picture, and caption are below, right. Nice work Brett and Jen! (CPT Masel — IM PGY3 also on the Belize and Guatemala portion of the CP15 mis-sion). We look forward hearing more upon your re-turn! “PUERTO BARRIOS, Guatemala (April 28, 2015) — Lt. Brett Sadowski, an internal medicine doctor assigned to Walter Reed National Military Medical Center Be-thesda, Md., checks a patient’s blood pressure at a medical site set up at Casa Social del Maestro Prof. Leopoldo in Puerto Barrios, Guatemala during Contin-uing Promise 2015. Continuing Promise is a U.S. Southern Command-sponsored and U.S. Naval Forces Southern Command/U.S. 4th Fleet-conducted deploy-ment to conduct civil-military operations including humanitarian-civil assistance, subject matter expert exchanges, medical, dental, veterinary and engineer-ing support and disaster response to partner nations and to show U.S. support and commitment to Central and South America and the Caribbean. (U.S. Navy photo by Mass Communication Specialist 2nd Class Derek Paumen/Released).” http://preview.tinyurl.com/OperationContinuingPromise

5 May 2015 Walter Reed DOM GME Snapshot

education, scholarship, and outreach

DERMATOLOGY – "The Murtha Cancer Center and Dermatology Service kicked off the first day of the month with the launch of its first Melanoma Awareness Day Summit and Screenings in the Memorial Auditorium of WRNMMC. From 8am-12pm, WRNMMC surgeons, pathologists, physicians, and out-of-state guest speakers presented studies and new findings on the basic science of melanoma, surgical advances, diagnosis, drug therapy, and prevention. Audience mem-bers included WRNMMC staff doctors and nurses, military, civilians, and contractors, with CME credits available. The summit wrapped with a final word from LTC (ret) Tom Toth speaking on surviving a melanoma diagnosis. Afterwards, patients and staff made their way to the Dermatology clinic in Bldg. 19 for mela-noma skin-check screenings, available to both Tri-Care and non-Tri-Care beneficiaries with base access. With over 15 doctors and resi-dents on hand and a team of nurses and corpsman on deck, the Dermatology Service team saw 139 patients, performed 34 biopsies, and scheduled follow up appointments for Tri-Care beneficiaries within a few hours." Barédu Barédu S. Ahmed Research Coordinator Dermatology Clinic

INTERNAL MEDICINE –

Our Faculty designed and delivered three well-attended workshops at the 2015 APDIM Spring Meet-ing in Houston, TX April 28-29, contributing to improv-ing GME in Internal Medicine nationally. Strong Work!

LCDR Travis Harrell (GIM), LTC Joshua Hartzell (ID) presented “Finding a New Homeostasis: A Practical Approach to Modern Rounding in an Academic Setting.” (MAJ David Callender contributed but was not able to attend)

LTC Jess Edison (Rheumatology) presented a work-shop on “Chief Resident Mistakes” to over 100 in-coming internal medicine chief residents from around the country.

MAJ Rohul Amin, MAJ Vincent Capaldi, III, LT Julia

Cheringal, MAJ Joshua Mitchell presented “When

the Kleenex Runs Out: Using Psychology to Assist

Distressed Residents.”

INTERNAL MEDICINE—

T he initiative, energy, and team work of MAJ Rohul Amin (IM Chief Resident 2014-2015), CPT Adam Barelski (IM Senior Resident, and soon-to-be IM Chief Resident 2015-2016), Dr. Tim Krohe (IM

Clinician Educator, and newly-recognized Master Clinician), and Dr. Joan Ritter (IM GME Associate Director, and newly-recognized Master Clinician), and a workshop led by Dr. Kro-he, resulted in the publication in Academic Internal Medi-cine Insight. Teaching Clinical Reasoning in the Outpatient Clinic: 18 Pearls for Efficient and Effective Diagnosis A framework of educator training based on five scenarios can elimi-nate some of the barriers to teaching diagnostic reasoning. As edu-cators form rapidly accessible mental patterns, they can rapidly rec-ognize thought based reasoning errors in a resident clinic and effi-ciently respond to unique scenarios with predetermined teaching points. To read the entire article: https://learning.usuhs.edu/x/D7l3HU

C ongratulations to the following IM in-terns and residents who successfully sub-mitted chapters in the American College of Physicians (ACP) Smart Medicine

online resource for practicing physicians. Thanks to faculty mentors Dr. Barb Cooper (GIM), Dr. Ju-lie Chen (GIM) and CAPT(SEL) Anthony Nations for your guidance to the house-staff! http://smartmedicine.acponline.org/ Ben Wilson (PGY1), Andrew Peacock (PGY1), Barb Cooper. Epistaxis. Dan Hodge (PGY2), Lee Jamison (PGY2), Barb Cooper. Hernia. John Peters (PGY1), Ben Collen (PGY1), Barb Cooper. Chronic Urticaria. Mike Dore (PGY3), Emily Brown (PGY2), Barb Cooper. Acute Appendicitis. Sarah Ordway (PGY1), Alison Lane (PGY1), Barb Cooper. Osteomyelitis. Gilda Bobele (PGY2), Camille Costan-Toth (PGY1), Julie Chen. Aortic Regurgi-tation. Shannon Wood (PGY2), Meredith Lutz(PGY1), Julie Chen. Scabies. Zach Junga (PGY1), Jimmy Fisher (PGY2), Julie Chen. Group A Streptococcal Pharyngitis. John Greenwald (PGY1), Robert Park (PGY1), Julie Chen. Kawasaki Disease. Brett Sadowski (PGY2), Shanley Ignacio(PGY1), Anthony Nations. Acute Res-piratory Distress Syndrome. Akira Shishido (PGY2), Diana Dougherty (PGY2), Julie Chen. Cholera. Brian Park (PGY3), Mark Pence (PGY2), Barb Cooper. Salicylate Poisoning

publications

6 May 2015 Walter Reed DOM GME Snapshot

research and academic success

Walter Reed from Maryland local chapter meeting of American College of Physicians (ACP)

At the Maryland American College of Physicians Residents Mulholland-Mohler Meeting this past Thursday, May 14, 2015 at St. Agnes Hospital in Baltimore, several Internal Medicine Residents presented vignettes

P rogram nominees for Chief Residents Award recognition for clinical vignette poster: Ryan Haley, “Epidural Abscess: Case Report of Provotella Bivia”

Benjamin Wilson, “An Unusual Case of Cough from Amiodarone Toxicity” Shannon Wood, “A Storm’s A-Brewin: A Case of Suicide Attempt by Massive Levothyroxine Ingestion”

C ongratulations to LT Patrick Moon (TY intern and future IM Resident) for winning 333rdrdrd place place place (out of 19) in the research abstract poster competition for “Long Term Mortality Associated with Coronary

Artery Calcium.” His mentors included Dr. Josh Mitchell from GIM and Dr. Todd Villines from Cardiology.

C ongratulations to LT Nick Fiacco for presenting his ongoing performance improvement project, "Block 4+1 Scheduling in the Ambulatory Clinic: Effects on the Internal Medicine Resident Continuity

Clinic Experience." LT Fiacco was selected to present an oral podium as one of 6 finalists from 25 research submissions. His presentation generated incredible interest and discussion among residency program leaders and faculty at the meeting. Thanks also Dr. Julie Chen for her mentorship and guidance.

O utstanding! LT Alison Lane gave a podium presentation entitled, "Methicillin-Resistant Staphylococ-cus aureus Causing Antibiotic-Associated Enterocolitis." Her presentation earned 2nd place out of

eleven Maryland residency program finalists, in a competition for which 145 clinical abstracts were sub-mitted.

Department of Medicine Finalists Included:

William Lewis, MD (Internal Medicine Intern) Stephen Savioli, MD IM (Internal Medicine Intern) Dustin Little, MD (Nephrology Faculty) Brian Cohee, MD (Pulmonary Fellow) Brian Foster, DO (Internal Medicine Resident) Nicholas Fiacco, MD (Internal Medicine Resident) David Kassop, MD (Cardiology Fellow) Michael Cahill, MD (Cardiology Fellow) Melissa Butts, DO (Rheumatology Fellow) David Hostler, MD, MPH (Pulmonary Fellow) Manish Singla, MD (Gastroenterology Fellow) David Hostler, MD (Pulmonary Fellow)

Hard work and persever-

ance earns LT Nicholas

Fiacco (left) third place in

the Evidence Based Prac-

tice - Quality Improve-

ment category at the 7th

Annual National Capital

Region Research Competi-

tions in May.

7th Annual National Capital Region Competition Finalists Present Work at Walter Reed

Congratulations to DoM awardees!!!

7 May 2015 Walter Reed DOM GME Snapshot

research and academic success

RHEUMATOLOGY—

Congratulations to Fellows LCDR Melissa Butts, CPT Rachel Robbins and CPT Aaron Pumerantz for presenting at the 9th Annual North American Young Rheumatology Investi-gator Forum in Destin, FL April 29, 2015.

LCDR Melissa Butts Oral presentation: "Characterization of Epitopes Identified with Cerebral Vasculature Injury,"

Poster presentation: RUNNER UP!!!

"Critical Mass-A Severe Presentation of Crowned-Dens Syn-drome" CPT Rachel Robbins: Poster Presentation: "Adrenal Hemorrhage with Resultant Adrenal Insufficiency in Antiphospholipid Syndrome" CPT Aaron Pumerantz: Poster Presentation: "Granulomatosis with Polyangiitis pre-senting with Acute Compartment Syndrome"

One of the finalists was a prospective pilot trial to evaluate a new point-of-care imaging technique with the goal of reducing bleeding complications from thoracentesis. Dr. Hostler and colleagues also presented this project at the American Thoracic Society meeting, where it was met with much enthusiasm -- they have since heard that a number of medical centers are incorporating this technique into their standard practice. They are planning to submit the work for publication soon.

PULMONARY MEDICINE—

7th Annual NCR Research Symposium, May 18-19, 2015 at Walter Reed Bethesda

8 May 2015 Walter Reed DOM GME Snapshot

well-deserved recognition

Congratulations to DMS CAPT Selectees CAPT(sel) John Bassett, CAPT(sel) Saira Aslam, and CAPT(sel) Joel Anthony Nations!!!

Teaching accolades for Fellows Recent Resident feedback from ICU rotation. “Drs. [Paul] Clark [Critical Care Fellow] and [Joe] Zeman [Pulmonary/Critical Care Fellow] provided lots of educational opportunities with each patient. I appre-ciated the time Dr. Clark spent with me to teach me some basic ultrasound skills.” “Outstanding! Thanks Joe and Paul. Another reason that coming to Walter Reed is awesome—working with great fellows who love to teach - strong work!” - Bill Shimeall

Click here to view current and past publications of Walter Reed DOM GME , including

DOM GME Snapshot, ImmunoNEWS, Chief of Medicine Weekly Update, and The Reeder

The Master Clinician Recognition Program was

created by BG Clark to provide official annual recog-nition for WRNMMC clinical staff who demonstrate consistently exemplary patient care, excellence in teaching and graduate medical education, exception-al scholarly activity/research, and consistent profes-sionalism. This is a two-tiered program designed to recognize outstanding clinicians, from more junior to the most experienced. From junior to senior, these two levels are Associate Master Clinician and Master Clinician. Congratulations to DoM awardees!!!

MASTER CLINICIANS Dr. Baranko, Darrell J. GIMS Dr. Buda-Okreglak, Edwarda Hem/Onc LTC Hartzell, Joshua D. ID Dr. Krohe, Timothy L. GIMS MAJ Mallory, Renee M. GIMS CDR Needleman, MatthewCARDS Ms. Novak, Lucia M. ENDO LTC Ressner, Roseanne A. ID Dr. Ritter, Joan B GIMS LTC Torres, Dawn M. GI CDR Whitman, Timothy J. ID LTC Woods, Kevin M. CARDS CDR Young, Patrick E. GI

ASSOCIATE MASTER CLINICIANS MAJ Blaylock, Jason M. ID MAJ Gratrix, Max L. DERM MAJ Green, Brian P. DERM LCDR Harrell, Travis E GIMS MAJ Laczek, Jeffrey T. GI They were recognized at the Master Clinician Recognition Ceremony at the USO on Thursday 28 May 2015. For more information on this annual recognition program, here is a link: https://learning.usuhs.edu/x/XSYpll

Congratulations MAJ Rohul Amin on your recent promotion, and congratulations to you and LT Julia Cheringal on an outstand-ing year as Chiefs of Residents!!

9 May 2015 Walter Reed DOM GME Snapshot

check it out

CREATIVE WRITING

Through her creative writing, MAJ Henry reminds us that “Humanism is a hallmark of the medical profession” I Have Been . . . I have been that judgmental, arrogant ass- Answers easy to come by Blacks and whites, Wrongs and rights I have been that student-athlete turned soldier Jumping into darkness, Weapon strapped to my leg, Repelling a cliff face, The weight of life strapped to my back, Always running, running, running Before the sun showed its face I have been that doctor, Repelling diseases, which cause death- Status post IED, PTSD, and breathing death My friends, my answers, my enemies, my questions Blurred together in grays and tears Before the sun showed its face Long after it showed its back I have been that person, broken Crying on the kitchen floor Face touching the cold, hard tile of the hospital corridor Humbled, Human. MAJ Jamie Lee Henry, GIMS

DID YOU KNOW… Arthur Conan Doyle, creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh. Sher-lock Holmes, a central character in 56 short stories and four novels, was based on Doyle's favorite professor.

FIRST ANNUAL USU INDOOR MINI-GOLF

EVENT was this past winter. Various departments at USU

were invited to create their own courses. Medicine trans-

formed a large hallway into a homage to Medicine, including

descriptions of various specialties and thematic hazards and

traps. See video. We won 1st prize!

https://www.youtube.com/watch?v=Wn9T2H23TTg Go to youtube, under wfkfilms to view Internal Medicine USUHS "Mini-golf” hole 2014 and many others. William F. Kelly COL, MC, USA Clerkship Director

"America's Medical School" USUHS - Department of Medicine (MED)

MINDFULNESS PRACTICE Practical Applications of Mindfulness: 12 Tools for

Managing Stress, Navigating Milestones, and Foster-

ing Professional Growth Educators must teach, assess, and monitor their learners while

fulfilling clinical duties. Learners must manage work hours,

provide clinical care, fulfill educational requirements, and

maintain work-life balance. Balancing these responsibilities

can become a source of stress, which can lead to burnout. Can

we provide an educational environment that stimulates learn-

ing but minimizes stress and burnout?

To read the entire article, click here.

GREAT TURNOUT! 3rd Annual IM Residency QI Poster Fair, took place Fri-day, May 29th. Twelve posters were on display – see a list of presenters and project titles: https://learning.usuhs.edu/x/uCOaLa

The competition was judged by an esteemed panel of judges— CAPT(SEL) Aslam, COL Yu (GME Chief), and CDR Schroeder (ECOMS President). Please look for the winners in next month’s Snapshot...

IM RESIDENCY FACULTY,

Do you want to know what’s going on in the residen-cy? Sign up for Sakai: http://tinyurl.com/IMaccountrequest

Sakai, if you don’t get it,...you DON’T GET IT.

To Share DOM GME News and Highlights, Please Contact Sean M. Lynch, Self-Declared Supreme, Editor-in-Chief, Sean.M.Lynch36.CTR@mail.mil, (301) 319-4399