WALTER REED DOM GME Snapshot

Graduate Medical Education
WALTER REED DOM GME
Department of Medicine
Walter Reed Bethesda
Snapshot
MAY 2015 - a monthly and evolving snapshot of GME news & highlights
highlights
Walter Reed Team Places in International Medical Knowledge Final
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.
CPT Adam Barelski, CPT Jack
Hutter and CPT Michael McMahon had a tremendous
The team (left to right:
run through 3 rounds, ending up tied for 3rd out of 47 finalist
teams, all of which were the winners/selectees of their respective ACP chapters from around the globe (including teams from
Saudi Arabia, SE Asia, Canada and Central America). The winning 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.
“All-Star” Navy Medical Jeopardy Team
WRB IM Residency Army Doctor’s Dilemma Team
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.
highlights
Walter Reed Bethesda Highlights from IM 2015 in Boston
CPT Cynthia Philip (IM PGY-1) presenting the
LT Ian Grasso (IM PGY-1) presented his Navy ACP
clinical vignette "A Case of Supplement-Associated
Acidemia and Acute kidney Injury in an Active Duty
Soldier."
Chapter-winning research abstract as a Poster “Do
Non-Benzodiazepine Sleep Aids affect the ECG Diagnosis of Sleep Apnea?” at the meeting.
LT Ian Grasso (right) presents winning abstract
CPT Cynthia Philip presenting at IM 2015
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."
NEED A PROCEDURE COMPLETED?
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Lumbar Puncture
Thoracentesis
Paracentesis
Arthrocentesis
Exercise Stress Test
GXT
WANT TO HELP OUR HOUSESTAFF
BECOME MORE PROFICIENT?
Page IM CONSULT PAGER
1062318
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).
CPT Michael McMahon presenting winning abstract at IM 2015
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Thanks in advance for thinking of the residents.
May 2015 Walter Reed DOM GME Snapshot
education, scholarship, and outreach
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.
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 master 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 Dermatopathologists at Walter Reed organized a board review course. The course differed from other Dermatopathology board review classes. 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 require more time to thoroughly evaluate a slide, such as
if you were searching for an infectious agent like leishmaniasis. The event was hosted by Dr. Nicholas
Logemann (current Dermatopathology Fellow at Walter 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 together to meet residents from other programs, espe“This photo is a histologic image of one of the infectious diagnoses found cially those in the local area.” The review took place
on the test. The picture demonstrates Leishmaniasis. The small little dots on May 2, 2015 in the Dermatology Department at Walter Reed.
are the organism found within histiocytes."
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 Bethesda, 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
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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,
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 mission). We look forward hearing more upon your return!
“PUERTO BARRIOS, Guatemala (April 28, 2015) — Lt.
Brett Sadowski, an internal medicine doctor assigned
to Walter Reed National Military Medical Center Bethesda, 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 Continuing Promise 2015. Continuing Promise is a U.S.
Southern Command-sponsored and U.S. Naval Forces
Southern Command/U.S. 4th Fleet-conducted deployment to conduct civil-military operations including
humanitarian-civil assistance, subject matter expert
exchanges, medical, dental, veterinary and engineering 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
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Just wanted to give you an update on our progress with CP15.
We completed our mission stop
in Belize and have moved down
the Caribbean coast to Guatemala 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 Chikungunya infection, although we have
no way to confirm it) and dyspepsia (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. surgery for torn meniscus) but not
being able to provide for them
because of time constraints or
May 2015 Walter Reed DOM GME Snapshot
surgical interventions and limited
resources. The surgeons were
already completely booked up
after one day of surgical screening. We do what we can nevertheless 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 service assistants for the entire deployment stay up on their medical 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 somewhat 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 potentially offer to our corpsman at WR
as well.
VADM Nathan was onboard while
we sailed from Belize to Guatemala 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 program are definitely contributing
in a great way. The residents that
follow us are going to just have a
more and more fantastic experience as time goes on.
Very respectfully,
Brett Sadowski, M.D.
LT, MC, USN
Internal Medicine, PGY-2
[Friday, April 24, 2015]
publications
education, scholarship, and outreach
INTERNAL MEDICINE—
T
DERMATOLOGY –
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 newlyrecognized Master Clinician), and a workshop led by Dr. Krohe, resulted in the publication in Academic Internal Medicine 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 eliminate some of the barriers to teaching diagnostic reasoning. As educators form rapidly accessible mental patterns, they can rapidly recognize thought based reasoning errors in a resident clinic and efficiently 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 interns and residents who successfully submitted chapters in the American College
of Physicians (ACP) Smart Medicine
online resource for practicing physicians. Thanks
to faculty mentors Dr. Barb Cooper (GIM), Dr. Julie 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 Regurgitation.
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 Respiratory Distress Syndrome.
Akira Shishido (PGY2), Diana Dougherty (PGY2), Julie Chen. Cholera.
Brian Park (PGY3), Mark Pence (PGY2), Barb Cooper. Salicylate Poisoning
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"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 members 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 melanoma skin-check screenings, available to both
Tri-Care and non-Tri-Care beneficiaries with
base access. With over 15 doctors and residents 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 TriCare beneficiaries within a few hours."
Barédu
Barédu S. Ahmed
Research Coordinator
Dermatology Clinic
INTERNAL MEDICINE –
Our Faculty designed and delivered three wellattended workshops at the 2015 APDIM Spring Meeting in Houston, TX April 28-29, contributing to improving 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 workshop on “Chief Resident Mistakes” to over 100 incoming 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.”
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 3rd 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 Staphylococcus 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 submitted.
7th Annual National Capital Region Competition Finalists Present Work at Walter Reed
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)
Congratulations to DoM awardees!!!
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May 2015 Walter Reed DOM GME Snapshot
Hard work and perseverance earns LT Nicholas
Fiacco (left) third place in
the Evidence Based Practice - Quality Improvement category at the 7th
Annual National Capital
Region Research Competitions in May.
research and academic success
PULMONARY MEDICINE—
7th Annual NCR Research Symposium, May 18-19, 2015 at Walter Reed Bethesda
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.
RHEUMATOLOGY—
Congratulations to Fellows LCDR Melissa Butts, CPT Rachel Robbins and CPT Aaron
Pumerantz for presenting at the 9th Annual North American Young Rheumatology Investigator 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 Syndrome"
CPT Rachel Robbins:
Poster Presentation: "Adrenal Hemorrhage with Resultant
Adrenal Insufficiency in Antiphospholipid Syndrome"
CPT Aaron Pumerantz:
Poster Presentation: "Granulomatosis with Polyangiitis presenting with Acute Compartment Syndrome"
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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!!!
The
Master Clinician
Recognition Program was
created by BG Clark to provide official annual recognition for WRNMMC clinical staff who demonstrate
consistently exemplary patient care, excellence in
teaching and graduate medical education, exceptional scholarly activity/research, and consistent professionalism. 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!!!
Teaching accolades for Fellows
MASTER CLINICIANS
Recent Resident feedback from ICU rotation.
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
“Drs. [Paul] Clark [Critical Care Fellow] and [Joe]
Zeman [Pulmonary/Critical Care Fellow] provided lots
of educational opportunities with each patient. I appreciated 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
Congratulations
MAJ Rohul Amin
on your recent
promotion, and
congratulations
to you and LT
Julia Cheringal
on an outstanding year as Chiefs
of Residents!!
ASSOCIATE MASTER CLINICIANS
MAJ Blaylock, Jason M.
MAJ Gratrix, Max L.
MAJ Green, Brian P.
LCDR Harrell, Travis E
MAJ Laczek, Jeffrey T.
ID
DERM
DERM
GIMS
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
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
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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”
FIRST ANNUAL USU INDOOR MINI-GOLF
EVENT was this past winter. Various departments at USU
were invited to create their own courses. Medicine transformed a large hallway into a homage to Medicine, including
descriptions of various specialties and thematic hazards and
traps. See video. We won 1st prize!
I Have Been . . .
https://www.youtube.com/watch?v=Wn9T2H23TTg
Go to youtube, under wfkfilms to view Internal Medicine
USUHS "Mini-golf” hole 2014 and many others.
I have been that judgmental, arrogant assAnswers easy to come by
Blacks and whites,
Wrongs and rights
William F. Kelly
COL, MC, USA
Clerkship Director
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 deathStatus 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
"America's Medical School"
USUHS - Department of Medicine (MED)
MINDFULNESS PRACTICE
Practical Applications of Mindfulness: 12 Tools for
Managing Stress, Navigating Milestones, and Fostering 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 learning but minimizes stress and burnout?
To read the entire article, click here.
GREAT TURNOUT!
3rd Annual IM Residency QI Poster Fair, took place Friday, 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,
DID YOU KNOW…
Arthur Conan Doyle, creator of the fictional detective Sherlock
Holmes, studied medicine at the University of Edinburgh. Sherlock Holmes, a central character in 56 short stories and four
novels, was based on Doyle's favorite professor.
Do you want to know what’s going on in the residency? 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
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May 2015 Walter Reed DOM GME Snapshot